Document Detail


Neuropsychiatric symptomatology predicts seizure recurrence in newly treated patients.
MedLine Citation:
PMID:  20837970     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To test the hypothesis that neuropsychiatric symptomatology is predictive of the success of seizure control in patients newly treated with antiepileptic drugs (AEDs), and that this predictive value adds to that provided by other clinical, imaging, and genomic factors in a multivariate model. METHODS: One hundred seventy newly treated patients with epilepsy completed the A-B Neuropsychological Assessment Scale (ABNAS) before commencing AED therapy and were prospectively followed up for 12 months. Patients were classified as nonresponsive if they had at least 1 seizure not explained by medication noncompliance or other significant provoking factors. RESULTS: Of the 138 patients in whom a drug response phenotype at 12 months was able to be determined, nonresponsive patients (n = 45) had a higher pretreatment ABNAS score than patients whose seizures were controlled (n = 93) (p = 0.007). A lesion on MRI was also associated with a higher risk of seizure recurrence (p = 0.003). On multivariate logistic regression, the ABNAS score, the MRI results, and a genomic classifier were all independently predictive of treatment outcome. For AED pharmacoresponse, this multivariate model had diagnostic values of 91% sensitivity, 64% specificity, 84% positive predictive, and 78% negative predictive values. The predictive value of the ABNAS score was validated in a second prospective cohort of 74 newly treated patients with epilepsy (p = 0.005). CONCLUSIONS: The ABNAS provides prognostic information regarding successful seizure control in patients newly treated with AEDs. Furthermore, these results demonstrate the multifactorial nature of the determinants of AED response, with neuropsychological, structural, and genomic factors all contributing to the complex response phenotype.
Authors:
S Petrovski; C E I Szoeke; N C Jones; M R Salzberg; L J Sheffield; R M Huggins; T J O'Brien
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  75     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-10-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1015-21     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Royal Parade, Parkville, Victoria, Australia.
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MeSH Terms
Descriptor/Qualifier:
Anticonvulsants / therapeutic use
Anxiety / psychology
Cognition / physiology
Cohort Studies
Depression / psychology
Drug Resistance
Electroencephalography
Humans
Longitudinal Studies
Magnetic Resonance Imaging
Memory / physiology
Mental Disorders / psychology*
Models, Neurological
Nervous System Diseases / pathology*
Neuropsychological Tests
Pharmacogenetics
Prospective Studies
Questionnaires
Recurrence
Reproducibility of Results
Seizures / genetics,  pathology*,  psychology*
Survival Analysis
Chemical
Reg. No./Substance:
0/Anticonvulsants

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