Document Detail


Prediction of risk of seizure recurrence after a single seizure and early epilepsy: further results from the MESS trial.
MedLine Citation:
PMID:  16545748     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The MRC Multicentre trial for Early Epilepsy and Single Seizures (MESS) showed a reduced risk of further seizures in patients, for whom treatment with antiepileptic drugs was uncertain, who were randomly assigned immediate treatment compared with delayed treatment. However, there was no evidence of an effect on [corrected] long-term remission rates. This study was undertaken to assess the role of patient characteristics and treatment in the prediction of seizure recurrence. This will enable decision-making on the basis of the perceived risk of treatment compared with the benefit of reducing the risk of further seizures in the initial years after diagnosis. METHODS: A prognostic model was developed based on individual patient data from MESS to enable identification of patients at low, medium, or high risk of seizure recurrence. A split-sample approach was used in which the model was developed on a subsample of the full data and validated on the remainder of the sample. Distinction of the prognostic groups and predictive accuracy of the model were assessed. FINDINGS: Number of seizures of all types at presentation, presence of a neurological disorder, and an abnormal electroencephalogram (EEG) were significant factors in indicating future seizures. Individuals with two or three seizures, a neurological disorder, or an abnormal EEG were identified as the medium-risk group, those with two of these features or more than three seizures as the high-risk group, and those with a single seizure only as the low-risk group. INTERPRETATION: The model shows that there is little benefit to immediate treatment in patients at low risk of seizure recurrence, but potentially worthwhile benefits are seen in those at medium and high risk.
Authors:
Lois G Kim; Tony L Johnson; Anthony G Marson; David W Chadwick;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet neurology     Volume:  5     ISSN:  1474-4422     ISO Abbreviation:  Lancet Neurol     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-20     Completed Date:  2006-05-09     Revised Date:  2010-06-17    
Medline Journal Info:
Nlm Unique ID:  101139309     Medline TA:  Lancet Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  317-22     Citation Subset:  IM    
Affiliation:
MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK. lois.kim@mrc-bsu.cam.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anticonvulsants / therapeutic use*
Electroencephalography
Epilepsy / drug therapy*,  epidemiology,  physiopathology
Female
Humans
Male
Models, Biological*
Predictive Value of Tests
Probability
Prognosis
Recurrence
Reproducibility of Results
Risk*
Time Factors
Chemical
Reg. No./Substance:
0/Anticonvulsants
Comments/Corrections
Comment In:
Epilepsy Curr. 2006 Nov-Dec;6(6):184-5   [PMID:  17260053 ]
Erratum In:
Lancet Neurol. 2006 May;5(5):383

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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