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Response to first drug trial predicts outcome in childhood temporal lobe epilepsy
D J Dlugos1, M D Sammel, B L Strom
1Pediatric Regional Epilepsy Program, Division of Neurology, Children's Hospital of Philadelphia, PA 19014, USA. dlugos@email.chop.edu
Insights
Failure of the first antiepileptic drug trial accurately predicts refractory epilepsy in children. This finding can help identify children who may benefit from earlier surgical interventions for temporal lobe epilepsy.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
- Clinical Prediction Modeling
Background:
- Refractory epilepsy poses a significant challenge in pediatric care.
- Early identification of children likely to develop refractory epilepsy is crucial for timely intervention.
Purpose of the Study:
- To develop a clinical prediction model for early identification of pediatric refractory temporal lobe epilepsy (TLE).
- To assess predictors of TLE developing within two years of epilepsy onset in children.
Main Methods:
- Retrospective cohort study of 120 children (1-18 years) with TLE.
- Data abstraction on epilepsy risk factors, MRI findings, and first antiepileptic drug (AED) trial outcomes.
- Bivariate and logistic regression analyses to identify predictors of refractory TLE.
Main Results:
- 37.5% of patients developed refractory TLE within two years.
- Significant predictors included early epilepsy risk factors, temporal lobe MRI abnormalities, and first AED trial failure.
- Failure of the first AED trial was the strongest predictor (RR=16.5), with high positive (0.89) and negative (0.95) predictive values.
Conclusions:
- Failure of the first AED trial is a strong predictor of refractory TLE in children.
- This finding supports earlier consideration of surgical options for pediatric epilepsy.
- Prospective validation and longer follow-up are recommended.
Objective:
To construct a clinical prediction model for the early identification of children destined to develop refractory temporal lobe epilepsy (TLE) 2 years after epilepsy onset.
Methods:
Patients with TLE between 1 and 18 years old seen in the Division of Neurology at Children's Hospital of Philadelphia during 1999 were identified through billing records and chart review. Data were abstracted independently on 5 candidate predictor variables for refractory TLE and on seizure frequency outcome at 2 years after epilepsy onset.
Results:
One hundred twenty patients met inclusion criteria and had at least 2 years of follow-up. Forty-five of 120 patients (37.5%) had refractory TLE at 2 years after onset, and 75 of 120 (62.5%) were seizure free. Three significant predictors of refractory TLE were found on bivariate analysis: an early risk factor for epilepsy (risk ratio = 3.5 [95% CI 2.2, 5.6]), temporal lobe abnormality on MRI scan (2.9 [95% CI 1.9, 4.6]), and failure of the first antiepileptic drug (AED) trial (16.5 [95% CI 6.3, 43.9]). Logistic regression indicated that the best model to predict refractory TLE contained only the variable "failure of first AED trial," with a positive predictive value of 0.89 (95% CI 0.76, 0.96) and negative predictive value of 0.95 (95% CI 0.87, 0.99) to predict "refractory TLE" at 2 years.
Conclusions:
Failure of first AED trial accurately predicts refractory TLE at 2 years after onset, based on retrospective cohort data in children. If verified prospectively and with longer follow-up, this finding should support earlier consideration of surgical options.