A study of a predictive score system about monotherapy failure in initial epilepsy patients—a single center real world research_Journal of Epilepsy

Authors：

LI Yaping , CHEN Ru , ZHANG Chen , YANG Heng , ZHENG Wen ,  SONG Zhi

Department of neurology, The Third Xiangya Hospital Central South University, Changsha 421001,China;

Corresponding author：

SONG Zhi, Email: docsong@126.com

Keywords：

Antiepileptic therapy; Monotherapy failure; Polytherapy; Predicting score system

DOI：

10.7507/2096-0247.20210048

Video：

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Objective To develop a score system to predict the probability of failure of monotherapy in epilepsy patients with initial treatment, and then provide pillars for early use of polytherapy.Methods This is a retrospective analysis of the clinical data of 189 patients with epilepsy treated in Department of Neurology, the Third Xiangya Hospital of Central South University from January 2019 to July 2020. Patients were divided into monotherapy acceptable group and monotherapy poor effect group according to their drug treatment plan and drug efficacy. The influencing factors were screened out by single factor analysis and binary logistic regression analysis. And on the basis of this β value, a quantitative scoring table for predicting the unsatisfying treatment effect of monotherapy is developed. And the receiver operating curve (ROC curve) was used to evaluate the effectiveness of the scale.Results Based on a standard of 75% reduction in seizures during the observation period, 138 cases (73%) were effective with monotherapy plan, while 51 cases (23%) were unsatisfactory. Regression analysis showed that multiple forms of seizures, status epilepticus (t2), brain damage, and the number of seizures ≥ 7 times before treatment are independent risk factors for poor outcome of monotherapy. The resulting score sheet has a total score of 12 points; the area under the ROC curve is 0.779, and the critical score is 6 points (sensitivity: 0.314; specificity: 0.957). Patients with more than this score have a strong probability of poor response in monotherapy.Conclusion This prediction model can effectively assess the risk of unsatisfactory therapeutic effect of monotherapy in epilepsy patients who are initially treated, and thus has reference function for the early selection of polytherapy.

Citation： LI Yaping, CHEN Ru, ZHANG Chen, YANG Heng, ZHENG Wen, SONG Zhi. A study of a predictive score system about monotherapy failure in initial epilepsy patients—a single center real world research. Journal of Epilepsy, 2021, 7(4): 302-308. doi: 10.7507/2096-0247.20210048 Copy

1.	Stephen LJ, Brodie MJ. Antiepileptic drug monotherapy versus polytherapy: pursuing seizure freedom and tolerability in adults. Curr Opin Neurol, 2012, 25(2): 164-172.
2.	Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med, 2000, 342(5): 314-9.
3.	Chen Z, Brodie MJ, Liew D, et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurol, 2018, 75(3): 279-286.
4.	French JA, Faught E. Rational polytherapy. Epilepsia, 2009, 50(Suppl 8): 63-68.
5.	Semah F, Thomas P, Coulbaut S, et al. Early add-on treatment vs alternative monotherapy in patients with partial epilepsy. Epileptic Disord, 2014, 16(2): 165-174.
6.	Beghi E, Gatti G, Tonini C, et al. Adjunctive therapy versus alternative monotherapy in patients with partial epilepsy failing on a single drug: a multicentre, randomised, pragmatic controlled trial. Epilepsy Res, 2003, 57(1): 1-13.
7.	Lee BI, Park KM, Kim SE, et al. Clinical opinion: Earlier employment of polytherapy in sequential pharmacotherapy of epilepsy. Epilepsy Res, 2019, 156: 106165.
8.	Chi X, Li R, Hao X, et al. Response to treatment schedules after the first antiepileptic drug failed. Epilepsia, 2018, 59(11): 2118-2124.
9.	Kwan P, Brodie MJ. Epilepsy after the first drug fails: substitution or add-on? Seizure, 2000, 9(7): 464-468.
10.	Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia, 2015, 56(10): 1515-1523.
11.	Bjørke AB, Nome CG, Falk RS, et al. Evaluation of long-term antiepileptic drug use in patients with temporal lobe epilepsy: Assessment of risk factors for drug resistance and polypharmacy. Seizure, 2018, 61: 63-70.
12.	Santulli L, Coppola A, Balestrini S, et al. The challenges of treating epilepsy with 25 antiepileptic drugs. Pharmacol Res, 2016, 107: 211-219.
13.	Horváth L, Fekete K, Márton S, et al. Outcome of antiepileptic drug treatment of 1282 patients with epilepsy, their pharmacovigilance reports and concomitant medication on CNS in an East-Hungarian adult database. J Neurol Sci, 2016, 369: 220-226.
14.	Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58: 512-521.
15.	Stafstrom CE, Carmant L. Seizures and epilepsy: an overview for neuroscientists. Cold Spring Harb Perspect Med, 2015, 5(6): a022426.
16.	Aaberg KM, Bakken IJ, Lossius MI, et al. Short-term seizure outcomes in childhood epilepsy. Pediatrics, 2018, 141(6): e20174016.
17.	Atalar AÇ, Vanlı-Yavuz EN, Yılmaz E, et al. Long-term follow-up of a large cohort with focal epilepsy of unknown cause: deciphering their clinical and prognostic characteristic. J Neurol, 2020, 267(3): 838-847.
18.	Löscher W, Potschka H, Sisodiya SM, et al. Drug resistance in epilepsy: Clinical impact, potential mechanisms, and new innovative treatment options. Pharmacol Rev, 2020, 72(3): 606-638.
19.	Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol, 2015, 14(6): 615-624.

1. Stephen LJ, Brodie MJ. Antiepileptic drug monotherapy versus polytherapy: pursuing seizure freedom and tolerability in adults. Curr Opin Neurol, 2012, 25(2): 164-172.
2. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med, 2000, 342(5): 314-9.
3. Chen Z, Brodie MJ, Liew D, et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurol, 2018, 75(3): 279-286.
4. French JA, Faught E. Rational polytherapy. Epilepsia, 2009, 50(Suppl 8): 63-68.
5. Semah F, Thomas P, Coulbaut S, et al. Early add-on treatment vs alternative monotherapy in patients with partial epilepsy. Epileptic Disord, 2014, 16(2): 165-174.
6. Beghi E, Gatti G, Tonini C, et al. Adjunctive therapy versus alternative monotherapy in patients with partial epilepsy failing on a single drug: a multicentre, randomised, pragmatic controlled trial. Epilepsy Res, 2003, 57(1): 1-13.
7. Lee BI, Park KM, Kim SE, et al. Clinical opinion: Earlier employment of polytherapy in sequential pharmacotherapy of epilepsy. Epilepsy Res, 2019, 156: 106165.
8. Chi X, Li R, Hao X, et al. Response to treatment schedules after the first antiepileptic drug failed. Epilepsia, 2018, 59(11): 2118-2124.
9. Kwan P, Brodie MJ. Epilepsy after the first drug fails: substitution or add-on? Seizure, 2000, 9(7): 464-468.
10. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia, 2015, 56(10): 1515-1523.
11. Bjørke AB, Nome CG, Falk RS, et al. Evaluation of long-term antiepileptic drug use in patients with temporal lobe epilepsy: Assessment of risk factors for drug resistance and polypharmacy. Seizure, 2018, 61: 63-70.
12. Santulli L, Coppola A, Balestrini S, et al. The challenges of treating epilepsy with 25 antiepileptic drugs. Pharmacol Res, 2016, 107: 211-219.
13. Horváth L, Fekete K, Márton S, et al. Outcome of antiepileptic drug treatment of 1282 patients with epilepsy, their pharmacovigilance reports and concomitant medication on CNS in an East-Hungarian adult database. J Neurol Sci, 2016, 369: 220-226.
14. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58: 512-521.
15. Stafstrom CE, Carmant L. Seizures and epilepsy: an overview for neuroscientists. Cold Spring Harb Perspect Med, 2015, 5(6): a022426.
16. Aaberg KM, Bakken IJ, Lossius MI, et al. Short-term seizure outcomes in childhood epilepsy. Pediatrics, 2018, 141(6): e20174016.
17. Atalar AÇ, Vanlı-Yavuz EN, Yılmaz E, et al. Long-term follow-up of a large cohort with focal epilepsy of unknown cause: deciphering their clinical and prognostic characteristic. J Neurol, 2020, 267(3): 838-847.
18. Löscher W, Potschka H, Sisodiya SM, et al. Drug resistance in epilepsy: Clinical impact, potential mechanisms, and new innovative treatment options. Pharmacol Rev, 2020, 72(3): 606-638.
19. Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol, 2015, 14(6): 615-624.

Journal of Epilepsy

A study of a predictive score system about monotherapy failure in initial epilepsy patients—a single center real world research

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