Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis

Stevelink, Remi; Al-Toma, Dania; Jansen, Floor E.; Lamberink, Herm J.; Asadi-Pooya, Ali A.; Farazdaghi, Mohsen; Cação, Gonçalo; Jayalakshmi, Sita; Patil, Anuja; Özkara, Çiğdem; Aydın, Şenay; Gesche, Joanna; Beier, Christoph P.; Stephen, Linda J.; Brodie, Martin J.; Unnithan, Gopeekrishnan; Radhakrishnan, Ashalatha; Höfler, Julia; Trinka, Eugen; KRAUSE, Roland; Irelli, Emanuele Cerulli; Bonaventura, Carlo Di; Szaflarski, Jerzy P.; Hernández-Vanegas, Laura E.; Moya-Alfaro, Monica L.; Zhang, Yingying; Zhou, Dong; Pietrafusa, Nicola; Specchio, Nicola; Japaridze, Giorgi; Beniczky, Sándor; Janmohamed, Mubeen; Kwan, Patrick; Syvertsen, Marte; Selmer, Kaja K.; Vorderwülbecke, Bernd J.; Holtkamp, Martin; Viswanathan, Lakshminarayanapuram G.; Sinha, Sanjib; Baykan, Betül; Altindag, Ebru; Podewils, Felix Von; Schulz, Juliane; Seneviratne, Udaya; Viloria-Alebesque, Alejandro; Karakis, Ioannis; D'Souza, Wendyl J.; Sander, Josemir W.; Koeleman, Bobby P. C.; Otte, Willem M.; Braun, Kees P. J.

doi:10.1016/j.eclinm.2022.101732

Article (Scientific journals)

Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis

Stevelink, Remi; Al-Toma, Dania; Jansen, Floor E. et al.

2022 • In EClinicalMedicine, p. 101732

Peer Reviewed verified by ORBi

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https://hdl.handle.net/10993/52799

DOI
10.1016/j.eclinm.2022.101732

PubMed
36467455

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Keywords :

Juvenile myoclonic epilepsy; Prediction model; Refractory epilepsy; Drug resistance; Medication withdrawal; Remission; Multivariable prediction; JME; Seizure recurrence; Meta-analysis; Individual participant data

Abstract :

[en] Summary Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed – last updated on March 11, 2021 – including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68–0·73). Interpretation We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding MING fonds.

Disciplines :

Neurology

Author, co-author :

Stevelink, Remi

Al-Toma, Dania

Jansen, Floor E.

Lamberink, Herm J.

Asadi-Pooya, Ali A.

Farazdaghi, Mohsen

Cação, Gonçalo

Jayalakshmi, Sita

Patil, Anuja

Özkara, Çiğdem

More authors (41 more)

External co-authors :

yes

Language :

English

Title :

Publication date :

November 2022

Journal title :

EClinicalMedicine

eISSN :

2589-5370

Publisher :

Elsevier, United Kingdom

Pages :

101732

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://www.sciencedirect.com/science/article/pii/S258953702200462X

European Projects :

FP7 - 279062 - EPIPGX - Epilepsy Pharmacogenomics: delivering biomarkers for clinical use

Funders :

CE - Commission Européenne

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since 17 November 2022

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