1. 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
- Author
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Stevelink, R, Al-Toma, D, Jansen, FE, Lamberink, HJ, Asadi-Pooya, AA, Farazdaghi, M, Cacao, G, Jayalakshmi, S, Patil, A, Ozkara, C, Aydin, S, Gesche, J, Beier, CP, Stephen, LJ, Brodie, MJ, Unnithan, G, Radhakrishnan, A, Hofler, J, Trinka, E, Krause, R, Irelli, EC, Di Bonaventura, C, Szaflarski, JP, Hernandez-Vanegas, LE, Moya-Alfaro, ML, Zhang, Y, Zhou, D, Pietrafusa, N, Specchio, N, Japaridze, G, Beniczky, S, Janmohamed, M, Kwan, P, Syvertsen, M, Selmer, KK, Vorderwulbecke, BJ, Holtkamp, M, Viswanathan, LG, Sinha, S, Baykan, B, Altindag, E, von Podewils, F, Schulz, J, Seneviratne, U, Viloria-Alebesque, A, Karakis, I, D'Souza, WJ, Sander, JW, Koeleman, BPC, Otte, WM, Braun, KPJ, Stevelink, R, Al-Toma, D, Jansen, FE, Lamberink, HJ, Asadi-Pooya, AA, Farazdaghi, M, Cacao, G, Jayalakshmi, S, Patil, A, Ozkara, C, Aydin, S, Gesche, J, Beier, CP, Stephen, LJ, Brodie, MJ, Unnithan, G, Radhakrishnan, A, Hofler, J, Trinka, E, Krause, R, Irelli, EC, Di Bonaventura, C, Szaflarski, JP, Hernandez-Vanegas, LE, Moya-Alfaro, ML, Zhang, Y, Zhou, D, Pietrafusa, N, Specchio, N, Japaridze, G, Beniczky, S, Janmohamed, M, Kwan, P, Syvertsen, M, Selmer, KK, Vorderwulbecke, BJ, Holtkamp, M, Viswanathan, LG, Sinha, S, Baykan, B, Altindag, E, von Podewils, F, Schulz, J, Seneviratne, U, Viloria-Alebesque, A, Karakis, I, D'Souza, WJ, Sander, JW, Koeleman, BPC, Otte, WM, and Braun, KPJ
- Abstract
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: Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an aver
- Published
- 2022