Predicting outcome of initial treatment with carbamazepine in childhood focal epilepsy.
We developed a model to predict the outcome of treatment with carbamazepine in children with newly diagnosed focal epilepsy of presumed temporal lobe origin, using data available at the time of diagnosis. Eligible children observed at The Children's Hospital of Philadelphia during 1999 were identified. Data were abstracted on four potential predictor variables for carbamazepine success or failure. A total of 149 patients completed an adequate first antiepileptic trial. Carbamazepine was the initial drug used in 129 (87%) patients. Forty-one of these 129 patients (32%) had persistent seizures. Significant predictors of initial carbamazepine failure were as follows: early risk factor for epilepsy (risk ratio = 3.1 [95% confidence interval 1.6, 4.0]) and temporal lobe abnormality on magnetic resonance imaging scan (risk ratio = 3.1 [1.7, 4.2]). The outcome of the initial carbamazepine trial was correctly classified in up to 78% of patients. Accurate prediction of initial carbamazepine failure was as high as 0.67 (0.53, 0.79). Accurate prediction of initial carbamazepine success was as high as 0.87 (0.77, 0.94). In this study, standard clinical data were less than adequate for predicting response to the initial trial of carbamazepine, with prediction of carbamazepine failure being particularly difficult. Better markers of antiepileptic response and nonresponse are required to guide optimal therapy in patients with epilepsy.
Dlugos
Dennis J
DJ
Pediatric Regional Epilepsy Program, Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19014, USA.
Buono
Russell J
RJ
D000293:Adolescent; D002220:Carbamazepine / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
D002220:Carbamazepine