Neuropsychiatric symptomatology predicts seizure recurrence in newly treated patients.
OBJECTIVE
To test the hypothesis that neuropsychiatric symptomatology is predictive of the success of seizure control in patients newly treated with antiepileptic drugs (AEDs), and that this predictive value adds to that provided by other clinical, imaging, and genomic factors in a multivariate model.


METHODS
One hundred seventy newly treated patients with epilepsy completed the A-B Neuropsychological Assessment Scale (ABNAS) before commencing AED therapy and were prospectively followed up for 12 months. Patients were classified as nonresponsive if they had at least 1 seizure not explained by medication noncompliance or other significant provoking factors.


RESULTS
Of the 138 patients in whom a drug response phenotype at 12 months was able to be determined, nonresponsive patients (n = 45) had a higher pretreatment ABNAS score than patients whose seizures were controlled (n = 93) (p = 0.007). A lesion on MRI was also associated with a higher risk of seizure recurrence (p = 0.003). On multivariate logistic regression, the ABNAS score, the MRI results, and a genomic classifier were all independently predictive of treatment outcome. For AED pharmacoresponse, this multivariate model had diagnostic values of 91% sensitivity, 64% specificity, 84% positive predictive, and 78% negative predictive values. The predictive value of the ABNAS score was validated in a second prospective cohort of 74 newly treated patients with epilepsy (p = 0.005).


CONCLUSIONS
The ABNAS provides prognostic information regarding successful seizure control in patients newly treated with AEDs. Furthermore, these results demonstrate the multifactorial nature of the determinants of AED response, with neuropsychological, structural, and genomic factors all contributing to the complex response phenotype.
Petrovski
S
S
Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Royal Parade, Parkville, Victoria, Australia.
Szoeke
C E I
CE
Jones
N C
NC
Salzberg
M R
MR
Sheffield
L J
LJ
Huggins
R M
RM
O'Brien
T J
TJ
D000927:Anticonvulsants / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D004351:Drug Resistance; D004569:Electroencephalography; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008568:Memory / Q000502:physiology; D001523:Mental Disorders / Q000523:psychology*; D008959:Models, Neurological; D009422:Nervous System Diseases / Q000473:pathology*; D009483:Neuropsychological Tests; D010597:Pharmacogenetics; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D012640:Seizures / Q000235:genetics / Q000473:pathology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D016019:Survival Analysis
D000927:Anticonvulsants