title: A predictive risk model for medical intractability in epilepsy.
abstract: OBJECTIVE
  This study aimed to investigate early predictors (6 months after diagnosis) of medical intractability in epilepsy.
  
  
  METHODS
  All children <12 years of age having two or more unprovoked seizures 24 h apart at Xinhua Hospital between 1992 and 2006 were included. Medical intractability was defined as failure, due to lack of seizure control, of more than 2 antiepileptic drugs at maximum tolerated doses, with an average of more than 1 seizure per month for 24 months and no more than 3 consecutive months of seizure freedom during this interval. Univariate and multivariate logistic regression models were performed to determine the risk factors for developing medical intractability. Receiver operating characteristic curve was applied to fit the best compounded predictive model.
  
  
  RESULTS
  A total of 649 patients were identified, out of which 119 (18%) met the study definition of intractable epilepsy at 2 years after diagnosis, and the rate of intractable epilepsy in patients with idiopathic syndromes was 12%. Multivariate logistic regression analysis revealed that neurodevelopmental delay, symptomatic etiology, partial seizures, and more than 10 seizures before diagnosis were significant and independent risk factors for intractable epilepsy. The best model to predict medical intractability in epilepsy comprised neurological physical abnormality, age at onset of epilepsy under 1 year, more than 10 seizures before diagnosis, and partial epilepsy, and the area under receiver operating characteristic curve was 0.7797. This model also fitted best in patients with idiopathic syndromes.
  
  
  CONCLUSIONS
  A predictive model of medically intractable epilepsy composed of only four characteristics is established. This model is comparatively accurate and simple to apply clinically.
authors.affiliation: Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lisu
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Chongming Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Dake
authors.initials: D
authors.lastname: He
authors.affiliation: Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Weiqun
authors.initials: W
authors.lastname: Bao
authors.affiliation: Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: lingli12@live.cn.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy*; D017211:Treatment Failure
chemical_list: D000927:Anticonvulsants
keywords: Medically intractable epilepsy; Predictive risk model; Prognosis; Receiver operating characteristic curve