title: Causal inference as an emerging statistical approach in neurology: an example for epilepsy in the elderly.
abstract: The elderly population faces an increasing number of cases of chronic neurological conditions, such as epilepsy and Alzheimer's disease. Because the elderly with epilepsy are commonly excluded from randomized controlled clinical trials, there are few rigorous studies to guide clinical practice. When the elderly are eligible for trials, they either rarely participate or frequently have poor adherence to therapy, thus limiting both generalizability and validity. In contrast, large observational data sets are increasingly available, but are susceptible to bias when using common analytic approaches. Recent developments in causal inference-analytic approaches also introduce the possibility of emulating randomized controlled trials to yield valid estimates. We provide a practical example of the application of the principles of causal inference to a large observational data set of patients with epilepsy. This review also provides a framework for comparative-effectiveness research in chronic neurological conditions.
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Lidia Mvr
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kwasnik
authors.affiliation: Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Massachusetts General Hospital, Mongan Institute, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA; Harvard Medical School, Department of Health Care Policy, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
keywords: causal inference; epidemiology; epilepsy; neurostatistics