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Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy?

Zaccara, G; Mula, M; Ferrò, B; Consoli, D; Elia, M; Giallonardo, AT; Iudice, A; La Neve, A; Meletti, S; Tinuper, P; et al. Zaccara, G; Mula, M; Ferrò, B; Consoli, D; Elia, M; Giallonardo, AT; Iudice, A; La Neve, A; Meletti, S; Tinuper, P; Zummo, L; Perucca, E (2019) Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy? Epilepsia, 60 (1). pp. 175-183. ISSN 1528-1167 https://doi.org/10.1111/epi.14622
SGUL Authors: Mula, Marco

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Abstract

OBJECTIVE: To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy. METHODS: A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled consecutively at 43 centers and followed up prospectively for 18-34 months. Treatment outcomes for all antiepileptic drugs (AEDs) used up to enrollment (retrospective assessment), and on an AED newly introduced at enrollment, were categorized by individual investigators and by 2 rotating members of a 16-member expert panel (EP) that reviewed the patient records independently. Interrater agreement was tested by Cohen's kappa (k) statistics and rated according to Landis and Koch's criteria. RESULTS: Agreement between EP members in categorizing outcomes on the newly introduced AED was almost perfect (90.1%, k = 0.84, 95% confidence interval [CI] 0.80-0.87), whereas agreement between the EP and individual investigators was moderate (70.4%, k = 0.57, 95% CI 0.53-0.61). Similarly, categorization of outcomes on previously used AEDs was almost perfect between EP members (91.7%, k = 0.83, 95% CI 0.81-0.84) and moderate between the EP and investigators (68.2%, k = 0.50, 95% CI 0.48-0.52). Disagreement was related predominantly to outcomes considered to be treatment failures by the investigators but categorized as undetermined by the EP. Overall, 19% of patients classified as having drug-resistant epilepsy by the investigators were considered by the EP to have "undefined responsiveness." SIGNIFICANCE: Interrater agreement in categorizing treatment outcomes according to ILAE criteria ranges from moderate to almost perfect. Nearly 1 in 5 patients considered by enrolling neurologists to be "drug-resistant" were classified by the EP as having "undefined responsiveness."

Item Type: Article
Additional Information: This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2018 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
Keywords: ILAE definition, antiepileptic drugs, classification, drug-resistant epilepsy, epilepsy, reliability, 1103 Clinical Sciences, 1109 Neurosciences, Neurology & Neurosurgery
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Epilepsia
ISSN: 1528-1167
Language: eng
Dates:
DateEvent
7 January 2019Published
25 December 2018Published Online
21 November 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 30585315
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110516
Publisher's version: https://doi.org/10.1111/epi.14622

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