EMPiRE model - Evidencio

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A model to predict the risk of seizures in pregnant women with epilepsy on anti-epileptic medication

Research authors: John Allotey, Borja Fernandez-Felix, Javier Zamora, Ngawai Moss, Manny Bagary, Andrew Kelso, Rehan Khan, Joris A. M. van der Post, Ben W. Mol, Alexander M. Pirie, Dougall McCorry, Khalid S. Khan, Shakila Thangaratinam

General practice
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The calculated predicted risk of seizures in pregnancy and up to 6 weeks after delivery is:

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Conditional information

The calculation is the risk of the pregnant woman having any siezure in pregnancy and up to 6 weeks after delivery. Use of the model in clinical practice should be complementary to individualised advice on safety, risk assessment, adherence and triggers for seizures.
Women predicted to have a low risk of seizure should be informed that their risk status is subject to adherence to their anti-epileptic medication.

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Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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Additional information

Details

Model author

jallotey

Model ID

1799

Version

1.30

Revision date

2020-03-26

Specialty

General practice, Neurology

Model type

Logistic regression ^{(Calculation)}

MeSH terms

Epilepsy

Epileptic Seizure

Pregnancy

Rating

Status

Public

Formula
No Formula defined yet

Condition	Formula

Study characteristics

Additional information

Current model was developed using data from the prospective multicentre EMPiRE (AntiEpileptic drug Monitoring in PREgnancy) study, which recruited pregnant women with epilepsy on antiepileptic drugs at first antenatal visit from 50 maternity units in the UK bewteen 4 November 2011 and 17 August 2014.

A multidisciplinary team of neurologists, obstetricians, and researchers selected the candidate predictors for further evaluation in the prognostic model, based on existing evidence and their relevance to clinical care.

The main outcome was the occurrence of tonic-clonic (convulsive) or non-tonic-clonic (nonconvulsive)
seizure. Participants prospectively recorded their epileptic seizures, if any, in purpose-built seizure diaries.

Missing values were handled using 10-fold multiple imputation by chained equation. LASSO method was used to develop logistic regression models.

The displayed study characteristics concen the characteristics of the development cohort (n = 399). The model was also externally validated on a separate cohort (n = 128)

Study Population

Total population size: 527

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Females: {{ model.numberOfFemales }}

Continuous characteristics

Name	Mean	SD	Unit
Age at first seizure	16.5	7.4	years
Gestational age at baseline	16.6	4	Weeks
Number of tonic-clonic seizures in pregnancy prior to the baseline visit (missing n = 82)	0.7	2.8	seizures
number of non-tonic-clonic seizures in pregnancy prior to the baseline visit	11.6	108.4	seizures
Baseline dose of Carbamazepine	706.0	348.5	mg/day
Baseline dose of Lamotrigine	272.1	155.6	mg/day
Baseline dose of Levetiracetam	1641.3	886.8	mg/day

Categorical characteristics

Name	Subset / Group	Nr. of patients
Age at first seizure (missing n = 5)	≤10 years	70
Age at first seizure (missing n = 5)	11 - 20 years	215
Age at first seizure (missing n = 5)	21 - 30 years	94
Age at first seizure (missing n = 5)	31 - 40 years	15
Hisrtory of learning difficulty or mental illness (missing n = 1)	No	348
Hisrtory of learning difficulty or mental illness (missing n = 1)	Yes	50
Admission to hospital for seizures in previous pregnancy (missing n = 22)	No	349
Admission to hospital for seizures in previous pregnancy (missing n = 22)	Yes	28
Seizure classification at baseline	Tonic-Clonic	155
Seizure classification at baseline	Non-tonic-clonic	232
Seizure classification at baseline	Unspecified	12
Seizure in the 3 months before pregnancy (missing n = 83)	No	217
Seizure in the 3 months before pregnancy (missing n = 83)	Tonic-Clonic	52
Seizure in the 3 months before pregnancy (missing n = 83)	Non-tonic-clonic	130
Antiepileptic drug intake at baseline	Carbamazepine	74
Antiepileptic drug intake at baseline	Lamotrigine	200
Antiepileptic drug intake at baseline	Levetiracetam	99
Antiepileptic drug intake at baseline	Phenytoin	0
Antiepileptic drug intake at baseline	Lamotrigine and carbamazepine	1
Antiepileptic drug intake at baseline	Lamotrigine and levetiracetam	25

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Disclaimer: Calculations alone should never dictate patient care, and are no substitute for professional judgement.