Definitions of Drug-Resistant Epilepsy for Administrative Claims Data Research
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background and Objective To assess the accuracy of definitions of drug-resistant epilepsy applied to administrative claims data.
Methods We randomly sampled 450 patients from a tertiary health system with ≥1 epilepsy/convulsion encounter, ≥2 distinct antiseizure medications (ASMs) from 2014 to 2020, and ≥2 years of electronic medical records (EMR) data. We established a drug-resistant epilepsy diagnosis at a specific visit by reviewing EMR data and using a rubric based on the 2010 International League Against Epilepsy definition. We performed logistic regressions to assess clinically relevant predictors of drug-resistant epilepsy and to inform claims-based definitions.
Results Of 450 patients reviewed, 150 were excluded for insufficient EMR data. Of the 300 patients included, 98 (33%) met criteria for current drug-resistant epilepsy. The strongest predictors of current drug-resistant epilepsy were drug-resistant epilepsy diagnosis code (odds ratio [OR] 16.9, 95% confidence interval [CI] 8.8–32.2), ≥2 ASMs in the prior 2 years (OR 13.0, 95% CI 5.1–33.3), ≥3 nongabapentinoid ASMs (OR 10.3, 95% CI 5.4–19.6), neurosurgery visit (OR 45.2, 95% CI 5.9–344.3), and epilepsy surgery (OR 30.7, 95% CI 7.1–133.3). We created claims-based drug-resistant epilepsy definitions (1) to maximize overall predictiveness (drug-resistant epilepsy diagnosis; sensitivity 0.86, specificity 0.74, area under the receiver operating characteristics curve [AUROC] 0.80), (2) to maximize sensitivity (drug-resistant epilepsy diagnosis or ≥3 ASMs; sensitivity 0.98, specificity 0.47, AUROC 0.72), and (3) to maximize specificity (drug-resistant epilepsy diagnosis and ≥3 nongabapentinoid ASMs; sensitivity 0.42, specificity 0.98, AUROC 0.70).
Discussion Our findings provide validation for several claims-based definitions of drug-resistant epilepsy that can be applied to a variety of research questions.
Glossary
- ASM=
- antiseizure medication;
- AUROC=
- area under the receiver operating characteristics curve;
- CI=
- confidence interval;
- ER=
- emergency room;
- ICD=
- International Classification of Diseases;
- ILAE=
- International League Against Epilepsy;
- NPV=
- negative predictive value;
- OR=
- odds ratio;
- PNES=
- psychogenic nonepileptic spells;
- PPV=
- positive predictive value
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received January 30, 2021.
- Accepted in final form July 1, 2021.
- © 2021 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Deborah Friedman and Dr. Stacy Smith
► Watch
Related Articles
- No related articles found.
Topics Discussed
Alert Me
Recommended articles
-
Article
Claims data analyses unable to properly characterize the value of neurologists in epilepsy careChloe E. Hill, Chun Chieh Lin, James F. Burke et al.Neurology, January 23, 2019 -
Articles
Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalizationRanjani Manjunath, Pierre Emmanuel Paradis, Hélène Parisé et al.Neurology, October 17, 2012 -
Article
Antiepileptic drug treatment after an unprovoked first seizureA decision analysisErik L. Bao, Ling-Ya Chao, Peiyun Ni et al.Neurology, September 12, 2018 -
Views & Reviews
Incidence and Prevalence of Drug-Resistant EpilepsyA Systematic Review and Meta-analysisBushra Sultana, Marie-Andrée Panzini, Ariane Veilleux Carpentier et al.Neurology, March 15, 2021