Abstract：
OBJECTIVE: The main purposes of this study were to validate the epilepsy diagnosis in incident epilepsy cases in the Danish National Patient Registry (DNPR), which contains information on nearly 9 000 000 individuals, and to identify persons in the validated cohort who fulfilled the International League Against Epilepsy (ILAE) criteria for drug-resistant epilepsy (DRE).
METHODS: We reviewed a random sample of medical records from all individuals registered with a first diagnosis of epilepsy (International Classification of Diseases, 10th Revision [ICD-10]: G40) or seizures (ICD-10: G41, R56, or F445) in the Central Denmark Region from 2010 to 2019. In persons with a validated incident epilepsy diagnosis, we determined the proportion with DRE at the latest contact. We performed logistic regression analyses to identify clinical factors that correlated with risk of DRE.
RESULTS: Of 20 723 persons with a first diagnosis of epilepsy (n = 11 812) or seizures (n = 8911), we reviewed the medical records of n = 1067 with incident epilepsy and n = 610 with incident seizures. Among those with a register diagnosis of epilepsy, the diagnosis was confirmed in 838 cases (45% females, mean age at onset = 42.4 years), providing a positive predictive value (PPV) of 79% (95% confidence interval [CI] = 76%-81%). The PPV of focal epilepsy was 86% (95% CI = 82%-89%), and the PPV of generalized epilepsy was 71% (95% CI = 61%-80%). Of 740 patients with confirmed incident epilepsy and ≥1 year of follow-up, 103 (14%) fulfilled the definition of DRE, 476 (64%) were drug responsive, and 161 (22%) had undefined responsiveness. In multivariable logistic regression analysis, early age at epilepsy onset, cognitive impairment, and a history of status epilepticus were associated with DRE.
CONCLUSIONS: In the DNPR, we found a PPV of the epilepsy diagnosis of 79%. Among persons with confirmed epilepsy, 14% fulfilled ILAE criteria for DRE. Early age at epilepsy onset, cognitive impairment, and a history of status epilepticus were independently associated with drug resistance.
METHODS: We reviewed a random sample of medical records from all individuals registered with a first diagnosis of epilepsy (International Classification of Diseases, 10th Revision [ICD-10]: G40) or seizures (ICD-10: G41, R56, or F445) in the Central Denmark Region from 2010 to 2019. In persons with a validated incident epilepsy diagnosis, we determined the proportion with DRE at the latest contact. We performed logistic regression analyses to identify clinical factors that correlated with risk of DRE.
RESULTS: Of 20 723 persons with a first diagnosis of epilepsy (n = 11 812) or seizures (n = 8911), we reviewed the medical records of n = 1067 with incident epilepsy and n = 610 with incident seizures. Among those with a register diagnosis of epilepsy, the diagnosis was confirmed in 838 cases (45% females, mean age at onset = 42.4 years), providing a positive predictive value (PPV) of 79% (95% confidence interval [CI] = 76%-81%). The PPV of focal epilepsy was 86% (95% CI = 82%-89%), and the PPV of generalized epilepsy was 71% (95% CI = 61%-80%). Of 740 patients with confirmed incident epilepsy and ≥1 year of follow-up, 103 (14%) fulfilled the definition of DRE, 476 (64%) were drug responsive, and 161 (22%) had undefined responsiveness. In multivariable logistic regression analysis, early age at epilepsy onset, cognitive impairment, and a history of status epilepticus were associated with DRE.
CONCLUSIONS: In the DNPR, we found a PPV of the epilepsy diagnosis of 79%. Among persons with confirmed epilepsy, 14% fulfilled ILAE criteria for DRE. Early age at epilepsy onset, cognitive impairment, and a history of status epilepticus were independently associated with drug resistance.
摘要：
目的：本研究的主要目的是验证丹麦国家患者登记处（DNPR）中癫痫发作病例的癫痫诊断，其中包含近9000000个人的信息，并确定经过验证的队列中符合国际抗癫痫联盟（ILAE）耐药性癫痫（DRE）标准的人员。
方法：我们回顾了所有首次诊断为癫痫的个体的医疗记录的随机样本（国际疾病分类，2010年至2019年，丹麦中部地区第10版[ICD-10]：G40）或缉获量（ICD-10：G41、R56或F445）。在确诊为癫痫事件的人中，我们在最近的接触中确定了与DRE的比例。我们进行了逻辑回归分析，以确定与DRE风险相关的临床因素。
结果：在20723名首次诊断为癫痫（n=11812）或癫痫发作（n=8911）的人中，我们回顾了n=1067例癫痫发作和n=610例癫痫发作的医疗记录.在那些有癫痫诊断的人中，838例确诊(45%为女性,发病平均年龄=42.4岁)，提供79%的阳性预测值（PPV）（95%置信区间[CI]=76%-81%）。局灶性癫痫的PPV为86％（95％CI=82％-89％），全身性癫痫的PPV为71％（95％CI=61％-80％）。在740例确诊的癫痫发作和≥1年的随访患者中，103（14%）符合DRE的定义，476（64％）是药物反应，161例(22%)患者的反应性不明确.在多变量逻辑回归分析中，癫痫发作的早期年龄，认知障碍，癫痫持续状态病史与DRE相关.
结论：在DNPR中，我们发现PPV的癫痫诊断为79%。在确诊的癫痫患者中，14%符合DRE的ILAE标准。癫痫发作的早期年龄，认知障碍，癫痫持续状态病史与耐药独立相关。
方法：我们回顾了所有首次诊断为癫痫的个体的医疗记录的随机样本（国际疾病分类，2010年至2019年，丹麦中部地区第10版[ICD-10]：G40）或缉获量（ICD-10：G41、R56或F445）。在确诊为癫痫事件的人中，我们在最近的接触中确定了与DRE的比例。我们进行了逻辑回归分析，以确定与DRE风险相关的临床因素。
结果：在20723名首次诊断为癫痫（n=11812）或癫痫发作（n=8911）的人中，我们回顾了n=1067例癫痫发作和n=610例癫痫发作的医疗记录.在那些有癫痫诊断的人中，838例确诊(45%为女性,发病平均年龄=42.4岁)，提供79%的阳性预测值（PPV）（95%置信区间[CI]=76%-81%）。局灶性癫痫的PPV为86％（95％CI=82％-89％），全身性癫痫的PPV为71％（95％CI=61％-80％）。在740例确诊的癫痫发作和≥1年的随访患者中，103（14%）符合DRE的定义，476（64％）是药物反应，161例(22%)患者的反应性不明确.在多变量逻辑回归分析中，癫痫发作的早期年龄，认知障碍，癫痫持续状态病史与DRE相关.
结论：在DNPR中，我们发现PPV的癫痫诊断为79%。在确诊的癫痫患者中，14%符合DRE的ILAE标准。癫痫发作的早期年龄，认知障碍，癫痫持续状态病史与耐药独立相关。
