Validation Study of the Simplified Seizure Classification Algorithm

NCT ID: NCT03796520

Last Updated: 2021-02-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

240 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-06-02

Study Completion Date

2020-12-31

Brief Summary

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An algorithm has been developed for simplified classification of epileptic seizures, in order to optimize choice of antiepileptic drugs.

The objective of this study was to clinically validate the algorithm.

Detailed Description

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Optimal choice of antiepileptic drugs (AEDs) depend on the patients´ seizure-types. Over the last four decades, several classification systems have been proposed for epileptic seizures. The recent position paper of the International League Against Epilepsy defines 63 seizure-types. While this complex system might be useful for detailed phenotyping, currently there is no evidence that each of these seizure-types needs different clinical management strategy, and many clinicians find it difficult to implement.

To help physicians with optimizing the choice of AEDs, the investigators developed a simplified seizure classification, consisting of the minimal number of seizure-types, necessary for choice of AEDs, and the investigators developed an algorithm that identifies the patient´s seizure-type, based on a set of 10 simple questions, that can be answered by physicians even without extensive training in epilepsy. The current form of the algorithm was developed for patients whose seizures started in adolescence or adulthood (at the age of 10 years or older).

In this study, the investigators aim to validate the diagnostic algorithm, by comparing the seizure-type identified by the algorithm with the diagnosis and seizure-type as defined by trained experts, in the clinical workup of the patients.

Conditions

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Epilepsy

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients suspected for epilepsy

The cohort includes patients referred to the participating centers on suspicion of epilepsy, provided their seizure onset was at 10 years of age or older.

EpiPick simplified seizure classification algorithm

Intervention Type DIAGNOSTIC_TEST

EpiPick simplified seizure classification algorithm input:

Grey matter brain lesion Exclusively nocturnal seizures First seizure at age \> 20 years Lip smacking or chewing during seizures Staring with impaired awareness, lasting less than 20s without postictal confusion Sudden irregular jerks, in isolation or brief series, if none of the following applies: Are the jerks consistently in the same limb? When resting in bed when falling asleep? Bilateral tonic-clonic seizures within 1h of awakening or immediately preceded by irregular jerks Any of the following is present: Skin turning pale pre-ictally; Loss of consciousness immediately after urination or defecation; Sudden slump with loss of awareness, lasting less than 10 seconds; Seizure lasting longer than 10 minutes, with eyes closed throughout the seizure; Severe pre-ictal headache; Episodes consisting of falls that occur always after change in posture to the upright position, or coughing or feeling pain.

Interventions

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EpiPick simplified seizure classification algorithm

EpiPick simplified seizure classification algorithm input:

Grey matter brain lesion Exclusively nocturnal seizures First seizure at age \> 20 years Lip smacking or chewing during seizures Staring with impaired awareness, lasting less than 20s without postictal confusion Sudden irregular jerks, in isolation or brief series, if none of the following applies: Are the jerks consistently in the same limb? When resting in bed when falling asleep? Bilateral tonic-clonic seizures within 1h of awakening or immediately preceded by irregular jerks Any of the following is present: Skin turning pale pre-ictally; Loss of consciousness immediately after urination or defecation; Sudden slump with loss of awareness, lasting less than 10 seconds; Seizure lasting longer than 10 minutes, with eyes closed throughout the seizure; Severe pre-ictal headache; Episodes consisting of falls that occur always after change in posture to the upright position, or coughing or feeling pain.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* patients referred to the participating centers on suspicion of epilepsy

Exclusion Criteria

* none
Minimum Eligible Age

10 Years

Maximum Eligible Age

120 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Danish Epilepsy Centre

UNKNOWN

Sponsor Role collaborator

Shiraz University of Medical Sciences

OTHER

Sponsor Role collaborator

University of Pavia

OTHER

Sponsor Role collaborator

Thomas Jefferson University

OTHER

Sponsor Role collaborator

Sándor Beniczky

OTHER

Sponsor Role lead

Responsible Party

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Sándor Beniczky

professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Sandor Beniczky, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Aarhus University Hospital

Guido Rubboli, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Danich Epilepsy Centre

Michael Sperling, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Thomas Jefferson University

Emilio Perucca, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pavia

Ali A Asadi-Pooya, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Shiraz University of Medical Sciences

Locations

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Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status

Aarhus University Hospital

Aarhus, , Denmark

Site Status

Danish Epilepsy Centre

Dianalund, , Denmark

Site Status

Shiraz University of Medical Sciences

Shiraz, , Iran

Site Status

University of Pavia

Pavia, , Italy

Site Status

Countries

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United States Denmark Iran Italy

References

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Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshe SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-530. doi: 10.1111/epi.13670. Epub 2017 Mar 8.

Reference Type BACKGROUND
PMID: 28276060 (View on PubMed)

Brodie MJ. Practical Use of Newer Antiepileptic Drugs as Adjunctive Therapy in Focal Epilepsy. CNS Drugs. 2015 Nov;29(11):893-904. doi: 10.1007/s40263-015-0285-4.

Reference Type BACKGROUND
PMID: 26507832 (View on PubMed)

Brodie MJ, Covanis A, Gil-Nagel A, Lerche H, Perucca E, Sills GJ, White HS. Antiepileptic drug therapy: does mechanism of action matter? Epilepsy Behav. 2011 Aug;21(4):331-41. doi: 10.1016/j.yebeh.2011.05.025. Epub 2011 Jul 16.

Reference Type BACKGROUND
PMID: 21763207 (View on PubMed)

Stephen LJ, Brodie MJ. Selection of antiepileptic drugs in adults. Neurol Clin. 2009 Nov;27(4):967-992. doi: 10.1016/j.ncl.2009.06.007.

Reference Type BACKGROUND
PMID: 19853218 (View on PubMed)

Brodie MJ, Elder AT, Kwan P. Epilepsy in later life. Lancet Neurol. 2009 Nov;8(11):1019-30. doi: 10.1016/S1474-4422(09)70240-6. Epub 2009 Oct 1.

Reference Type BACKGROUND
PMID: 19800848 (View on PubMed)

Beniczky S, Rubboli G, Aurlien H, Hirsch LJ, Trinka E, Schomer DL; SCORE consortium. The new ILAE seizure classification: 63 seizure types? Epilepsia. 2017 Jul;58(7):1298-1300. doi: 10.1111/epi.13799. No abstract available.

Reference Type BACKGROUND
PMID: 28677857 (View on PubMed)

Beniczky S, Asadi-Pooya AA, Perucca E, Rubboli G, Tartara E, Meritam Larsen P, Ebrahimi S, Farzinmehr S, Rampp S, Sperling MR. A web-based algorithm to rapidly classify seizures for the purpose of drug selection. Epilepsia. 2021 Oct;62(10):2474-2484. doi: 10.1111/epi.17039. Epub 2021 Aug 22.

Reference Type DERIVED
PMID: 34420206 (View on PubMed)

Other Identifiers

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EpiPick-1

Identifier Type: -

Identifier Source: org_study_id

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