PURPOSE The purpose of this study was to validate the practicability of Lamberink's prediction model in risk assessment of antiepileptic drug (AED) withdrawal in a real, seizure-free population and to find a practical cutoff value to guide clinical withdrawal. METHODS A group of seizure-free patients from West China Hospital was recruited. Each patient had been seizure-free for at least two years. The seizure recurrence risk among the patients was calculated by an online AED withdrawal risk calculator. The predictive ability of Lamberink's model was assessed by analyzing discrimination and calibration with receiver operating characteristic (ROC) curves and calibration plots, respectively. RESULTS A total of 184 seizure-free patients received risk evaluation, all of whom were followed up for at least two years or had an earlier report of seizure relapse. Of these patients, 128 patients were followed up for at least five years or had an earlier report of relapse within five years. Sixty-two of 184 (33.7%) patients relapsed within two years, while 81 of 184 (44.0%) patients relapsed within five years after the start of AEDs' withdrawal. Cox regression analyses showed that seizure duration before remission and the age of seizure onset were independent predictors of relapse at two years. For predictors of recurrence at five years, seizure duration before remission, age at onset, and withdrawal were significant. For discrimination, ROC curve analysis showed that the area under the curve (AUC) for the seizure recurrence within two and five years was 0.605 (95% confidence interval [CI]: 0.518-0.692, p = 0.02) and 0.656 (95% CI: 0.563-0.749, p = 0.003), respectively. For calibration, it was poor in two-year prediction; the observed number was considerably lower than the predicted number. However, the calibration plot showed good calibration with the five-year prediction except for the second, fourth, and eighth deciles. With a cutoff two-year recurrence risk of 47%, the model had a sensitivity of 0.758 and a specificity of 0.410; the largest Youden index was 1.168. With a cutoff five-year recurrence risk of 77%, the model had a sensitivity of 0.358 and a specificity of 0.979; the largest Youden index was 1.337. CONCLUSIONS Lamberink's prediction model has a general discrimination ability. The model overestimated the actual recurrence events when predicting the two-year recurrence risk, but it showed relatively good calibration with five-year prediction. The cutoff value found in this study may be used to guide patients and clinicians towards a decision regarding the withdrawal of AEDs. The model appears to be a useful tool for predicting seizure recurrence for the five-year recurrence risk.

中文翻译：

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抗癫痫药物停药后癫痫复发预测模型的验证

目的 本研究的目的是验证 Lamberink 预测模型在真实无癫痫发作人群中抗癫痫药物 (AED) 戒断风险评估中的实用性，并找到一个实用的临界值来指导临床戒断。方法以华西医院无癫痫发作患者为研究对象。每名患者至少两年没有癫痫发作。患者的癫痫复发风险是通过在线 AED 戒断风险计算器计算的。Lamberlink 模型的预测能力是通过分别使用受试者工作特征 (ROC) 曲线和校准图分析辨别和校准来评估的。结果 共有 184 名无癫痫发作的患者接受了风险评估，所有这些人都接受了至少两年的随访，或者有早期癫痫复发的报告。在这些患者中，有 128 名患者至少接受了五年的随访，或者有五年内复发的早期报告。184 名患者中有 62 名（33.7%）在两年内复发，而 184 名患者中有 81 名（44.0%）在 AED 停用后五年内复发。Cox 回归分析显示，缓解前癫痫发作持续时间和癫痫发作年龄是两年后复发的独立预测因素。对于 5 年复发的预测因素，缓解前的癫痫持续时间、发病年龄和戒断是显着的。对于鉴别，ROC曲线分析显示，两年和五年内癫痫复发的曲线下面积（AUC）为0.605（95%置信区间[CI]：0.518-0.692，p = 0.02) 和 0.656（95% CI：0.563-0.749，p = 0.003）。校准方面，两年预测较差；观察到的数量远低于预测的数量。但是，校准图显示了与五年预测的良好校准，除了第二、第四和第八个十分位数。截止两年复发风险为 47%，该模型的敏感性为 0.758，特异性为 0.410；最大的约登指数为 1.168。截止五年复发风险为 77%，该模型的敏感性为 0.358，特异性为 0.979；最大的约登指数为 1.337。结论 Lamberlink 的预测模型具有一般的判别能力。该模型在预测两年复发风险时高估了实际复发事件，但它显示出相对良好的五年预测校准。本研究中发现的临界值可用于指导患者和临床医生做出有关停用 AED 的决定。该模型似乎是预测五年复发风险的癫痫复发的有用工具。