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Patient preferences pertaining to treatment options for drug-resistant focal epilepsy.

Publication ,  Journal Article
Sinha, SR; Yang, J-C; Wallace, MJ; Grover, K; Johnson, FR; Reed, SD
Published in: Epilepsy Behav
February 2022

OBJECTIVE: To determine patient acceptability of benefit-risk trade-offs in selecting treatment options for drug-resistant mesial temporal lobe epilepsy, including open brain surgery, laser ablation (laser interstitial thermal therapy [LITT]), and continued medications. METHODS: A discrete-choice experiment survey was developed, consisting of 20 versions that were randomly assigned to respondents. Each version had 8 sets of constructed treatment alternatives, representing open brain surgery, LITT, or continued medical management. For each set, respondents indicated the treatment alternative they would choose first. Treatment alternatives were characterized by varying levels of chance of seizure freedom for at least 2 years (20-70%), risk of 30-day mortality (0-10%), and risk of neurological deficits (0-40%). Respondents' choices were analyzed using random-parameters logit models to quantify acceptable benefit-risk trade-offs. Preference heterogeneity was evaluated using latent-class analysis. RESULTS: The survey was administered to 2 cohorts of adult patients with drug-resistant epilepsy: a Duke cohort identified using diagnostic codes (n = 106) and a web-recruited panel with a self-reported physician diagnosis of drug-resistant epilepsy (n = 300). Based on mean preference weights, respondents who indicated a willingness to consider surgical intervention would accept a reduction in chance of seizure freedom from 70% to a minimum-acceptable benefit (MAB) of 23% if they could undergo LITT rather than open brain surgery. For a reduction in 30-day mortality from 1% to 0%, MAB was 52%. For a reduction in risk of long-term deficits from 10% to 0%, MAB was 39%. Latent-class analysis revealed additional choice patterns identifying respondent groups that more strongly favored continuing medications or undergoing surgery. CONCLUSION: Patients who are receptive to surgery would accept significantly lower treatment effectiveness to undergo a minimally invasive procedure relative to open brain surgery. They also were willing to accept lower treatment benefit to reduce risks of mortality or neurological deficits.

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Published In

Epilepsy Behav

DOI

EISSN

1525-5069

Publication Date

February 2022

Volume

127

Start / End Page

108529

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Temporal Lobe
  • Patient Preference
  • Neurology & Neurosurgery
  • Magnetic Resonance Imaging
  • Laser Therapy
  • Humans
  • Epilepsy, Temporal Lobe
  • Drug Resistant Epilepsy
  • Adult
 

Citation

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Chicago
ICMJE
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Sinha, S. R., Yang, J.-C., Wallace, M. J., Grover, K., Johnson, F. R., & Reed, S. D. (2022). Patient preferences pertaining to treatment options for drug-resistant focal epilepsy. Epilepsy Behav, 127, 108529. https://doi.org/10.1016/j.yebeh.2021.108529
Sinha, Saurabh R., Jui-Chen Yang, Matthew J. Wallace, Kiran Grover, F Reed Johnson, and Shelby D. Reed. “Patient preferences pertaining to treatment options for drug-resistant focal epilepsy.Epilepsy Behav 127 (February 2022): 108529. https://doi.org/10.1016/j.yebeh.2021.108529.
Sinha SR, Yang J-C, Wallace MJ, Grover K, Johnson FR, Reed SD. Patient preferences pertaining to treatment options for drug-resistant focal epilepsy. Epilepsy Behav. 2022 Feb;127:108529.
Sinha, Saurabh R., et al. “Patient preferences pertaining to treatment options for drug-resistant focal epilepsy.Epilepsy Behav, vol. 127, Feb. 2022, p. 108529. Pubmed, doi:10.1016/j.yebeh.2021.108529.
Sinha SR, Yang J-C, Wallace MJ, Grover K, Johnson FR, Reed SD. Patient preferences pertaining to treatment options for drug-resistant focal epilepsy. Epilepsy Behav. 2022 Feb;127:108529.
Journal cover image

Published In

Epilepsy Behav

DOI

EISSN

1525-5069

Publication Date

February 2022

Volume

127

Start / End Page

108529

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Temporal Lobe
  • Patient Preference
  • Neurology & Neurosurgery
  • Magnetic Resonance Imaging
  • Laser Therapy
  • Humans
  • Epilepsy, Temporal Lobe
  • Drug Resistant Epilepsy
  • Adult