001 PREDICTING SEIZURE RECURRENCE WITH AND WITHOUT ANTIEPILEPTIC DRUG TREATMENT FOLLOWING SINGLE SEIZURES AND FOR EARLY EPILEPSY: A PREDICTIVE MODEL FROM A MULTICENTRE RANDOMIZED CONTROLLED TRIAL

A. G. Marson, L. Kim, A. L. Johnson, A. Jacoby, D. W. Chadwick on behalf of the MESS collaborators. Department of Neurological Science University of Liverpool, Department of Primary Care University of Liverpool, MRC Biostatistics Unit University of Cambridge

Rationale and Methods: The multicentre study of early epilepsy and single seizures (MESS) represents the largest epilepsy RCT so far. 1443 patients were recruited following a single seizure or with early epilepsy. Patients were randomized to either immediate or deferred treatment with an antiepileptic drug (AED). In order to predict seizure recurrence risk for individual patients associated with these treatment policies, data for time to a first seizure after randomization have been used to generate a predictive model.

Results: Results below are all hazard ratios (HR) with 95% CIs. Overall, there were significantly fewer seizure recurrences for patients allocated to immediate treatment, hazard ratio 1.4 (1.2 to 1.7). Regression models found the following clinical factors to be significantly associated with outcome, 2 or more seizures prior to randomization 1.6 (1.3 to 2.0), 3 or more seizures prior to randomization 2.6 (1.6 to 4.1), 10 or more seizures prior to randomization 1.3 (1.0 to 1.7), ‘brain pathology’ (learning difficulty, delayed development, neurological signs) 1.4 (1.1 to 1.8)), abnormal EEG 1.6 (1.3, 1.9). A predictive model using these factors is well calibrated within the MESS dataset.

Conclusions: MESS provides a simple prognostic model which will inform clinical decision making. The model is reliable within the MESS dataset and should be tested in other datasets and in clinical practice.

002 MEDICALLY REFRACTORY EPILEPSY ASSOCIATED WITH HYPOTHALAMIC HAMARTOMAS CAN BE SIGNIFICANTLY AMELIORATED USING STEREOTACTIC NEUROSURGICAL TECHNIQUES

C. Watts, C. Polkey, N. Mullatti, R. Selway. Depts Neurosurgery and Clinical Neurophysiology, Kings College Hospital, London

Objective: To determine the feasibility of a stereotactic approach to the surgical management of medically refractory epilepsy in patients with hypothalamic hamartoma.

Methods: Three adult male patients underwent …