2024 American Academy of Neurology Abstract Website

Objective:

We aim to understand the value of a clinical adjudication committee in verifying the diagnosis of new onset focal epilepsy.

Background:

Human Epilepsy Project (HEP) 1 is a multicenter prospective observational study of newly treated focal epilepsy patients with a goal of identifying biomarkers predictive of patient prognosis. Significant effort was employed to ensure proper enrollment including an adjudication committee.

Design/Methods:

Subjects were submitted for enrollment if they were deemed to have a >80% likelihood of focal epilepsy and were seen within four months of treatment initiation. If subjects had a normal or no MRI/ EEG, or if eligibility was in question for any other reason, they were adjudicated by 4 expert epileptologists to establish a consensus agreement on the diagnosis. Details of history, MRI and EEG findings at time of enrollment for each group were analyzed, along with reasons for later disqualification.

Results:

489 participants were enrolled, with 354 (72%) requiring adjudication. During the course of the study, 13 participants were later rejected for not having a diagnosis of focal epilepsy; 5/135 (3.7%) not adjudicated and 8/354 (2.3%) adjudicated. 10/13 ultimately did not have epilepsy (7 non-epileptic seizures, 1 long QT syndrome, and 2 others) and 3 had generalized epilepsy. At time of enrollment, 6 subjects had a normal EEG, 3 had no EEG, and 4 had an abnormal EEG. 7 subjects had a normal MRI, 3 had no MRI, and 3 had an abnormal MRI.

Conclusions:

Using strict enrollment criteria and an expert adjudication panel, only 2.6% (13/489) of those enrolled were later discovered not to have a diagnosis of focal epilepsy. Despite lacking MRI/EEG confirmation of focal epilepsy, those requiring adjudication had a lower rate of misdiagnosis when compared to those who did not require adjudication.