Long-term seizure diary tracking habits in clinical studies: Evidence from the Human Epilepsy Project

• Published in: Epilepsy research Vol. 203; p. 107379
• Main Authors: Miller, Kristen R., Barnard, Sarah, Juarez-Colunga, Elizabeth, French, Jacqueline A., Pellinen, Jacob
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.07.2024
• Subjects: Adolescent; Adult; Diaries as Topic; Electronic seizure diary; Epilepsies, Partial - physiopathology; Epilepsy - diagnosis; Epilepsy - physiopathology; Female; Habits; Humans; Male; Middle Aged; Seizure outcomes; Seizure tracking; Seizures - diagnosis; Seizures - physiopathology; Young Adult; Seizure tracking; Seizure outcomes; Electronic seizure diary
• ISSN: 0920-1211; 1872-6844; 1872-6844
• DOI: 10.1016/j.eplepsyres.2024.107379

To characterize seizure tracking patterns of people with focal epilepsy using electronic seizure diary entries, and to assess for risk factors associated with poor tracking. We analyzed electronic seizure diary data from 410 participants with newly diagnosed focal epilepsy in the Human Epilepsy Project 1 (HEP1). Each participant was expected to record data each day during the study, regardless of seizure occurrence. The primary outcome of this post-hoc analysis was whether each participant properly tracked a seizure diary entry each day during their study participation. Using finite mixture modeling, we grouped patient tracking trajectories into data-driven clusters. Once defined, we used multinomial modeling to test for independent risk factors of tracking group membership. Using over up to three years of daily seizure diary data per subject, we found four distinct seizure tracking groups: consistent, frequent at study onset, occasional, and rare. Participants in the consistent tracking group tracked a median of 92% (interquartile range, IQR: 82%, 99%) of expected days, compared to 47% (IQR:34%, 60%) in the frequent at study onset group, 37% (IQR: 26%, 49%) in the occasional group, and 9% (IQR: 3%, 15%) in the rare group. In multivariable analysis, consistent trackers had lower rates of seizure days per tracked year during their study participation, compared to other groups. Future efforts need to focus on improving seizure diary tracking adherence to improve quality of outcome data, particularly in those with higher seizure burden. In addition, accounting for missing data when using seizure diary data as a primary outcome is important in research trials. If not properly accounted for, total seizure burden may be underestimated and biased, skewing results of clinical trials. •Use of electronic seizure diaries is increasing despite a paucity of adherence data.•Participants split into 4 tracking groups: consistent, frequent at study onset, occasional, rare.•Consistent trackers had fewer seizures during HEP1 compared to other groups.•Strategies are needed to improve diary tracking adherence for outcome research.