Evidence map›Paper›PMID 41474365›Full record

ArticleEpilepsia2026

L-Relationship between uncertainty and average seizure frequency in clinical trials of antiseizure medications.

Wesley T Kerr, Neo Kok, Katherine N McFarlane, Advith S Reddy, Lavanya Biju, Jacqueline A French, Daniel M Goldenholz

Abstract read
In one paragraph

Article in Epilepsia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Wesley T KerrDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.ORCID https://orcid.org/0000-0002-5546-5951
Neo KokDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.ORCID https://orcid.org/0009-0001-0505-6084
Katherine N McFarlaneDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.ORCID https://orcid.org/0009-0000-0365-813X
Advith S ReddyDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.ORCID https://orcid.org/0009-0007-9831-0275
Lavanya BijuDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jacqueline A FrenchComprehensive Epilepsy Center, New York University, New York, New York, USA.ORCID https://orcid.org/0000-0003-2242-8027
Daniel M GoldenholzDivision of Epilepsy, Beth Israel Medical Center, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0002-8370-2758

Funding

NeuroNEXT Clinical Research Site at the University of MichiganU24NS107158 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI CHOU, KELVIN L · 2018 to 2022
$1.6M
UM Clinical Neuroscientist Training ProgramR25NS089450 · NINDS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI ALBIN, ROGER L · 2014 to 2023
$1.3M
Non-Invasive Seizure Forecasting System Using E-Diaries, Internal and External FactorsK23NS124656 · NINDS · BETH ISRAEL DEACONESS MEDICAL CENTER · PI Daniel M Goldenholz · 2022 to 2026
$954k
Feasibility of machine learning to improve the diagnostic odyssey for functional seizuresK23NS135134 · NINDS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Wesley Thomas Kim Kerr · 2025 to 2026
$448k
American Academy of Neurology Susan S. Spencer Clinical Research Training ScholalarshipNINDS NIH HHS K23 NS124656NINDS NIH HHS K23NS124656NINDS NIH HHS K23 NS135134NINDS NIH HHS K23NS135134NINDS NIH HHS R25NS089450NINDS NIH HHS U24NS107158
6 · The paper itself

Abstract

objectiveAntiseizure medications are approved based on clinical trials that demonstrate their efficacy as measured by reductions in seizure frequency (SF). When designing these trials, trialists must select inclusion criteria where SF can be reliably measured to maintain statistical power. Statistical power is based on the magnitude and uncertainty of the difference between active treatment and placebo. To inform choices about how minimum, maximum, and individual participant SF impacts the statistical power of trials, we evaluated how the uncertainty in SF was associated with average SF within multiple clinical trials.

methodsUsing data from 11 double-blind placebo-controlled trials of antiseizure medications for either focal or generalized onset epilepsy, we used log-log multivariable regression to associate the SD of SF in maintenance with the average SF in baseline and maintenance. We also evaluated whether capturing more seizures in people with high average SF offset the increased uncertainty in SF and asked whether these associations persisted when time to event designs were used.

resultsThe uncertainty (SD) of maintenance SF was proportional to baseline average SF (daily diaries: slope of log-log association = .575, 95% confidence interval [CI] = .556-.593; fortnightly diaries: .657, 95% CI = .0642-.0671). Increased uncertainty for high SF was offset by counting more seizures. These relationships were maintained with a time to event design. SIGNIFICANCE: This study validates the foundational L-relationship between average and SD of SF in which the uncertainty of seizure counts increased proportional to the number of seizures counted. When used for efficacy outcomes of trials, the statistical benefit of counting more seizures in participants with high SF was much greater than the increased challenge from higher uncertainty seizure counts. These results provide quantitative insights for SF-based inclusion criteria and statistical power calculations.

Indexed as

AnticonvulsantsSeizuresAdultDouble-Blind MethodFemaleHumansMaleMiddle AgedTreatment OutcomeUncertaintyYoung AdultAnticonvulsantsantiepileptic drugsclinical trialsepilepsyL‐relationshiptime to event

Identifiers

PMID41474365
PMCPMC13075602

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.