From Clinical Narrative to Diagnosis: Scalable Identification of Acquired Epilepsy

Acquired epilepsy is a disabling, potentially preventable complication of acute brain injury (ABI). Yet, it remains a leading cause of new onset epilepsy in adults. Acquired epilepsy is a particularly challenging subtype of epilepsy to identify, as the ABI and its acute consequences can confound the later diagnosis of acquired epilepsy. We identified a retrospective cohort of patients with ABI (N=828) and optimized a general epilepsy algorithm to extract relevant keywords. We confirmed that applying a broad epilepsy phenotyping algorithm to a high risk, complex population like acute brain injured patients results in a high number of false positives. We developed multivariate models to identify ABI-acquired epilepsy 1) at the patient level using temporal trends, and 2) the note-level using keywords. Our models achieved high performance in both internal and external validation cohorts. Note-level re-classification also allowed for an estimation of time to epilepsy onset. This work enables large-scale, retrospective studies of ABI-acquired epilepsy across sites. Large-scale implementation may provide insights into acquired epilepsy epidemiology, identification of novel epilepsy risk factors and ultimately new treatments.