2011
DOI: 10.1111/j.1528-1167.2011.03355.x
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Revising the “Rule of Three” for inferring seizure freedom

Abstract: Summary Purpose How long after starting a new medication must a patient go without seizures before they can be regarded as seizure free? A recent ILAE task force proposed using a “Rule of Three” as an operational definition of seizure freedom, according to which a patient should be considered seizure-free following an intervention after a period without seizures has elapsed equal to three times the longest pre-intervention inter-seizure interval over the previous year. This rule was motivated in large part by… Show more

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Cited by 31 publications
(14 citation statements)
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“…If seizure freedom of at least three times the longest preintervention seizure interval has been reached but for less than 12 months, the outcome regarding seizure control is considered “undetermined” until seizure freedom lasts for at least 12 months [ 1 ]. More recently, Westover et al [ 57 ] have stated that the “Rule of Three” as an operational definition of seizure freedom might be reasonable in many cases, but that in other common cases a longer waiting time might be necessary. The authors suggested a revised criterion for seizure freedom which they termed the ‘Rule of Three-to-Six’ [ 57 ].…”
Section: Assessment Of Outcome In Individual Patientsmentioning
confidence: 99%
See 1 more Smart Citation
“…If seizure freedom of at least three times the longest preintervention seizure interval has been reached but for less than 12 months, the outcome regarding seizure control is considered “undetermined” until seizure freedom lasts for at least 12 months [ 1 ]. More recently, Westover et al [ 57 ] have stated that the “Rule of Three” as an operational definition of seizure freedom might be reasonable in many cases, but that in other common cases a longer waiting time might be necessary. The authors suggested a revised criterion for seizure freedom which they termed the ‘Rule of Three-to-Six’ [ 57 ].…”
Section: Assessment Of Outcome In Individual Patientsmentioning
confidence: 99%
“…More recently, Westover et al [ 57 ] have stated that the “Rule of Three” as an operational definition of seizure freedom might be reasonable in many cases, but that in other common cases a longer waiting time might be necessary. The authors suggested a revised criterion for seizure freedom which they termed the ‘Rule of Three-to-Six’ [ 57 ]. This suggestion considers the pre-intervention probability for therapeutic success, which for instance can be significantly reduced in patients with a history of multiple failed therapeutic trials.…”
Section: Assessment Of Outcome In Individual Patientsmentioning
confidence: 99%
“…Seizure freedom was defined as a patient experiencing no seizures for the previous 12 months or longer after receiving an intervention 30 . Every patients would have EEG at least 1–2 times every year.…”
Section: Methodsmentioning
confidence: 99%
“…The International League Against Epilepsy (ILAE) proposed the “rule of three” [24] to define seizure freedom as ‘without seizure for three times the pre-intervention inter-seizure duration or at least one year’ [25]. The rule of three was recently reassessed [26] and in some cases of refractory epilepsy (the probability of success of an intervention being 5%), ‘six times the pre-intervention inter-seizure duration’ would be more adequate, supporting the ILAE’s definition of the shortest period to assess the response to the treatment as 1 year in all cases. Although it appears robust, the ILAE definition of drug response, leads to long periods of observation so that predicting treatment response in the short-term is not possible.…”
Section: Why Monitor Disease Activity?mentioning
confidence: 99%
“…None of the changes listed above are specific to the disease; the future lies probably in a combination of markers that together reach sufficient specificity and sensitivity. The usefulness of such combined biomarkers will need to correlate with statistically robust clinical outcome, such as seizure freedom defined by the rule of 3 [26]. One question remaining is will these markers reflect on past occurrence of seizures or monitor the propensity of new seizures to come, which would be more useful.…”
Section: Potential Epilepsy Biomarkersmentioning
confidence: 99%