Application of High Order Markov Model and Mover-Stayer Model to the Prognosis of Patients with Intractable Epilepsy
Date Issued
2009
Date
2009
Author(s)
Li, Fang-Yi
Abstract
Elucidating the prognosis of intractable epileptic patients treated with surgery is important. However, as follow-up data on the episodes of seizure of these patients are fraught with heterogeneity and correlated property, both preclude one from analyzing the data with conventional statistical method. The higher-order and mover-stayer Markov model with or without considering covariates were therefore proposed to accommodate these intractable properties. A total of 274 patients who had undergone surgery were followed over five years on the monthly episodes of seizure with classification of three states: Normal – 0 count of episode; Mild – 1 to 2 counts of episode; Severe – above 3 counts of episode. Baseline covariates were collected including age, gender, age of onset, medication, perinatal insult, MST, and duration of epilepsy.irst-order Markov model, second-order Markov model, and mover-stayer model were applied to modeling this data by using maximum likelihood estimate (MLE) method. The result of first-order Markov model showed the rates of progression and regression depended on initial status. The forces of progression to severe state were, 1% and 15%, respectively, for normal and mild in nascent state. The similar findings were noted in the second-order Markov model and the transitions for mover in the mover-stayer model. Note thate the results of mover-stayer model found 62% stayer. In the light of AIC criteria, we found the mover-stayer model had the best fit.n the covariate-specific regression model, we found medication and perinatal insult were two accelerated factors for the net force of progression and MTS was a decelerated factor.n summary, higher order and mover-stayer model were very useful for modeling the progression and regression and identification of prognostic factors in intractable epileptic patients treated with surgery.
Subjects
High-order Markov model
Mover-stayer Markov model
Intractable epileptic patients
Type
thesis
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