Abstracts

Rationale: Current epilepsy outcome metrics such as Engel and ILAE classifications emphasize seizure frequency but overlook broader effects of treatment on cognition, emotional health, independence, and patient satisfaction. This narrow scope often leads to misclassification of therapeutic benefit, especially for neuromodulation and alternative procedures.

Methods: I developed the Multidimensional Outcome Reporting in Epilepsy (MORE) framework to align epilepsy outcome reporting with patient-centered care. The model assigns 40% weight each to seizure control and quality of life, and 20% to patient-reported experience. Eleven subdomains—ranging from seizure-free duration to cognitive function, mood, ADLs, ASM burden, and treatment satisfaction—are scored using a structured 100-point scale. MORE incorporates both validated measures and pragmatic clinical inputs.

Results: Application of MORE to diverse cases revealed significant divergences from traditional classifications. In several patients labeled Engel III–IV, MORE scores captured meaningful functional and emotional gains. Conversely, in cases where seizure burden changed little, declines in QoL were clearly reflected via negative scoring. The framework supports longitudinal tracking, better reflects treatment goals in neuromodulation, and captures subjective benefit often missed by seizure-based metrics.

Conclusions: MORE redefines success in epilepsy treatment by incorporating what matters most to patients. It provides a structured yet adaptable model for research, quality improvement, and shared decision-making. As clinical care evolves toward more holistic paradigms, frameworks like MORE may help modernize how we define and measure outcomes in epilepsy.

Funding: None