Enhanced differential diagnosis of anticonvulsant XXXX reactions by an integrated Bayesian and biochemical approach.

@entity1 @entity137 @entity56
OBJECTIVE: The differential diagnosis of @entity56 reactions associated with anticonvulsants requires accuracy because of the many implications for @entity1 management. We tested an integrated Bayesian and biochemical diagnostic approach. METHODS: The @entity1 were analyzed clinically by two tests. One test, the Bayesian Adverse Reaction Diagnostic Instrument (BARDI), calculates the posterior probability of a drug being the cause based on epidemiologic and case data. The other, the lymphocyte @entity137 assay, is an in vitro rechallenge that determines the percentage of cell death attributable to a @entity137 . The setting for the study was an adverse drug reaction clinic at Sunnybrook Health Science Centre and the Hospital for Sick @entity1 , Toronto, Ontario, Canada. Fifty-one @entity1 who had @entity56 reactions after receiving aromatic anticonvulsants were tested. Four of these @entity1 had more than one reaction reported, with different anticonvulsants generating 56 distinct events. RESULTS: Compared to the lymphocyte @entity137 assay, BARDI had 94% sensitivity, 93% accuracy, and 50% specificity. When lymphocyte @entity137 assay data were incorporated into BARDI, agreement rose from 93% to 100%. BARDI also identified which drug was a more likely cause for 11 @entity1 receiving multiple anticonvulsants. CONCLUSION: These findings show that BARDI and the lymphocyte @entity137 assay have high concordance and, when used in an integrated approach, these tests can improve the diagnostic accuracy and enhance the management of @entity1 with @entity56 reactions.
