Join Dr. Bermeo in a conversation with Dr. Danielle Becker, Dr. Jacqueline French and Dr. Ammar Kheder as they discuss the article, "TRADEOFFS: What Are Patient-Reported Outcome Measures Missing?"

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This podcast was sponsored by UCB.

We'd like to acknowledge Epilepsy Currents podcast editor Dr. Adriana Bermeo-Ovalle, contributing editor Dr. Rohit Marawar, and the team at Sage.

The episode focuses on epilepsy outcomes that matter beyond seizure counts alone, using two 2025 papers and a related commentary to rethink how success should be measured in epilepsy care. Validation of the Seizure-Related Impact Assessment Scale by Dr. French and authors introduces a brief patient-reported tool that captures how many days are lost to seizures and how many are lost to treatment side effects. More Than Seizure Control: Multi-Dimensional Outcome Reporting in Epilepsy (MORE) as a patient-centered framework, redefining success in treatment by Dr. Kheder proposes a broader framework that combines seizure control, quality of life, and the patient's own experience of treatment. The commentary by Dr. Becker, TRADE-OFFS: What Are Patient-Reported Outcome Measures Missing?, ties these ideas together by emphasizing that better seizure control is not always a true success if it comes with worse cognition, mood, fatigue, or day-to-day functioning. The overall message is that epilepsy treatment should be judged not only by fewer seizures, but by whether life is actually better.

Key Takeaways

Seizure counts alone do not capture treatment success Across the discussion, a major point was that patients often care just as much, or more, about cognition, mood, side effects, independence, work, driving, and daily function as they do about seizure frequency.
SERIAS measures the real-life impact of seizures and side effects Validation of the Seizure-Related Impact Assessment Scale highlights a simple tool that asks how many days, or parts of days, were disrupted by seizures and separately by treatment-related adverse effects. This helps clinicians see the net impact of treatment rather than focusing only on seizure reduction.
MORE broadens outcome measurement beyond seizure control More Than Seizure Control: Multi-Dimensional Outcome Reporting in Epilepsy (MORE) as a patient-centered framework, redefining success in treatment proposes a structured way to combine seizure control, quality of life, and patient experience, so that meaningful improvement is recognized even when seizure reduction is modest.
The commentary frames these issues as trade-offs TRADE-OFFS: What Are Patient-Reported Outcome Measures Missing? emphasizes that every treatment decision should consider what is gained and what is lost. A patient may have fewer seizures but worse fatigue, worse memory, heavier medication burden, or new social and functional problems.
These approaches could improve both clinic care and research trials The discussion suggests that tools like SERIAS and frameworks like MORE could help with medication decisions, surgical counseling, neuromodulation follow-up, and clinical trials by capturing outcomes that matter most to patients in everyday life.

Adriana Bermeo-Ovalle, MD (Host): What if the most difficult part of living with epilepsy is not the seizures? Most people living with epilepsy report being more burdened by stigma, social limitations, and psychiatric comorbidities than by seizures themselves. So, the real question becomes: how do we measure the impact of epilepsy and the success of our treatments beyond side effects and seizure counts?

UCB is the proud sponsor of Episode 11 of Epilepsy Currents Podcast. I am the senior podcast editor for Epilepsy Currents, the official journal of the American Epilepsy Society. Today, we will be discussing the epilepsy outcomes beyond seizures with a phenomenal panel of speakers.

Let me first introduce our own Epilepsy Currents contributing editor, Dr. Danielle Becker, who's a recurrent guest in our Epilepsy Currents podcast. Dr. Becker wrote a commentary titled TRADE-OFFS: What Are Patient‑Reported Outcome Measures Missing? This commentary was published in October 2025. Dr. Becker, welcome back.

Danielle Becker, MD, MS: Thank you so much for having me.

Host: It is also my pleasure to welcome Dr. Jackie French, senior author of one of the studies which inspired that commentary published in Neurology in August 2025, titled Validation of the Seizure-Related Impact Assessment Scale. Dr. French is Professor of Neurology in the Comprehensive Epilepsy Center at NYU Grossman School of Medicine and Founder and Director of the Epilepsy Study Consortium and leader of multiple initiatives in our epilepsy community. Dr. French, welcome. It is a pleasure to have you.

Jacqueline French, MD: It's great to be here. Thanks a lot for inviting me.

Host: And last but not least, I am very happy to introduce Dr. Ammar Kheder, who wrote a second paper referenced also in Dr. Becker's commentary titled More Than Seizure Control: Multi-Dimensional Outcome Reporting in Epilepsy (MORE) as a patient-centered framework, redefining success in treatment. This article was published in epilepsy in March 2025. Dr. Kheder is Associate Professor at Emory University and Assistant Medical Director for Epilepsy and Neurodiagnostics at WellStar Health Systems in Georgia. Welcome, Dr. Kheder.

Ammar Kheder, MD: Thank you so much for having me. It's a pleasure to be here with you today.

Host: Okay. So, let's get started. Dr. Becker, how would you describe the current state of patient-reported outcomes in epilepsy? What are we still missing? What are we not capturing?

Danielle Becker, MD, MS: Thank you for this important question. I feel the current state focuses on seizure frequency and seizure freedom, but we need to acknowledge that seizure freedom may not be the number one goal of our patients or the only thing that matters. And the other question is at what costs.

So, there are other important factors: cognition, memory, mood, side effects, quality of life. And when you talk to patients, they often will focus on functional outcomes such as driving and employment and their independence. But they will also talk about the treatment-related adverse events and the unpredictability of seizures and how that individually affects their everyday lives.

So as was mentioned in the two reporting outcome papers that we'll talk about today, they call for the incorporation of individual priorities for patients' subjective experiences really to promote that patient-centered care and improvement in outcomes not only looking at seizure frequency or seizure freedom, but also at that balance or tradeoff of treatment-related adverse events. So ultimately, with where we are today, I think we need to refocus our epilepsy care on considering outcomes that are most important to each individual patient and their families, and really move to that patient-centered care of the goals that are most important to them, as well as their seizure frequency and seizure freedom possibility.

Host: Thank you for that, Dr. Becker. Very important to keep in mind what matters to each patient, what maybe to ask our patients, what really matters to you on an individualized basis. Dr. Kheder, can you please give us a quick overview of what MORE is and what it was designed to measure? And how do you envision people to use it?

Ammar Kheder, MD: Well, thank you for this question. MORE is a way for capturing what doing well in epilepsy actually means in real life. I see it as a complementary to what Dr. French has done in making impact visible over time, and to the questions Dr. Becker raises about what current outcomes don't fully capture when taken individually.

So instead of focusing only on seizures, MORE brings together three domains: seizure control, quality of life, and the patient's own experience. The idea in my mind is simple, a treatment isn't necessarily successful unless it improves how someone lives, not just how often they have seizures. For example, if you have two patients who might have the same seizure reduction, but one has gone back to work and reduced medication while the other is cognitively worse and more depressed, MORE is designed to see that difference. It's meant to be practical using structured questions that can fit into a routine clinic visit. It's less about replacing existing systems and more about bringing together dimensions that have often been measured separately.

Host: Very ...