Seizure freedom is a key clinical outcome for people with epilepsy (PWE) yet it is primarily recorded in free-text notes and letters in the United Kingdom, making it difficult to aggregate and track at scale. This paper introduces a generative LLM-based pipeline boosted by synthetic data to identify a PWE’s seizure freedom status in clinicians’ records. We fine-tuned seven different LLMs with between 4-14 billion parameters using LoRA to compare models trained on synthetic records against those trained on expert annotated records. The best performing configuration, based on Qwen-2.5-14B, was trained entirely on synthetic records and used chain-of-thought (CoT) reasoning (both generated by GPT-5). This achieved an F1 score of 0.90±0.02 on double-annotated test data and outperformed the equivalent model trained on authentic clinician records, which achieved 0.87±0.04. The synthetically trained models also have the benefit of outputting their CoT reasoning process for greater decision-making transparency and can also make use of the unused supervised training data for significantly increased test examples. This work has implications for monitoring a key treatment outcome for PWE automatically and at scale.

Electronic Health Records contain vast amounts of valuable clinical data, much of which is stored as unstructured text. Extracting meaningful clinical events (e.g., disorders, symptoms, findings, medications, and procedures etc.) in context within real-world healthcare settings is crucial for enabling downstream applications such as disease prediction, clinical coding for billing and decision support.After Named Entity Recognition and Linking (NER+L) methodology, the identified concepts need to be further classified (i.e. contextualized) for distinct properties such as their relevance to the patient, their temporal and negated status for meaningful clinical use. We present a solution that, using an existing NER+L approach - MedCAT, classifies and contextualizes medical entities at scale. We evaluate the NLP approaches through 14 distinct real-world clinical text classification projects, testing our suite of models tailored to different clinical NLP needs. For tasks requiring high minority class recall, BERT proves the most effective when coupled with class imbalance mitigation techniques, outperforming Bi-LSTM with up to 28%. For majority class focused tasks, Bi-LSTM offers a lightweight alternative with, on average, 32% faster training time and lower computational cost. Importantly, these tools are integrated into an openly available library, enabling users to select the best model for their specific downstream applications.

We fill a gap in scholarship by applying a generative Large Language Model (LLM) to extract information from clinical free text about the frequency of seizures experienced by people with epilepsy. Seizure frequency is difficult to determine across time from unstructured doctors’ and nurses’ reports of outpatients’ visits that are stored in Electronic Health Records (EHRs) in the United Kingdom’s National Health Service (NHS). We employ Meta’s Llama 2 to mine the EHRs of people with epilepsy and determine, where possible, a person’s seizure frequency at a given point in time. The results demonstrate that the new, powerful generative LLMs may improve outcomes for clinical NLP research in epilepsy and other areas.