International evaluation of the SEIZUre Risk in Encephalitis (SEIZURE) score for predicting acute seizure risk.
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Hughes Thomas, Venkatesan Arun, Hetherington Claire, Egbe Franklyn Nkongho, Netravathi M, Thakur Kiran T, Baykan Betul, Hui Jan Tan, Arias Susana, García-de Soto Jesús, Kahwagi Jamil, Vogrig Alberto, Versace Salvatore, Habis Ralph, Sowmitran Swathi, Husari Khalil S, Probasco John, Hasbun Rodrigo, Bean Paris, Heck Ashley, GözübatıkÇelik Gökçen R, Ataklı Dilek, Mayda Domac Fusun, Ferreira Vitor, Calado Sofia, Sangeeth Thuppanattumadam Ananthasubramanian, Defres Sylviane, Romozzi Marina, Iorio Raffaele, Pensato Umberto, Pleshkevich Maria, Steriade Claude, Sharifi-Razavi Athena, Tabrizi Nasim, Sipila Jussi, Kim Carla Y, Diaz-Ariza Alexandra, Satish Poorvikha, Gowda Vinutha, Gowda Chandrakanta, Oh Seong-Il, Del Carpio-Orantes Luis, Cotelli Mariasofia, Ferreira Luís, Kovalchuk Maria, Goncharova Anna, Solomon Tom, Winkler Andrea, Guekht Alla, Wood Greta K, Global NeuroResearch Coalition, Michael Benedict D
Аннотация
DESIGN: Patients were retrospectively analysed regionally, and by country, in this international evaluation study. Univariate analysis was conducted between patients who did and did not have inpatient seizures, followed by multivariable logistic regression, hierarchical clustering and analysis of the area under the receiver operating curves (AUROC) with 95% CIs.
PARTICIPANTS AND SETTING: 2032 patients across 13 countries were identified, among whom 1324 were included in SEIZURE score calculations and 970 were included in regression modelling. The involved countries comprised 19 organisations spanning all WHO regions.
OUTCOME MEASURES: The primary outcome was measuring inpatient seizure rates.
RESULTS: Autoantibody-associated encephalitis, low GCS and presenting with a seizure were frequently associated with inpatient seizures; fever showed no association. Globally, the score had limited discriminatory ability (basic AUROC 0.58 (95% CI 0.55 to 0.62), advanced AUROC 0.63 (95% CI 0.60 to 0.66)). The scoring system performed acceptably in western Europe, excluding Spain, with the best performance in Portugal (basic AUROC 0.82 (95% CI 0.69 to 0.94), advanced AUROC 0.83 (95% CI 0.72 to 0.95)).
CONCLUSIONS: The SEIZURE score performed best in several countries in Western Europe but performed poorly elsewhere, partly due to differing and unknown aetiologies. In most regions, the score did not reach a threshold to be clinically useful. The Western European results could aid in designing clinical trials assessing primary anti-seizure prophylaxis in encephalitis following further prospective trials. Beyond Western Europe, there is a need for tailored, localised scoring systems and future large-scale prospective studies with optimised aetiological testing to accurately identify high-risk patients.