Why the fuck are you uselessly predicting this rather than doing the research that will prevent it from happening? We already know about the risk. I'd fire you all including your mentors and senior researchers!
post-stroke epilepsy (9 posts to December 2016)
Predictive Model for Estimating the Risk of Epilepsy After Aneurysmal Subarachnoid Hemorrhage
The RISE Score
Abstract
Background and Objectives
The
occurrence of seizures after aneurysmal subarachnoid hemorrhage (aSAH)
is associated with a poorer functional and cognitive prognosis and less
favorable quality of life. It would be of value to promptly identify
patients at risk of epilepsy to optimize follow-up protocols and design
preventive strategies. Our aim was to develop a predictive score to help
stratify epilepsy risk in patients with aSAH.
Methods
This
is a retrospective, longitudinal study of all adults with aSAH admitted
to our center (2012–2021). We collected demographic data, clinical and
radiologic variables, data on early-onset seizures (EOSs), and data on
development of epilepsy. Exclusion criteria were previous structural
brain lesion, epilepsy, and ≤7 days' follow-up. Multiple Cox regression
was used to evaluate factors independently associated with unprovoked
remote seizures (i.e., epilepsy). The best fitting regression model was
used to develop a predictive score. Performance was evaluated in an
external validation cohort of 308 patients using receiver-operating
characteristic curve analysis.
Results
From
an initial database of 743 patients, 419 met the inclusion criteria and
were included in the analysis. The mean age was 60 ± 14 years, 269
patients (64%) were women, and 50 (11.9%) developed epilepsy within a
median follow-up of 4.2 years. Premorbid modified Rankin Score (mRS)
(hazard ratio [HR] 4.74 [1.8–12.4], p = 0.001), VASOGRADE score (HR 2.45 [1.4–4.2], p = 0.001), surgical treatment (HR 2.77 [1.6–4.9], p = 0.001), and presence of EOSs (HR 1.84 [1.0–3.4], p = 0.05) were independently associated with epilepsy. The proposed scale, designated RISE,
scores 1 point for premorbid mRS ≥ 2 (R), VASOGRADE-Yellow (I,
Ischemia), surgical intervention (S), and history of EOSs (E) and 2
points for VASOGRADE-Red. RISE stratifies patients into 3 groups: low
(0–1), moderate (2–3), and high (4–5) risk (2.9%, 20.8%, and 75.7%
developed epilepsy, respectively). On validation in a cohort from a
different tertiary care center (N = 308), the new scale yielded a
similar risk distribution and good predictive power for epilepsy within 5
years after aSAH (area under the curve [AUC] 0.82; 95% CI 0.74–0.90).
Discussion
The
RISE scale is a robust predictor of post-SAH epilepsy with immediate
clinical applicability. In addition to facilitating personalized
diagnosis and treatment, RISE may be of value for exploring future
antiepileptogenesis strategies.
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