Does Levetiracetam Prevent Post-Traumatic Epilepsy After TBI?

 What is your competent? doctors EXACT PROTOCOL  to prevent post-stroke epilepsy and seizures?

• 10% seizures post stroke (19 posts to April 2017)
• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (24 posts to December 2016) 

Does Levetiracetam Prevent Post-Traumatic Epilepsy After TBI?

Levetiracetam did not prevent late post-traumatic epilepsy and was associated with a higher burden of adverse outcomes despite reducing early epilepsy risk in patients with severe traumatic brain injury.

Prophylactic levetiracetam is associated with reduced risk for early epilepsy after severe traumatic brain injury (TBI) but not with reduced risk for long-term epilepsy, according to study results published in the Annals of Neurology. Patients with TBI are often prescribed ASMs to prevent post-traumatic epilepsy. However, current recommendations are largely based on older phenytoin and valproate trials and do not incorporate large-scale evidence evaluating levetiracetam, the current agent of choice.

Researchers used data from the TriNetX Research Network to examine the effectiveness and safety of prophylactic levetiracetam for preventing post-traumatic epilepsy after TBI. Patients (N=51,263) were assessed on the basis of whether they received levetiracetam (n=14,630) or no ASMs (n=34,226). Mild TBI was defined as a Glasgow Coma Scale (GCS) score of 13 to 15, moderate TBI as a GCS score of 9 to 12, severe TBI as a GCS score of 3 to 8, early epilepsy as onset within 7 days of injury, and late epilepsy as onset between day 7 and 1 year after injury. Our findings challenge widespread use of levetiracetam and suggest that prophylaxis should not be offered indiscriminately.

The levetiracetam and no ASM cohorts comprised 31.0% and 35.8% women (P <.0001), had a mean (SD) age of 53.9 (20.5) and 47.9 (20.5) years (P <.0001), included 28.9% and 31.2% non-White patients (P <.0001), and included 34.7% and 17.9% of patients with severe TBI, respectively (P <.0001).

Overall, epilepsy occurred in 6.7% of participants, and 14.1% died within 1 year of injury. Epilepsy within 1 year of injury was more frequent among patients with moderate (12.1%) and severe (11.3%) TBI than among those with mild TBI (4.8%; P <.001). Similarly, mortality was higher among patients with severe (39.0%) and moderate (15.7%) TBI than among those with mild TBI (4.7%; P <.001).

After adjustment for potential confounders, levetiracetam was associated with reduced risk for early epilepsy among patients with severe TBI (hazard ratio [HR], 0.545; 95% CI, 0.306-0.969; P =.039). Independent predictors of early epilepsy in this cohort included traumatic subdural hemorrhage, left cerebral contusion or laceration, craniectomy or craniotomy, and routine electroencephalography (EEG).

The researchers observed no significant association between prophylactic levetiracetam and late epilepsy overall or among patients with mild or severe TBI (HR range, 0.897-1.001). Levetiracetam was associated with lower risk for mortality through 1 year in the overall cohort (HR, 0.826; 95% CI, 0.787-0.867; P <.001) and among individuals who survived longer than 7 days after injury (HR, 0.881; 95% CI, 0.815-0.952; P =.001). However, in a sensitivity analysis limited to patients who survived longer than 7 days after injury, levetiracetam was not associated with a reduced risk for early epilepsy, including among patients with severe TBI.

Across 5 years of follow-up, patients who received levetiracetam had higher rates of mortality (difference, 2.2%; P <.0001), impaired memory or awareness (difference, 5.4%; P <.0001), migraine and headache (difference, 4.3%; P <.0001), metabolic disorders (difference, 2.6%; P <.0001), and malaise and fatigue (difference, 2.0%; P <.0001), among other adverse outcomes.

Study limitations include the inability of the TriNetX dataset to determine the sequence of events on the day of injury, preventing investigators from establishing whether levetiracetam was administered before seizure onset.

The researchers concluded, “In this large, severity-stratified cohort study, prophylactic levetiracetam reduced the risk of early seizures only in patients with severe TBI, without preventing late posttraumatic epilepsy and while conferring a substantial burden of adverse outcomes.” They continued, “Our findings challenge widespread use of levetiracetam and suggest that prophylaxis should not be offered indiscriminately.”

Spiritual Distress Is a Clinical Reality in Brain Disease

 In stroke there would be no distress at all if your competent? doctor had 100% recovery protocols! But I'm sure your doctor has nothing of that at all! If they did they would be in the running for a Nobel prize in medicine.

With your risk of dementia, Parkinsons and epilepsy post stroke you'll want a competent doctor that can prevent those problems. 

Your risk of dementia, has your doctor told you of this?  Your doctor is responsible for preventing this! Is s/he willing to try this on you?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

Parkinson’s Disease May Have Link to Stroke March 2017 

• post-stroke epilepsy (22 posts to December 2016) 

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

The latest here:

Spiritual Distress Is a Clinical Reality in Brain Disease

Summary: Neurological diseases like Parkinson’s and dementia don’t just affect the body; they dismantle a person’s sense of self, memory, and communication. A new paper argues that because these diseases attack the core of human identity, spiritual care must become a routine part of neurological treatment.

The researchers propose a “biopsychosocial-spiritual” model, moving beyond purely physical symptoms to address the existential distress that often accompanies a life-altering diagnosis.

Key Facts

• The Identity Crisis: Neurological conditions are unique because they erode the traits that define who we are. For these patients, spirituality is often a primary tool for finding meaning and resilience.
• The 60% Gap: While roughly 60% of adults want their spiritual concerns acknowledged by doctors, most clinicians avoid the topic due to lack of training, time constraints, or personal discomfort.
• The FICA Framework: The paper recommends the FICA tool (Faith, Importance, Community, Address) to help neurologists take a quick, structured spiritual history in under two minutes.
• Spiritual Generalists: Neurologists don’t need to be clergy; they act as “spiritual generalists” who identify distress, validate a patient’s humanity, and refer them to chaplains or therapists when needed.
• Clinician Burnout: Integrating spiritual care isn’t just for patients—it’s linked to lower burnout and higher job satisfaction for physicians who feel they are treating “the whole person.”

Source: UCLA

People living with neurological diseases such as Parkinson’s disease, dementia and epilepsy face not only physical decline, but also profound questions about identity, purpose, and meaning. Yet physicians best positioned to address those concerns do not have the adequate training and tools to do so, a new paper states.

The paper, published in the journal Neurology Clinical Practice by researchers from UCLA Health, the University of Colorado, Harvard Medical School and Brown University, argues that spiritual assessment should become a routine part of neurological care, and offers practical guidance for how clinicians can make it happen.

New clinical guidance encourages neurologists to adopt a four-dimensional approach to care, recognizing that spiritual health is central to how patients cope with neurological decline. Credit: Neuroscience News

The paper describes why neurologists are uniquely suited to engage patients on matters of spirituality, and why the field’s reluctance to do so may be leaving an important dimension of patient care unaddressed.

“Neurologic diseases attack the very things that define who we are: our memory, our movement, our ability to communicate,” said lead author Dr. Indu Subramanian, a movement disorders neurologist at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System.

“In that context, a patient’s spirituality isn’t peripheral to their medical care. It’s often central to how they cope, find meaning and make decisions about treatment.”

Research cited in the paper suggests that roughly 60% of American adults express interest in having their religious or spiritual concerns acknowledged in a medical setting. At the same time, studies consistently show that clinicians, including neurologists, are reluctant to raise the subject, citing discomfort, lack of training and time constraints.

Subramanian and the paper coauthors argue this gap can have real consequences to patients. Unaddressed spiritual distress has been associated with poorer quality of life in patients with serious illness, while spiritual support has been linked to improved coping, stronger patient-clinician relationships and better alignment around treatment goals. For patients with progressive neurological conditions, who often experience an erosion of identity and memory alongside physical decline, these factors can be especially significant.

The paper draws on a biopsychosocial-spiritual model of care, an expansion of the widely adopted biopsychosocial framework, which recognizes spirituality as a distinct and measurable dimension of health, alongside physical, psychological and social factors. This model has been endorsed by multiple major medical organizations and is increasingly recognized as relevant to neurological care.

Simple Tools for a Sensitive Conversation

A key contribution of the paper is its practical guidance for neurologists who want to integrate spiritual assessment into their practice without extensive additional training or time.

The authors recommend beginning with a brief, two-question screen that takes less than two minutes: asking whether spirituality or faith is important to a patient in thinking about their health, and whether they have or would like someone to speak with about those concerns.

For clinicians who prefer a less direct approach, the paper suggests open-ended questions such as “What do I need to know about you as a person to give you the best care possible?” or “From where do you draw your strength?”

The authors also describe a Faith, Importance, Community and Address (FICA) framework, which is a structured tool for taking a more detailed spiritual history, as well as phrases clinicians should listen for that may signal unaddressed spiritual distress, such as “Why is this happening to me?” or “I’ve lost touch with my faith since this diagnosis.”

Subramanian emphasized that neurologists need not act as spiritual counselors but can function as “spiritual generalists” capable of identifying a patient’s needs, validating their beliefs and making referrals to chaplains, psychotherapists or community faith leaders when appropriate.

A patient’s perspective

The paper includes the voice of Kirk Hall, a patient living with Parkinson’s disease and a paper co-author, who describes how faith has been central to navigating his diagnosis.

“It has not escaped me that this is a gift from God, even if I don’t necessarily agree with His choice of gift wrap,” Hall writes. “Our belief that we will be equipped to deal with whatever happens is extremely comforting to us.”

His perspective, the authors note, illustrates what research has demonstrated: for many patients, spirituality is not a supplement to medical care, but a foundation for resilience.

Benefits for clinicians

The paper also addresses what the authors describe as an underappreciated dimension of spiritual care in medicine: its potential benefit to clinicians themselves. Studies cited in the paper indicate that spiritual care training is associated with reduced burnout, lower work-related stress and improved well-being among physicians.

Practicing medicine in a way that attends to patients’ full humanity, the authors argue, may help neurologists find greater meaning in their work.

Key Questions Answered:

Q: Why should my brain doctor care about my religion or faith?

A: Because your brain is where your “self” lives. When Parkinson’s or dementia changes how you move or think, it triggers deep questions like, “Who am I now?” and “Why is this happening?” If a doctor only fixes your tremors but ignores your existential fear, they are only treating half the problem. Spirituality is often the “engine” that drives a patient’s ability to cope with treatment.

Q: Isn’t this just going to make doctor appointments longer?

A: The study suggests it takes less than two minutes. A simple question like, “From where do you draw your strength?” can provide a neurologist with more insight into a patient’s resilience than an hour of physical testing. It’s about quality of conversation, not quantity of time.

Q: What if the patient isn’t religious?

A: In this medical context, “spirituality” is broader than religion. It’s about what gives a person purpose, meaning, and a sense of connection. Even for secular patients, addressing “spiritual distress”—feelings of hopelessness or a lost sense of purpose—is critical for mental health and physical recovery.

Editorial Notes:

• This article was edited by a Neuroscience News editor.
• Journal paper reviewed in full.
• Additional context added by our staff.

About this neuroscience and neuroethics research news

Author: Will Houston
Source: UCLA
Contact: Will Houston – UCLA
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Spiritual Assessment of Neurologic Patients” by Indu Subramanian, Christina L. Vaughan, John R. Peteet, Kirk Hall, and W. Curt LaFrance Jr. Neurology Clinical Practice
DOI:10.1212/CPJ.0000000000200591

Detecting major neurological disorders via saliva

With your risk of Parkinsons and epilepsy post stroke, your competent? doctor will immediately implement these tests so appropriate prevention protocols can be initiated, right? Oh NO, you DON'T have a functioning stroke doctor, do you? Doesn't read or implement research! And your incompetent? board of directors can't identify incompetence to be able to fire them!

• Parkinson’s Disease May Have Link to Stroke March 2017 
• post-stroke epilepsy (22 posts to December 2016) 

 Detecting major neurological disorders via saliva

A team of Korean researchers has, for the first time in the world, developed a technology capable of enabling early diagnosis of major neurological disorders, including epilepsy, Parkinson's disease, and schizophrenia, using only a small amount of saliva.

This study was conducted jointly by a research team led by Dr. Sung-Gyu Park of the Advanced Bio and Healthcare Materials Research Division at the Korea Institute of Materials Science (KIMS), together with Prof. Ho Sang Jung's team at Korea University and researchers from the College of Medicine at The Catholic University of Korea. The research has recently been published in Advanced Materials, one of the world's leading journals in the field of materials science, drawing significant international attention.

The joint research team developed a Galvanic Molecular Entrapment (GME)–SERS platform that directly detects structural changes in proteins using saliva, replacing conventional diagnostic methods based on blood or cerebrospinal fluid that are costly and invasive. This technology leverages plasmonic "hotspots" that form naturally as proteins are captured on nanostructures composed of copper oxide and gold (Au–CuO).

A key feature of the platform is its ability to amplify the extremely weak Raman signals of biomolecules by more than a billion times. Using this approach, the system can sensitively distinguish protein fibrillation states (monomers versus fibrils), which have been difficult to measure with conventional diagnostic techniques.

The joint research team analyzed saliva samples from a total of 44 patients with epilepsy, schizophrenia, and Parkinson's disease, as well as 23 healthy controls, in collaboration with St. Vincent's Hospital. The results confirmed that the technology can classify these disorders with high accuracy, exceeding 90%, reaching up to 98%.

In particular, the ability to distinguish neurological disorders based on fundamental pathological indicators-namely, structural changes in proteins rather than total protein concentration-is regarded as a rare and significant achievement on a global scale.

An era has begun in which brain disease conditions can be assessed through simple saliva analysis without the need for costly PET imaging or cerebrospinal fluid testing."

Dr. Sung-Gyu Park, Study Principal Researcher, Korean Institute of Materials Science 

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Event guide: 3rd Measuring Patient Engagement Summit eBook Moving beyond anecdotal engagement, this summit centres on measurable, data-driven patient involvement across clinical development.Download the latest edition

As the work has been published in a top-tier international journal, the originality and innovation of the technology have now been formally recognized worldwide. Prof. Ho Sang Jung of Korea University added, "Given its non-invasive and low-cost nature, the technology holds significant potential for expansion beyond hospital outpatient settings to include home-based diagnostic devices."

The research team plans to pursue commercialization by developing portable Raman sensor–based point-of-care diagnostic devices and by promoting technology transfer to medical and life-science companies.

Source:

National Research Council of Science & Technology

Journal reference:

Al Ja'farawy, M. S., et al. (2026). Label-Free SERS Fingerprinting of Neuroprotein Conformational Dynamics in Human Saliva. Advanced Materials. DOI: 10.1002/adma.202513500. https://advanced.onlinelibrary.wiley.com/doi/10.1002/adma.202513500.

Ketogenic Diet May Reduce Epileptic Seizures by Changing Brain Signals: Study

 

We've known of this problem a long time. Is this a guaranteed solution?

• 10% seizures post stroke (19 posts to April 2017)
• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (14 posts to December 2016) 

The latest here:

Ketogenic Diet May Reduce Epileptic Seizures by Changing Brain Signals: Study

IsCHEMiA Score Predicts Post-Stroke Epilepsy Risk

 Survivors would actually like you to prevent epilepsy rather than this FUCKING USELESS PREDICTION!     

You mean you are that blitheringly stupid that you don't understand that? 

Let's see how long everyone in stroke has been incompetent about preventing epilepsy!  Over a decade, WOW! That's world class incompetency!

• 10% seizures post stroke (19 posts to April 2017)

• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (7 posts to December 2016)

IsCHEMiA Score Predicts Post-Stroke Epilepsy Risk

The 6-variable IsCHEMiA score identified patients at high risk for post-stroke epilepsy and demonstrated superior discrimination over the SeLECT score.

A novel 6-variable score incorporating clinical and neuroimaging features can predict post-stroke epilepsy (PSE), according to study findings published in Neurology.Stroke is one of the most common causes of adult-onset epilepsy, and PSE — defined as the occurrence or recurrence of unprovoked seizures more than 7 days after stroke — remains a clinically important complication following ischemic stroke.

Researchers developed a PSE prediction model (IsCHEMiA score) using a prospective stroke registry of patients consecutively admitted for acute ischemic stroke at Massachusetts General Hospital (MGH) between January 1, 2016, and December 31, 2018. The derivation cohort included 1436 patients, among whom the mean age was 67.4 years, and 54.7% were men.

 

In the evolving era of personalized medicine, the IsCHEMiA score may serve as the first step in identifying patients with acute ischemic stroke at a higher risk of PSE.

External validation was conducted in 3 independent international cohorts comprising 2534 patients from Queen Mary Hospital (QMH; n=1286), Ruttonjee Hospital (RH; n=272), and the National Cerebral and Cardiovascular Center (NCVC; n=976). Across cohorts, PSE occurred in 5.9% of patients at MGH, 5.1% at QMH, 5.1% at RH, and 5.5% at NCVC. Any post-stroke seizure occurred in 6.0%, 5.6%, 5.1%, and 8.3% of patients, respectively. Overall, PSE occurred in 5.5% of the total study population.

In the derivation cohort, PSE was associated with status epilepticus within 7 days of stroke (subdistribution hazard ratio [SHR], 13.1; 95% CI, 2.47-69.8; P =.0025), early symptomatic seizure within 7 days of stroke (SHR, 7.74; 95% CI, 3.22-18.6; P <.0001), acute symptomatic seizure within 7 days of stroke (SHR, 6.98; 95% CI, 2.75-17.7; P <.0001), and parenchymal hemorrhage-1 (SHR, 6.18; 95% CI, 3.14-12.2; P <.0001).

After backward stepwise elimination, significant predictors included infarct size 5 cm or larger (adjusted SHR [aSHR], 4.87; 95% CI, 2.75-8.65; P <.0001), early symptomatic seizures within 7 days of stroke (aSHR, 4.69; 95% CI, 1.84-11.9; P =.001), hemorrhagic transformation (aSHR, 4.34; 95% CI, 2.58-7.30; P <.0001), middle cerebral artery territory involvement (aSHR, 2.47; 95% CI, 1.18-5.17; P =.016), and age younger than 65 years (aSHR, 1.86; 95% CI, 1.20-2.89; P =.006).

The infarct size, cortical involvement, hemorrhagic transformation, early seizures, middle cerebral artery involvement, and age younger than 65 years variables were incorporated into the IsCHEMiA score, which assigns 2 points for infarct size 5 cm or larger, 1 point for cortical involvement, 2 points for hemorrhagic transformation, 2 points for early seizures, 1 point for middle cerebral artery territory involvement, and 1 point for age less than 65 years.n external validation, the IsCHEMiA score demonstrated good discrimination, with c-statistics of 0.870 in the United States cohort and consistent performance across validation cohorts. The score also outperformed the SeLECT score for predicting PSE in the overall study population (c-statistic, 0.848 vs 0.782; P < .0001).

Study limitations include differences in post-stroke care and follow-up across international cohorts.

The study authors concluded, “In the evolving era of personalized medicine, the IsCHEMiA score may serve as the first step in identifying patients with acute ischemic stroke at a higher risk of PSE.”

Novel Tool Improves Prediction of Epilepsy After Ischemic Stroke

 Once epilepsy is predicted; WHAT ARE THE EXACT PROTOCOLS THAT WILL PREVENT IT FROM OCCURRING? That is the research needed which won't occur because we have NO stroke leadership at all! 

We already knew of epilepsy post stroke; why the fuck aren't you solving the prevention problem?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!

• 10% seizures post stroke (19 posts to April 2017)

• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (7 posts to December 2016)

Just maybe you want your doctor to try these solutions.

Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 The latest here:

Novel Tool Improves Prediction of Epilepsy After Ischemic Stroke

A new clinical and neuroimaging tool that predicts which patients are most likely to develop epilepsy following an ischemic stroke has been developed.

The score is “an updated, validated, and readily applicable tool” that can help clinicians identify patients at high risk of poststroke epilepsy (PSE), the researchers reported. Led by William C.Y. Leung, MBBS, MRCP, of Massachusetts General Hospital (MGH), Harvard Medical School, Boston, and the University of Hong Kong, Pok Fu Lam, Hong Kong, the team said the approach may enable more personalized care and inform future trials of antiepileptogenic therapies after ischemic stroke.

The findings were published online on January 5 in Neurology.

Internationally Validated

Defined as an unprovoked seizure occurring more than 7 days after an acute stroke, PSE is a relatively common complication, affecting about 4% of patients within the first year and 8% within 5 years after stroke.

The authors noted that current tools used to predict PSE have important limitations, including minimal incorporation of neuroimaging features that influence epileptogenesis and development in patient cohorts treated before modern reperfusion therapies became routine.

To address these limitations, the researchers developed and internationally validated a practical, imaging-informed risk score using routinely available clinical and neuroimaging data to better identify patients at a high risk for PSE.

To develop it, the researchers assessed 1436 adults with a first ischemic stroke (mean age, 67.4 years; 54.7% male) from a prospective stroke registry at MGH.

From medical records and neuroimaging scans, they gathered and assessed information on relevant stroke variables, and use of intravenous (IV) thrombolysis or intra-arterial thrombectomy.

They also obtained seizure information, including EEG reports, treatment, date of first seizure, and any status epilepticus, seizure requiring intensive care monitoring, and drug-resistant seizures.

After a median follow-up of 68 months, 5.5% of the study population developed PSE.

Strong PSE Predictor

The final model underlying the proposed score — called IsCHEMiA, derived from the first letters of each variable — includes six factors: infarct size ≥ 5 cm, cortical involvement, any hemorrhagic transformation, early symptomatic seizure within 7 days of stroke, middle cerebral artery involvement, and age younger than 65 years.

Researchers calculated the probability of developing PSE and risk estimates of PSE at 1 and 5 years after a stroke.

Results showed that the IsCHEMiA score was a strong predictor of PSE and demonstrated excellent discrimination, with a c-statistic of 0.87 (with 1.0 indicating perfect discrimination).

The model was validated in two independent international cohorts totaling 2534 patients — two in Hong Kong and one in Japan. The analyses showed discrimination similar to that seen in the US cohort, with c-statistics of 0.852 and 0.857 in the Hong Kong cohorts and 0.826 in the Japanese cohort.

The validation suggests that the IsCHEMiA score may be applicable worldwide, independent of ethnic differences in stroke, including variations in etiology, lifestyle, and diet, the authors noted.

Using the tool, a score of 3 corresponds to a low risk for PSE — about 2% at 1 year and 6% at 5 years — whereas a score of 8 or higher predicts a high risk, with seizure rates of 67% at 1 year and 78% at 5 years after stroke.

The findings also suggest that antiseizure medications may be appropriate for patients who experience a single early seizure and have an IsCHEMiA score of 8 or higher, the authors noted.

New and Improved Tool

Overall, the IsCHEMiA score outperformed previous prediction tools by incorporating infarct size and hemorrhagic transformation, two key imaging features not included in earlier models.

Younger age was another newly identified risk factor included in the score. The authors suggest this may reflect greater neuroplasticity and neuroinflammatory responses in younger adults, as well as increased vigilance and awareness for seizures.

A key strength of the study is that the predictors used in IsCHEMiA are objectively measured, clearly defined, and routinely available in clinical practice, making the score “a practical tool that is easily applicable in daily clinical practice,” the authors wrote.

In addition to strengths, the investigators noted several limitations, including potential variations in stroke management across international cohorts and differences in the detection of hemorrhagic transformation related to imaging availability, sequences, and timing.

In addition, the effects of revascularization therapies on PSE were not well assessed because of small sample sizes, and follow-up in the validation cohorts was shorter than in the US derivation cohort.

Recall bias may also have influenced the findings because some patients may not recognize subtle or nonmotor seizure symptoms, while those with cognitive or language impairments may be unable to report seizure-related events.

The authors outlined several potential clinical uses for the IsCHEMiA score. In addition to identifying stroke patients at a high risk for PSE, the tool could prompt EEG screening and closer monitoring, help guide decisions about antiseizure medication use, and support future research into the added predictive value of serum biomarkers, EEG patterns, and advanced imaging techniques.

Appealing Features

In an accompanying editorial, Joseph Kamtchum Tatuene of the Wolfson Centre for Prevention of Stroke and Dementia at the University of Oxford, Oxford, England, and Alain Lekoubou of the Penn State College of Medicine, Hershey, Pennsylvania, wrote that several features of the new score are “appealing.”

They cited its ease of use, lack of reliance on EEG findings, and incorporation of objective neuroimaging measures such as infarct size and hemorrhagic transformation.

The editorial noted that including hemorrhagic transformation in the IsCHEMiA score is particularly relevant as revascularization therapies become more widely used. The authors emphasized that this highlights the need for closer monitoring for hemorrhagic transformation and more aggressive management of modifiable risk factors, especially elevated blood pressure and hyperglycemia before IV thrombolysis.

They also cautioned that the score does not account for several pre- or poststroke factors that may influence brain health and seizure susceptibility, including family history of epilepsy and genetic risk.

In addition, although the IsCHEMiA score was derived in a North American cohort and validated in Asian populations, its performance relative to other prediction tools in European or African populations remains uncertain.

The editorialists added that other potential determinants of PSE — such as prior seizures, psychiatric illness, traumatic brain injury, meningitis, chronic alcohol exposure, medical comorbidities, and environmental factors — were not included and warrant further study.

However, they noted the score doesn’t consider some important pre- or poststroke determinants of brain health and susceptibility to seizures such as a family history of epilepsy and a high polygenic risk score for epilepsy that significantly increases the risk for PSE.

While the IsCHEMiA score was derived in a North American population and validated in Asian populations, it’s not clear if it would outperform other predictive scores in European or African populations, said the editorial writers.

Several factors still need to be considered, they added. These include history of seizures (provoked or not), psychiatric disorders, meningitis, traumatic brain injury, chronic exposure to alcohol consumption, perinatal adverse events, medical comorbidities, and environmental exposures to, for example, noise and pollution.

The authors and editorialists reported having no relevant financial disclosures.