Photo Credit: Thitaree Sarmkasat
The following is a summary of “Predictive Model for Estimating the Risk of Epilepsy After Aneurysmal Subarachnoid Hemorrhage: The RISE Score,” published in the March 2024 issue of Neurology by Campos-Fernandez et al.
Researchers conducted a retrospective study to develop a scoring system that predicts which aneurysmal subarachnoid hemorrhage (aSAH) patients are more likely to develop epilepsy.
They encompassed all adult patients with aSAH admitted (2012 to 2021). Demographic, clinical, and radiologic data were gathered, along with information on early-onset seizures (EOSs) and the occurrence of epilepsy. Exclusion criteria included prior structural brain lesions, epilepsy history, and follow-up periods of ≤7 days. Multiple Cox regression analysis was employed to assess factors independently linked with unprovoked remote seizures (epilepsy). The most suitable regression model was utilized to devise a predictive score. Performance was evaluated in an external validation group comprising 308 patients via receiver-operating characteristic (ROC) curve analysis.
The results showed that 743 patients were initially screened, and 419 were eligible for analysis. Their mean age was 60 ± 14 years, with 64% being women. Over a median follow-up of 4.2 years, 11.9% developed epilepsy. Premorbid modified Rankin Score (mRS), VASOGRADE score, surgical treatment, and early-onset seizures (EOSs) were independently linked with epilepsy. A new scale, RISE, categorized patients into low (0–1), moderate (2–3), and high (4–5) risk groups, with corresponding epilepsy development rates of 2.9%, 20.8%, and 75.7%, respectively. Validation in another tertiary care center (N = 308) demonstrated similar risk distribution and predictive power for epilepsy within 5 years post-aSAH (area under the curve [AUC] 0.82; 95% CI 0.74–0.90).
Investigators concluded that the RISE scale accurately predicted epilepsy after SAH, potentially enabling personalized care and future research into preventing the condition.