Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany.
Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany.
Seizure. 2021 Oct;91:228-232. doi: 10.1016/j.seizure.2021.06.019. Epub 2021 Jun 29.
This observational study was done to develop a score based on clinical predictors that enables a guided decision for the necessity of cerebrospinal fluid (CSF) analysis after first unprovoked epileptic seizures and to validate this score in a retrospective patient cohort.
Clinical predictors were identified by two panels of epilepsy experts and selected according to content validity ratios. Based on these predictors a score was created and applied to a cohort of patients with first epileptic seizures.
The "IDEAL score" consists of 9 items (fever, prolonged disturbance of consciousness, headache, imaging results, cognitive dysfunction, status epilepticus, malignancy, autoimmune encephalitis symptoms) that are collected at two different time points (< 3 h [A-score]; > 3 h [B-score] after hospital admittance). A CSF analysis is recommended, if at least one clinical finding is present, either one of the items evaluated during the acute phase (A-score) or later in the diagnostic process (B-score). In 41 patients (13%) CSF analysis provided essential clues to the cause of the seizure. The combined IDEAL score reached a sensitivity of 98%, a specificity of 53%, a positive predictive value of 24% and a negative predictive value of 99% in this patient cohort.
A CSF analysis after first epileptic seizures provided decisive etiological findings in only 13% of all investigated patients. The IDEAL score offers clinicians a simple and easy-to-implement algorithm to assess the necessity of a CSF analysis, and to prevent unnecessary diagnostic procedures.
本观察性研究旨在开发一种基于临床预测因素的评分系统，以便在首次无诱因癫痫发作后指导是否进行脑脊液（CSF）分析的决策，并在回顾性患者队列中验证该评分系统。
通过两组癫痫专家确定临床预测因素，并根据内容有效性比进行选择。基于这些预测因素创建了一个评分，并将其应用于首次癫痫发作的患者队列。
“IDEAL 评分”由 9 个项目组成（发热、意识障碍延长、头痛、影像学结果、认知功能障碍、癫痫持续状态、恶性肿瘤、自身免疫性脑炎症状），这些项目在入院后不同的两个时间点收集（<3 h [A 评分]；>3 h [B 评分]）。如果至少有一个临床发现存在，无论是在急性期评估的项目之一（A 评分）还是在诊断过程后期出现的项目（B 评分），都建议进行 CSF 分析。在 41 名患者（13%）中，CSF 分析为癫痫发作的病因提供了重要线索。在该患者队列中，综合 IDEAL 评分的敏感性为 98%，特异性为 53%，阳性预测值为 24%，阴性预测值为 99%。
在所有接受调查的患者中，CSF 分析仅在 13%的患者中提供了决定性的病因发现。IDEAL 评分提供了一种简单易用的算法，帮助临床医生评估 CSF 分析的必要性，并避免不必要的诊断程序。
