From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain.
Neurology. 2024 Apr 23;102(8):e209221. doi: 10.1212/WNL.0000000000209221. Epub 2024 Mar 25.
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.
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.
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], = 0.001), VASOGRADE score (HR 2.45 [1.4-4.2], = 0.001), surgical treatment (HR 2.77 [1.6-4.9], = 0.001), and presence of EOSs (HR 1.84 [1.0-3.4], = 0.05) were independently associated with epilepsy. The proposed scale, designated , 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).
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.
蛛网膜下腔出血（aSAH）后发生癫痫与更差的功能和认知预后以及更差的生活质量相关。及时识别有癫痫风险的患者以优化随访方案和设计预防策略将具有重要价值。我们的目的是开发一种预测评分，以帮助分层 aSAH 患者的癫痫风险。
这是一项对我院（2012-2021 年）收治的所有成人 aSAH 患者的回顾性、纵向研究。我们收集了人口统计学数据、临床和影像学变量、早发性发作（EOSs）数据以及癫痫发作的数据。排除标准为既往结构性脑损伤、癫痫和随访时间≤7 天。采用多 Cox 回归评估与无诱因迟发性癫痫（即癫痫）独立相关的因素。使用最佳拟合回归模型开发预测评分。使用来自另一家三级护理中心的 308 例患者的外部验证队列进行接受者操作特征曲线分析来评估性能。
从最初的 743 例患者数据库中，有 419 例符合纳入标准并纳入分析。平均年龄为 60±14 岁，269 例（64%）为女性，中位随访 4.2 年后有 50 例（11.9%）发生癫痫。发病前改良 Rankin 量表评分（mRS）（风险比 [HR] 4.74 [1.8-12.4]， = 0.001）、VASOGRADE 评分（HR 2.45 [1.4-4.2]， = 0.001）、手术治疗（HR 2.77 [1.6-4.9]， = 0.001）和存在 EOSs（HR 1.84 [1.0-3.4]， = 0.05）与癫痫独立相关。该名为“RISE”的新量表，对于发病前 mRS 评分≥2（R）、VASOGRADE-Yellow（I，缺血）、手术干预（S）和 EOSs 病史（E），分别记 1 分，VASOGRADE-Red 记 2 分，共可记 0-5 分。RISE 将患者分为 3 组：低（0-1）、中（2-3）和高（4-5）风险（分别有 2.9%、20.8%和 75.7%的患者发生癫痫）。在另一所三级护理中心的队列（N=308）中进行验证时，新量表在 aSAH 后 5 年内对癫痫的风险分布和预测能力具有相似性（曲线下面积 [AUC] 0.82；95%CI 0.74-0.90）。
RISE 量表是一种强大的蛛网膜下腔出血后癫痫预测工具，具有直接的临床适用性。除了有助于个性化诊断和治疗外，RISE 可能还有助于探索未来的抗癫痫发生策略。
