RT Journal Article
SR Electronic
T1 Acute seizure risk in patients with encephalitis: development and validation of clinical prediction models from two independent prospective multicentre cohorts
JF BMJ Neurology Open
JO BMJ Neurol Open
FD BMJ Publishing Group Ltd
SP e000323
DO 10.1136/bmjno-2022-000323
VO 4
IS 2
A1 Greta K Wood
A1 Roshan Babar
A1 Mark A Ellul
A1 Rhys Huw Thomas
A1 Harriet Van Den Tooren
A1 Ava Easton
A1 Kukatharmini Tharmaratnam
A1 Girvan Burnside
A1 Ali M Alam
A1 Hannah Castell
A1 Sarah Boardman
A1 Ceryce Collie
A1 Bethany Facer
A1 Cordelia Dunai
A1 Sylviane Defres
A1 Julia Granerod
A1 David W G Brown
A1 Angela Vincent
A1 Anthony Guy Marson
A1 Sarosh R Irani
A1 Tom Solomon
A1 Benedict D Michael
YR 2022
UL http://neurologyopen.bmj.com/content/4/2/e000323.abstract
AB Objective In patients with encephalitis, the development of acute symptomatic seizures is highly variable, but when present is associated with a worse outcome. We aimed to determine the factors associated with seizures in encephalitis and develop a clinical prediction model.Methods We analysed 203 patients from 24 English hospitals (2005–2008) (Cohort 1). Outcome measures were seizures prior to and during admission, inpatient seizures and status epilepticus. A binary logistic regression risk model was converted to a clinical score and independently validated on an additional 233 patients from 31 UK hospitals (2013–2016) (Cohort 2).Results In Cohort 1, 121 (60%) patients had a seizure including 103 (51%) with inpatient seizures. Admission Glasgow Coma Scale (GCS) ≤8/15 was predictive of subsequent inpatient seizures (OR (95% CI) 5.55 (2.10 to 14.64), p<0.001), including in those without a history of prior seizures at presentation (OR 6.57 (95% CI 1.37 to 31.5), p=0.025).A clinical model of overall seizure risk identified admission GCS along with aetiology (autoantibody-associated OR 11.99 (95% CI 2.09 to 68.86) and Herpes simplex virus 3.58 (95% CI 1.06 to 12.12)) (area under receiver operating characteristics curve (AUROC) =0.75 (95% CI 0.701 to 0.848), p<0.001). The same model was externally validated in Cohort 2 (AUROC=0.744 (95% CI 0.677 to 0.811), p<0.001). A clinical scoring system for stratifying inpatient seizure risk by decile demonstrated good discrimination using variables available on admission; age, GCS and fever (AUROC=0.716 (95% CI 0.634 to 0.798), p<0.001) and once probable aetiology established (AUROC=0.761 (95% CI 0.6840.839), p<0.001).Conclusion Age, GCS, fever and aetiology can effectively stratify acute seizure risk in patients with encephalitis. These findings can support the development of targeted interventions and aid clinical trial design for antiseizure medication prophylaxis.Data are available upon reasonable request. The de-identified data that support the findings of this study are available from the corresponding author, for any purpose for which there is ethical approval, immediately following publication and ending in September 2022. Researchers should provide a methodologically sound proposal for approval by the UK Health Security Agency, Virus Reference Department. Data are available alongside study protocol.