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Although continuous electroencephalography use is increasing, there is not a validated way to determine the risk of seizure when ictal abnormalities are not found. Struck and coauthors used a prospective multicenter database of 5427 continuous EEG sessions from 4772 participants (median age, 61 years) to create a risk score to predict seizure occurrence in critically ill patients. The model, termed 2HELPS2B, has 6 variables to calculate the risk score: brief (ictal) rhythmic discharges (2 points); presence of lateralized periodic discharges, lateralized rhythmic delta activity, or bilateral independent periodic discharges (1 point); prior seizure (1 point); sporadic epileptiform discharges (1 point); frequency greater than 2.0 Hz of periodic/rhythmic pattern (1 point); and presence of “plus” features (1 point). The 2HELPS2B score combined with knowledge of the patient’s seizure history may help physicians assess seizure risk. Editorial perspective is provided by Czeisler and Claassen.
Highlights. JAMA Neurol. 2017;74(12):1389. doi:10.1001/jamaneurol.2016.4029
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