Is the 2HELPS2B Score Reliable at Predicting Late Electrographic Seizures?
Abstract number :
3.158
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2204803
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Manuel Melo Bicchi, MD – University of Miami; Kamil Detyniecki, MD – University of Miami; Andres Kanner, MD – University of Miami; Ramses Ribot, MD – University of Miami; Naymee Velez, MD – University of Miami; Amedeo Merenda, MD – University of Miami; Mohan Kottapally, MD – University of Miami; Kristine O'Phelan, MD – University of Miami; Ayham Alkhachroum, MD – University of Miami
Rationale: Traumatic brain injury (TBI) and intracerebral hemorrhage (ICH) are amongst the most common causes of non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE) that often go underrecognized. Prolonged EEG has been used to identify patients at risk of NCS/NCSE but the duration remains controversial. The 2HELPS2B score (Table 1) was developed to “forecast” seizures based on early EEG findings. We aimed to study the prevalence and timing of seizures in comatose TBI and ICH patients who had prolonged EEG monitoring.
Methods: This is a prospective study of TBI and ICH patients who were monitored via EEG as part of a recovery of consciousness study. Inclusion criteria (1) adult patients (≥ 18 years) who were admitted to the neuroICU; (2) coma as evaluated by the Coma Recovery Scale-Revised. We collected basic demographic data, location/severity of injury, and the electrographic features including seizures. We calculated 2HELPS2B score on the first day of recording. The score is commonly used and validated to stratify seizure risk in this population. We calculated descriptive statistics (median, IQR, and range) to report our findings.
Results: A total of 68 patients were included (Table 2). Patients were monitored for an average of 7.3 days (Q1 6, Q3 9). The average 2HELPS2B score on day one was 1 (12% seizure risk) in TBI and 0 (< 5% seizure risk) in ICH. A quarter of TBI patients had NCSE, and 8% had NCS, whereas in ICH only 3% of patients had NCS. NCS and NCSE were seen on average at 2 days of EEG monitoring but up to 14 days after injury. The average 2HELPS2B score for TBI patients who had seizures was 2 (Q1 1, Q3 3 – 27% seizure risk), and for ICH patients 0. On average seizures were controlled after 1.9 (Q1 1, Q3 2.75) days. Four patients (5.8%) had seizures after day 2 of monitoring. In patients who experienced late seizures (>48 hours), the average 2HELPS2B score was 0.75 compared to 2.4 in those who experienced early seizures (< 48 hours)._x000D_
Most common electrographic findings in TBI were delta-theta slowing 100%, epileptiform discharges 61%, LRDA 20%, LPDs 10%, BIRDs 10%, GPDs with triphasic wave morphology 8%, and stimulus induced periodic discharges 3%. Electrographic findings in ICH were delta-theta slowing 100%, epileptiform discharges 76%, GPDs with TW morphology 24%, LRDA 10%, GRDA 10%, and bilateral asymmetric PDs 7%.
Conclusions: Our data show that the 2HELPS2B score is a reliable score for predicting early seizures. However, a low score (< 1) does not exclude the possibility of late seizures. Seizures were most commonly seen on day 2, and up to day 14 of EEG monitoring.
Neurophysiology