{
  "abstract": "Objective Encephalitis is brain parenchyma inflammation, frequently resulting in seizures which worsens outcomes. Early anti-seizure medication could improve outcomes but requires identifying patients at greatest risk of acute seizures. The SEIZURE (SEIZUre Risk in Encephalitis) score was developed in UK cohorts to stratify patients by acute seizure risk. A ‘basic score’ used Glasgow Coma Scale (GCS), fever and age; the ‘advanced score’ added aetiology. This study aimed to evaluate the score internationally to determine its global applicability.Design Patients were retrospectively analysed regionally, and by country, in this international evaluation study. Univariate analysis was conducted between patients who did and did not have inpatient seizures, followed by multivariable logistic regression, hierarchical clustering and analysis of the area under the receiver operating curves (AUROC) with 95% CIs.Participants and setting 2032 patients across 13 countries were identified, among whom 1324 were included in SEIZURE score calculations and 970 were included in regression modelling. The involved countries comprised 19 organisations spanning all WHO regions.Outcome measures The primary outcome was measuring inpatient seizure rates.Results Autoantibody-associated encephalitis, low GCS and presenting with a seizure were frequently associated with inpatient seizures; fever showed no association. Globally, the score had limited discriminatory ability (basic AUROC 0.58 (95% CI 0.55 to 0.62), advanced AUROC 0.63 (95% CI 0.60 to 0.66)). The scoring system performed acceptably in western Europe, excluding Spain, with the best performance in Portugal (basic AUROC 0.82 (95% CI 0.69 to 0.94), advanced AUROC 0.83 (95% CI 0.72 to 0.95)).Conclusions The SEIZURE score performed best in several countries in Western Europe but performed poorly elsewhere, partly due to differing and unknown aetiologies. In most regions, the score did not reach a threshold to be clinically useful. The Western European results could aid in designing clinical trials assessing primary anti-seizure prophylaxis in encephalitis following further prospective trials. Beyond Western Europe, there is a need for tailored, localised scoring systems and future large-scale prospective studies with optimised aetiological testing to accurately identify high-risk patients.",
  "authors": [
    {
      "affiliations": [
        "Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "Thomas Hughes"
    },
    {
      "affiliations": [
        "Department of Neurology, John Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Arun Venkatesan"
    },
    {
      "affiliations": [
        "Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "Claire Hetherington"
    },
    {
      "affiliations": [
        "Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "Franklyn Nkongho Egbe"
    },
    {
      "affiliations": [
        "Department of Neurology, NIMHANS, Bangalore, Karnataka, India"
      ],
      "name": "M Netravathi"
    },
    {
      "affiliations": [
        "Neurology, Columbia University Medical Center, New York, New York, USA"
      ],
      "name": "Kiran T Thakur"
    },
    {
      "affiliations": [
        "Department of Neurology, EMAR Medical Center, Istanbul, Turkey"
      ],
      "name": "Betul Baykan"
    },
    {
      "affiliations": [
        "Department of Medicine, National University of Malaysia, Bangi, Selangor, Malaysia"
      ],
      "name": "Tan Hui Jan"
    },
    {
      "affiliations": [
        "Neurology, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain"
      ],
      "name": "Susana Arias"
    },
    {
      "affiliations": [
        "Neurology, Hospital Universitario Lucus Augusti, Lugo, Spain"
      ],
      "name": "Jesús García-de Soto"
    },
    {
      "affiliations": [
        "University Hospital Fann, Dakar, Senegal"
      ],
      "name": "Jamil Kahwagi"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Udine Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy"
      ],
      "name": "Alberto Vogrig"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Udine Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy"
      ],
      "name": "Salvatore Versace"
    },
    {
      "affiliations": [
        "Department of Neurology, John Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Ralph Habis"
    },
    {
      "affiliations": [
        "Department of Neurology, John Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Swathi Sowmitran"
    },
    {
      "affiliations": [
        "Neurology, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "Khalil S Husari"
    },
    {
      "affiliations": [
        "Department of Neurology, John Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "John Probasco"
    },
    {
      "affiliations": [
        "Department of Neurology, The University of Texas at Austin, Austin, Texas, USA"
      ],
      "name": "Rodrigo Hasbun"
    },
    {
      "affiliations": [
        "Department of Neurology, The University of Texas at Austin, Austin, Texas, USA"
      ],
      "name": "Paris Bean"
    },
    {
      "affiliations": [
        "Department of Neurology, The University of Texas at Austin, Austin, Texas, USA"
      ],
      "name": "Ashley Heck"
    },
    {
      "affiliations": [
        "University of Health Sciences, Bakirkoy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey"
      ],
      "name": "Gökçen R GözübatıkÇelik"
    },
    {
      "affiliations": [
        "University of Health Sciences, Bakirkoy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey"
      ],
      "name": "Dilek Ataklı"
    },
    {
      "affiliations": [
        "University of health sciences, Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey"
      ],
      "name": "Fusun Mayda Domac"
    },
    {
      "affiliations": [
        "Neurology Department, Hospital de Egas Moniz Serviço de Neurologia, Lisboa, Portugal"
      ],
      "name": "Vitor Ferreira"
    },
    {
      "affiliations": [
        "Neurology Department, Hospital de Egas Moniz Serviço de Neurologia, Lisboa, Portugal"
      ],
      "name": "Sofia Calado"
    },
    {
      "affiliations": [
        "Department of Neurology, NIMHANS, Bangalore, Karnataka, India"
      ],
      "name": "Thuppanattumadam Ananthasubramanian Sangeeth"
    },
    {
      "affiliations": [
        "Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection and Global Health, Liverpool, UK",
        "Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK"
      ],
      "name": "Sylviane Defres"
    },
    {
      "affiliations": [
        "Dipartimento di Neuroscienze, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy",
        "Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy"
      ],
      "name": "Marina Romozzi"
    },
    {
      "affiliations": [
        "Dipartimento di Neuroscienze, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy",
        "Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy"
      ],
      "name": "Raffaele Iorio"
    },
    {
      "affiliations": [
        "IRCCS Humanitas Research Hospital, Rozzano, Italy",
        "Department of Biomedical Sciences, Humanitas University, Milan, Italy"
      ],
      "name": "Umberto Pensato"
    },
    {
      "affiliations": [
        "Department of Neurology, NYU Langone Medical Center, New York, New York, USA",
        "Department of Psychology, Suffolk University, Boston, Massachusetts, USA"
      ],
      "name": "Maria Pleshkevich"
    },
    {
      "affiliations": [
        "NYU Langone Medical Center, New York, New York, USA"
      ],
      "name": "Claude Steriade"
    },
    {
      "affiliations": [
        "Department of Neurology, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of"
      ],
      "name": "Athena Sharifi-Razavi"
    },
    {
      "affiliations": [
        "Department of Neurology, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of"
      ],
      "name": "Nasim Tabrizi"
    },
    {
      "affiliations": [
        "Cclinical Neurosciences, University of Turku, Turku, Varsinais-Suomi, Finland",
        "Department of Neurology, North Karelia Central Hospital, Joensuu, Finland"
      ],
      "name": "Jussi Sipila"
    },
    {
      "affiliations": [
        "Neurology, Columbia University Medical Center, New York, New York, USA"
      ],
      "name": "Carla Y Kim"
    },
    {
      "affiliations": [
        "Neurology, Columbia University Medical Center, New York, New York, USA"
      ],
      "name": "Alexandra Diaz-Ariza"
    },
    {
      "affiliations": [
        "Department of Neurology, St John’s Medical College Hospital, Bangalore, Karnataka, India"
      ],
      "name": "Poorvikha Satish"
    },
    {
      "affiliations": [
        "Department of Neurology, St John’s Medical College Hospital, Bangalore, Karnataka, India"
      ],
      "name": "Vinutha Gowda"
    },
    {
      "affiliations": [
        "Department of Neurology, St John’s Medical College Hospital, Bangalore, Karnataka, India"
      ],
      "name": "Chandrakanta Gowda"
    },
    {
      "affiliations": [
        "Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of)",
        "Department of Neurology, Kyung Hee University Hospital, Dongdaemun-gu, Seoul, Korea (the Republic of)"
      ],
      "name": "Seong-il Oh"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico"
      ],
      "name": "Luis del Carpio-Orantes"
    },
    {
      "affiliations": [
        "Neurology Unit, ASST della Valcamonica, Breno, Lombardia, Italy"
      ],
      "name": "Mariasofia Cotelli"
    },
    {
      "affiliations": [
        "Centro Hospitalar Universitário de Santo António, Porto, Portugal"
      ],
      "name": "Luís Ferreira"
    },
    {
      "affiliations": [
        "Buyanov City Hospital, Moscow, Russian Federation"
      ],
      "name": "Maria Kovalchuk"
    },
    {
      "affiliations": [
        "Pirogov Russian National Research Medical University, Moskva, Russian Federation"
      ],
      "name": "Anna Goncharova"
    },
    {
      "affiliations": [
        "Institute of Infection and Global Health, University of Liverpool, Liverpool, UK"
      ],
      "name": "Tom Solomon"
    },
    {
      "affiliations": [
        "Department of Neurology, Technical University of Munich Hospital Rechts der Isar Neuro-Head Center, Munchen, Bayern, Germany",
        "Department of Community Medicine and Global Health, University of Oslo Department of Health and Society, Oslo, Norway",
        "Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Andrea Winkler"
    },
    {
      "affiliations": [
        "Pirogov Russian National Research Medical University, Moskva, Russian Federation"
      ],
      "name": "Alla Guekht"
    },
    {
      "affiliations": [
        "University of Liverpool Department of Clinical Infection Microbiology and Immunology, Liverpool, UK"
      ],
      "name": "Greta K Wood"
    },
    {
      "affiliations": [
        "Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK",
        "Department of Neurology, Technical University of Munich Hospital Rechts der Isar Neuro-Head Center, Munchen, Bayern, Germany"
      ],
      "name": "On Behalf of The Global NeuroResearch Coalition"
    },
    {
      "affiliations": [
        "Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"
      ],
      "name": "Benedict D Michael"
    }
  ],
  "title": "International evaluation of the SEIZUre Risk in Encephalitis (SEIZURE) score for predicting acute seizure risk",
  "uid": "0327b904-e491-5a64-9d8f-5a5007edaab1"
}