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Application of the 2HELPS2B score with short-duration EEG for seizure prediction in acute impaired consciousness: A
Tatsuya Sato1, Shuichiro Neshige2, Masaya Togo3
1Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan.
Background:
Continuous EEG (cEEG) is recommended for detecting seizures in critically ill patients, but resource constraints often limit its availability. Identifying high-risk patients using a shorter EEG recording could optimize seizure detection and management.
Objective:
To evaluate the predictive validity of the 2HELPS2B score for estimating seizure risk based on EEG recordings of 30 min or less.
Methods:
This multicenter observational study was conducted at six tertiary care hospitals. A total of 287 patients (aged ≥18 years) with acute impaired consciousness who underwent short-duration EEG (15-30 min) were enrolled. The primary outcomes were the occurrence of seizures within 24 h and seizure status on day 7 following the initial EEG. The Cochran-Armitage trend test evaluated whether seizure frequency increased with the 2HELPS2B score, and receiver operating characteristic (ROC) analysis assessed predictive accuracy.
Results:
Within 24 h of the initial EEG, seizures were observed in 17.4 % of patients (n = 50), and day-7 seizure status indicated a lack of seizure freedom in 7.0 % (n = 20). The seizure risk within 24 h was 0.8 % at a 2HELPS2B score of 0, 13.3 % at a score of 1, and 36.8 % at a score of ≥2 (p < 0.001). The area under the curve for seizure prediction was 0.84 (95 % CI: 0.79-0.90) within 24 h and 0.79 (95 % CI: 0.70-0.88) on day 7.
Conclusion:
The 2HELPS2B score reliably predicts seizure risk from ≤30-min EEGs in patients with acute impaired consciousness, supporting its utility for early risk assessment where cEEG availability is limited.
