Informed DEcision for cerebrospinal fluid analysis after epiLeptic seizures- the IDEAL-score: A development and validation study. (October 2021)

• Record Type: Journal Article
• Authors: Süße, Marie; Gag, Konrad; Hannich, Malte J.; Hamann, Laura; Nass, Robert D.; Malter, Michael P.; Quesada, Carlos M.; Remi, Jan; Möddel, Gabriel; Knake, Susanne; Schmitt, Friedhelm C.; Hirsch, Martin; Kunze, Albrecht; Strzelczyk, Adam; von Podewils, Felix
• Is Part Of: Seizure. Volume 91(2021)
• Page Start: 228
• Page End: 232
• Publication Date: 2021-10
• Subjects: Cerebrospinal fluid analysis -- Epilepsy -- Spinal tap -- Infection -- First epileptic seizure; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2021.06.019
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Analyzing CSF is crucial in the diagnostic workup after a first epileptic seizure. CSF analysis provides decisive etiological findings in only 13%. The IDEAL score has a sensitivity of 98% to detect etiological findings in CSF. The IDEAL score has a negative predictive value of 99%. The IDEAL score can help to decide whether a CSF analysis is required. Abstract: Background: This observational study was done to develop a score based on clinical predictors that enables a guided decision for the necessity of cerebrospinal fluid (CSF) analysis after first unprovoked epileptic seizures and to validate this score in a retrospective patient cohort. Methods: Clinical predictors were identified by two panels of epilepsy experts and selected according to content validity ratios. Based on these predictors a score was created and applied to a cohort of patients with first epileptic seizures. Results: The "IDEAL score" consists of 9 items (fever, prolonged disturbance of consciousness, headache, imaging results, cognitive dysfunction, status epilepticus, malignancy, autoimmune encephalitis symptoms) that are collected at two different time points (< 3 h [A-score]; > 3 h [B-score] after hospital admittance). A CSF analysis is recommended, if at least one clinical finding is present, either one of the items evaluated during the acute phase (A-score) or later in the diagnostic process (B-score). In 41 patients (13%) CSF analysis provided essential clues to the cause of the seizure. The combined IDEAL score reached a sensitivity of 98%, a specificity of 53%, a positive predictive value of 24% and a negative predictive value of 99% in this patient cohort. Conclusions: A CSF analysis after first epileptic seizures provided decisive etiological findings in only 13% of all investigated patients. The IDEAL score offers clinicians a simple and easy-to-implement algorithm to assess the necessity of a CSF analysis, and to prevent unnecessary diagnostic procedures.