Assessment of Individual Risk for Epilepsy After CVT Using the DIAS³ Score

A new study published in JAMA Neurology aimed to assess the individual risk of developing epilepsy in patients with cerebral venous thrombosis (CVT) through the development of a clinical score.

Once a patient is diagnosed with CVT, they face significant health risks. Approximately 10% of patients develop epilepsy in the late phase following CVT diagnosis. However, clinicians have struggled to predict individual risk. In response, researchers developed the DIAS³ score, which was externally validated to predict the risk of post-CVT epilepsy using 6 readily available clinical variables.

This observational cohort study analyzed data from both retrospective and prospective sources spanning 1994 to 2022. Data from 1128 patients in the International CVT Consortium were used to develop the DIAS³. Validation was constructed using data from 2 independent cohorts: ACTION-CVT (543 patients) and the Israel CVT study (556 patients). Patients with preexisting epilepsy, follow-up shorter than 8 days, or incomplete data were excluded, resulting in a final sample of 2227 patients.

The DIAS³ score incorporates 6 readily available clinical variables observed in the acute phase of CVT: decompressive hemicraniectomy, intracerebral hemorrhage at presentation, age, seizure(s) in the acute phase (excluding status epilepticus), status epilepticus in the acute phase, and subdural hematoma at presentation. These clinical variables are used to calculate the risk of developing epilepsy within 1 year and 3 years after CVT diagnosis.

Results showed that over a median follow-up period of 12 months, 11% (128 or 1128) of patients in the derivation cohort developed epilepsy following CVT diagnosis. The DIAS³ score demonstrated strong predictive performance, with a C statistic of 0.74 at 1 year and 3 years in the derivation cohort and C statistics of 0.76 to 0.80 in the validation cohorts. The accuracy and accessibility of this tool show promise for guiding treatment decisions in patients at risk of post-CVT epilepsy.

“The DIAS³ score (freely available online) is a simple tool that can help predict the risk of post-CVT epilepsy in individual patients,” researchers concluded. “The model can improve opportunities for personalized medicine and may aid in decision-making regarding antiseizure medication, patient counseling, and facilitation of research on epileptogenesis in CVT.”

Reference

Lindgren E, Simaan N, Krzywicka K, et al. Development and validation of a clinical score to predict epilepsy after cerebral venous thrombosis. JAMA Neurol. Published online October 21, 2024. doi: 10.1001/jamaneurol.2024.3481