Journal Article Validation Study Ppublish 2 citations
PubMed: 41490217 DOI: 10.1212/WNL.0000000000214486
Development and International Validation of a Novel Imaging-Based Risk Score (IsCHEMiA) for the Prediction of Poststroke Epilepsy.
Neurology 106(2):e214486
Authors: William C Y Leung, Tomotaka Tanaka, Rachel A Donahue, Kandace Chi Wing Chan, Jianing Wang, Tommy Ho Fung Chung, Yuen Kwun Wong, K C Roxanna Liu, Ian Y H Leung, Ryan Wui-Hang Ho, Florinda Hui Ning Chu, Anthony Ka Long Leung, Kay Cheong Teo, Shirley Yin Yu Pang, Edwin Kin-Keung Yip, Masafumi Ihara, Kazuki Fukuma, Harrison T Reeder, Lori B Chibnik, Andrew J Cole, Gary Kui Kai Lau, Aneesh B Singhal
Affiliations
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, China.
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
- Neurology Clinical Research Institute, Massachusetts General Hospital, Boston.
- Massachusetts General Biostatistics, Harvard Medical School, Boston.
- Department of Psychology, University of Hong Kong, China.
- Department of Medicine and Geriatrics, Ruttonjee Hospital, Hong Kong SAR, China.
- Tam Wing Fan Neuroimaging Research Laboratory, Li Ka Shing Faculty of Medicine, University of Hong Kong, China; and.
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, China.
Abstract
BACKGROUND AND OBJECTIVES
Stroke is one of the most common causes of adult-onset epilepsy. We aimed to develop a model to predict poststroke epilepsy (PSE) after a first-ever ischemic stroke, incorporating neuroimaging features of incident stroke.
METHODS
We analyzed clinical and neuroimaging features of patients with first-ever acute ischemic stroke consecutively admitted to Massachusetts General Hospital, United States. We performed competing risk regression with all-cause mortality as a competing event and derived the final multivariable model using backward stepwise elimination by the Akaike Information Criterion. We externally validated the model in 3 international cohorts in Hong Kong (Queen Mary Hospital [HK-QMH], Ruttonjee Hospital [HK-RH]) and Japan (National Cerebral and Cardiovascular Center) by discrimination and calibration and compared its performance with the SeLECT and SeLECT2.0 scores.
RESULTS
We included a final derivative cohort of 1,436 patients with a mean age of 67.4 years and a slight male predominance (54.7%), along with a total of 2,534 patients in the validation cohorts. PSE, defined as the occurrence or recurrence of unprovoked seizure >7 days after stroke, occurred in 5.5% of the overall study population. Six variables (infarct size [Is], cortical involvement [C], hemorrhagic transformation [H], early seizures [E], MCA involvement [Mi], and age younger than 65 [A]) were independent predictors included in the final model and formed the IsCHEMiA score. Model discrimination was consistent across all cohorts, with c-statistics of 0.870 (United States), 0.852 (HK-QMH), 0.857 (HK-RH), and 0.826 (Japan). The model was well calibrated at 1 and 3 years after stroke in the overall validation cohort. The IsCHEMiA score improved the prediction of PSE compared with SeLECT in all cohorts and the overall study population (c-statistic 0.848 vs 0.782, z = 5.170, p < 0.0001). For example, an IsCHEMiA score of 3 predicts a low risk of PSE at 1 year (2%) and 5 years (6%) while an IsCHEMiA score ≥8 predicts a high risk at 1 year (67%) and 5 years (78%).
DISCUSSION
The IsCHEMiA score is an improved and readily applicable predictive model developed and validated using international stroke cohorts in the modern era of reperfusion therapies. It serves as a foundation for personalized management and may guide future clinical trials on antiepileptogenic therapies in acute ischemic stroke.
MeSH
Epilepsy, Ischemic Stroke, Stroke, Neuroimaging, Seizures, Therapeutics, Neurology, Ischemia