ESOC 2026 | Predicting post-stroke epilepsy: a novel imaging-based risk score (IsCHEMiA)

Yeah, I think that we just commented on the research that was done by a team of researchers based in Japan, in Hong Kong and Japan, so they basically wanted to predict the onset of post-stroke epilepsy, that is, epilepsy occurring after a first-ever ischemic stroke, and it’s important to predict that or to find scores to predict it because it’s important to prevent it from happening, and currently, we don’t have kind of standard guidelines to know how to identify those who are at higher risk of stroke and what to do with those people, that is, do we need to give them systematic anti-epileptic treatment or not? So, before the work done by these researchers, Leung et al, there were other scores that had been designed in European populations, helping to identify patients who are at high risk of developing post-stroke epilepsy, which is mostly defined as any seizure occurring beyond a week after an initial stroke event, and associated with a greater than 60% risk of recurring. And so what they did is design a score that includes parameters such as the size of the stroke, the presence of bleeding inside the brain after the ischemic stroke, the presence of lesions that affect the cerebral cortex, that is, the most superficial layer of the brain, and also elements like whether or not the patient had a seizure in the very early days of the stroke. So, there were approximately six parameters. And what they found out in their data sets of nearly 1,500 patients is that they could predict with a very good kind of discrimination ability who would develop epilepsy during the follow-up. And they followed up the patients for a bit more than four years. And so that was one thing. And they also noticed that if you had a score, they call this the overall score ischemia, which is just an acronym including all the parameters, if you had that ischemia score greater than 8%, you had more than 60% chance of having epilepsy or post-stroke epilepsy within a year after the stroke or during the 10 years following the stroke. And they compared their results to their score, the performance of their score to the pre-existing score, which is called the SELECT score. There are various iterations of that SELECT score, and they showed that both the initial SELECT and the SELECT version 2.0 did not perform as well as the ischemia score. So, we could say that the ischemia score might be the standard now for prediction. But with the caveat that it was designed in people from the U.S., so it was a cohort from the Massachusetts General Hospital and validated in Asian populations, so patients from Japan, from Hong Kong, and a lot of that cohort. So, we don’t know yet how the Ischemia score will perform in the European population or in Black Africans or other populations. So, that’s one thing that needs to be done in the future. But it’s interesting that things are moving forward, we are, we have some progress in terms of predicting and potentially preventing epilepsy after stroke.

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