### Description

Cramer et al developed a seizure severity rating score for patients in the Veterans Administration (VA) Health System. The rating for complex partial seizures is combined with those for generalized tonic-clonic and simple partial seizures.

Criteria for completion: history of complex partial seizures with altered consciousness

Parameters:

(1) total number of seizures since the last visit or other interval

(2) occurrence of the seizures in a cluster

(3) total number of seizures

(4) seizure frequency

(5) presence of aura (aura allows for avoidance of harm)

(6) precipitating factors (lack of sleep, alcohol, illness, other)

(7) subtherapeutic drug levels during period

(8) low therapeutic range drug levels during period

(9) presence of known cyclic or diurnal patterns

(10) loss of consciousness

Step 1: Determine if any of the seizures occurred in a cluster (>= 3 seizures within a 24 hour period). If so, divide the number of seizures in that cluster in half.

Step 2: Determine points for the seizure frequency.

 Frequency of Seizures Points >= 4 per month 50 + (10 * (N - 4)) 3 per month 40 2 per month 30 1 per month 20 more than 1 in 3 months and less than 1 per month 15 less than or equal to 1 in 3 months 10

where:

• "More than 1 in 3 months and less than 1 per month" equates to 2 in 3 months.

Step 3: Adjust initial points for other factors.

 Factors Present Absent aura 0.80 1 precipitating factor 0.50 1 subtherapeutic drug level 0.30 1 low therapeutic drug range 0.80 1 cyclic or diurnal patterns 0.60 1 loss of consciousness 1 0.5

where:

• The 2 drug levels are mutually exclusive (only 1 drug factor applies).

adjusted score for complex partial seizures =

= (initial score) * (factor for aura) * (factor for precipitating cause) * (factor for drug level) * (factor for cyclic or diurnal patterns) * (factor for loss of consciousness)

Interpretation:

• The final score for a patient is a summation of the adjusted scores for each seizure type present (generalized tonic clonic, complex partial, simple partial).