Cramer et al developed a seizure severity rating score for patients in the Veterans Administration (VA) Health System. The rating for generalized tonic-clonic seizures is combined with those for complex and simple partial seizures.
Criteria for completion: history of primary or secondary generalized tonic-clonic seizures
Parameters:
(1) total number of seizures since the last visit or other interval
(2) total number of seizures since starting drug regimen
(3) seizure frequency
(4) presence of aura (aura allows for avoidance of harm)
(5) precipitating factors (lack of sleep, alcohol, illness, other)
(6) subtherapeutic drug levels during period
(7) low therapeutic range drug levels during period
(8) presence of known cyclic or diurnal patterns
Step 1: Determine points for the seizure frequency over time interval.
|
Time Interval |
Number of Seizures |
Points |
|
12 months |
>= 3 seizures |
(number) * 20 |
|
3 months |
2 |
50 |
|
3 months |
1 |
40 |
|
6 months |
2 |
45 |
|
6 months |
1 |
40 |
|
6 - 12 months |
2 |
30 |
|
6 - 12 months |
1 |
20 |
|
12 - 24 months |
2 |
20 |
|
12 - 24 months |
1 |
10 |
Step 2: 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 |
where:
• The 2 drug levels are mutually exclusive (only 1 drug factor applies).
adjusted score for generalized tonic-clonic seizures =
= (initial score) * (factor for aura) * (factor for precipitating cause) * (factor for drug level) * (factor for cyclic or diurnal patterns)
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).
Specialty: Neurology
ICD-10: ,
