Validation of SeLECT score and its modification for predicting unprovoked epileptic seizures in patients after ischemic stroke

Vascular epilepsy represents a significant late complication of ischemic stroke. SeLECT score is an important prediction model for late poststroke seizures. The study aimed to validate the ability of the SeLECT score, its parameters, and other selected biomarkers to predict the occurrence of unprovoked epileptic seizures in patients after ischemic stroke. Retrospective analysis of consecutive supratentorial ischemic stroke survivors with a negative history of epilepsy, admitted to 2 major comprehensive stroke centers in the Czech Republic and Austria in 1 year period. The follow-up information was collected from available medical documentation, using a structured telephone questionnaire and patient visits. Three hundred fifteen patients were included (59% men, median age 69 years, median National Institutes of Health Stroke Scale [NIHSS] 4, intravenous thrombolysis was administered to 29.2%, mechanical thrombectomy was done in 6.3%). Unprovoked epileptic seizures occurred in 24 patients (7.6%), and the median follow-up period was 3.3 years. Vascular epilepsy was significantly associated with cortical localization of the ischemic lesion (hazard ratio [HR] 3.324; 95% confidence intervals [CI] 1.432–7.714; P = .005), higher NIHSS at discharge (HR 1.1; 95% CI 1.017–1.191; P = .018), and a history of prior stroke (HR 4.098; 95% CI 1.86–9.03; P < .001). Validation of the SeLECT score confirmed its predictive capabilities (area under the receiver operating characteristic curve 0.668; P = .005), and modifications incorporating NIHSS at discharge improved its performance (area under the receiver operating characteristic curve 0.715; P = .001).