{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:55:14Z","timestamp":1791824114104,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018336","name":"National Institute for Health Research Health Protection Research Unit","doi-asserted-by":"publisher","award":["200907"],"award-info":[{"award-number":["200907"]}],"id":[{"id":"10.13039\/100018336","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018336","name":"National Institute for Health Research Health Protection Research Unit","doi-asserted-by":"publisher","award":["200927"],"award-info":[{"award-number":["200927"]}],"id":[{"id":"10.13039\/100018336","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS126156"],"award-info":[{"award-number":["R01NS126156"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR i4i FAST","award":["NIHR208981"],"award-info":[{"award-number":["NIHR208981"]}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T028750\/1"],"award-info":[{"award-number":["MR\/T028750\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V007181\/1"],"award-info":[{"award-number":["MR\/V007181\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V03605X\/1"],"award-info":[{"award-number":["MR\/V03605X\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["315711\/Z\/24\/Z"],"award-info":[{"award-number":["315711\/Z\/24\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["ISSF201902\/3"],"award-info":[{"award-number":["ISSF201902\/3"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR health protection research unit in emerging and zoonotic infections","award":["IS-HPU-1112-10117),"],"award-info":[{"award-number":["IS-HPU-1112-10117),"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,3]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Encephalitis is brain parenchyma inflammation, frequently resulting in seizures which worsens outcomes. Early anti-seizure medication could improve outcomes but requires identifying patients at greatest risk of acute seizures. The SEIZURE (SEIZUre Risk in Encephalitis) score was developed in UK cohorts to stratify patients by acute seizure risk. A \u2018basic score\u2019 used Glasgow Coma Scale (GCS), fever and age; the \u2018advanced score\u2019 added aetiology. This study aimed to evaluate the score internationally to determine its global applicability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Patients were retrospectively analysed regionally, and by country, in this international evaluation study. Univariate analysis was conducted between patients who did and did not have inpatient seizures, followed by multivariable logistic regression, hierarchical clustering and analysis of the area under the receiver operating curves (AUROC) with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and setting<\/jats:title>\n                    <jats:p>2032 patients across 13 countries were identified, among whom 1324 were included in SEIZURE score calculations and 970 were included in regression modelling. The involved countries comprised 19 organisations spanning all WHO regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was measuring inpatient seizure rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Autoantibody-associated encephalitis, low GCS and presenting with a seizure were frequently associated with inpatient seizures; fever showed no association. Globally, the score had limited discriminatory ability (basic AUROC 0.58 (95% CI 0.55 to 0.62), advanced AUROC 0.63 (95% CI 0.60 to 0.66)). The scoring system performed acceptably in western Europe, excluding Spain, with the best performance in Portugal (basic AUROC 0.82 (95% CI 0.69 to 0.94), advanced AUROC 0.83 (95% CI 0.72 to 0.95)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The SEIZURE score performed best in several countries in Western Europe but performed poorly elsewhere, partly due to differing and unknown aetiologies. In most regions, the score did not reach a threshold to be clinically useful. The Western European results could aid in designing clinical trials assessing primary anti-seizure prophylaxis in encephalitis following further prospective trials. Beyond Western Europe, there is a need for tailored, localised scoring systems and future large-scale prospective studies with optimised aetiological testing to accurately identify high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099451","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T06:30:11Z","timestamp":1765175411000},"page":"e099451","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["International evaluation of the SEIZUre Risk in Encephalitis (SEIZURE) score for predicting acute seizure risk"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1561-7615","authenticated-orcid":false,"given":"Thomas","family":"Hughes","sequence":"first","affiliation":[{"name":"Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Venkatesan","sequence":"additional","affiliation":[{"name":"Department of Neurology, John Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Hetherington","sequence":"additional","affiliation":[{"name":"Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklyn Nkongho","family":"Egbe","sequence":"additional","affiliation":[{"name":"Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Netravathi","sequence":"additional","affiliation":[{"name":"Department of Neurology, NIMHANS, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0050-0323","authenticated-orcid":false,"given":"Kiran T","family":"Thakur","sequence":"additional","affiliation":[{"name":"Neurology, Columbia University Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betul","family":"Baykan","sequence":"additional","affiliation":[{"name":"Department of Neurology, EMAR Medical Center, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan","family":"Hui Jan","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University of Malaysia, Bangi, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Arias","sequence":"additional","affiliation":[{"name":"Neurology, Hospital Cl\u00ednico Universitario, Santiago de Compostela, A Coru\u00f1a, 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of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"del Carpio-Orantes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariasofia","family":"Cotelli","sequence":"additional","affiliation":[{"name":"Neurology Unit, ASST della Valcamonica, Breno, Lombardia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kovalchuk","sequence":"additional","affiliation":[{"name":"Buyanov City Hospital, Moscow, Russian 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