Predicting epilepsy after new onset refractory status epilepticus due to autoimmune encephalitis: The DAME score

Objective: This study aimed to identify risk factors and develop a predictive scor-ing system for autoimmune-associated epilepsy in subjects with autoimmune en-cephalitis presenting with new onset refractory status epilepticus (NORSE).Methods: This retrospective, multicenter, cohort study included subjects whopresented with NORSE at the onset of autoimmune encephalitis and had at least24 months of follow-up after immunotherapy. The outcome was the develop-ment of autoimmune-associated epilepsy, defined as persistent seizures despiteadequate immunotherapy and absence of active inflammation. Factors indepen-dently associated with the outcome were identified through a backward stepwiseselection. Adjusted regression coefficients of each independent predictor weretransformed to produce a points- based risk-scoring system.Results: Seventy participants were included (median age = 24.2 years, 38.6%male). During a median follow-up of 53 months, 54.3% of subjects developedautoimmune- associated epilepsy. Status epilepticus duration ≥ 10 days (oddsratio [OR] = 31.14, 95% confidence interval [CI] = 2.12–456.87, p = .012), positiv-ity for antibodies against surface antigens (OR = .12, 95% CI = .02–.85, p = .034),bitemporal magnetic resonance imaging (MRI) abnormalities suggestive of au-toimmune encephalitis during acute stage (OR = 49.80, 95% CI = 2.95–841.77,p = .007), and interictal epileptiform discharges during electroencephalographic(EEG) follow- up (OR = 71.32, 95% CI = 6.48–785.32, p < .001) were indepen-dently associated with the study outcome. The duration–antibodies–MRI–EEG(DAME) score was developed as an integer-based scoring system predictive ofautoimmune- associated epilepsy. With an optimal cutoff of ≥3 points, it yielded asensitivity of 86.8%, a specificity of 87.5%, and an overall accuracy of 87.1%.Significance: The DAME score could serve as a user-friendly score to predict therisk of autoimmune-associated epilepsy in patients with NORSE due to autoim-mune encephalitis.