ADDONS / SCALES

2HELPS2B

David Goldemund M.D.
Updated on 01/06/2024, published on 21/05/2024
  • The 2HELPS2B is a clinical prediction tool used to estimate the risk of seizures in acutely ill patients undergoing continuous EEG (cEEG)  → calculator
  • it can guide decisions regarding prophylactic anticonvulsant therapy
  • initial cEEG ≥ 1 hour
  • 2HELPS2B score of 1 –  it is recommended to continue with cEEG for 12 hours
  • 2HELPS2B score ≥ 2 – it is recommended to continue with cEEG for 24 hours
2HELPS2B – Risk Factor Points
frequency > 2Hz for any periodic or rhythmic pattern 1
sporadic epileptiform discharges 1
lateralized periodic discharges (LPD), lateralized rhythmic delta activity (LRDA), or bilateral periodic discharges (BIPD) 1
presence of other abnormalities (Plus features) 1
prior seizure (Seizure) 1
 (BRIEF (ictal) rhythmic discharges – B[I]RDS 2

[Struck, 2017]

2HELPS2B Score Seizure Risk
0 5%
1 12%
2 27%
3 50%
4 73%
5 88%
6-7 > 95%

Strategy of prophylactic anticonvulsant therapy in stroke patients

Approach  
conservative
  • short-term (~ 7 days) secondary prevention after an early seizure
  • long-term prevention after a late seizure
intermediate
  • long-term secondary prevention after an early or late seizure
aggressive
  • long-term primary prevention (without a previous seizure)
based on individual risk
  • short-term secondary prevention (after an early seizure) in low-risk patients (2HELPS2B score 0)
  • short-term primary prevention in at-risk patients (2HELPS2B score ≥1)
  • long-term prevention for late seizures

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2HELPS2B
link: https://www.stroke-manual.com/2helps2b/