MDCalc

2HELPS2B Score

Estimates seizure risk in acutely ill patients undergoing continuous EEG (cEEG).

Can be assessed after 1 hour of cEEG monitoring (Struck et al., 2020).

B[I]RDs

Presence of LPDs, LRDA, or BIPDs

Prior seizure

Sporadic epileptiform discharges

Frequency >2.0 Hz for any periodic or rhythmic pattern

Presence of “plus” features 

i.e., superimposed, rhythmic, sharp, or fast activity

Result:

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Advice
  • This tool does not replace clinical judgment or other diagnostic tools and should only be used as part of a comprehensive assessment.
  • Patients should be monitored clinically for any changes that might increase seizure risk.
  • Investigate underlying causes of seizures or encephalopathy (e.g., infection, structural lesions, metabolic disturbances).
  • Consider rescoring if new findings emerge during cEEG.
  • Document the rationale for cEEG continuation or discontinuation.
Management

The following suggestions are based on the validation study by Struck et al. (2020).

  • Low risk (0 points): Consider discontinuing cEEG monitoring if no seizures are detected and clinical suspicion is low. Some experts recommend ensuring cEEG has been negative for several hours before discontinuing.
  • Medium risk (1 point): Consider discontinuing cEEG monitoring after 12 hours if no seizures are detected and clinical suspicion is low.
  • High risk (≥2 points): Continue cEEG monitoring for at least 24 hours.
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