Abstract
BACKGROUND: Neuroinflammation-mediated epilepsy has become a focus of attention in recent years. Post-stroke epilepsy (PSE) is common, with most studies focusing on ischemic stroke rather than intracerebral hemorrhage (ICH) patients. Therefore, we aimed to determine the association between monocyte-to-lymphocyte ratio (MLR) levels and epilepsy after ICH. Additionally, we sought to develop a clinical score integrating MLR with the CAVE score to improve the risk stratification of PSE. METHODS: We retrospectively included consecutive ICH patients from January 2010 to July 2020. MLR was acquired from a routine blood test at admission. Multiple logistics and linear regression analyses were performed to identify risk factors for the PSE when MLR levels were divided into tertiles. Receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of epilepsy models based on the CAVE score and the MNCAVE score. RESULTS: Among the 834 patients with ICH, 47 (5.6%) patients had PSE. In multivariable logistics and linear regression analysis, elevated MLR levels were independently associated with the PSE after adjusting for several confounders (OR 2.545, 95% CI 1.036-6.255, P = 0.042). Six risk factors were selected to derive the MNCAVE score (higher MLR, severe stroke, cortical location, young age, large hematoma volume, and early seizures), which showed better prognostic performance than the conventional CAVE score (0.875 vs. 0.848, P = 0.041). CONCLUSIONS: Elevated MLR levels were associated with PSE after ICH. We developed the MNCAVE score for predicting PSE, which could improve the management of patients after ICH. Inflammatory markers may provide personalized guidance for patients with varying degrees of neurological impairment.