CAVE Score — Seizure Recurrence Risk
4 binary factors after first unprovoked seizure. Score 0–4.
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Pro Tip
Always perform both MRI brain and EEG (ideally sleep-deprived) as part of a first-seizure assessment before applying CAVE. A normal EEG performed while awake misses up to 40% of patients who would show epileptiform activity on a sleep or sleep-deprived recording.
Did you know?
The concept of using a single unprovoked seizure plus a high recurrence risk as sufficient to diagnose epilepsy — without waiting for a second seizure — was formally adopted by the ILAE in 2014. This changed how tools like CAVE are used: a score of 3-4 now effectively diagnoses epilepsy, enabling earlier treatment that was previously delayed until the second event.
References
- ›Stroink H et al. The first unprovoked, untreated seizure in childhood — a hospital based study of predictive factors. Epilepsia 1998.
- ›Fisher RS et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014.
- ›NICE Guideline NG217 — Epilepsies in children, young people and adults (2022).
- ›Kim LG et al. Risk of recurrence after a first unprovoked seizure. Neurology 2006.
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