2HELPS2B Score

Estimate duration of EEG monitoring needed to detect 95% of seizures


The 2HELPS2B Score was designed to stratify seizure risk in hospital inpatients, and thus improve cost-effectiveness of continuous EEG (cEEG). By doing an initial 1 hour-long EEG and applying the score, patients can be stratified to stop EEG monitoring at that point, or continue to 12 hour or 24-hour cEEG monitoring. To achieve at least a less than 5% risk of undetected seizures, a 2HELPS2B score of 0 only required the 1-hour screening EEG, a 2HELPS2B score of 1 required 12 hours, and a 2HELPS2B score of 2 or greater required 24 hours. The risks of seizures (within 72 hours) for each possible 2HELPS2B score are 5% for a score of 0, 12% for a score of 1, 27% for a score of 2, 50% for a score of 3, 73% for a score of 4, 88%for a score of 5, and greater than 95% for a score of 6 or 7. The score was created in 2017 (Struck et al, 2017), and validated in 2020. It does not apply to patients admitted for elective epilepsy monitoring and post-cardiac arrest patients.


Struck AF, Ustun B, Ruiz AR, Lee JW, LaRoche SM, Hirsch LJ, Gilmore EJ, Vlachy J, Haider HA, Rudin C, Westover MB.

JAMA Neurology 2017 December 1, 74 (12): 1419-1424

Struck AF, Fesharaki MT, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T, Hernandez C, Kaleem S, Haider HA, Cissé AF, Dhakar MB, Hirsch LJ, Rosenthal ES, Zafar SF, Gaspard N, Westover MB.

JAMA Neurology 2020 January 13.

The 2HELPS2B Score calculator is created by QxMD.

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1. Frequency of any periodic or rhythmic pattern of more than 2 Hz except generalized rhythmic delta activity?

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