Neurotoxicity	Grade 1	Grade 2	Grade 3	Grade 4
ICE	9–7	6–3	2–0	0
Level of consciousness	Awake	Responds to voice	Responds to tactile stimulus	Unconscious or requires vigorous stimulation. Stupor
Seizures	No	No	Any type of seizure (focal or generalized) that resolves quickly or non-convulsive seizures (EEEg) that resolve without intervention	Convulsive or non-convulsive status without recovery of consciousness
Motor deficit	No	No	No	Focal motor weakness: hemiparesis or paraparesis
ELEVATION ICP/cerebral edema	No	No	Focal cerebral edema detected by CT or cranial MRI	Diffuse cerebral edema on CT or MRI. Brain damage or decorticated posture. Cushing’s triad
Evaluation and monitoring	General recommendations: ICE scale every 4 h. Basal EEG, fundus, assessment of PL, CT, and/or MRI according to availability. Prophylaxis with levetiracetam. Avoid and treat hyponatremia. Avoid medication that causes depression of the central nervous system	Assess transfer to SMI: ICE score every hour. General recommendations described in grade 1	Transfer to the SMI: ICE score every hour. Clinical assessment of signs of HITC. General recommendations described in grade 2	Transfer to the SMI: Assess sedation, intubation, and mechanical ventilation for airway protection and/or seizure status control. General recommendations described in grade 3 [47]