Lima Fabricio O, Ricardo João A G, Coan Ana C, Soriano Diogo C, Avelar Wagner M, Min Li L
Health Sciences Center, University of Fortaleza, Fortaleza, Brazil.
Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas-SP, Campinas, Brazil.
Cerebrovasc Dis. 2017;44(3-4):128-134. doi: 10.1159/000477674. Epub 2017 Jun 13.
The prognostic significance of interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke has not been assessed. We sought to test whether IED and PP, detected on standard Electroencephalography (EEG) performed during the acute phase of ischemic stroke are associated with a worse functional outcome.
One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 h from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a blinded board certified neurophysiologist. IED and PP (grouped as epileptiform activity [EA]) were defined according to proposed guidelines. Univariable and multivariable analyses were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤2 vs. ≥3) at 3 months.
In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p = 0.001), age (OR 1.03, 95% CI 1.01-1.05, p = 0.02), and presence of EA (OR 2.94, 95% CI 1.51-5.88, p = 0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p < 0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p = 0.04) were independently associated with the prognosis.
The importance of EEG in the prognosis of acute ischemic stroke warrants additional research, examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.
缺血性卒中后发作间期癫痫样放电（IED）和周期性模式（PP）的预后意义尚未得到评估。我们试图检验在缺血性卒中急性期进行的标准脑电图（EEG）检测到的IED和PP是否与更差的功能结局相关。
前瞻性纳入并随访了157例年龄在18岁及以上、诊断为急性缺血性卒中且在卒中发作72小时内就诊的患者。排除有卒中前癫痫发作或癫痫病史、既往有衰弱性神经疾病或无法进行脑电图检查的情况的患者。由一位盲法认证的神经生理学家进行解读。根据提议的指南定义IED和PP（归类为癫痫样活动[EA]）。采用单变量和多变量分析来确定3个月时结局（改良Rankin量表分为≤2与≥3）的预测因素。
在单变量分析中，入院时美国国立卫生研究院卒中量表（NIHSS）评分（比值比[OR]1.20，95%置信区间[CI]1.12 - 1.28，p = 0.001）、年龄（OR 1.03，95% CI 1.01 - 1.05，p = 0.02）以及EA的存在（OR 2.94，95% CI 1.51 - 5.88，p = 0.001）与3个月时的结局显著相关。在多变量分析中，只有入院时NIHSS评分（OR 1.19，95% CI 1.11 - 1.28，p < 0.001）和EA的存在（OR 2.27，95% CI 1.04 - 5.00，p = 0.04）与预后独立相关。
脑电图在急性缺血性卒中预后中的重要性值得进一步研究，探讨药物治疗对结局的作用以及特定脑电图模式患者癫痫发作的发生情况。
