Bentes Carla, Peralta Ana Rita, Martins Hugo, Casimiro Carlos, Morgado Carlos, Franco Ana Catarina, Viana Pedro, Fonseca Ana Catarina, Geraldes Ruth, Canhão Patrícia, Pinho E Melo Teresa, Paiva Teresa, Ferro José M
EEG/Sleep Laboratory and Stroke Unit Department of Neurosciences and Mental Health (Neurology) Santa Maria Hospital, North Lisbon Hospitalar Center Lisbon Portugal.
Faculty of Medicine University of Lisbon Lisbon Portugal.
Epilepsia Open. 2017 Aug 23;2(4):441-452. doi: 10.1002/epi4.12075. eCollection 2017 Dec.
Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity.
A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (<60 min) was performed in the first 72 h. The Alberta Stroke Program Early CT Score quantified middle cerebral artery infarct size. The outcomes in this study were an unfavorable functional outcome (modified Rankin Scale [mRS] ≥ 3) and death (mRS = 6) at discharge and 12 months after stroke.
Unfavorable outcome at discharge was independently associated with NIHSS score (p = 0.001), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Unfavorable outcome 1 year after stroke was independently associated with age (p = 0.001), NIHSS score (p < 0.001), remote symptomatic seizures (p = 0.046), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Death in the first year after stroke was independently associated with age (p = 0.028), NIHSS score (p = 0.001), acute symptomatic seizures (p = 0.015), and EEG suppression (p = 0.019).
Acute symptomatic seizures were independent predictors of vital outcome and remote symptomatic seizures of functional outcome in the first year after stroke. Therefore, their recognition and prevention strategies may be clinically relevant. Early EEG abnormalities were independent predictors and comparable to age and early clinical/imaging infarct severity in stroke functional outcome discrimination, reflecting the concept that EEG is a sensitive and robust method in the functional assessment of the brain.
癫痫发作和脑电图（EEG）异常与不良的卒中功能结局相关。然而，这种关联可能取决于临床和影像学卒中严重程度。我们旨在分析在调整年龄以及临床/影像学梗死严重程度后，癫痫发作和早期EEG异常是否为卒中结局的预测因素。
对连续的、先前独立的急性卒中患者进行前瞻性研究，这些患者入院时美国国立卫生研究院卒中量表（NIHSS）评分≥4，且脑成像显示为急性前循环缺血性病变。所有患者在入院期间和出院后均接受标准化临床和诊断评估，并随访12个月。在最初72小时内进行视频脑电图（<60分钟）检查。阿尔伯塔卒中项目早期CT评分对大脑中动脉梗死大小进行量化。本研究的结局为出院时以及卒中后12个月时不良功能结局（改良Rankin量表[mRS]≥3）和死亡（mRS = 6）。
出院时的不良结局与NIHSS评分（p = 0.001）、EEG背景活动减慢（p < 0.001）和不对称性（p < 0.001）独立相关。卒中后1年的不良结局与年龄（p = 0.001）、NIHSS评分（p < 0.001）、远隔症状性癫痫发作（p = 0.046）、EEG背景活动减慢（p < 0.001）和不对称性（p < 0.001）独立相关。卒中后第一年的死亡与年龄（p = 0.028）、NIHSS评分（p = 0.001）、急性症状性癫痫发作（p = 0.015）和EEG抑制（p = 0.019）独立相关。
急性症状性癫痫发作是卒中后第一年生命结局的独立预测因素，远隔症状性癫痫发作是功能结局的独立预测因素。因此，对它们的识别和预防策略可能具有临床相关性。早期EEG异常是独立预测因素，在卒中功能结局判别方面与年龄以及早期临床/影像学梗死严重程度相当，这反映了EEG在脑功能评估中是一种敏感且可靠方法的概念。
