Carla Bentes1, Ana Rita Peralta2, Pedro Viana2, Hugo Martins3, Carlos Morgado4, Carlos Casimiro5, Ana Catarina Franco6, Ana Catarina Fonseca2, Ruth Geraldes2, Patrícia Canhão2, Teresa Pinho E Melo2, Teresa Paiva7, José M Ferro2. 1. EEG/Sleep Laboratory and Stroke Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria - CHLN, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal; Faculty of Medicine, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal. Electronic address: ccbentes@gmail.com. 2. EEG/Sleep Laboratory and Stroke Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria - CHLN, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal; Faculty of Medicine, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal. 3. Department of Medicine, Hospital de São José - CHLC, R. José António Serrano, Lisboa 1150-199, Portugal. 4. Faculty of Medicine, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal; Department of Neuroradiology, Hospital de Santa Maria - CHLN, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal. 5. Department of Neuroradiology, Hospital de Santa Maria - CHLN, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal. 6. EEG/Sleep Laboratory and Stroke Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria - CHLN, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal. 7. Eletroencefalography and Clinic Neurophysiology Centre (CENC), R. Conde Antas 5, Lisboa 1070-079, Portugal.
Abstract
OBJECTIVE: To identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers. METHODS: Prospective cohort of 151 consecutive anterior circulation ischemic stroke patients followed for 12 months. EEG was recorded within 72 h and at discharge or 7 days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS ≥ 3), at discharge and 12 months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS. RESULTS: Higher delta, lower alpha and beta relative powers (RP) predicted outcome. Indices with higher discriminative capacity were delta-theta to alpha-beta ratio (DTABR) and alpha RP. Outcome models including either of these and other clinical/imaging stroke outcome predictors were superior to models without qEEG data. In models with qEEG indices, infarct size was not a significant outcome predictor. CONCLUSIONS: DTAABR and alpha RP are the best qEEG indices and superior to ASPECTS in post-stroke outcome prediction. They improve the discriminative capacity of already known clinical and imaging stroke outcome predictors, both at discharge and 12 months after stroke. SIGNIFICANCE: qEEG indices are independent predictors of stroke outcome.
OBJECTIVE: To identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers. METHODS: Prospective cohort of 151 consecutive anterior circulation ischemic strokepatients followed for 12 months. EEG was recorded within 72 h and at discharge or 7 days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS ≥ 3), at discharge and 12 months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS. RESULTS: Higher delta, lower alpha and beta relative powers (RP) predicted outcome. Indices with higher discriminative capacity were delta-theta to alpha-beta ratio (DTABR) and alpha RP. Outcome models including either of these and other clinical/imaging stroke outcome predictors were superior to models without qEEG data. In models with qEEG indices, infarct size was not a significant outcome predictor. CONCLUSIONS:DTAABR and alpha RP are the best qEEG indices and superior to ASPECTS in post-stroke outcome prediction. They improve the discriminative capacity of already known clinical and imaging stroke outcome predictors, both at discharge and 12 months after stroke. SIGNIFICANCE: qEEG indices are independent predictors of stroke outcome.
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