BACKGROUND AND PURPOSE: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. METHODS: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. RESULTS: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. SIGNIFICANCE: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.

译文

背景与目的:尚未评估缺血性中风后发作性癫痫样放电(IED)和周期性模式(PP)的预后意义。我们试图测试在缺血性中风急性期通过标准脑电图(EEG)检测到的IED和PP是否与较差的功能预后相关。
方法:前瞻性纳入并随访了18岁或以上的157例诊断为中风发作后72小时内出现急性缺血性中风的患者。中风前有癫痫发作或癫痫病史,先前使人衰弱的神经系统疾病或无法进行脑电图检查的患者被排除在外。解释由一位盲目合格的神经生理学家进行。根据提出的指南定义了IED和PP(分组为癫痫样活性[EA])。在3个月时使用单变量和多变量分析来确定结果的预测因子(修正的Rankin量表分为≤2vs.≥3)。
结果:在单变量分析中,入院NIHSS(OR 1.20,95%CI 1.12-1.28,p = 0.001),年龄(OR 1.03,95%CI 1.01-1.05,p = 0.02)和EA(OR 2.94, 95%CI 1.51-5.88,p = 0.001)与3个月时的结局显着相关。在多变量分析中,仅入院NIHSS(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。
意义:脑电图在急性缺血性中风的预后中的重要性值得进一步研究,研究对于特定脑电图模式的患者,药物治疗对预后和癫痫发作的作用。

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