ArticleNeurocritical care2020
Burden of Epileptiform Activity Predicts Discharge Neurologic Outcomes in Severe Acute Ischemic Stroke.
Article in Neurocritical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Guidelines for Seizure Prophylaxis in Patients Undergoing Supratentorial Neurosurgery: A Statement for Healthcare Professionals from the Neurocritical Care Society.Neurocritical care · 2026Guideline
- The Prognostic Utility of Electroencephalography in Stroke Recovery: A Systematic Review and Meta-Analysis.Neurorehabilitation and neural repair · 2022Pooled it
- Intracranial EEG for Detecting Epileptic Activity in Acute Brain Injury: A Systematic Review and Meta-analysis.Neurocritical care · 2026Review
- Systemic inflammatory profiles associated with early EEG abnormalities following ischemic stroke: a cohort study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Observational
- Impact of standardized electroencephalography terminology education among early-career neurologists in Korea: a single-group pretest-posttest study.Encephalitis (Seoul, Korea) · 2025Article
- Using artificial intelligence to optimize anti-seizure treatment and EEG-guided decisions in severe brain injury.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Review
- Ketamine reduces seizure and interictal continuum activity in refractory status epilepticus: a multicenter in-person and teleneurocritical care study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Article
- Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures.JAMA neurology · 2024Article
- Identifying inpatient hospitalizations with continuous electroencephalogram monitoring from administrative data.BMC health services research · 2023Article
- Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study.The Lancet. Digital health · 2023Article
- Association of Epileptiform Activity With Outcomes in Toxic-Metabolic Encephalopathy.Critical care explorations · 2023Article
- Development of Expert-Level Classification of Seizures and Rhythmic and Periodic Patterns During EEG Interpretation.Neurology · 2023Article
- Interrater Reliability of Expert Electroencephalographers Identifying Seizures and Rhythmic and Periodic Patterns in EEGs.Neurology · 2023Article
- Epileptiform activity in the acute phase of stroke predicts the outcomes in patients without seizures.Frontiers in neurology · 2023Article
- Electrographic Seizures in the Critically Ill.Neurologic clinics · 2022Review
- Anti-seizure medication treatment and outcomes in acute ischemic stroke patients undergoing continuous EEG monitoring.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022Article
- Evaluation and Treatment of Seizures and Epilepsy During the COVID-19 Pandemic.Current neurology and neuroscience reports · 2022Review
- Association of Epileptiform Abnormality on Electroencephalography with Development of Epilepsy After Acute Brain Injury.Neurocritical care · 2021Article
- Automated Annotation of Epileptiform Burden and Its Association with Outcomes.Annals of neurology · 2021Article
- Seizures and epilepsy after intracerebral hemorrhage: an update.Journal of neurology · 2021Article
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17 authors.
Funding
Abstract
BACKGROUND/
objectivesClinical seizures following acute ischemic stroke (AIS) appear to contribute to worse neurologic outcomes. However, the effect of electrographic epileptiform abnormalities (EAs) more broadly is less clear. Here, we evaluate the impact of EAs, including electrographic seizures and periodic and rhythmic patterns, on outcomes in patients with AIS.
methodsThis is a retrospective study of all patients with AIS aged ≥ 18 years who underwent at least 18 h of continuous electroencephalogram (EEG) monitoring at a single center between 2012 and 2017. EAs were classified according to American Clinical Neurophysiology Society (ACNS) nomenclature and included seizures and periodic and rhythmic patterns. EA burden for each 24-h epoch was defined using the following cutoffs: EA presence, maximum daily burden < 10% versus > 10%, maximum daily burden < 50% versus > 50%, and maximum daily burden using categories from ACNS nomenclature ("rare" < 1%; "occasional" 1-9%; "frequent" 10-49%; "abundant" 50-89%; "continuous" > 90%). Maximum EA frequency for each epoch was dichotomized into ≥ 1.5 Hz versus < 1.5 Hz. Poor neurologic outcome was defined as a modified Rankin Scale score of 4-6 (vs. 0-3 as good outcome) at hospital discharge.
resultsOne hundred and forty-three patients met study inclusion criteria. Sixty-seven patients (46.9%) had EAs. One hundred and twenty-four patients (86.7%) had poor outcome. On univariate analysis, the presence of EAs (OR 3.87 [1.27-11.71], p = 0.024) and maximum daily burden > 10% (OR 12.34 [2.34-210], p = 0.001) and > 50% (OR 8.26 [1.34-122], p = 0.035) were associated with worse outcomes. On multivariate analysis, after adjusting for clinical covariates (age, gender, NIHSS, APACHE II, stroke location, stroke treatment, hemorrhagic transformation, Charlson comorbidity index, history of epilepsy), EA presence (OR 5.78 [1.36-24.56], p = 0.017), maximum daily burden > 10% (OR 23.69 [2.43-230.7], p = 0.006), and maximum daily burden > 50% (OR 9.34 [1.01-86.72], p = 0.049) were associated with worse outcomes. After adjusting for covariates, we also found a dose-dependent association between increasing EA burden and increasing probability of poor outcomes (OR 1.89 [1.18-3.03] p = 0.009). We did not find an independent association between EA frequency and outcomes (OR: 4.43 [.98-20.03] p = 0.053). However, the combined effect of increasing EA burden and frequency ≥ 1.5 Hz (EA burden * frequency) was significantly associated with worse outcomes (OR 1.64 [1.03-2.63] p = 0.039).
conclusionsElectrographic seizures and periodic and rhythmic patterns in patients with AIS are associated with worse outcomes in a dose-dependent manner. Future studies are needed to assess whether treatment of this EEG activity can improve outcomes.
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