Abstract Details

Title Burden of Epileptiform Activity Predicts Discharge Neurologic Outcomes in Severe Acute Ischemic Stroke

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 053

Objective

Here, we evaluate the impact of electrographic epileptiform abnormalities (EAs), including electrographic seizures and periodic and rhythmic patterns, on outcomes in patients with acute ischemic stroke (AIS).

Background

Clinical seizures following AIS appear to contribute to worse neurologic outcomes. However, the effect of EAs more broadly is less clear.

Design/Methods This is a retrospective study of all patients with AIS aged ≥ 18 years who underwent at least 18 h of continuous EEG monitoring at a single center between 2012 and 2017. EAs were classified as seizures and periodic and rhythmic patterns. EA burden for each 24-h epoch was as: EA presence, maximum daily burden < 10% versus > 10%, maximum daily burden < 50% versus > 50%, and maximum daily burden using categories(“rare” < 1%; “occasional” 1–9%; “frequent” 10–49%; “abundant” 50–89%; “continuous”> 90%). Poor neurologic outcome was defined as a modified Rankin Scale score of 4–6 (vs. 0–3 as good outcome) at hospital discharge.

Results

One hundred and forty-three patients met study inclusion criteria. 46.9% had EAs. 86.7% had poor outcome. On univariate analysis, the presence of EAs and maximum daily burden > 10% and > 50% 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. 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).

Conclusions

Electrographic seizures and periodic and rhythmic patterns in patients with AIS are associated with worse outcomes in a dose-dependent manner.

Authors/Disclosures
Mohammad Tabaeizadeh Fesharaki, MD PRESENTER	Dr. Tabaeizadeh Fesharaki has nothing to disclose.
Hassan Aboul Nour, MD	Dr. Aboul Nour has nothing to disclose.
Maryum Shoukat, MD	Dr. Shoukat has nothing to disclose.
Haoqi Sun, PhD (Massachusetts General Hospital)	Dr. Sun has nothing to disclose.
Jin Jing	No disclosure on file
Farrukh Javed, MD	Dr. Javed has nothing to disclose.
	No disclosure on file
Muhammad Muzzammil Edhi, MBBS (Brown University/ Rhode Island Hospital)	Dr. Edhi has nothing to disclose.
Elahe Bordbar, MD	Dr. Bordbar has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Andrew Cole, MD, FAAN (Massachusetts General Hospital)	Dr. Cole has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Cole has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ANA. Dr. Cole has received publishing royalties from a publication relating to health care.
Eric Rosenthal, MD (Massachusetts General Hospital)	Dr. Rosenthal has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma, Inc. . Dr. Rosenthal has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell, Inc. . The institution of Dr. Rosenthal has received research support from Sage Therapeutics. Dr. Rosenthal has received intellectual property interests from a discovery or technology relating to health care.
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Sahar Zafar, MD	Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Zafar has received research support from NIH. Dr. Zafar has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker for a lecture with Marinus.

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