Abstract Details

Title Accounting for Death in the Prediction of Post-intracerebral Hemorrhage Epilepsy Using Quantitative Electroencephalogram and Neuroimaging

Topic Neuro Trauma and Critical Care

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 PM)

Poster/Presentation
Number 7-002

Objective Determine whether incorporating quantitative EEG and neuroimaging features can simultaneously account for risk of epilepsy and death following intracerebral hemorrhage (ICH).

Background Hemorrhagic stroke has the highest rates, of all subtypes, of post-stroke epilepsy and mortality. As stroke severity increases, both the risk of epilepsy and mortality increases, yet few studies have disambiguated factors that may uniquely increase risk for each outcome.

Design/Methods We identified a retrospective cohort of adult ICH patients admitted to a tertiary care center between 2014-2023 who received continuous EEG monitoring. Of 238 included patients, 51 developed PICHE (unprovoked seizure >7 days post-ICH). We extracted total EEG power, rhythmicity, and epileptiform abnormalities (EA; Jing 2023). We obtained automated intraparenchymal (IPH), extra-axial (EAH), intraventricular (IVH) hemorrhage, and edema volumes from stability computed tomography (CT) scans (Monteiro 2020). We conducted proportional cause-specific hazard modeling to identify predictors of PICHE and death and forward selected features in a random survival forest (RSF). We trained and tested the RSF under a competing risk framework using five-fold cross-validation and evaluated model performance using area under the receiver operating curve (AUROC).

Results Features associated with PICHE included early seizures, cortical involvement of ICH, total EA, lateralized period discharges, lateralized rhythmic delta activity, power asymmetry, rhythmicity asymmetry, IPH volume, and edema volume. Features associated with death included age, midline shift, ICH score, generalized rhythmic delta activity, total power, total rhythmicity, and IPH, EAH, edema, and IVH volume. The final model including clinical features, quantitative EEG and neuroimaging predicted PICHE (AUC=0.744 [95CI: 0.581, 0.894]) and death (AUC=0.753 [95CI: 0.664, 0.922]).

Conclusions A competing risk model including clinical features, quantitative EEG, and neuroimaging predicts PICHE and death. Further work is needed to validate in a multicenter cohort. This model could be utilized to guide anti-epileptogenic treatment trial enrollment and patient counseling.

Authors/Disclosures
Justin R. Wheelock PRESENTER	Mr. Wheelock has nothing to disclose.
Yilun Chen (Yale University)	Ms. Chen has nothing to disclose.
Jacob Garetti	Mr. Garetti has nothing to disclose.
Haoqi Sun, PhD (Massachusetts General Hospital)	Dr. Sun has nothing to disclose.
jin jing, PhD	Dr. jing has received publishing royalties from a publication relating to health care.
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.
Aaron F. Struck, MD (Washington University in St. Louis)	The institution of Dr. Struck has received research support from Ceribell.
Lawrence J. Hirsch, MD, FAAN (Yale University Comprehensive Epilepsy Center)	Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for marinus. The institution of Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport Therapeutics. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker; Faculty for Fellows' training course with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus.
Adithya Sivaraju, MD (Yale New Haven Medical Center)	Dr. Sivaraju has nothing to disclose.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
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.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.

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