Abstract
Introduction This study examines the utility of electroencephalography (EEG) in clinical decision making in acute ischemic stroke (AIS) patients in regards to the prescription of antiseizure medications. Methods Patients were grouped as having positive EEG (+) for epileptiform activity or negative EEG (-). These studies were no more than 30 minutes in length. Patients' charts were retrospectively reviewed for antiepileptic drug (AED) use before, during, and on discharge from AIS hospitalization. Results Of the 509 patients meeting inclusion criteria, 24 (4.7%) had a positive EEG. Patients did not significantly differ with respect to any demographic or baseline characteristics with the exception of prior history of seizure. In the EEG- group, AEDs were discontinued in only 3.5% of patients. In the EEG+ group, only 37.5% of patients had an initiation or change to their AED regimen within 36 hours of the study. 62.5% of the EEG+ group had a cortical stroke. Significance. Our results indicate that vascular neurologists are not using spot EEGs to routinely guide inpatient AED management. EEGs may have greater utility in those with a prior history of seizures and cortical strokes. Longer or continuous EEG monitoring may have better utility in the AIS population if there is clinical suspicion of seizure.
Highlights
This study examines the utility of electroencephalography (EEG) in clinical decision making in acute ischemic stroke (AIS) patients in regards to the prescription of antiseizure medications
Studies have suggested that epileptiform activity on EEG increases the risk of poststroke seizure, and this has been associated with an unfavorable outcome [6, 7]
509 patients out of 1807 patients (28.1%) who were admitted between 09/2008 and 01/2015 had at least one EEG performed after AIS
Summary
This study examines the utility of electroencephalography (EEG) in clinical decision making in acute ischemic stroke (AIS) patients in regards to the prescription of antiseizure medications. Patients were grouped as having positive EEG (+) for epileptiform activity or negative EEG (-) These studies were no more than 30 minutes in length. EEGs may have greater utility in those with a prior history of seizures and cortical strokes. Studies have suggested that epileptiform activity on EEG increases the risk of poststroke seizure, and this has been associated with an unfavorable outcome [6, 7]. The employment of EEG in guiding antiepileptic drug (AED) management in stroke patients is unclear. In one study of intracerebral hemorrhage, less than 20% of EEGs were ordered to monitor clinically suspected seizure activity [8]. One study from 2019 showed that EEG performed in the ED may help identify patients with large acute strokes and may correlate with infarct volume [9], but with modern imaging techniques and interruption of stroke workflow, the utility of an EEG in ischemic stroke needs to be brought into question
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