Abstract
Owing to the large inter-subject variability, early post-stroke prognosis is challenging, and objective biomarkers that can provide further prognostic information are still needed. The relation between quantitative EEG parameters in pre-thrombolysis hyper-acute phase and outcomes has still to be investigated. Hence, possible correlations between early EEG biomarkers, measured on bedside wireless EEG, and short-term/long-term functional and morphological outcomes were investigated in thrombolysis-treated strokes. EEG with a wireless device was performed in 20 patients with hyper-acute (< 4.5 h from onset) anterior ischemic stroke before reperfusion treatment. The correlations between outcome parameters (i.e., 7-day/12-month National Institutes of Health Stroke Scale NIHSS, 12-month modified Rankin Scale mRS, final infarct volume) and the pre-treatment EEG parameters were studied. Relative delta power and alpha power, delta/alpha (DAR), and (delta+theta)/(alpha+beta) (DTABR) ratios significantly correlated with NIHSS 7-day (rho = 0.80, − 0.81, 0.76, 0.75, respectively) and NIHSS 12-month (0.73, − 0.78, 0.74, 0.73, respectively), as well as with final infarct volume (0.75, − 0.70, 0.78, 0.62, respectively). A good outcome in terms of mRS ≤ 2 at 12 months was associated with DAR parameter (p = 0.008). The neurophysiological biomarkers obtained by non-invasive and portable technique as wireless EEG in the early pre-treatment phase may contribute as objective parameters to the short/long-term outcome prediction pivotal to better establish the treatment strategies.Graphical abstractBlock diagram of study protocol and main findings. Assessment at admission including wireless EEG acquisition in emergency setting (< 4.5 from stroke onset), extracted EEG features before reperfusion thrombolytic treatment. The main findings in our study sample are summarized in two different exemplificative stroke patients with different pre-thrombolysis alterations of EEG parameters resulting in different final infarct volume extensions and short/long-term clinical outcomes (NIHSS, mRS).
Highlights
Ischemic stroke is a neuroemergency condition in which reperfusion therapy in selected patients can restore cerebral blood flow and lead to improvement or resolution of neurological deficits [24]
Several independent early predictors of treatmentassociated stroke outcome like age, sex, mean arterial pressure, history of diabetes, baseline glucose levels, baseline National Institutes of Health Stroke Scale (NIHSS) score, neuroimaging findings, time to treatment and recanalization, current smoking, and atrial fibrillation were reported [11, 24, 28]
The aim of this study was to investigate the relation between early stroke-related EEG parameters, measured bedside with wireless EEG before the thrombolysis treatment, and short-term/long-term neurological disability measured with NIHSS and modified Rankin scale (mRS) in thrombolysis-treated ischemic stroke patients
Summary
Ischemic stroke is a neuroemergency condition in which reperfusion therapy in selected patients can restore cerebral blood flow and lead to improvement or resolution of neurological deficits [24]. Thrombolytic therapy delivered within 4.5 h from stroke onset significantly improves the overall odds of a good stroke outcome [27]. Several independent early predictors of treatmentassociated stroke outcome like age, sex, mean arterial pressure, history of diabetes, baseline glucose levels, baseline National Institutes of Health Stroke Scale (NIHSS) score, neuroimaging findings, time to treatment and recanalization, current smoking, and atrial fibrillation were reported [11, 24, 28]. Early prediction of post-stroke outcome is still challenging since there is large inter-subject variability [31]. For this reason, reliable, non-invasive, inexpensive biomarkers that provide further prognostic information are still needed
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