Hyper-acute EEG alterations predict functional and morphological outcomes in thrombolysis-treated ischemic stroke: a wir
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ORIGINAL ARTICLE
Hyper-acute EEG alterations predict functional and morphological outcomes in thrombolysis-treated ischemic stroke: a wireless EEG study Miloš Ajčević 1 & Giovanni Furlanis 2 & Marcello Naccarato 2 & Aleksandar Miladinović 1 & Alex Buoite Stella 2 & Paola Caruso 2 & Tommaso Cillotto 2 & Agostino Accardo 1 & Paolo Manganotti 2 Received: 29 April 2020 / Accepted: 20 October 2020 # The Author(s) 2020
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 hyperacute 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 thrombolysistreated 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. Keywords EEG . NIHSS . Hyperacute ischemic stroke . Biomedical signal processing . Outcome prediction
1 Introduction 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]. Recent studies highlighted the efficacy and safety of thrombolytic treatment in extended time
* Miloš Ajčević [email protected] 1
Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10, 34127 Trieste, Italy
2
Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
window, too (4.5–9 h from stroke onset or wake-up stroke) in patients selected by advanced neuroimaging [7, 8, 15, 20]. Early post-stroke prognosis is essential to better establish t
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