Kai Michael Schubert, Vijaya Dasari, Ana Lúcia Oliveira, Chiara Tatillo, Gilles Naeije, Adam Strzelczyk, Giovanni Merlino, Mariarosaria Valente, Nicolas Gaspard, Vineet Punia, Marian Galovic, Carla Bentes
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引用次数: 0
Abstract
Objective: Seizures negatively impact stroke outcomes, highlighting the need for reliable predictors of post-stroke epilepsy. Although acute symptomatic seizures are a known risk factor, most stroke survivors who develop epilepsy do not experience them. Early electroencephalography (EEG) findings may enhance risk prediction, particularly in patients without acute symptomatic seizures, aiding in patient management and counseling.
Methods: We conducted a multicenter cohort study using data from 1,105 stroke survivors (mean age 71 years, 54% male) with neuroimaging-confirmed ischemic stroke who underwent EEG within 7 days post-stroke. Electrographic biomarkers, including epileptiform activity and regional slowing, were analyzed for their association with post-stroke epilepsy using Cox proportional hazards regression and Fine-Gray subdistribution hazard models, adjusted for differences in EEG timing and patient characteristics.
Results: Post-stroke epilepsy developed in 119 patients (11%), whereas 233 (21%) had acute symptomatic seizures. The 5-year epilepsy risk was 42% (95% confidence interval [CI]: 30-49%) in patients with epileptiform activity versus 13% (95% CI: 9-16%) in those without. Regional slowing doubled the 5-year epilepsy risk (23%, 95% CI: 17-30% vs 11%, 95% CI: 7-16%). Epileptiform activity (subdistribution hazard ratio: 2.3, 95% CI: 1.5-3.4, p < 0.001) and regional slowing (subdistribution hazard ratio: 1.7, 95% CI: 1.1-2.7, p = 0.02) were independently associated with post-stroke epilepsy. A novel prognostic model, SeLECT-EEG (concordance statistic: 0.75, 95% CI: 0.71-0.80), outperformed the previous standard (SeLECT2.0; 0.71, 95% CI: 0.65-0.76, p < 0.001).
Interpretation: Electrographic biomarkers improve post-stroke epilepsy prediction beyond clinical risk factors. The SeLECT-EEG model enhances early risk stratification, particularly in patients without acute symptomatic seizures, informing management strategies and patient counseling. ANN NEUROL 2025.
期刊介绍：
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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