Electroencephalographic biomarkers of epilepsy development in patients with acute brain injury: a matched, parallel cohort study

Abstract

ObjectiveThis study was designed to investigate if highly epileptic electroencephalogram (EEG) findings in patients with acute brain injury increase the long‐term risk of epilepsy development.MethodsAdults patients, lacking epilepsy history, with electrographic seizures or lateralized periodic discharges (LPDs) (cases) were identified and matched based on age, mental status, and etiology with the ones lacking any epileptiform activity (controls) on continuous EEG (cEEG) during hospitalization. The primary outcome of clinical seizures after hospital discharge and their antiepileptic drug (AED) status was determined using a telephonic interview. Logistic regression models using generalized estimating equations to account for the matched nature of the data were performed.ResultsA total of 70 cases [16 (22.9%) “LPDs only,” 34 (48.6%) “electrographic seizure only,” and 20 (28.6%) “both”] and controls were enrolled. A total of 22 (31.4%) cases developed epilepsy after a mean follow‐up duration of 20.6 ± 5.0 months compared to three (4.3%) controls. After adjusting for cEEG indication and follow‐up duration, the odds of cases developing epilepsy were almost 15 times higher compared to the controls (OR = 14.8, 95% CI = 2.4–92.3, P = 0.004). This elevated risk was despite a 10 times higher likelihood of cases to be taking AEDs at the last follow‐up (OR = 10.34, 95% CI = 3.7–29, P < 0.001).InterpretationHighly epileptic EEG findings in patients with acute brain injury may serve as prognostic biomarkers of epilepsy development. Although prospective studies are required to confirm our findings, it seems that with epilepsy developing in almost one‐third cases in less than 2‐year follow‐up period, such patients may potentially be ideal candidates for epilepsy prevention clinical trials.

Long‐term continuation of anti‐seizure medications after acute stroke

“…The follow‐up period in our study is too short to draw any conclusion about the safety of ASM discontinuation before hospital discharge. Prior evidence suggests that only 5%–7% of patients with acute brain injury lacking ASySs and EAs on cEEG develop epilepsy 34,36 …”

Continuous electroencephalography characteristics and acute symptomatic seizures in COVID-19 patients

“…As the COVID-19 pandemic continues, there is a need to better understand the neurological manifestations and associated complications of COVID-19. Acute, clinical, and non-clinical seizures are well-known complications in critically ill patients with sepsis and brain injury ( Oddo et al, 2009 , Newey et al, 2018 , Punia et al, 2019 ). Continuous electroencephalogram (cEEG) monitoring in acutely ill patients has revealed that the acute seizures these patients face are mostly non-convulsive ( Claassen et al, 2004 , Rodriguez Ruiz et al, 2017 ).…”

Seizures and Interictal Epileptiform Activity in the Rat Collagenase Model for Intracerebral Hemorrhage

“…Nevertheless, this activity could not be associated with the development of acute or late seizures (Karhunen et al, 2006). Clinical research already showed the role of epileptiform abnormalities in predicting acute post-stroke seizures (Mecarelli et al, 2011) and more recent research also showed an increased risk of late seizures following early epileptiform abnormalities in patients suffering from acute brain injury (Bentes et al, 2018;Punia et al, 2019;Chen et al, 2021). Furthermore, there is some evidence that post-stroke interictal epileptiform activity is associated with neurological deterioration (Claassen et al, 2007;Scoppettuolo et al, 2019).…”