Electroencephalography Might Improve Diagnosis of Acute Stroke and Large Vessel Occlusion

Erani, Fareshte; Zolotova, Nadezhda; Vanderschelden, Benjamin; Khoshab, Nima; Sarian, Hagop; Nazarzai, Laila; Wu, Jianni; Chakravarthy, Bharath; Hoonpongsimanont, Wirachin; Yu, Wengui; Shahbaba, Babak; Srinivasan, Ramesh; Cramer, Steven C.

doi:10.1161/strokeaha.120.030150

Cited by 42 publications

(69 citation statements)

References 11 publications

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“…A previous small study of 24 suspected stroke patients found that the alpha-delta ratio, the (delta*theta)/(alpha*beta) ratio, delta power and lower beta power discriminated between patients with and without an AIS with a large infarct volume, in a population of suspected stroke patients in the ER [16]. In another study, dry electrode EEG recordings were performed in 100 patients with suspected or definite stroke in the ER [17]. In this study, the relative theta power and relative alpha power combined identified LVO-a stroke with an AUC of 0.69.…”

Section: Discussionmentioning

confidence: 99%

“…Electroencephalography (EEG) may be an alternative to boost diagnostic accuracy of prehospital LVO-a stroke identification. Recently, two small studies performed in an emergency department setting have provided preliminary data that suggest that EEG could be a feasible instrument for detection of LVO-a stroke [16,17]. Although traditional EEG measurement requires long preparation times, solutions for faster and easier application are available.…”

Section: Introductionmentioning

confidence: 99%

“…Although traditional EEG measurement requires long preparation times, solutions for faster and easier application are available. For example, dry electrodes require no skin preparation or conductive paste and can reduce EEG preparation time to less than 5 min [17]. ELECTRA-STROKE is an ongoing study with the primary aim to determine the diagnostic accuracy of dry electrode EEG for LVO-a stroke detection in the prehospital setting.…”

Section: Introductionmentioning

confidence: 99%

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Detection of large vessel occlusion stroke with electroencephalography in the emergency room: first results of the ELECTRA-STROKE study

et al. 2021

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Background Prehospital detection of large vessel occlusion stroke of the anterior circulation (LVO-a) would enable direct transportation of these patients to an endovascular thrombectomy (EVT) capable hospital. The ongoing ELECTRA-STROKE study investigates the diagnostic accuracy of dry electrode electroencephalography (EEG) for LVO-a stroke in the prehospital setting. To determine which EEG features are most useful for this purpose and assess EEG data quality, EEG recordings are also performed in the emergency room (ER). Here, we report data of the first 100 patients included in the ER. Methods Patients presented to the ER with a suspected stroke or known LVO-a stroke underwent a single EEG prior to EVT. Diagnostic accuracy for LVO-a stroke of frequency band power, brain symmetry and phase synchronization measures were evaluated by calculating receiver operating characteristic curves. Optimal cut-offs were determined as the highest sensitivity at a specificity of ≥ 80%. Results EEG data were of sufficient quality for analysis in 65/100 included patients. Of these, 35/65 (54%) had an acute ischemic stroke, of whom 9/65 (14%) had an LVO-a stroke. Median onset-to-EEG-time was 266 min (IQR 121–655) and median EEG-recording-time was 3 min (IQR 3–5). The EEG feature with the highest diagnostic accuracy for LVO-a stroke was theta–alpha ratio (AUC 0.83; sensitivity 75%; specificity 81%). Combined, weighted phase lag index and relative theta power best identified LVO-a stroke (sensitivity 100%; specificity 84%). Conclusion Dry electrode EEG is a promising tool for LVO-a stroke detection, but data quality needs to be improved and validation in the prehospital setting is necessary. (TRN: NCT03699397, registered October 9 2018).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Detection of large vessel occlusion stroke with electroencephalography in the emergency room: first results of the ELECTRA-STROKE study

et al. 2021

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“…The quality of these studies was mixed, with a median score of 3 (range 2-4). Four reported that relative spectral power detected large infarct volume (more common in LVO), either by identifying areas of increased slower-waves (delta [11,21] and theta [22]) and/or decreased fast-waves (beta [21,38] and alpha [22]). Epileptiform activity (including slowing of frequencies) differentiated between territorial infarcts more typical of LVO and sub-cortical infarcts more likely to result from small vessel ischaemia [39].…”

Section: B) Identi Cation Of Ischaemic Versus Haemorrhagic Strokementioning

confidence: 99%

Surface Electroencephalography (EEG) During the Acute Phase of Stroke to Assist With Diagnosis and Prediction of Prognosis: a Scoping Review.

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et al. 2021

Preprint

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BackgroundStroke is a common medical emergency responsible for significant mortality and disability. Early identification improves outcomes by promoting access to time-critical treatments such as thrombectomy for large vessel occlusion (LVO), whilst accurate prognosis could inform many acute management decisions. Surface electroencephalography (EEG) shows promise for stroke identification and outcome prediction, but evaluations have varied in technology, setting, population and purpose. This scoping review aimed to summarise published literature addressing the following questions:1. Can EEG during acute clinical assessment identify:a) Stroke versus non-stroke mimic conditionsb) Ischaemic versus haemorrhagic strokec) Ischaemic stroke due to LVO. 2. Can these states be identified if EEG is applied <6hrs since onset. 3. Does EEG during acute assessment predict clinical recovery following confirmed stroke.MethodsWe performed a systematic search of five bibliographic databases ending 19/10/2020. Two reviewers assessed eligibility of articles describing diagnostic and/or prognostic EEG application <72hrs since suspected or confirmed stroke. ResultsFrom 5892 abstracts, 210 full text articles were screened and 39 retained. Studies were small and heterogeneous. Amongst 21 reports of diagnostic data, consistent associations were reported between stroke, greater delta power, reduced alpha/beta power, corresponding ratios and greater brain asymmetry. When reported, the area under the curve (AUC) was at least good (0.81–1.00). Only one study combined clinical and EEG data (AUC 0.88). There was little data found describing whether EEG could identify ischaemic versus haemorrhagic stroke. Radiological changes suggestive of LVO were also associated with increased slow and decreased fast waves. The only study with angiographic proof of LVO reported AUC 0.86 for detection <24hrs since onset. Amongst 26 reports of prognostic data, increased slow and reduced fast wave EEG changes were associated with future dependency, neurological impairment, mortality and poor cognition, but there was little evidence that EEG enhanced outcome prediction relative to clinical and/or radiological variables. Only one study focussed solely on patients <6hrs since onset, for predicting neurological prognosis post-thrombolysis.ConclusionsAlthough studies report important associations with EEG biomarkers, further technological development and adequately powered real-world studies are required before recommendations can be made regarding application during acute stroke assessment.

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“…There has been growing utilization of EEG for diagnosis and monitoring of neurological disorders such as stroke 6 , and concussion 7 . Common imaging methods for detecting brain damage, e.g., magnetic resonance imaging (MRI) 8,9 , or computed tomography 10 , are not portable, are not designed for continuous (or frequent) monitoring, are difficult to use in many emergency situations, and may not even be available at medical facilities in many countries.…”

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confidence: 99%

Neural silences can be localized rapidly using noninvasive scalp EEG

2021

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A rapid and cost-effective noninvasive tool to detect and characterize neural silences can be of important benefit in diagnosing and treating many disorders. We propose an algorithm, SilenceMap, for uncovering the absence of electrophysiological signals, or neural silences, using noninvasive scalp electroencephalography (EEG) signals. By accounting for the contributions of different sources to the power of the recorded signals, and using a hemispheric baseline approach and a convex spectral clustering framework, SilenceMap permits rapid detection and localization of regions of silence in the brain using a relatively small amount of EEG data. SilenceMap substantially outperformed existing source localization algorithms in estimating the center-of-mass of the silence for three pediatric cortical resection patients, using fewer than 3 minutes of EEG recordings (13, 2, and 11mm vs. 25, 62, and 53 mm), as well for 100 different simulated regions of silence based on a real human head model (12 ± 0.7 mm vs. 54 ± 2.2 mm). SilenceMap paves the way towards accessible early diagnosis and continuous monitoring of altered physiological properties of human cortical function.

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Electroencephalography Might Improve Diagnosis of Acute Stroke and Large Vessel Occlusion

Cited by 42 publications

References 11 publications

Detection of large vessel occlusion stroke with electroencephalography in the emergency room: first results of the ELECTRA-STROKE study

Detection of large vessel occlusion stroke with electroencephalography in the emergency room: first results of the ELECTRA-STROKE study

Surface Electroencephalography (EEG) During the Acute Phase of Stroke to Assist With Diagnosis and Prediction of Prognosis: a Scoping Review.

Neural silences can be localized rapidly using noninvasive scalp EEG

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