Early EEG biomarkers of perinatal arterial ischemic stroke: a case series

Background: Continuous electroencephalogram (EEG) monitoring after seizures may provide an early clue to the diagnosis of perinatal arterial ischemic stroke (PAIS). We aimed to explore EEG biomarkers and seizure patterns of PAIS within 7 days. Methods: Data of children with PAIS were retrospectively analyzed. Using multi-channel video electroencephalogram (vEEG) and amplitude-integrated electroencephalogram (aEEG), the patients were divided into three groups according to the monitoring start time after symptom onset: [≤]48 h, 48-72 h, and 4-7 days. The characteristics of EEG activity and the law of seizures were compared across groups. Together with magnetic resonance imaging (MRI), the spatial correspondence between brain electrical activity and injury site was determined. Results: Of 21 children studied, 19 (90.47%) developed disease within 48 h of delivery. Abnormal sleep-wake cycle, abnormal fast-wave activity, abnormal wave activity, hemispheric asymmetry, electrographic seizures (ESz), and electroclinical seizures (ECSz) were more common in the [≤]48 h group and 48-72 h group. Differences among all groups were statistically significant (P <0.01). The most common abnormal wave activity was sharp wave or freak wave, consistent with the MRI-confirmed injury site. ESz and ECSz were detected in 12 cases (92.31%) in the [≤]48 h group and two cases (15.38%) in the 48-72 h group, 66.67% were clonic, and 91.67% were frequent seizures. ESz or ECSz were not detected in the 4-7-day group. The starting point of ESz or ECSz was consistent with the area of the lesion shown by MRI. Conclusions: Bi-hemispheric diffuse abnormal fast wave activity, sharp wave or freak wave activity in the local brain region, and ESz or ECSz initiated in the same brain region are EEG biomarkers indicating PAIS. The duration of ESz or ECSz triggered by PAIS was less than 72 h.

[1]  S. Moshé,et al.  The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures , 2021, Epilepsia.

[2]  A. Kirton,et al.  Population Based Birth Prevalence of Disease-Specific Perinatal Stroke , 2020, Pediatrics.

[3]  Adam Kirton,et al.  Perinatal stroke: mechanisms, management, and outcomes of early cerebrovascular brain injury. , 2018, The Lancet. Child & adolescent health.

[4]  L. D. de Vries,et al.  Neurodevelopment After Perinatal Arterial Ischemic Stroke , 2018, Pediatrics.

[5]  J. R. Castro Conde,et al.  EEG findings and outcomes of continuous video-EEG monitoring started prior to initiation of seizure treatment in the perinatal stroke. , 2018, Early human development.

[6]  L. Hirsch,et al.  Brief Potentially Ictal Rhythmic Discharges [B(I)RDs] in Noncritically Ill Adults , 2017, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[7]  R. Ichord,et al.  Incidence and predictors of epilepsy after pediatric arterial ischemic stroke , 2017, Neurology.

[8]  L. Hirsch,et al.  Brief Potentially Ictal Rhythmic Discharges [B(I)RDs] in Non-critically Ill Adults. , 2016, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[9]  E. Boltshauser,et al.  Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke , 2015, Pediatrics.

[10]  Geraldine B. Boylan,et al.  Early Postnatal EEG Features of Perinatal Arterial Ischaemic Stroke with Seizures , 2014, PloS one.

[11]  David Moher,et al.  The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development , 2013, Journal of Medical Case Reports.

[12]  Joseph E. Sullivan,et al.  American Clinical Neurophysiology Society Standardized EEG Terminology and Categorization for the Description of Continuous EEG Monitoring in Neonates: Report of the American Clinical Neurophysiology Society Critical Care Monitoring Committee , 2013, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[13]  M. Benders,et al.  Neonatal posterior cerebral artery stroke: clinical presentation, MRI findings, and outcome , 2013, Developmental medicine and child neurology.

[14]  Taeun Chang,et al.  Symptomatic Neonatal Arterial Ischemic Stroke: The International Pediatric Stroke Study , 2011, Pediatrics.

[15]  F. Tortella,et al.  Occurrence of nonconvulsive seizures, periodic epileptiform discharges, and intermittent rhythmic delta activity in rat focal ischemia , 2003, Experimental Neurology.

[16]  M. André,et al.  [EEG and ischemic stroke in full-term newborns]. , 2003, Neurophysiologie clinique = Clinical neurophysiology.

[17]  E. Mercuri,et al.  Periodic Lateralized Epileptiform Discharges (PLEDs) as Early Indicator of Stroke in Full-Term Newborns , 2000, Neuropediatrics.