High epileptiform discharge burden predicts delayed cerebral ischemia after subarachnoid hemorrhage

• Published in: Clinical neurophysiology Vol. 141; pp. 139 - 146
• Main Authors: Kim, Jennifer A., Zheng, Wei-Long, Elmer, Jonathan, Jing, Jin, Zafar, Sahar F., Ghanta, Manohar, Moura, Valdery, Gilmore, Emily J., Hirsch, Lawrence J., Patel, Aman, Rosenthal, Eric, Westover, M. Brandon
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2022
• Subjects: Brain Ischemia - diagnosis; Brain Ischemia - epidemiology; Brain Ischemia - etiology; Burden; Cerebral Infarction; Delayed cerebral ischemia; EEG; Epileptiform discharges; Humans; Periodicity; Retrospective Studies; SAH; Subarachnoid Hemorrhage - complications; Delayed cerebral ischemia; SAH; Burden; Epileptiform discharges; EEG
• ISSN: 1388-2457; 1872-8952; 1872-8952
• DOI: 10.1016/j.clinph.2021.01.022

•Epileptiform discharges(ED) increase after subarachnoid hemorrhage during the high risk delayed cerebral ischemia(DCI) time-frame.•Quantitative ED burden is higher in those who develop DCI compared to those who do not.•ED burden can be used as a marker of DCI risk for automated prediction algorithm development. To investigate whether epileptiform discharge burden can identify those at risk for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). Retrospective analysis of 113 moderate to severe grade SAH patients who had continuous EEG (cEEG) recordings during their hospitalization. We calculated the burden of epileptiform discharges (ED), measured as number of ED per hour. We find that many SAH patients have an increase in ED burden during the first 3–10 days following rupture, the major risk period for DCI. However, those who develop DCI have a significantly higher hourly burden from days 3.5–6 after SAH vs. those who do not. ED burden is higher in DCI patients when assessed in relation to the onset of DCI (area under the receiver operator curve 0.72). Finally, specific trends of ED burden over time, assessed by group-based trajectory analysis, also help stratify DCI risk. These results suggest that ED burden is a useful parameter for identifying those at higher risk of developing DCI after SAH. The higher burden rate associated with DCI supports the theory of metabolic supply-demand mismatch which contributes to this complication. ED burden is a novel biomarker for predicting those at high risk of DCI.