Stellenwert frühzeitiger Langzeit-EEG-Ableitungen nach akuter zerebraler Ischämie

E. I. Strittmatter; W. Scheuler; S. Behrens; D. Capone; B. Pohlmann-Eden

doi:10.1055/s-2002-23088

Klinische Neurophysiologie, Table of Contents

Klinische Neurophysiologie 2002; 33(1): 34-41
DOI: 10.1055/s-2002-23088

Originalia

Stellenwert frühzeitiger Langzeit-EEG-Ableitungen nach akuter zerebraler Ischämie

The Relevance of Early Electroencephalography in Acute Ischemic StrokeE. I. Strittmatter¹ , W. Scheuler² , S. Behrens¹ , D. Capone¹ , B. Pohlmann-Eden^1, ³

¹Neurologische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg
²Lindenhofspital, Bern, Schweiz
³Division of Neurology, Western Toronto Hospital, University of Toronto, Canada

Abstract

Zusammenfassung

Einleitung: Der breiten Anwendung aktueller bildgebender Verfahren zur Klärung der Pathophysiologie des ischämischen Insults steht ein deutlicher Mangel an frühen prospektiven, standardisierten funktionellen elektroenzephalographischen Studien gegenüber. Methoden: In der vorliegenden prospektiven Studie wurden 25 konsekutive Patienten mit erstmaliger akuter, supratentorieller, zerebraler Ischämie ohne Anfallsvorgeschichte untersucht. Hierzu wurden 12 Stunden nach Symptombeginn 24-stündige Langzeit-EEGs abgeleitet. Das neurologische Defizit wurde mittels NIH Stroke Scale (NIHSS) und der Behinderungsgrad mit dem Barthel-Index (BI) zum Zeitpunkt der EEG-Ableitung sowie nach einem Jahr erfasst. Ergebnisse: Die geblindet durchgeführte EEG-Auswertung ergab drei hierarchische Gruppen: unspezifische Verlangsamungen (n = 9, Gruppe C), fokale hochgespannte Entladungen (n = 10, Gruppe B) und epileptiforme Entladungen (n = 6, Gruppe A). Die temporospatiale Evolution spezifischer, elektrischer Potenzialmuster ermöglichte eine verfeinerte Analyse der pathophysiologischen Abläufe. Eine deutlich verlangsamte Grundaktivität, die Manifestation kontralateraler Veränderungen und eine Rhythmisierung des Herdbefundes war positiv korreliert mit dem Auftreten steilerer Potenziale und epileptiformer Entladungen. Die EEG-Gruppen unterschieden sich in der NIHSS, im BI sowie bezüglich des Auftretens epileptischer Anfälle jeweils statistisch hoch signifikant (p < 0,0001). Alle Patienten der EEG-Gruppe C hatten ein gutes Outcome (NIHSS < 10 bzw. BI > 60) und keiner von ihnen entwickelte epileptische Anfälle (EA) (positiver Vorhersagewert [PV] 1; 95 %-Konfidenzintervall [KI]: 0,72 - 1). Alle Patienten der EEG-Gruppe A zeigten ein schlechtes Outcome (NIHSS > 20 bzw. BI < 20 oder Tod: PV 1; KI 0,61 - 1). 5 der 6 Patienten bekamen EA (PV 0,83; KI 0,36 - 1). Patienten mit EA wiesen eine signifikant erhöhte Mortalität auf (p < 0,025). Schlussfolgerung: Die vorliegenden Daten unterstreichen die Bedeutung von frühzeitigem EEG-Monitoring nach akuter, zerebraler Ischämie für ein erweitertes pathophysiologisches Verständnis ischämieassoziierter Anfälle und prognoserelevanter Faktoren.

Abstract

Introduction: There is substantial lack of well-designed functional electrophysiological studies with respect to pathophysiology and prognosis after cerebral ischaemia despite increasing progress in neuroimaging. Methods: We prospectively investigated 25 consecutive patients with acute first-ever supratentorial ischaemic stroke and no history of epilepsy. 24h-EEG monitoring was started within 12 hours after the onset of symptoms. The neurological deficit was assessed by NIH Stroke Scale (NIHSS) and Barthel Index (BI) during EEG recording and after 1 year. Results: Blinded EEG evaluation revealed 3 hierarchical classes: focal slowing (n = 9, group C), focal high voltage discharges (n = 10, group B) and epileptiform activity (n = 6, group A). Temporo-spatial EEG evolution was illustrated in reproducible time series and thus allowed a refined analysis of the underlying pathophysiology. Slowing-down of the background activity, occurrence of contralateral potentials and rhythmic focal slowing-down seemed to correlate with a higher incidence of high-voltage discharges and epileptiform activity. The EEG groups differed significantly (p < 0.0001) in NIHSS BI and in the occurrence of seizures. All patients of group C had a good outcome (NIHSS < 10, BI > 60) and no one developed seizures (predictive value [pv] = 1; 95 % confidence interval [CI] 0,72 - 1). In contrast all patients of group A had a poor outcome (NIHSS > 20, BI < 20 or death; PV 1, CI 0,61 - 1) and 5 of them developed seizures (PV 0,83; CI 0,36 - 1). Patients with epileptic seizures had a significant higher mortality (p < 0.025) Conclusions: Our data underline the importance of early post-ischaemic EEG recording both for understanding pathophysiological mechanisms of post-ischaemic seizures and the prognosis of acute stroke.

Key words

Acute stroke - EEG - Seizures - Outcome

Full Text

References

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Dr. med. E. I. Strittmatter

Neurologische Klinik · Universitätsklinikum Heidelberg

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