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Continuous assessment of electrical epileptic activity in acute stroke

From the Departments of Neurology (E.C., P.M., P.-A.D., M.M.-I., D.D., J.G., G.D., J.B.) and Biostatistics (C.R.), University Hospital, Lausanne, Switzerland.

Address correspondence and reprint requests to Dr. Emmanuel Carrera, Department of Neurology, BH 13, 1011 Lausanne-CHUV, Switzerland; e-mail: Emmanuel.Carrera{at}chuv.ch

Objective: To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke.

Methods: One hundred consecutive patients with acute stroke admitted to our stroke unit underwent cEEG using 10 electrodes. In addition to electrical seizures, repetitive focal sharp waves (RSHWs), repetitive focal spikes (RSPs), and periodic lateralized epileptic discharges (PLEDs) were recorded.

Results: In the 100 patients, cEEG was recorded for a mean duration of 17 hours 34 minutes (range 1 hour 12 minutes to 37 hours 10 minutes). Epileptic activity occurred in 17 patients and consisted of RSHWs in seven, RSPs in seven, and PLEDs in three. Electrical seizures occurred in two patients. On univariate Cox regression analysis, predictors for electrical epileptic activity were stroke severity (high score on the National Institutes of Health Stroke Scale) (hazard ratio [HR] 1.12; p = 0.002), cortical involvement (HR 5.71; p = 0.021), and thrombolysis (HR 3.27; p = 0.040). Age, sex, stroke type, use of EEG-modifying medication, and cardiovascular risk factors were not predictors of electrical epileptic activity. On multivariate analysis, stroke severity was the only independent predictor (HR 1.09; p = 0.016).

Conclusion: In patients with acute stroke, electrical epileptic activity occurs more frequently than previously suspected.

Disclosure: The authors report no conflicts of interest.

Received October 10, 2005. Accepted in final form March 16, 2006.

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