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Lanzone J, Motolese F, Ricci L, Tecchio F, Tombini M, Zappasodi F, Cruciani A, Capone F, Di Lazzaro V, Assenza G. Quantitative measures of the resting EEG in stroke: a systematic review on clinical correlation and prognostic value. Neurol Sci 2023; 44:4247-4261. [PMID: 37542545 DOI: 10.1007/s10072-023-06981-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECT Quantitative electroencephalography (qEEG) has shown promising results as a predictor of clinical impairment in stroke. We systematically reviewed published papers that focus on qEEG metrics in the resting EEG of patients with mono-hemispheric stroke, to summarize current knowledge and pave the way for future research. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched the literature for papers that fitted our inclusion criteria. Rayyan QCRR was used to allow deduplication and collaborative blinded paper review. Due to multiple outcomes and non-homogeneous literature, a scoping review approach was used to address the topic. RESULTS Or initial search (PubMed, Embase, Google scholar) yielded 3200 papers. After proper screening, we selected 71 papers that fitted our inclusion criteria and we developed a scoping review thar describes the current state of the art of qEEG in stroke. Notably, among selected papers 53 (74.3%) focused on spectral power; 11 (15.7%) focused on symmetry indexes, 17 (24.3%) on connectivity metrics, while 5 (7.1%) were about other metrics (e.g. detrended fluctuation analysis). Moreover, 42 (58.6%) studies were performed with standard 19 electrodes EEG caps and only a minority used high-definition EEG. CONCLUSIONS We systematically assessed major findings on qEEG and stroke, evidencing strengths and potential pitfalls of this promising branch of research.
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Affiliation(s)
- J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy.
| | - F Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - L Ricci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - F Tecchio
- Laboratory of Electrophysiology for Translational Neuroscience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale Delle Ricerche CNR, Rome, Italy
| | - M Tombini
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - F Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences and Institute for Advanced Biomedical Technologies, 'Gabriele D'Annunzio' University, Chieti, Italy
| | - A Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - F Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - V Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - G Assenza
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
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Rubinos C, Bruzzone MJ, Viswanathan V, Figueredo L, Maciel CB, LaRoche S. Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury. Semin Neurol 2023; 43:675-688. [PMID: 37832589 DOI: 10.1055/s-0043-1775816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Electroencephalography (EEG) is a noninvasive tool that allows the monitoring of cerebral brain function in critically ill patients, aiding with diagnosis, management, and prognostication. Specific EEG features have shown utility in the prediction of outcomes in critically ill patients with status epilepticus, acute brain injury (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and traumatic brain injury), anoxic brain injury, and toxic-metabolic encephalopathy. Studies have also found an association between particular EEG patterns and long-term functional and cognitive outcomes as well as prediction of recovery of consciousness following acute brain injury. This review summarizes these findings and demonstrates the value of utilizing EEG findings in the determination of prognosis.
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Affiliation(s)
- Clio Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Vyas Viswanathan
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Lorena Figueredo
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Carolina B Maciel
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Suzette LaRoche
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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Effect of transcranial direct-current stimulation on executive function and resting EEG after stroke: A pilot randomized controlled study. J Clin Neurosci 2022; 103:141-147. [PMID: 35872448 DOI: 10.1016/j.jocn.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/28/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effects of transcranial direct current stimulation (tDCS) on post-stroke executive impairment (PSEI) remain controversial. Resting stateelectroencephalogram (EEG) can assist in the diagnosis and assessment of executive dysfunction. OBJECTIVES We aimed to use EEG to explore the effect of tDCS on executive function among stroke patients. METHODS Twenty-four patients with PSEI were randomly divided into experimental and control groups, which received real and sham stimulation, respectively. Anodal electrical stimulation was applied to the left dorsolateral prefrontal lobe (F3). The stimulation intensity was 2 mA for 20 min once daily for 7 days. Executive function was monitored using neuropsychological scales. RESULTS The experimental group outperformed the control group in clinical scale results, with significant differences in the following scores: symbol digital modalities test, TMT-A, TMT-B, and digital span test. In the left central zone, theta band power was significantly higher after anodal electrical stimulation than before. Analysis of the correlation between EEG power and psychometric scores revealed that the power change was positively correlated with the scores on the symbol digital modality test (r = 0.435, p < 0.05). CONCLUSION Anodal tDCS can enhance executive function in patients with PSEI, and tDCS-related improvements are related to the enhancement of theta power in the affected region.
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Vatinno AA, Simpson A, Ramakrishnan V, Bonilha HS, Bonilha L, Seo NJ. The Prognostic Utility of Electroencephalography in Stroke Recovery: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2022; 36:255-268. [PMID: 35311412 PMCID: PMC9007868 DOI: 10.1177/15459683221078294] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Improved ability to predict patient recovery would guide post-stroke care by helping clinicians personalize treatment and maximize outcomes. Electroencephalography (EEG) provides a direct measure of the functional neuroelectric activity in the brain that forms the basis for neuroplasticity and recovery, and thus may increase prognostic ability. OBJECTIVE To examine evidence for the prognostic utility of EEG in stroke recovery via systematic review/meta-analysis. METHODS Peer-reviewed journal articles that examined the relationship between EEG and subsequent clinical outcome(s) in stroke were searched using electronic databases. Two independent researchers extracted data for synthesis. Linear meta-regressions were performed across subsets of papers with common outcome measures to quantify the association between EEG and outcome. RESULTS 75 papers were included. Association between EEG and clinical outcomes was seen not only early post-stroke, but more than 6 months post-stroke. The most studied prognostic potential of EEG was in predicting independence and stroke severity in the standard acute stroke care setting. The meta-analysis showed that EEG was associated with subsequent clinical outcomes measured by the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Fugl-Meyer Upper Extremity Assessment (r = .72, .70, and .53 from 8, 13, and 12 papers, respectively). EEG improved prognostic abilities beyond prediction afforded by standard clinical assessments. However, the EEG variables examined were highly variable across studies and did not converge. CONCLUSIONS EEG shows potential to predict post-stroke recovery outcomes. However, evidence is largely explorative, primarily due to the lack of a definitive set of EEG measures to be used for prognosis.
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Affiliation(s)
- Amanda A Vatinno
- Department of Health Sciences and Research, College of Health Professions, 2345Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Annie Simpson
- Department of Health Sciences and Research, College of Health Professions, 2345Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Healthcare Leadership and Management, College of Health Professions, 2345MUSC, Charleston, SC, USA
| | | | - Heather S Bonilha
- Department of Health Sciences and Research, College of Health Professions, 2345Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, 2345MUSC, Charleston, SC, USA
| | - Na Jin Seo
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Health Sciences and Research, 2345MUSC, Charleston, SC, USA
- Division of Occupational Therapy, Department of Rehabilitation Sciences, MUSC, Charleston, SC, USA
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Sutcliffe L, Lumley H, Shaw L, Francis R, Price CI. Surface electroencephalography (EEG) during the acute phase of stroke to assist with diagnosis and prediction of prognosis: a scoping review. BMC Emerg Med 2022; 22:29. [PMID: 35227206 PMCID: PMC8883639 DOI: 10.1186/s12873-022-00585-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke 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 conditions. b) Ischaemic versus haemorrhagic stroke. c) Ischaemic stroke due to LVO. 2. Can these states be identified if EEG is applied < 6 h since onset. 3. Does EEG during acute assessment predict clinical recovery following confirmed stroke. METHODS We 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 < 72 h since suspected or confirmed stroke. RESULTS From 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 < 24 h 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 < 6 h since onset for predicting neurological prognosis post-thrombolysis, with more favourable outcomes associated with greater hemispheric symmetry and a greater ratio of fast to slow waves. CONCLUSIONS Although 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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Affiliation(s)
- Lou Sutcliffe
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Hannah Lumley
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Lisa Shaw
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Richard Francis
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Christopher I Price
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
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Keser Z, Buchl SC, Seven NA, Markota M, Clark HM, Jones DT, Lanzino G, Brown RD, Worrell GA, Lundstrom BN. Electroencephalogram (EEG) With or Without Transcranial Magnetic Stimulation (TMS) as Biomarkers for Post-stroke Recovery: A Narrative Review. Front Neurol 2022; 13:827866. [PMID: 35273559 PMCID: PMC8902309 DOI: 10.3389/fneur.2022.827866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/31/2022] [Indexed: 01/20/2023] Open
Abstract
Stroke is one of the leading causes of death and disability. Despite the high prevalence of stroke, characterizing the acute neural recovery patterns that follow stroke and predicting long-term recovery remains challenging. Objective methods to quantify and characterize neural injury are still lacking. Since neuroimaging methods have a poor temporal resolution, EEG has been used as a method for characterizing post-stroke recovery mechanisms for various deficits including motor, language, and cognition as well as predicting treatment response to experimental therapies. In addition, transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, has been used in conjunction with EEG (TMS-EEG) to evaluate neurophysiology for a variety of indications. TMS-EEG has significant potential for exploring brain connectivity using focal TMS-evoked potentials and oscillations, which may allow for the system-specific delineation of recovery patterns after stroke. In this review, we summarize the use of EEG alone or in combination with TMS in post-stroke motor, language, cognition, and functional/global recovery. Overall, stroke leads to a reduction in higher frequency activity (≥8 Hz) and intra-hemispheric connectivity in the lesioned hemisphere, which creates an activity imbalance between non-lesioned and lesioned hemispheres. Compensatory activity in the non-lesioned hemisphere leads mostly to unfavorable outcomes and further aggravated interhemispheric imbalance. Balanced interhemispheric activity with increased intrahemispheric coherence in the lesioned networks correlates with improved post-stroke recovery. TMS-EEG studies reveal the clinical importance of cortical reactivity and functional connectivity within the sensorimotor cortex for motor recovery after stroke. Although post-stroke motor studies support the prognostic value of TMS-EEG, more studies are needed to determine its utility as a biomarker for recovery across domains including language, cognition, and hemispatial neglect. As a complement to MRI-based technologies, EEG-based technologies are accessible and valuable non-invasive clinical tools in stroke neurology.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Samuel C. Buchl
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Nathan A. Seven
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Matej Markota
- Department of Psychiatry, Mayo Clinic, Rochester, MN, United States
| | - Heather M. Clark
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Robert D. Brown
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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7
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N-Pep-12 supplementation after ischemic stroke positively impacts frequency domain QEEG. Neurol Sci 2021; 43:1115-1125. [PMID: 34173086 DOI: 10.1007/s10072-021-05406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND N-Pep-12 is a dietary supplement with neuroprotective and pro-cognitive effects, as shown in experimental models and clinical studies on patients after ischemic stroke. We tested the hypothesis that N-Pep-12 influences quantitative electroencephalography (QEEG) parameters in patients with subacute to chronic supratentorial ischemic lesions. METHODS We performed secondary data analysis on an exploratory clinical trial (ISRCTN10702895), assessing the efficacy and safety of 90 days of once-daily treatment with 90 mg N-Pep-12 on neurocognitive function and neurorecovery outcome in patients with post-stroke cognitive impairment against a control group. All participants performed two 32-channel QEEG in resting and active states at baseline (30-120 days after stroke) and 90 days later. Power spectral density on the alpha, beta, theta, delta frequency bands, delta/alpha power ratio (DAR), and (delta+theta)/(alpha+beta) ratio (DTABR) were computed and compared across study groups using means comparison and descriptive methods. Secondarily, associations between QEEG parameters and available neuropsychological tests were explored. RESULTS Our analysis showed a statistically significant main effect of EEG segments (p<0.001) in alpha, beta, delta, theta, DA, and DTAB power spectral density. An interaction effect between EEG segments and time was noticed in the alpha power. There was a significant difference in theta spectral power between patients with N-Pep-12 supplementation versus placebo at 0.05 alpha level (p=0.023), independent of time points. CONCLUSION A 90-day, 90 mg daily administration of N-Pep-12 had significant impact on some QEEG indicators in patients after supratentorial ischemic stroke, confirming possible enhancement of post-stroke neurorecovery. Further research is needed to consolidate our findings.
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8
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Dalton SGH, Cavanagh JF, Richardson JD. Spectral Resting-State EEG (rsEEG) in Chronic Aphasia Is Reliable, Sensitive, and Correlates With Functional Behavior. Front Hum Neurosci 2021; 15:624660. [PMID: 33815079 PMCID: PMC8010195 DOI: 10.3389/fnhum.2021.624660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
We investigated spectral resting-state EEG in persons with chronic stroke-induced aphasia to determine its reliability, sensitivity, and relationship to functional behaviors. Resting-state EEG has not yet been characterized in this population and was selected given the demonstrated potential of resting-state investigations using other neuroimaging techniques to guide clinical decision-making. Controls and persons with chronic stroke-induced aphasia completed two EEG recording sessions, separated by approximately 1 month, as well as behavioral assessments of language, sensorimotor, and cognitive domains. Power in the classic frequency bands (delta, theta, alpha, and beta) was examined via spectral analysis of resting-state EEG data. Results suggest that power in the theta, alpha, and beta bands is reliable for use as a repeated measure. Significantly greater theta and lower beta power was observed in persons with aphasia (PWAs) than controls. Finally, in PWAs theta power negatively correlated with performance on a discourse informativeness measure, while alpha and beta power positively correlated with performance on the same measure. This indicates that spectral rsEEG slowing observed in PWAs in the chronic stage is pathological and suggests a possible avenue for directly altering brain activation to improve behavioral function. Taken together, these results suggest that spectral resting-state EEG holds promise for sensitive measurement of functioning and change in persons with chronic aphasia. Future studies investigating the utility of these measures as biomarkers of frank or latent aphasic deficits and treatment response in chronic stroke-induced aphasia are warranted.
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Affiliation(s)
- Sarah G. H. Dalton
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI, United States
| | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Jessica D. Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
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9
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Doerrfuss JI, Kilic T, Ahmadi M, Holtkamp M, Weber JE. Quantitative and Qualitative EEG as a Prediction Tool for Outcome and Complications in Acute Stroke Patients. Clin EEG Neurosci 2020; 51:121-129. [PMID: 31533467 DOI: 10.1177/1550059419875916] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently, the relevance of EEG measurements in acute stroke patients is considered low in clinical practice. However, recent studies on the predictive value of EEG measurements after stroke for various outcomes may increase the role of EEG in patients with stroke. We aimed to review the current literature on the utility of EEG measurements after stroke as a tool to predict outcome and complications, focusing on studies in which the EEG measurement was performed in the acute phase after the event and in which long-term outcome measures were reported. In our literature review, we identified 4 different outcome measures (functional outcome, mortality, development of post-stroke cognitive decline, and development of post-stroke epilepsy) where studies on the utility of acute EEG measurements exist. There is a large body of evidence for the prediction of functional outcome, in which a multitude of associated quantitative and qualitative EEG parameters are described. In contrast, only few studies focus on mortality as outcome parameter. We found studies of high methodical quality on the prediction of post-stroke cognitive decline, though the number of patients in these studies often was small. The role of EEG as a prediction tool for seizures and epilepsy after stroke could increase after a recently published study, especially if its result can be incorporated into already existing post-stroke epilepsy prediction tools. In summary, EEG is useful for the prediction of functional outcome, mortality, development of post-stroke cognitive decline and epilepsy, even though there is a discrepancy between the large amount of studies on EEG in acute stroke patients and its underuse in clinical practice.
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Affiliation(s)
- Jakob I Doerrfuss
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Tayfun Kilic
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Michael Ahmadi
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim E Weber
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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Sivam S, Poon J, Wong KKH, Yee BJ, Piper AJ, D’rozario AL, Wang D, Grunstein RR. Slow-frequency electroencephalography activity during wake and sleep in obesity hypoventilation syndrome. Sleep 2019; 43:5573562. [DOI: 10.1093/sleep/zsz214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/06/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractStudy ObjectiveNeurophysiological activity during wake and sleep states in obesity hypoventilation (OHS) and its relationship with neurocognitive function is not well understood. This study compared OHS with equally obese obstructive sleep apnea (OSA) patients, with similar apnea-hypopnea indices.MethodsResting wake and overnight sleep electroencephalography (EEG) recordings, neurocognitive tests, and sleepiness, depression and anxiety scores were assessed before and after 3 months of positive airway pressure (PAP) therapy in 15 OHS and 36 OSA patients.ResultsPretreatment, greater slow frequency EEG activity during wake and sleep states (increased delta-alpha ratio during sleep, and theta power during awake) was observed in the OHS group compared to the OSA group. EEG slowing was correlated with poorer performance on the psychomotor vigilance task (slowest 10% of reciprocal reaction times, psychomotor vigilance test [PVT SRRT], primary outcome), and worse sleep-related hypoxemia measures in OHS. There was no between-group significant difference in PVT performance at pre or post-treatment. Similarly, despite both groups demonstrating improved sleepiness, anxiety and depression scores with PAP therapy, there were no differences in treatment response between the OSA and OHS groups.ConclusionPatients with OHS have greater slow frequency EEG activity during sleep and wake than equally obese patients with OSA. Greater EEG slowing was associated with worse vigilance and lower oxygenation during sleep.Clinical TrialThis trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12615000122550).
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Affiliation(s)
- Sheila Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Joseph Poon
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Keith K H Wong
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Brendon J Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Amanda J Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Angela L D’rozario
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
- The University of Sydney, School of Psychology, Brain and Mind Centre and Charles Perkins Centre, Camperdown, Australia Institution where work was performed: Royal Prince Alfred Hospital, Sydney, Australia
| | - David Wang
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Ronald R Grunstein
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
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Petrovic J, Milosevic V, Zivkovic M, Stojanov D, Milojkovic O, Kalauzi A, Saponjic J. Slower EEG alpha generation, synchronization and "flow"-possible biomarkers of cognitive impairment and neuropathology of minor stroke. PeerJ 2017; 5:e3839. [PMID: 28970969 PMCID: PMC5623310 DOI: 10.7717/peerj.3839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background We investigated EEG rhythms, particularly alpha activity, and their relationship to post-stroke neuropathology and cognitive functions in the subacute and chronic stages of minor strokes. Methods We included 10 patients with right middle cerebral artery (MCA) ischemic strokes and 11 healthy controls. All the assessments of stroke patients were done both in the subacute and chronic stages. Neurological impairment was measured using the National Institute of Health Stroke Scale (NIHSS), whereas cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) and MoCA memory index (MoCA-MIS). The EEG was recorded using a 19 channel EEG system with standard EEG electrode placement. In particular, we analyzed the EEGs derived from the four lateral frontal (F3, F7, F4, F8), and corresponding lateral posterior (P3, P4, T5, T6) electrodes. Quantitative EEG analysis included: the group FFT spectra, the weighted average of alpha frequency (αAVG), the group probability density distributions of all conventional EEG frequency band relative amplitudes (EEG microstructure), the inter- and intra-hemispheric coherences, and the topographic distribution of alpha carrier frequency phase potentials (PPs). Statistical analysis was done using a Kruskal–Wallis ANOVA with a post-hoc Mann–Whitney U two-tailed test, and Spearman’s correlation. Results We demonstrated transient cognitive impairment alongside a slower alpha frequency (αAVG) in the subacute right MCA stroke patients vs. the controls. This slower alpha frequency showed no amplitude change, but was highly synchronized intra-hemispherically, overlying the ipsi-lesional hemisphere, and inter-hemispherically, overlying the frontal cortex. In addition, the disturbances in EEG alpha activity in subacute stroke patients were expressed as a decrease in alpha PPs over the frontal cortex and an altered “alpha flow”, indicating the sustained augmentation of inter-hemispheric interactions. Although the stroke induced slower alpha was a transient phenomenon, the increased alpha intra-hemispheric synchronization, overlying the ipsi-lesional hemisphere, the increased alpha F3–F4 inter-hemispheric synchronization, the delayed alpha waves, and the newly established inter-hemispheric “alpha flow” within the frontal cortex, remained as a permanent consequence of the minor stroke. This newly established frontal inter-hemispheric “alpha flow” represented a permanent consequence of the “hidden” stroke neuropathology, despite the fact that cognitive impairment has been returned to the control values. All the detected permanent changes at the EEG level with no cognitive impairment after a minor stroke could be a way for the brain to compensate for the lesion and restore the lost function. Discussion Our study indicates slower EEG alpha generation, synchronization and “flow” as potential biomarkers of cognitive impairment onset and/or compensatory post-stroke re-organizational processes.
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Affiliation(s)
- Jelena Petrovic
- Department of Neurobiology, Institute for Biological Research-Sinisa Stankovic, University of Belgrade, Belgrade, Serbia
| | - Vuk Milosevic
- Clinic of Neurology, Clinical Center Nis, Nis, Serbia
| | | | | | - Olga Milojkovic
- Clinic for Mental Health Protection, Clinical Center Nis, Nis, Serbia
| | - Aleksandar Kalauzi
- Department for Life Sciences, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Jasna Saponjic
- Department of Neurobiology, Institute for Biological Research-Sinisa Stankovic, University of Belgrade, Belgrade, Serbia
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12
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Schleiger E, Wong A, Read S, Rowland T, Finnigan S. Poststroke QEEG informs early prognostication of cognitive impairment. Psychophysiology 2016; 54:301-309. [DOI: 10.1111/psyp.12785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Schleiger
- The University of Queensland, UQ Centre for Clinical Research; Brisbane Australia
- School of Medicine; The University of Queensland; Brisbane Australia
| | - Andrew Wong
- School of Medicine; The University of Queensland; Brisbane Australia
- Acute Stroke Unit, Neurology Department, Royal Brisbane and Women's Hospital; Herston Australia
| | - Stephen Read
- School of Medicine; The University of Queensland; Brisbane Australia
| | - Tennille Rowland
- Acute Stroke Unit, Neurology Department, Royal Brisbane and Women's Hospital; Herston Australia
- Occupational Therapy Department; Royal Brisbane and Women's Hospital; Herston Australia
| | - Simon Finnigan
- The University of Queensland, UQ Centre for Clinical Research; Brisbane Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital; Herston Australia
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13
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Carrick FR, Oggero E, Pagnacco G, Wright CHG, Machado C, Estrada G, Pando A, Cossio JC, Beltrán C. Eye-Movement Training Results in Changes in qEEG and NIH Stroke Scale in Subjects Suffering from Acute Middle Cerebral Artery Ischemic Stroke: A Randomized Control Trial. Front Neurol 2016; 7:3. [PMID: 26834698 PMCID: PMC4722822 DOI: 10.3389/fneur.2016.00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/08/2016] [Indexed: 11/25/2022] Open
Abstract
Context Eye-movement training (EMT) can induce altered brain activation and change the functionality of saccades with changes of the brain in general. Objective To determine if EMT would result in changes in quantitative electroencephalogram (qEEG) and NIH Stroke Scale (NIHSS) in patients suffering from acute middle cerebral artery (MCA) infarction. Our hypothesis is that there would be positive changes in qEEG and NIHSS after EMT in patients suffering from acute MCA ischemic stroke. Design Double-blind randomized controlled trial. Setting and participants Thirty-four subjects with acute MCA ischemic stroke treated at university affiliated hospital intensive care unit. Interventions Subjects were randomized into a “control” group treated only with aspirin (125 mg/day) and a “treatment” group treated with aspirin (125 mg/day) and a subject-specific EMT. Main outcome measures Delta–alpha ratio, power ratio index, and the brain symmetry index calculated by qEEG and NIHSS. Results There was strong statistical and substantive significant improvement in all outcome measures for the group of stroke patients undergoing EMT. Such improvement was not observed for the “control” group, and there were no adverse effects. Conclusion The addition of EMT to a MCA ischemic stroke treatment paradigm has demonstrated statistically significant changes in outcome measures and is a low cost, safe, and effective complement to standard treatment.
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Affiliation(s)
- Frederick Robert Carrick
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Global Clinical Scholars Research Training Program (GCSRT), Harvard Medical School, Boston, MA, USA; Institute of Neurology and Neurosurgery, Havana, Cuba; Bedfordshire Centre for Mental Health Research, University of Cambridge, Cambridge, UK
| | - Elena Oggero
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Electrical and Computer Engineering, University of Wyoming, Laramie, WY, USA
| | - Guido Pagnacco
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Electrical and Computer Engineering, University of Wyoming, Laramie, WY, USA
| | - Cameron H G Wright
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Electrical and Computer Engineering, University of Wyoming, Laramie, WY, USA
| | - Calixto Machado
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Institute of Neurology and Neurosurgery, Havana, Cuba
| | - Genco Estrada
- Institute of Neurology and Neurosurgery , Havana , Cuba
| | | | - Juan C Cossio
- Institute of Neurology and Neurosurgery , Havana , Cuba
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