High epileptiform discharge burden predicts delayed cerebral ischemia after subarachnoid hemorrhage

Objective: To investigate whether epileptiform discharge burden can identify those at risk for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH).Methods: 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.Results: We find that many SAH patients have an increase in ED burden during the first 3-10 days follow-ing 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.Conclusions: 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 meta-bolic supply-demand mismatch which contributes to this complication.Significance: ED burden is a novel biomarker for predicting those at high risk of DCI.(c) 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Automated summary

This study aims to investigate whether epileptiform discharge burden can identify individuals at risk for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). A retrospective analysis was conducted on 113 SAH patients with moderate to severe grade who had continuous EEG (cEEG) recordings during hospitalization. The burden of epileptiform discharges (ED), measured as the number of ED per hour, was calculated. The results indicate that ED burden is a useful parameter for identifying individuals at higher risk of developing DCI after SAH, and specific trends of ED burden over time can help stratify DCI risk.