Early EEG biomarkers of perinatal arterial ischemic stroke:a case series

Background Continuous electroencephalogram (EEG) monitoring after seizures may provide an early clue to the diagnosis of perinatal arterial ischemic stroke (PAIS). We aimed to explore EEG biomarkers and seizure patterns of PAIS within 7 days. Methods Data of children with PAIS were retrospectively analyzed. Using multi-channel video electroencephalogram (vEEG) and amplitude-integrated electroencephalogram (aEEG), the patients were divided into three groups according to the monitoring start time after symptom onset: ≤48 h, 48–72 h, and 4–7 days. The characteristics of EEG activity and the law of seizures were compared across groups. Together with magnetic resonance imaging (MRI), the spatial correspondence between brain electrical activity and injury site was determined. Results Of 21 children studied, 19 (90.47%) developed disease within 48 h of delivery. Abnormal sleep–wake cycle, abnormal fast-wave activity, abnormal wave activity, hemispheric asymmetry, electrographic seizures (ESz), and electroclinical seizures (ECSz) were more common in the ≤48 h group and 48–72 h group. Differences among all groups were statistically significant ( P <0.01). The most common abnormal wave activity was sharp wave or freak wave, consistent with the MRI-confirmed injury site. ESz and ECSz were detected in 12 cases (92.31%) in the ≤48 h group and two cases (15.38%) in the 48–72 h group, 66.67% were clonic, and 91.67% were frequent seizures. ESz or ECSz were not detected in the 4–7-day group. The starting point of ESz or ECSz was consistent with the area of the lesion shown by MRI. Conclusions Bi-hemispheric diffuse abnormal fast wave activity, sharp wave or freak wave activity in the local brain region, and ESz or ECSz initiated in the same brain region are EEG biomarkers indicating PAIS. The duration of ESz or ECSz triggered by PAIS was less than 72 h. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was sponsored by Project 82101525 supported by the National Natural Science Foundation of China. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Research Ethics Committee of Shengjing Hospital of China Medical University. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author upon reasonable request. The corresponding author has full access to the data in this study and attests to the quality and integrity of the data set and associated analyses. * (BRDs) : brief rhythmic discharges (ECSz) : electroclinical seizures (EEG) : electroencephalogram (ESz) : electrographic seizures (IBI) : interburst interval (MRI) : magnetic resonance imaging (PAIS) : perinatal arterial ischemic stroke (PDs) : periodic discharges (SWC) : sleep–wake cycling (SE) : status epilepticus