Early point-of-care EEG in acute stroke: Prevalence and predictive factors of early post-stroke status epilepticus (e-PSSE)

Purpose: Status epilepticus (SE) is a severe complication of acute stroke (AS), with an incidence of approximately 1.5 %. This study aimed to investigate the prevalence of early post-stroke status epilepticus (e-PSSE) in a real-world stroke cohort using point-of-care EEG within the first 72 h after admission and identify the clinical and laboratory factors associated with its onset during the acute phase. Methods: Clinical, laboratory and radiological data of 647 consecutive patients with AS assessed with point-of-care EEG were retrospectively analyzed. EEG was evaluated for the diagnosis of e-PSSE according to the International Federation of Clinical Neurophysiology criteria. Data of AS patients with PSSE were compared with those without PSSE. Multivariate logistic regression analysis was conducted to identify factors associated with the onset of PSSE. Results: The median age of the cohort was 78 (68–83) and the median NIHSS at admission was 7 (2–11). Early PSSE was found in 27 (4.2 %) of 647 included patients. Multivariate analysis showed that female sex (OR=1.039, p = 0.011), chronic kidney disease (OR=1.052, p = 0.018), hemorrhagic stroke (OR=1.075, p < 0.001), a higher neutrophil to lymphocyte ratio (NLR) (OR=1.005, p = 0.001) and NIHSS at admission (OR=1.004, p = 0.002) were significantly associated with the onset of PSSE. Conclusion: This study highlights the critical role of early EEG assessment in detecting e-PSSE, with an incidence of 4.2 %. Moreover, our findings identify female sex, a history of CKD, higher NIHSS scores, hemorrhagic stroke, and the NLR as independent predictors of PSSE in the acute phase.