None listed
Conditions
Brief summary
Stroke is a leading cause of death, disability and huge socio-economic burden. It is caused by reduced blood supply (acute ischaemic stroke = AIS) or bleeding in the brain (intracerebral haemorrhage = ICH). Clinical prognosis and management in the acute post-stroke period are vitally informed by neurological assessment and accurate characterisation of brain injury. It is known that stroke-affected brain regions generate abnormal electrical signals which can be detected with electroencephalography (EEG) using electrodes placed non-invasively on the head. Quantitative analyses of EEG (QEEG) have been utilised over the past decade in stroke and other patients. EEG has a significant advantage in that it is virtually without contraindication or side effects and can be continuously performed at the bedside. This enables QEEG to monitor response to treatments as well; especially in consonance with the current brain imaging techniques. However, despite mounting evidence, QEEG surprisingly remains relatively under-utilised in acute stroke patients. An apparent reason for this is that it is unclear which parameter(s) is able to predict the patient’s clinical outcome most precisely and; whether this varies with stroke sub-type or timing of EEG. Broadly, this research is intended to identify the optimal QEEG parameters (timing, frequency/amplitude vs. interhemispheric symmetry measures) for prognostication in AIS & ICH.
Interventions
QEEG Recording
Nineteen electrode (10–20 system) standard clinical EEG will be performed. This will be done using a cap for convenient and accurate placement of sensors (electrodes) as we have used in the past stroke EEG studies at the RBWH. The “NicoletOne ICU Brain Monitor” EEG System (CareFusion Healthcare) will be used. This system is currently a leading clinical EEG system in the global market. EEG data will be recorded into a hard drive installed in this system. With this EEG system, th
QEEG Recording Nineteen electrode (10–20 system) standard clinical EEG will be performed. This will be done using a cap for convenient and accurate placement of sensors (electrodes) as we have used in the past stroke EEG studies at the RBWH. The “NicoletOne ICU Brain Monitor” EEG System (CareFusion Healthcare) will be used. This system is currently a leading clinical EEG system in the global market. EEG data will be recorded into a hard drive installed in this system. With this EEG system, the electrodes can be connected to a portable wireless device which would facilitate patient movement and comfort. The acute recording duration will be from 30 minutes minimum to 6 hours maximum depending upon factors such as treatment, stroke severity and an individual patient's comfort. The expected median acute EEG recording time per patient will be 2 hours across all patients. A subacute EEG will be performed at 72 +/-4 hours. Its duration will be up to 30 minutes at maximum. It is endeavoured to ensure that recording of EEG is carried out in an absolutely conducive manner without causing any alterations or delay to the standard of care of the participants. This will enhance the research aim of supporting the complementary nature of this vital investigative tool. QEEG Analysis We will apply the same quantified EEG analysis methods that we have in past published studies (e.g., Finnigan et al., 2004; 2007). In addition the QEEG “brain symmetry index” will be calculated precisely as per the published methods of Sheorajpanday and colleagues (2010). These analyses will be performed “offline”, subsequent to end of the EEG recording. These will be performed in a blinded manner; that is, the investigator performing the QEEG analyses will be blinded to patient outcomes and stroke type. Clinical Assessments Patients’ clinical assessments will be performed at the initial presentation, at day 5-7, at discharge (if later than a week) and at a 3 month (approximately) follow up. This will be done using the universally used (both in clinical practice and stroke research) NIHSS. In addition the patients will be assessed on modified Rankin Scale {mRS; (Rankin 1957)} as well as Barthel Index {BI; (Mahoney 1965)} at the 3 month follow up appointment. These assessments (initial as well as at the 3 – moth follow up) are an integral part of the routine evaluation of stroke patients.
Sponsors
Royal Brisbane & Women's Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient presenting with acute stroke within 24 hours of onset of symptoms
Exclusion criteria
Patients under 18 years of age (RBWH primarily treats adult patients and data of use of EEG in stroke patients < 18 years of age is limited) Pregnant patients (use of various investigations e.g., CT and treatments e.g., thrombolysis is limited in pregnancy) Patients with previous craniotomy affecting the EEG electrode placement and signal recording Any participant who is unable to (or declines to) consent for any reason or for whom consent from a substitute decision maker is unavailable or declined.
Outcome results
None listed