Quantitative EEG and EEG-Derived Markers of Severity, Prognosis, and Recovery After Ischemic Stroke: A Systematic Review
学术急诊医学档案,
卷 14 编号 1 (2026),
1 十月 2025
,
第 e43 页
https://doi.org/10.22037/aaem.v14i1.3043
摘要
Introduction: Electroencephalography (EEG) and quantitative electroencephalography (QEEG) may provide noninvasive functional biomarkers that complement clinical and imaging predictors when evaluating stroke outcomes. This systematic review evaluated QEEG, selected routine EEG, processed EEG, and advanced neurophysiological biomarkers of severity, lesion burden, longitudinal prognosis, cognitive/language outcome, rehabilitation response, and recovery after ischemic stroke. Methods: PubMed, Embase, Scopus, and Web of Science were searched on 30 March 2026 using ischemic stroke or cerebral infarction terms, QEEG or EEG-derived biomarker terms, and prognosis, outcome, severity, infarct-volume, mortality, rehabilitation, motor-recovery, and language-recovery terms. Selected structured routine EEG, visual EEG grading, processed EEG/Bispectral Index (BIS), and EEG-derived neurovascular-coupling studies were included when they provided predefined severity, prognostic, monitoring, cognitive/language, rehabilitation, or recovery-related evidence. The search identified 2,564 records; 851 duplicates were removed, leaving 1,713 unique records for screening. Evidence was classified as cross-sectional severity or lesion-burden association, longitudinal functional prognosis, mortality or clinical deterioration, rehabilitation or motor recovery, cognitive/language outcome, selected routine or processed EEG evidence, or advanced QEEG/connectivity/nonlinear/neurovascular-coupling evidence. Risk of bias was assessed using Quality in Prognostic Studies (QUIPS)-oriented criteria, and certainty was summarized using domain-level Grading of Recommendations Assessment, Development and Evaluation (GRADE)-informed judgments. Results: Thirty-three study records were included, representing 1,696 stroke or suspected-stroke participants, 1,598 EEG/QEEG/BIS/neurovascular coupling (NVC)-analyzable participants, and 317 controls or comparators. The most consistent prognostic pattern was that greater EEG/QEEG abnormality, particularly increased slow-wave activity and higher delta/alpha ratio (DAR) or delta-theta/alpha-beta ratio (DTABR), was associated with greater neurological severity, larger infarct or lesion burden, and poorer functional outcomes. Measures of interhemispheric imbalance, including a higher brain symmetry index (BSI), pairwise-derived brain symmetry index (pdBSI), and greater hemispheric asymmetry, were also generally associated with unfavorable outcomes, including greater disability, clinical deterioration, mortality, or less favorable recovery. Reduced alpha or beta activity was similarly associated with poorer neurological or functional outcomes in several studies. Post-endovascular treatment (EVT)/mechanical thrombectomy (MT) studies suggested potential monitoring value for detecting or predicting cortical dysfunction, early neurological deterioration, cerebral edema, nonconvulsive seizures/status epilepticus, infarct growth, and unfavorable 90-day outcome. Rehabilitation and advanced QEEG studies suggested that motor/language recovery may relate to interhemispheric balance, phase synchrony, weighted node degree, nonlinear complexity, and neurovascular coupling. However, the evidence was heterogeneous, mostly exploratory, and generally low to very-low certainty; no universal prognostic threshold or pooled prognostic estimate was supported. Conclusions: EEG/QEEG abnormalities may provide candidate severity association, monitoring, prognostic, and recovery biomarkers after ischemic stroke. This review distinguishes cross-sectional severity or lesion burden associations from longitudinal prognostic, monitoring, and recovery outcomes. However, current evidence remains heterogeneous and mostly low to very low certainty and does not support a universal prognostic threshold or global pooled prognostic estimate.
- Ischemic Stroke
- Electroencephalography
- Prognosis
- Recovery of Function
- Rehabilitation
- Neurovascular Coupling
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参考
1. GBD 2021 Stroke Risk Factor Collaborators. Global, region-al, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol. 2024;23(10):973–1003.
2. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.
3. Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie C, Dippel DWJ. Time to treatment with endovascular throm-bectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316(12):1279–88.
4. Foreman B, Claassen J. Quantitative EEG for the detection of brain ischemia. Crit Care. 2012;16:216.
5. Finnigan S, van Putten M. EEG in ischaemic stroke: quanti-tative EEG can uniquely inform (sub-)acute prognoses and clinical management. Clin Neurophysiol. 2013;124(1):10–9.
6. van Putten M, Hofmeijer J. EEG monitoring in cerebral is-chemia: basic concepts and clinical applications. J Clin Neuro-physiol. 2016;33(3):203–10.
7. Astrup J, Siesjö BK, Symon L. Thresholds in cerebral is-chemia - the ischemic penumbra. Stroke. 1981;12(6):723–5.
8. Hossmann KA. Viability thresholds and the penumbra of focal ischemia. Ann Neurol. 1994;36(4):557–65.
9. Finnigan SP, Rose SE, Walsh M, Griffin M, Janke AL, McMahon KL. Correlation of quantitative EEG in acute is-chemic stroke with 30-day NIHSS score: comparison with dif-fusion and perfusion MRI. Stroke. 2004;35(4):899–903.
10. Finnigan SP, Walsh M, Rose SE, Chalk JB. Quantitative EEG indices of sub-acute ischaemic stroke correlate with clin-ical outcomes. Clin Neurophysiol. 2007;118(11):2525–32.
11. Sheorajpanday RVA, Nagels G, Weeren A, De Deyn PP. Quantitative EEG in ischemic stroke: correlation with infarct volume and functional status in posterior circulation and la-cunar syndromes. Clin Neurophysiol. 2011;122(5):884–90.
12. Sheorajpanday RVA, Nagels G, Weeren A, van Putten M, De Deyn PP. Quantitative EEG in ischemic stroke: correlation with functional status after 6 months. Clin Neurophysiol. 2011;122(5):874–83.
13. Bentes C, Peralta AR, Viana P, Martins H, Morgado C, Cas-imiro C. Quantitative EEG and functional outcome following acute ischemic stroke. Clin Neurophysiol. 2018;129(8):1680–7.
14. Ajčević M, Furlanis G, Naccarato M, Miladinović A, Buoite Stella A, Caruso P. Hyper-acute EEG alterations predict func-tional and morphological outcomes in thrombolysis-treated ischemic stroke: a wireless EEG study. Med Biol Eng Comput. 2021;59(1):121–9.
15. Wang Y, Liu D, Liu J, Kong C, Zhang Z, Duan W. Quantita-tive EEG provides early prediction of poor outcome in acute ischemic stroke after endovascular treatment: a preliminary study. Neurol Res. 2021;43(10):831–7.
16. Zhang N, Chen F, Xie X, Xie Z, Hong D, Li J. Application of quantitative EEG in acute ischemic stroke patients who un-derwent thrombectomy: a comparison with CT perfusion. Clin Neurophysiol. 2022;141:24–33.
17. Assenza G, Zappasodi F, Pasqualetti P, Vernieri F, Tecchio F. A contralesional EEG power increase mediated by interhemispheric disconnection provides negative prognosis in acute stroke. Restor Neurol Neurosci. 2013;31(2):177–88.
18. Cuspineda E, Machado C, Galan L, Aubert E. QEEG prog-nostic value in acute stroke. Clin EEG Neurosci. 2007;38(3):155–60.
19. Xin X, Gao Y, Zhang H, Cao K, Shi Y. Correlation of contin-uous electroencephalogram with clinical assessment scores in acute stroke patients. Neurosci Bull. 2012;28(5):611–7.
20. Capon AP. Quantitative EEG with brain mapping in strokes: Is it useful for prognosis? Brain Topogr. 1996;9(2):77–82.
21. Cillessen J, van Huffelen AC, Kappelle LJ, Algra A, van Gijn J. Electroencephalography improves the prediction of functional outcome in the acute stage of cerebral ischemia. Stroke. 1994;25(10):1968–72.
22. Wolf ME, Ebert AD, Chatzikonstantinou A. The use of routine EEG in acute ischemic stroke patients without sei-zures: generalized but not focal EEG pathology is associated with clinical deterioration. Int J Neurosci. 2017;127(5):421–6.
23. Akgol Gur ST, Akbas I, Kose MZ, Kocak AO, Eren A, Cakir Z. Bispectral Index in predicting in-hospital mortality in pa-tients with ischemic stroke: A methodological study. Hong Kong J Emerg Med. 2022;29(3):144–50.
24. Rogers J, Middleton S, Wilson PH, Johnstone SJ. Predict-ing functional outcomes after stroke: an observational study of acute single-channel EEG. Top Stroke Rehabil. 2020;27(3):161–72.
25. Xin X, Chang J, Gao Y, Shi Y. Correlation between the re-vised brain symmetry index, an EEG feature index, and short-term prognosis in acute ischemic stroke. J Clin Neuro-physiol. 2017;34(2):162–7.
26. Shen Y, You H, Yang Y, Tang R, Ji Z, Liu H. Predicting brain edema and outcomes after thrombectomy in stroke: frontal delta/alpha ratio as an optimal quantitative EEG in-dex. Clin Neurophysiol. 2024;164:149–60.
27. Prandin G, Furlanis G, Scali I, Palacino F, Mancinelli L, Vincis E. Status epilepticus after mechanical thrombectomy: the role of early EEG assessment in Stroke Unit, clinical and radiological prognostication. Epilepsy Res. 2024;202:107343.
28. Yang Y, Peng L, Li Y, Wang M, Zhou W, Zhou Z. The use of EEG in predicting the prognosis of patients undergoing endovascular treatment for acute anterior circulation infarc-tion. J Clin Neurosci. 2025;137:111252.
29. Yan Y, An X, Ma Y, Jiang Z, Di Y, Li T. Detection of early neurological deterioration using a quantitative electroen-cephalography system in patients with large vessel occlusion stroke after endovascular treatment. J Neurointerv Surg. 2025;17(8):883–9.
30. Zhang Z, Hasan S, Sadan O, Rosenthal ES, Pu Y, Wen Z. Contralateral neurovascular coupling in patients with is-chemic stroke after endovascular thrombectomy. Neurocrit Care. 2025;42:996–1006.
31. Batra D, Chen M, Meis J, Möhlenbruch MA, Klose C, Ringleb P. Feasibility of noninvasive neuromonitoring using BIS and NIRS during endovascular treatment of acute is-chemic stroke. Neurol Res Pract. 2025;7:60.
32. Agius Anastasi A, Falzon O, Camilleri K, Vella M, Muscat R. Brain symmetry index in healthy and stroke patients for assessment and prognosis. Stroke Res Treat. 2017;2017:8276136.
33. Nicolo P, Rizk S, Magnin C, Di Pietro M, Schnider A, Gug-gisberg AG. Coherent neural oscillations predict future motor and language improvement after stroke. Brain. 2015;138(10):3048–60.
34. Mane R, Chew E, Phua KS, Ang KK, Robinson N, Vinod AP. Prognostic and monitory EEG-biomarkers for BCI upper-limb stroke rehabilitation. IEEE Trans Neural Syst Rehabil Eng. 2019;27(8):1654–64.
35. Kawano T, Hattori N, Uno Y, Hatakenaka M, Yagura H, Fujimoto H. Electroencephalographic phase synchrony index as a biomarker of poststroke motor impairment and recov-ery. Neurorehabil Neural Repair. 2020;34(8):711–22.
36. Saes M, Meskers CGM, Daffertshofer A, van Wegen EEH, Kwakkel G. Are early measured resting-state EEG parameters predictive for upper limb motor impairment six months post-stroke? Clin Neurophysiol. 2021;132(1):56–62.
37. Sebastián-Romagosa M, Udina E, Ortner R, Dinarès-Ferran J, Cho W, Murovec N. EEG biomarkers related with the functional state of stroke patients. Front Neurosci. 2020;14:582.
38. Zappasodi F, Olejarczyk E, Marzetti L, Assenza G, Pizzella V, Tecchio F. Fractal dimension of EEG activity senses neu-ronal impairment in acute stroke. PLoS One. 2014;9(6):e100199.
39. Buzsáki G, Draguhn A. Neuronal oscillations in cortical networks. Sci. 2004;304(5679):1926–9.
40. Fries P. A mechanism for cognitive dynamics: neuronal communication through neuronal coherence. Trends Cogn Sci. 2005;9(10):474–80.
41. Liu X, Pu Y, Wu D, Zhang Z, Hu X, Liu L. Cross-frequency coupling between cerebral blood flow velocity and EEG in is-chemic stroke patients with large vessel occlusion. Front Neu-rol. 2019;10:194.
42. Iadecola C. The neurovascular unit coming of age: a jour-ney through neurovascular coupling in health and disease. Neuron. 2017;96(1):17–42.
43. Grefkes C, Fink GR. Reorganization of cerebral networks after stroke: new insights from neuroimaging with connectiv-ity approaches. Brain. 2011;134(5):1264–76.
44. Silasi G, Murphy TH. Stroke and the connectome: how connectivity guides therapeutic intervention. Neuron. 2014;83(6):1354–68.
45. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.
46. McKenzie JE, Brennan SE. Chapter 12: Synthesizing and presenting findings using other methods. In: Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane 2023.
47. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368: l6890.
48. Moons KGM, de Groot JAH, Bouwmeester W, Vergouwe Y, Mallett S, Altman DG. Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Med. 2014;11(10):e1001744.
49. Collins GS, Moons KGM, Dhiman P, Riley RD, Beam AL, Van Calster B. TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ. 2024;385:e078378.
50. Wolff RF, Moons KGM, Riley RD, Whiting PF, Westwood M, Collins GS. PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med. 2019;170(1):51–8.
51. Wang Y, Zhang X, Huang J, Zhu M, Guan Q, Liu C. Associa-tions between EEG beta power abnormality and diagnosis in cognitive impairment post cerebral infarcts. J Mol Neurosci. 2013;49(3):632–8.
52. Wilkinson CM, Burrell JI, Kuziek JWP, Thirunavukkarasu S, Buck BH, Mathewson KE. Predicting stroke severity with a 3-min recording from the Muse portable EEG system for rap-id diagnosis of stroke. Sci Rep. 2020;10(1):18465.
53. Hofmeijer J, van Kaam R, Vermeer SE, van Putten MJ. Contralesional brain activity in acute ischemic stroke. Clin Neurophysiol. 2018;129:e93–e4.
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