Quantitative electroencephalography to assess post-stroke functional disability: A systematic review and meta-analysis.

Objective: Quantitative electroencephalography (QEEG) is a non-invasive, reliable and easily accessible modality to assess neuronal activity. QEEG in acute stroke may predict short and long-term functional outcomes. The role of individual indices has not been studied in a meta-analysis. We aim to assess individual QEEG-derived indices to predict post-stroke disability.

Methods: We included studies (sample size ≥ 10) with stroke patients who underwent EEG and a follow-up outcome assessment was available either in the form of modified Rankin scale (mRS) or National Institute of Stroke scale (NIHSS) or Fugl-Meyer scale (FMA). QEEG indices analysed were delta-alpha ratio (DAR), delta-theta-alpha-beta ratio (DTABR), brain symmetry index (BSI) and pairwise derived brain symmetry (pdBSI).

Results: Nine studies (8 had only ischemic stroke, and one had both ischemic and haemorrhagic stroke), including 482 participants were included for meta-analysis. Higher DAR was associated with worse mRS (n=300, Pearson's r 0.26, 95 % CI 0.21-0.31). Higher DTABR was associated with worse mRS (n=337, r=0.32, 95 % CI 0.26-0.39). Higher DAR was associated with higher NIHSS (n=161, r=0.42, 95 % CI0.24-0.6). Higher DTABR was associated with higher NIHSS (n=158, r=0.49, 95 % CI 0.31-0.67).

Conclusions: QEEG-derived indices DAR and DTABR have the potential to assess post-stroke disability. Adding QEEG to the clinical and imaging biomarkers in the acute phase may help in better prediction of post-stroke recovery.

Registry: PROSPERO 2022 CRD42022292281.