Elevated neutrophil count is independently associated with early epileptiform discharges after ischemic stroke, supporting a role for systemic inflammation in acute post-stroke EEG hyperexcitability, while slow-wave activity mainly reflects stroke severity and local complications.
Epileptiform discharges (ED) after ischemic stroke were independently associated with higher white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR).
Neutrophil count showed the highest discriminative ability for epileptiform discharges and significantly improved model performance when added to clinical predictors.
No peripheral inflammatory biomarker remained independently associated with slow-wave activity (SA) after multivariable adjustment in patients without epileptiform discharges.
Stroke severity and hemorrhagic transformation were the main independent predictors of slow-wave activity after ischemic stroke.
The study enrolled 307 patients with acute supratentorial ischemic stroke who underwent EEG within 72 hours of admission.
This research suggests that after an ischemic stroke, different types of abnormal brain electrical activity (detected by EEG) have different underlying causes. The study followed 307 stroke patients and measured both blood inflammation markers and brain electrical activity within the first 72 hours. Researchers found that epileptiform discharges — abnormal electrical patterns that can signal seizure risk — were linked to higher levels of white blood cells, particularly neutrophils, which are a key part of the body's immune response. This suggests that the body's own inflammatory reaction after a stroke may contribute to the brain becoming electrically overexcitable in some patients. In contrast, slow-wave activity — another common EEG abnormality after stroke that reflects general brain disturbance — was not linked to any inflammation markers. Instead, slow-wave activity was primarily explained by how severe the stroke was and whether bleeding had occurred into the damaged brain tissue (hemorrhagic transformation). This indicates that slow-wave activity reflects direct structural brain damage rather than the body's immune response. These findings matter because they suggest that monitoring neutrophil levels shortly after a stroke might help clinicians identify patients at higher risk of early seizure-related brain activity, potentially informing monitoring strategies. The distinction between the two EEG patterns also highlights that post-stroke brain abnormalities arise through different biological pathways, which could eventually guide more targeted treatment approaches.
Prandin G, Furlanis G, Ricci E, Mancinelli L, Vincis E, Quagliotto M, et al.. (2026). Systemic inflammatory profiles associated with early EEG abnormalities following ischemic stroke: a cohort study.. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. https://doi.org/10.1007/s10072-026-09397-3