ABSTRACT NUMBER: ESOC2026LT90 PROGNOSTIC ROLE OF AWAKE AND SLEEP EEG AFTER ISCHEMIC STROKE

Abstract Background and aims Pediatric arterial ischemic stroke (AIS) is uncommon but frequently associated with long-term neurological sequelae. Electroencephalography (EEG) is commonly performed to detect seizures; however, its prognostic value in children with AIS remains unclear. Sleep enhances cortical synchronization and may improve detection of post-stroke abnormalities, yet pediatric evidence is limited. Methods In this prospective multicenter study, 116 children (1 month–18 years) with first-ever MRI-confirmed AIS underwent 30-minute awake EEG followed by 60-minute sleep EEG within 5–7 days of symptom onset. EEG findings included focal or diffuse slowing, background asymmetry, and epileptiform discharges. Stroke severity was assessed using the Pediatric NIHSS (PedNIHSS). Six-month functional outcome was measured by the Pediatric Stroke Outcome Measure (PSOM) and classified as favorable (0–1) or unfavorable (2–10). Multivariate logistic regression adjusted for age, PedNIHSS, and infarct volume. Results EEG abnormalities were identified in 55.2% of awake recordings and 79.3% of sleep recordings (p<0.001). Focal slowing was most frequent (63.8%). At 6 months, 59.5% achieved favorable outcome. Sleep EEG focal slowing with background asymmetry independently predicted unfavorable outcome (OR 4.1, 95% CI 1.9–8.8, p<0.001). Epileptiform discharges were associated with post-stroke epilepsy (p=0.006). Conclusions Sleep EEG is more sensitive than awake EEG in pediatric AIS and provides independent prognostic information regarding functional outcome. Conflict of interest