2025
Evolution of EEG Findings in Patients with Acute Brain Injury
Narrett J, Byrnes M, Gilmore E, Hirsch L, Punia V, Sivaraju A. Evolution of EEG Findings in Patients with Acute Brain Injury. Neurocritical Care 2025, 1-8. PMID: 40038178, DOI: 10.1007/s12028-025-02227-y.Peer-Reviewed Original ResearchAcute brain injuryLateralized rhythmic delta activityLateralized periodic dischargesRhythmic delta activityEEG findingsContinuous electroencephalographyPeriodic dischargesDelta activityEEG patternsRetrospective chart review of patientsChart review of patientsSporadic epileptiform dischargesFollow-up EEGReview of patientsBrain injuryGeneralized periodic dischargesRetrospective chart reviewAcute symptomatic seizuresAntiseizure medication treatmentEvolution of EEG patternsConclusionsIn patientsElectrographic seizuresNeurological outcomeBackgroundIncreasing useElectroclinical seizures
2024
Antiseizure Medication Withdrawal, Risk of Epilepsy, and Longterm EEG Trends in Acute Symptomatic Seizures or Epileptic EEG Patterns
Sivaraju A, Tao A, Jadav R, Kirunda K, Rampal N, Kim J, Gilmore E, Hirsch L. Antiseizure Medication Withdrawal, Risk of Epilepsy, and Longterm EEG Trends in Acute Symptomatic Seizures or Epileptic EEG Patterns. Neurology Clinical Practice 2024, 14: e200342. PMID: 39185097, PMCID: PMC11341085, DOI: 10.1212/cpj.0000000000200342.Peer-Reviewed Original ResearchEEG for good outcome prediction after cardiac arrest: A multicentre cohort study
Turella S, Dankiewicz J, Ben-Hamouda N, Nilsen K, Düring J, Endisch C, Engstrøm M, Flügel D, Gaspard N, Grejs A, Haenggi M, Haffey S, Imbach L, Johnsen B, Kemlink D, Leithner C, Legriel S, Lindehammar H, Mazzon G, Nielsen N, Peyre A, Stanford B, Roman-Pognuz E, Rossetti A, Schrag C, Valeriánová A, Wendel-Garcia P, Zubler F, Cronberg T, Westhall E, investigators T. EEG for good outcome prediction after cardiac arrest: A multicentre cohort study. Resuscitation 2024, 202: 110319. PMID: 39029579, DOI: 10.1016/j.resuscitation.2024.110319.Peer-Reviewed Original ResearchConceptsMalignant EEG patternsEEG reactivityReactive EEGsCardiac arrestComatose patientsEEG patternsOut-of-hospital cardiac arrest trialModified Rankin Scale scoreMulticentre cohort studyRankin Scale scoreLong-term outcomesOut-of-hospitalCardiac arrest trialsSpecificity of EEGEEG assessmentHospital stayGood outcomeMultimodal prognosticationPrognostic performanceNon-highlyPrognostic abilityCohort studyMalignant patternArrest trialsBurst suppressionQuantitative Characterization of Rhythmic and Periodic EEG Patterns in Patients in a Coma After Cardiac Arrest and Association With Outcome
van Putten M, Ruijter B, Horn J, van Rootselaar A, Tromp S, van Kranen-Mastenbroek V, Gaspard N, Hofmeijer J, Investigators F. Quantitative Characterization of Rhythmic and Periodic EEG Patterns in Patients in a Coma After Cardiac Arrest and Association With Outcome. Neurology 2024, 103: e209608. PMID: 38991197, DOI: 10.1212/wnl.0000000000209608.Peer-Reviewed Original ResearchImproving Clinician Performance in Classifying EEG Patterns on the Ictal-Interictal Injury Continuum Using Interpretable Machine Learning.
Barnett A, Guo Z, Jing J, Ge W, Kaplan P, Kong W, Karakis I, Herlopian A, Jayagopal L, Taraschenko O, Selioutski O, Osman G, Goldenholz D, Rudin C, Westover M. Improving Clinician Performance in Classifying EEG Patterns on the Ictal-Interictal Injury Continuum Using Interpretable Machine Learning. NEJM AI 2024, 1 PMID: 38872809, PMCID: PMC11175595, DOI: 10.1056/aioa2300331.Peer-Reviewed Original Research
2020
Neuroimaging Correlates of Lateralized Rhythmic Delta Activity, Lateralized Periodic Discharges, and Generalized Rhythmic Delta Activity on EEG in Critically Ill Patients
Alzawahmah M, Fong MWK, Gilmore EJ, Hirsch LJ. Neuroimaging Correlates of Lateralized Rhythmic Delta Activity, Lateralized Periodic Discharges, and Generalized Rhythmic Delta Activity on EEG in Critically Ill Patients. Journal Of Clinical Neurophysiology 2020, 39: 228-234. PMID: 33235178, DOI: 10.1097/wnp.0000000000000763.Peer-Reviewed Original ResearchConceptsRhythmic delta activityDelta activityMRI abnormalitiesNormal MRIGeneralized rhythmic delta activityLateralized rhythmic delta activityLateralized periodic dischargesCritically ill patientsMajority of patientsMultifocal abnormalitiesIll patientsFocal findingsMRI characteristicsFocal abnormalitiesLRDAPatientsDiscordant findingsEpileptiform patternsMost abnormalitiesContinuous EEGPeriodic dischargesAbnormalitiesEEG patternsStatistical significanceMRIDeep active learning for Interictal Ictal Injury Continuum EEG patterns
Ge W, Jing J, An S, Herlopian A, Ng M, Struck AF, Appavu B, Johnson EL, Osman G, Haider HA, Karakis I, Kim JA, Halford JJ, Dhakar MB, Sarkis RA, Swisher CB, Schmitt S, Lee JW, Tabaeizadeh M, Rodriguez A, Gaspard N, Gilmore E, Herman ST, Kaplan PW, Pathmanathan J, Hong S, Rosenthal ES, Zafar S, Sun J, Westover M. Deep active learning for Interictal Ictal Injury Continuum EEG patterns. Journal Of Neuroscience Methods 2020, 351: 108966. PMID: 33131680, PMCID: PMC8135050, DOI: 10.1016/j.jneumeth.2020.108966.Peer-Reviewed Original ResearchConceptsConvolutional neural networkIll patientsActive learningLarge labeled datasetExpert-level performanceDeep active learningLarge EEG datasetsPseudo-labeled dataUse of ALElectroencephalography patternsPatient careQuery criteriaLabeled datasetLabel spreadingEEG patternsPatientsExpert labelsClass balancingNeural networkAvailable labelsVector representationQueriesInformative examplesAL approachEEG datasetDiagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients
Westover MB, Gururangan K, Markert MS, Blond BN, Lai S, Benard S, Bickel S, Hirsch LJ, Parvizi J. Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients. Neurocritical Care 2020, 33: 479-490. PMID: 32034656, PMCID: PMC7416437, DOI: 10.1007/s12028-019-00911-4.Peer-Reviewed Original ResearchConceptsDiagnostic valueAncillary clinical informationCritical care settingMassachusetts General HospitalGold standard diagnosisSame raterIll patientsSeizure activityGeneral HospitalIntra-rater agreementCare settingsHospital cliniciansClinical informationInter-rater variabilitySeizuresStandard diagnosisPathological activityEEG patternsPhase IGold standardHigh concordancePhase IIElectroencephalographyDiagnosisPresent study
2018
Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage
Stretz C, Sheikh Z, Maciel CB, Hirsch LJ, Gilmore EJ. Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage. Annals Of Clinical And Translational Neurology 2018, 5: 1104-1111. PMID: 30250866, PMCID: PMC6144442, DOI: 10.1002/acn3.627.Peer-Reviewed Original ResearchPrimary intraventricular hemorrhageFrequency of seizuresIctal-interictal continuumAntiseizure medicationsIntraventricular hemorrhageCEEG monitoringExternal ventricular drain placementPresence of hydrocephalusRhythmic EEG patternsVentricular drain placementCEEG durationCEEG patternsMedian ageNeuronal injuryElectrographic seizuresDrain placementRisk factorsOnly significant differenceGraeb scoreContinuous electroencephalographyCEEG recordingsSeizuresPatientsPeriodic dischargesEEG patternsT62. Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study
Osman G, Rahangdale R, Britton J, Gilmore E, Haider H, Hantus S, Herlopian A, Hocker S, Lee J, Legros B, Punia V, Rampal N, Szaflarski J, Wallace A, Westover M, Hirsch L, Gaspard N. T62. Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study. Clinical Neurophysiology 2018, 129: e25-e26. DOI: 10.1016/j.clinph.2018.04.063.Peer-Reviewed Original ResearchBilateral independent periodic dischargesCase-control studyRetrospective case-control studyElectrographic seizuresBrain injuryPeriodic dischargesPoor outcomePD groupHospital mortality rateAcute brain injuryAnoxic brain injuryCNS infectionsFrequent etiologyLPD groupHemorrhagic strokeClinical correlatesWorse outcomesLevel of alertnessHigh riskBetter outcomesMortality rateControl groupMultivariate analysisSeizuresEEG patterns
2017
Ictal-Interictal Continuum: When to Worry About the Continuous Electroencephalography Pattern
Cormier J, Maciel CB, Gilmore EJ. Ictal-Interictal Continuum: When to Worry About the Continuous Electroencephalography Pattern. Seminars In Respiratory And Critical Care Medicine 2017, 38: 793-806. PMID: 29262437, DOI: 10.1055/s-0037-1607987.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusIctal-interictal continuumNonconvulsive seizuresEEG patternsSecondary brain injuryContinuous electroencephalography monitoringCritical care physiciansClear clinical significanceIIC patternsIll patientsStatus epilepticusCare physiciansCEEG monitoringElectroencephalography monitoringSeizure riskBrain injuryGuideline statementsClinical dilemmaClinical significanceNeuronal stressClinical approachDefinitive guidelinesElectroencephalography patternsPotential associationEarly detection
2016
Extreme delta brush evolving into status epilepticus in a patient with anti-NMDA encephalitis
Herlopian A, Rosenthal ES, Chu CJ, Cole AJ, Struck AF. Extreme delta brush evolving into status epilepticus in a patient with anti-NMDA encephalitis. Epilepsy & Behavior Reports 2016, 7: 69-71. PMID: 28616386, PMCID: PMC5459970, DOI: 10.1016/j.ebcr.2016.09.002.Peer-Reviewed Original ResearchUnderstanding and Managing the Ictal-Interictal Continuum in Neurocritical Care
Sivaraju A, Gilmore EJ. Understanding and Managing the Ictal-Interictal Continuum in Neurocritical Care. Current Treatment Options In Neurology 2016, 18: 8. PMID: 26874841, DOI: 10.1007/s11940-015-0391-0.Peer-Reviewed Original ResearchIctal-interictal continuumSpike-wave dischargesNeuronal injuryEEG patternsStatus epilepticusIctal-interictal continuum (IIC) patternsIntensive care unit settingClear clinical correlatePossible neuronal injuryBrain imaging findingsDepth electrode recordingsUse of anestheticsIntracranial pressure fluctuationsElectrographic improvementMultiple AEDsEnolase levelsIll patientsInterictal patternsAntiepileptic drugsElectrographic seizuresImaging findingsElectrographic patternsNeurocritical careClinical correlatesUnit setting
2014
Interrater agreement for Critical Care EEG Terminology
Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB, Consortium T. Interrater agreement for Critical Care EEG Terminology. Epilepsia 2014, 55: 1366-1373. PMID: 24888711, PMCID: PMC4879939, DOI: 10.1111/epi.12653.Peer-Reviewed Original ResearchConceptsCritical care EEG terminologyEEG terminologyClinical significanceInterrater agreementAmerican Clinical Neurophysiology SocietyUncertain clinical significanceSupporting Information sectionElectrographic seizuresTriphasic morphologyHigh interrater agreementMulticenter researchEEG patternsSeizuresElectroencephalography studyStandardized terminologyInformation sectionIdentical questionsTraining slidesWeb-based testEEG samples
2013
Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients
Gaspard N, Manganas L, Rampal N, Petroff OA, Hirsch LJ. Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients. JAMA Neurology 2013, 70: 1288-1295. PMID: 23921464, DOI: 10.1001/jamaneurol.2013.3475.Peer-Reviewed Original ResearchConceptsLateralized rhythmic delta activityRhythmic delta activityContinuous EEG monitoringIll patientsDelta activityPeriodic dischargesAcute seizuresClinical significanceIll subjectsEEG monitoringEEG patternsPeriodic lateralized epileptiform dischargesJuxtacortical white matterContinuous electroencephalography monitoringIntensive care unitCross-sectional prevalenceFocal EEG abnormalitiesAcademic medical centerSimilar clinical significanceRadiological correlatesEarly seizuresMost patientsAcute illnessDischarge groupIndependent predictorsPitfalls in ictal EEG interpretation
Gaspard N, Hirsch LJ. Pitfalls in ictal EEG interpretation. Neurology 2013, 80: s26-s42. PMID: 23267042, DOI: 10.1212/wnl.0b013e31827974f8.Peer-Reviewed Original Research
2011
Classification of EEG patterns in patients with impaired consciousness
Hirsch LJ. Classification of EEG patterns in patients with impaired consciousness. Epilepsia 2011, 52: 21-24. PMID: 21967354, DOI: 10.1111/j.1528-1167.2011.03228.x.Peer-Reviewed Original Research
2005
Continuous electroencephalogram monitoring in critically ill patients
Jette N, Hirsch LJ. Continuous electroencephalogram monitoring in critically ill patients. Current Neurology And Neuroscience Reports 2005, 5: 312-321. PMID: 15987616, DOI: 10.1007/s11910-005-0077-1.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringIll patientsPermanent neuronal injuryContinuous electroencephalogram monitoringStandard of careRhythmic EEG patternsNeuronal injuryCerebral ischemiaNonconvulsive seizuresNeurologic impairmentClinical managementContinuous brain monitoringElectroencephalogram monitoringEEG monitoringPatientsEEG patternsBrain monitoringFurther studiesSeizuresIndicationsRemarkable advancesIschemiaInjuryPrognosticationImpairmentThe ACNS Subcommittee on Research Terminology for Continuous EEG Monitoring: Proposed Standardized Terminology for Rhythmic and Periodic EEG Patterns Encountered in Critically Ill Patients
Hirsch LJ, Brenner RP, Drislane FW, So E, Kaplan PW, Jordan KG, Herman ST, LaRoche SM, Young B, Bleck TP, Scheuer ML, Emerson RG. The ACNS Subcommittee on Research Terminology for Continuous EEG Monitoring: Proposed Standardized Terminology for Rhythmic and Periodic EEG Patterns Encountered in Critically Ill Patients. Journal Of Clinical Neurophysiology 2005, 22: 128-135. PMID: 15805813, DOI: 10.1097/01.wnp.0000158701.89576.4c.Peer-Reviewed Original ResearchWhich EEG Patterns Warrant Treatment in the Critically Ill? Reviewing the Evidence for Treatment of Periodic Epileptiform Discharges and Related Patterns
Chong DJ, Hirsch LJ. Which EEG Patterns Warrant Treatment in the Critically Ill? Reviewing the Evidence for Treatment of Periodic Epileptiform Discharges and Related Patterns. Journal Of Clinical Neurophysiology 2005, 22: 79-91. PMID: 15805807, DOI: 10.1097/01.wnp.0000158699.78529.af.Peer-Reviewed Original ResearchConceptsNonconvulsive seizuresPeriodic dischargesContinuous electroencephalographic monitoringPeriodic epileptiform dischargesCritically IllNeuronal injuryIll patientsElectrographic patternsElectroencephalographic monitoringEpileptiform dischargesClinical settingEEG patternsCurrent criteriaSeizuresTreatmentManagement recommendationsDischargePatientsEtiologyInjuryDiagnosis
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