2024
Immediate and long‐term management practices of acute symptomatic seizures and epileptiform abnormalities: A cross‐sectional international survey
Punia V, Daruvala S, Dhakar M, Zafar S, Rubinos C, Ayub N, Hirsch L, Sivaraju A, investigators F. Immediate and long‐term management practices of acute symptomatic seizures and epileptiform abnormalities: A cross‐sectional international survey. Epilepsia 2024, 65: 909-919. PMID: 38358383, DOI: 10.1111/epi.17915.Peer-Reviewed Original ResearchAnti-seizure medicationsEpileptiform abnormalitiesAcute symptomatic seizuresAcute brain injuryContinuous EEGSecondary prophylaxisSymptomatic seizuresSporadic epileptiform dischargesLateralized periodic dischargesCross-sectional international surveyOutpatient follow-upAnti-seizure medication useOptimal care pathwayDose escalationBrain injuryDose changesLong-term managementElectrographic seizuresEpileptiform dischargesFollow-upAncillary testsReal-world practiceRecommended durationContinuous electroencephalographyHospital discharge
2022
Quantitative epileptiform burden and electroencephalography background features predict post-traumatic epilepsy
Chen Y, Li S, Ge W, Jing J, Chen HY, Doherty D, Herman A, Kaleem S, Ding K, Osman G, Swisher CB, Smith C, Maciel CB, Alkhachroum A, Lee JW, Dhakar MB, Gilmore EJ, Sivaraju A, Hirsch LJ, Omay SB, Blumenfeld H, Sheth KN, Struck AF, Edlow BL, Westover MB, Kim JA. Quantitative epileptiform burden and electroencephalography background features predict post-traumatic epilepsy. Journal Of Neurology Neurosurgery & Psychiatry 2022, 94: 245-249. PMID: 36241423, PMCID: PMC9931627, DOI: 10.1136/jnnp-2022-329542.Peer-Reviewed Original ResearchConceptsPost-traumatic epilepsyTraumatic brain injuryCT abnormalitiesElectroencephalography featuresAdmission Glasgow Coma Scale scoreGlasgow Coma Scale scoreRetrospective case-control studyMultivariable logistic regression analysisRisk stratification modelCase-control studyLogistic regression analysisTBI admissionsSevere complicationsFuture trialsBrain injuryCT reportsSeizure diagnosisPredictive valueScale scorePatientsLogistic regressionStratification modelQuantitative electroencephalogramTBI mechanismsRegression analysisElectroencephalogram in the intensive care unit: a focused look at acute brain injury
Alkhachroum A, Appavu B, Egawa S, Foreman B, Gaspard N, Gilmore EJ, Hirsch LJ, Kurtz P, Lambrecq V, Kromm J, Vespa P, Zafar SF, Rohaut B, Claassen J. Electroencephalogram in the intensive care unit: a focused look at acute brain injury. Intensive Care Medicine 2022, 48: 1443-1462. PMID: 35997792, PMCID: PMC10008537, DOI: 10.1007/s00134-022-06854-3.Peer-Reviewed Original ResearchConceptsAcute brain injuryNonconvulsive status epilepticusBrain injuryStatus epilepticusEEG monitoringIntensive care unit settingRefractory status epilepticusSecondary brain injuryIntensive care unitPossible clinical relevanceAssessment of consciousnessResource-limited settingsICU EEG monitoringFrequent seizuresAcute illnessCommon indicationCare unitWorse outcomesUnit settingClinical relevancePathophysiological eventsSeizure criteriaIschemia monitoringInjuryApplication of electroencephalography
2020
Detecting Seizures and Epileptiform Abnormalities in Acute Brain Injury
Singla S, Garcia GE, Rovenolt GE, Soto AL, Gilmore EJ, Hirsch LJ, Blumenfeld H, Sheth KN, Omay SB, Struck AF, Westover MB, Kim JA. Detecting Seizures and Epileptiform Abnormalities in Acute Brain Injury. Current Neurology And Neuroscience Reports 2020, 20: 42. PMID: 32715371, PMCID: PMC9353690, DOI: 10.1007/s11910-020-01060-4.Peer-Reviewed Original ResearchConceptsIctal-interictal continuumBrain injuryAcute brain injuryBetter clinical outcomesTraumatic brain injuryRecent FindingsCurrent literatureIncreased morbidityClinical outcomesEpileptiform abnormalitiesEEG findingsMortality riskEEG monitoringEpileptiform patternsPrognostic modelSeizuresClinical settingInjuryLogistical barriersElectroencephalogram studyUse of EEGABIPractical barriersEEG analysisEEGMorbidityValidation of an algorithm of time-dependent electro-clinical risk stratification for electrographic seizures (TERSE) in critically ill patients
Cissé FA, Osman GM, Legros B, Depondt C, Hirsch LJ, Struck AF, Gaspard N. Validation of an algorithm of time-dependent electro-clinical risk stratification for electrographic seizures (TERSE) in critically ill patients. Clinical Neurophysiology 2020, 131: 1956-1961. PMID: 32622337, DOI: 10.1016/j.clinph.2020.05.031.Peer-Reviewed Original ResearchConceptsElectrographic seizuresRisk stratificationIll patientsAcute brain injuryContinuous electroencephalography monitoringElectrographic status epilepticusSubgroup of patientsDuration of EEGClinical seizuresConsecutive patientsStatus epilepticusElectroencephalography monitoringBrain injuryMedical recordsSubstantial burdenPatientsClinical practiceCEEGClinical neurophysiologistsSeizuresClinical implementationEEG recordingsTwo-thirdsFuture studiesEEG timeValidation of the 2HELPS2B Seizure Risk Score in Acute Brain Injury Patients
Moffet EW, Subramaniam T, Hirsch LJ, Gilmore EJ, Lee JW, Rodriguez-Ruiz AA, Haider HA, Dhakar MB, Jadeja N, Osman G, Gaspard N, Struck AF. Validation of the 2HELPS2B Seizure Risk Score in Acute Brain Injury Patients. Neurocritical Care 2020, 33: 701-707. PMID: 32107733, DOI: 10.1007/s12028-020-00939-x.Peer-Reviewed Original ResearchConceptsAcute brain injuryClinical factorsContinuous EEG monitoringTraumatic brain injurySeizure incidenceEEG findingsClinical seizuresPrimary outcomeSubdural hematomaBrain injuryEEG monitoringAcute brain injury patientsRisk of seizuresBrain injury patientsReceiver operator characteristic curveOperator characteristic curveABI patientsPatient ageHospitalized patientsElectrographic seizuresInjury patientsIntraparenchymal hemorrhageClinical findingsSubarachnoid hemorrhageResultsA total
2018
Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study
Osman G, Rahangdale R, Britton JW, Gilmore EJ, Haider HA, Hantus S, Herlopian A, Hocker SE, Woo Lee J, Legros B, Mendoza M, Punia V, Rampal N, Szaflarski JP, Wallace AD, Westover MB, Hirsch LJ, Gaspard N. Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study. Clinical Neurophysiology 2018, 129: 2284-2289. PMID: 30227348, PMCID: PMC6785981, DOI: 10.1016/j.clinph.2018.07.025.Peer-Reviewed Original ResearchConceptsBilateral independent periodic dischargesCase-control studyElectrographic seizuresPoor outcomePeriodic dischargesLPD groupBrain injuryRetrospective case-control studyAcute brain injuryAnoxic brain injuryCNS infectionsFrequent etiologyCerebral injuryIll patientsClinical managementPD groupLevel of alertnessHigh riskBetter outcomesPatientsMultivariate analysisSeizuresInjuryPotential important implicationsOutcomesThe epilepsy bioinformatics study for anti-epileptogenic therapy (EpiBioS4Rx) clinical biomarker: Study design and protocol
Vespa PM, Shrestha V, Abend N, Agoston D, Au A, Bell MJ, Bleck TP, Blanco MB, Claassen J, Diaz-Arrastia R, Duncan D, Ellingson B, Foreman B, Gilmore EJ, Hirsch L, Hunn M, Kamnaksh A, McArthur D, Morokoff A, O'Brien T, O'Phelan K, Robertson CL, Rosenthal E, Staba R, Toga A, Willyerd FA, Zimmermann L, Yam E, Martinez S, Real C, Engel J. The epilepsy bioinformatics study for anti-epileptogenic therapy (EpiBioS4Rx) clinical biomarker: Study design and protocol. Neurobiology Of Disease 2018, 123: 110-114. PMID: 30048805, PMCID: PMC6344322, DOI: 10.1016/j.nbd.2018.07.025.Peer-Reviewed Original ResearchConceptsPost-traumatic epilepsyTraumatic brain injuryIncidence of PTELongitudinal prospective observational studyAnti-epileptogenic therapiesEpilepsy Bioinformatics StudyProspective observational studyFuture interventional studiesModerate-severe TBI patientsHemorrhagic contusionAcute evaluationTBI patientsBlood biomarkersDiscovery of biomarkersInterventional studyBrain injuryElectroencephalographic monitoringObservational studyInternational cohortAnimal modelsClinical biomarkersStudy designBiomarkersMultidisciplinary approachNational InstituteDefinition and Classification of Periodic and Rhythmic Patterns
Maciel CB, Hirsch LJ. Definition and Classification of Periodic and Rhythmic Patterns. Journal Of Clinical Neurophysiology 2018, 35: 179-188. PMID: 29718827, DOI: 10.1097/wnp.0000000000000462.Peer-Reviewed Original ResearchConceptsAmerican Clinical Neurophysiology SocietyContinuous video-EEG recordingOverall clinical implicationsAcute brain injuryRhythmic delta activityVideo-EEG recordingsEpileptogenic potentialTherapeutic algorithmAbnormal findingsNonconvulsive seizuresComatose patientsBrain injuryClinical indicationsInpatient settingDelta activityClinical implicationsMorphologic featuresPeriodic dischargesStandardized definitionsPatientsPrevalence of occurrenceDefinitive evidenceExcellent temporal resolutionIschemia detectionOfficial guidelines
2017
Commonalities in epileptogenic processes from different acute brain insults: Do they translate?
Klein P, Dingledine R, Aronica E, Bernard C, Blümcke I, Boison D, Brodie MJ, Brooks‐Kayal A, Engel J, Forcelli PA, Hirsch LJ, Kaminski RM, Klitgaard H, Kobow K, Lowenstein DH, Pearl PL, Pitkänen A, Puhakka N, Rogawski MA, Schmidt D, Sillanpää M, Sloviter RS, Steinhäuser C, Vezzani A, Walker MC, Löscher W. Commonalities in epileptogenic processes from different acute brain insults: Do they translate? Epilepsia 2017, 59: 37-66. PMID: 29247482, PMCID: PMC5993212, DOI: 10.1111/epi.13965.Peer-Reviewed Original ResearchConceptsAcute brain insultsAnimal modelsPrevention therapyBrain insultsBrain injuryInjury etiologyHuman epilepsyClinical testingCentral nervous system infectionFluid percussion injury modelTemporal lobe epilepsy patientsPost-status epilepticus modelDisease modification strategiesNervous system infectionMolecular targetsBetter patient selectionInflammatory cellular infiltrateLoss of neuronsWeeks of injuryBlood-brain barrierTraumatic brain injuryPreclinical animal modelsGap junction couplingCommon histopathologicEpilepsy preventionCyclic seizures in critically ill patients: Clinical correlates, DC recordings and outcomes
Pinto LF, Gilmore EJ, Petroff OA, Sivaraju A, Rampal N, Hirsch LJ, Gaspard N. Cyclic seizures in critically ill patients: Clinical correlates, DC recordings and outcomes. Clinical Neurophysiology 2017, 128: 1083-1090. PMID: 28214108, DOI: 10.1016/j.clinph.2017.01.015.Peer-Reviewed Original ResearchConceptsCyclic seizuresProgressive brain injuryStatus epilepticusIll patientsClinical correlatesBrain injuryDC recordingsNon-convulsive status epilepticusEEG baselineNonconvulsive status epilepticusOlder patientsElectrographic seizuresWorse prognosisFocal onsetPoor outcomePrognostic significanceSeizure initiationPatientsInfraslow activitySeizuresCommon formEpilepticusFurther studiesPosterior regionInjury
2015
Clinical Correlates and Prognostic Significance of Lateralized Periodic Discharges in Patients Without Acute or Progressive Brain Injury
Sainju RK, Manganas LN, Gilmore EJ, Petroff OA, Rampal N, Hirsch LJ, Gaspard N. Clinical Correlates and Prognostic Significance of Lateralized Periodic Discharges in Patients Without Acute or Progressive Brain Injury. Journal Of Clinical Neurophysiology 2015, 32: 495-500. PMID: 26200591, DOI: 10.1097/wnp.0000000000000206.Peer-Reviewed Original ResearchConceptsProgressive brain injuryAcute brain injuryBrain injuryAbnormal consciousnessPeriodic dischargesClinical correlatesFunctional declineLateralized periodic dischargesRemote brain injuryOutcomes of patientsCase-control studyContinuous EEG monitoringHistory of epilepsyRadiologic evidenceHospital dischargeStatus epilepticusWorse prognosisAcute injuryPrognostic significanceWorse outcomesEEG monitoringMultivariate analysisInjuryPatientsLower likelihoodThe enigma of the latent period in the development of symptomatic acquired epilepsy — Traditional view versus new concepts
Löscher W, Hirsch LJ, Schmidt D. The enigma of the latent period in the development of symptomatic acquired epilepsy — Traditional view versus new concepts. Epilepsy & Behavior 2015, 52: 78-92. PMID: 26409135, DOI: 10.1016/j.yebeh.2015.08.037.Peer-Reviewed Original ResearchConceptsBrain injuryLatent periodBrain insultsAnimal modelsMajor unmet clinical needPre-epileptic stateProcess of epileptogenesisUnderstanding of epileptogenesisTraumatic brain injuryUnmet clinical needAntiepileptogenic agentsAntiepileptogenic treatmentsSymptomatic epilepsyHuman epilepsyTrial designFunctional alterationsEpileptogenesisEpilepsySubclinical epilepsyClinical needInjuryPatientsRecent dataInsultPeriodThe Time Course and Prognostic Values of Electroencephalographic Patterns after Anoxic Brain Injury (P7.005)
Sivaraju A, Gilmore E, Moeller J, Greer D, Hirsch L, Gaspard N. The Time Course and Prognostic Values of Electroencephalographic Patterns after Anoxic Brain Injury (P7.005). Neurology 2015, 84 DOI: 10.1212/wnl.84.14_supplement.p7.005.Peer-Reviewed Original Research
2013
Nonconvulsive seizures after subarachnoid hemorrhage: Multimodal detection and outcomes
Claassen J, Perotte A, Albers D, Kleinberg S, Schmidt JM, Tu B, Badjatia N, Lantigua H, Hirsch LJ, Mayer SA, Connolly ES, Hripcsak G. Nonconvulsive seizures after subarachnoid hemorrhage: Multimodal detection and outcomes. Annals Of Neurology 2013, 74: 53-64. PMID: 23813945, PMCID: PMC3775941, DOI: 10.1002/ana.23859.Peer-Reviewed Original ResearchConceptsRegional cerebral blood flowAcute brain injuryBrain injuryCerebral physiologic effectsCerebral perfusion pressureSecondary brain injuryBrain tissue oxygenationSubarachnoid hemorrhage patientsCerebral blood flowGlobal brain metabolismElevated heart rateComplex physiologic processBlood pressureNonconvulsive seizuresHemorrhage patientsPerfusion pressureSubarachnoid hemorrhageBrain metabolismFunctional outcomeIntracranial pressureSeizure onsetPhysiologic effectsHeart rateOnly seizuresBlood flowIntravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study
Gaspard N, Foreman B, Judd LM, Brenton JN, Nathan BR, McCoy BM, Al‐Otaibi A, Kilbride R, Fernández IS, Mendoza L, Samuel S, Zakaria A, Kalamangalam GP, Legros B, Szaflarski JP, Loddenkemper T, Hahn CD, Goodkin HP, Claassen J, Hirsch LJ, LaRoche SM. Intravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study. Epilepsia 2013, 54: 1498-1503. PMID: 23758557, PMCID: PMC3731413, DOI: 10.1111/epi.12247.Peer-Reviewed Original ResearchConceptsRefractory status epilepticusTreatment of RSEIntravenous ketamineStatus epilepticusBrain injuryEpisodes of RSEPostanoxic brain injuryAnoxic brain injuryMulticenter retrospective reviewRetrospective multicenter studyRole of ketaminePossible adverse eventsAcademic medical centerKetamine initiationProspective trialAdverse eventsRetrospective reviewRetrospective seriesSE onsetMulticenter studyLast drugMedical recordsMedical CenterSafe drugConcurrent drugs
2012
Generalized periodic discharges in the critically ill
Foreman B, Claassen J, Abou Khaled K, Jirsch J, Alschuler DM, Wittman J, Emerson RG, Hirsch LJ. Generalized periodic discharges in the critically ill. Neurology 2012, 79: 1951-1960. PMID: 23035068, PMCID: PMC3484988, DOI: 10.1212/wnl.0b013e3182735cd7.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusStatus epilepticusLevel of consciousnessPeriodic dischargesNonconvulsive seizuresCardiac arrestWorse outcomesAcute systemic illnessAcute brain injuryCardiac arrest patientsContinuous EEG monitoringHospital staySystemic illnessConvulsive seizuresArrest patientsMean ageUnivariate analysisBrain injuryMultivariate predictorsEpilepticusEEG monitoringPatientsSeizuresSevere disabilityVegetative stateEpilepsy Emergencies: Diagnosis and Management
Foreman B, Hirsch LJ. Epilepsy Emergencies: Diagnosis and Management. Neurologic Clinics 2012, 30: 11-41. PMID: 22284053, DOI: 10.1016/j.ncl.2011.09.005.Peer-Reviewed Original ResearchConceptsStatus epilepticusLimited evidence-based guidanceIrreversible brain injuryNonconvulsive status epilepticusEvidence-based guidanceEpilepsy emergenciesNonconvulsive seizuresHigh morbidityBrain injuryEarly treatmentTreatment responseProlonged casesRefractory conditionEpilepticusPatientsPrognosisSeizuresTreatmentDiagnosisMorbidityComatoseInjuryMortality
2010
Seizures and CNS Hemorrhage
Gilmore E, Choi HA, Hirsch LJ, Claassen J. Seizures and CNS Hemorrhage. The Neurologist 2010, 16: 165-175. PMID: 20445426, DOI: 10.1097/nrl.0b013e3181c7cd0b.Peer-Reviewed Original ResearchConceptsAneurysmal subarachnoid hemorrhageCentral nervous system hemorrhageShort-term prophylaxisNonconvulsive seizuresIntracerebral hemorrhageSpontaneous intracerebral hemorrhageSeizure prophylaxisASAH patientsAdditional injuriesAcute brain injuryPoor clinical gradeEvidence-based guidelinesCommon neurologic conditionsDeleterious effectsAntiepileptic medicationsControlled TrialsConvulsive seizuresCNS hemorrhagePoor outcomeSubarachnoid hemorrhageNeurologic conditionsSurrogate markerBrain injuryClinical gradeRecent injuryIntracranial Multimodal Monitoring for Acute Brain Injury: A Single Institution Review of Current Practices
Stuart RM, Schmidt M, Kurtz P, Waziri A, Helbok R, Mayer SA, Lee K, Badjatia N, Hirsch LJ, Connolly ES, Claassen J. Intracranial Multimodal Monitoring for Acute Brain Injury: A Single Institution Review of Current Practices. Neurocritical Care 2010, 12: 188-198. PMID: 20107926, DOI: 10.1007/s12028-010-9330-9.Peer-Reviewed Original ResearchConceptsAcute brain injuryBrain injurySevere acute brain injuryNeurological intensive care unitInsertion techniqueSecondary brain injuryDay of admissionMethodsSixty-one patientsRate of hematomaSingle-institution reviewIntensive care unitBrain tissue oxygenCerebral blood flowFocal brain injuryMultimodality brain monitoringPatient-specific selectionInvasive monitoring devicesHospital lengthFrequent complicationNICU lengthPatient demographicsCare unitMultimodality monitoringConsecutive seriesInstitution review