2024
The human claustrum tracks slow waves during sleep
Lamsam L, Gu B, Liang M, Sun G, Khan K, Sheth K, Hirsch L, Pittenger C, Kaye A, Krystal J, Damisah E. The human claustrum tracks slow waves during sleep. Nature Communications 2024, 15: 8964. PMID: 39419999, PMCID: PMC11487173, DOI: 10.1038/s41467-024-53477-x.Peer-Reviewed Original ResearchSeizure Assessment and Forecasting With Efficient Rapid-EEG
Kalkach-Aparicio M, Fatima S, Selte A, Sheikh I, Cormier J, Gallagher K, Avagyan G, Cespedes J, Krishnamurthy P, Elazim A, Khan N, Hussein O, Maganti R, Larocque J, Holla S, Desai M, Westover B, Hirsch L, Struck A. Seizure Assessment and Forecasting With Efficient Rapid-EEG. Neurology 2024, 103: e209621. PMID: 38875512, DOI: 10.1212/wnl.0000000000209621.Peer-Reviewed Original ResearchConceptsMonitoring of at-risk patientsRecords of patientsTertiary care centerReceiver operating characteristic curveCritically ill patientsAt-risk patientsClass II evidenceDiagnostic accuracy studiesOperating characteristics curveMedian ageSecondary endpointsPrevent overtreatmentNo significant differenceEEG reviewRisk stratificationNoninferiority marginAntiseizure medicationsClinical correlatesPrimary outcomeII evidenceEEG technologistsSeizure assessmentIll patientsComparative effectiveness studiesLow risk
2022
Association of Serum Pyridoxal Phosphate Levels with Established Status Epilepticus
Rubinos C, Bruzzone MJ, Blodgett C, Tsai C, Patel P, Hianik R, Jadav R, Boudesseul J, Liu C, Zhu H, Wilson SE, Olm-Shipman C, Meeker R, Hirsch LJ. Association of Serum Pyridoxal Phosphate Levels with Established Status Epilepticus. Neurocritical Care 2022, 38: 41-51. PMID: 36071331, DOI: 10.1007/s12028-022-01579-z.Peer-Reviewed Original ResearchConceptsStatus epilepticusPyridoxal phosphate levelsPLP levelsPyridoxine deficiencyHigh prevalenceControl groupMethodsThis retrospective cohort studyIntensive care unit patientsYale-New Haven HospitalCritical illness severitySerum PLP levelsRetrospective cohort studyCare unit patientsNon-ICU inpatientsPhosphate levelsHistory of epilepsyRole of pyridoxineNorth Carolina HospitalsNew Haven HospitalUnit patientsCohort studyMedian ageIllness severityPyridoxine supplementationProspective study
2021
Hospital Revisits for Post-Ischemic Stroke Epilepsy after Acute Stroke Interventions
Kuohn LR, Herman AL, Soto AL, Brown SC, Gilmore EJ, Hirsch LJ, Matouk CC, Sheth KN, Kim JA. Hospital Revisits for Post-Ischemic Stroke Epilepsy after Acute Stroke Interventions. Journal Of Stroke And Cerebrovascular Diseases 2021, 31: 106155. PMID: 34688213, PMCID: PMC8766898, DOI: 10.1016/j.jstrokecerebrovasdis.2021.106155.Peer-Reviewed Original ResearchConceptsIschemic stroke survivorsIV-tPADecompressive craniectomyHospital revisitsStroke survivorsAcute stroke interventionAcute ischemic strokeAcute stroke careProportional hazards regressionImpact of therapyHistory of epilepsyAcute seizuresHospital seizuresIschemic strokeStroke severityPrimary outcomeStroke interventionStroke treatmentStroke careHazards regressionMultivariable modelRetrospective analysisCumulative rateClaims dataPatientsPatient‐detectable responsive neurostimulation as a seizure warning system
Quraishi IH, Hirsch LJ. Patient‐detectable responsive neurostimulation as a seizure warning system. Epilepsia 2021, 62: e110-e116. PMID: 34018182, PMCID: PMC8629031, DOI: 10.1111/epi.16933.Peer-Reviewed Original ResearchConceptsResponsive neurostimulation systemFocal impaired awareness seizuresProportion of patientsQuality of lifeSeizure warningTolerable symptomsClinical seizuresLatter therapySelect patientsAwareness seizuresEpileptiform activityEarly recognitionResponsive neurostimulationEpileptiform patternsCognitive impairmentPatientsNeurostimulation systemSymptomsSeizuresTherapyTreatment of clustersStimulationSeizure warning systemSeizure recognitionEpilepsyElectroencephalographic Abnormalities are Common in COVID‐19 and are Associated with Outcomes
Lin L, Al‐Faraj A, Ayub N, Bravo P, Das S, Ferlini L, Karakis I, Lee JW, Mukerji SS, Newey CR, Pathmanathan J, Abdennadher M, Casassa C, Gaspard N, Goldenholz DM, Gilmore EJ, Jing J, Kim JA, Kimchi EY, Ladha HS, Tobochnik S, Zafar S, Hirsch LJ, Westover MB, Shafi MM. Electroencephalographic Abnormalities are Common in COVID‐19 and are Associated with Outcomes. Annals Of Neurology 2021, 89: 872-883. PMID: 33704826, PMCID: PMC8104061, DOI: 10.1002/ana.26060.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusElectrographic seizuresClinical outcomesEpileptiform abnormalitiesRisk factorsPresence of NCSEMultivariate Cox proportional hazards analysisMulticenter retrospective cohort studyCox proportional hazards analysisCOVID-19Retrospective cohort studyClinical risk factorsContinuous electroencephalogram monitoringAdverse clinical outcomesProportional hazards analysisCoronavirus disease 2019Ann NeurolHospital mortalityHospital lengthClinical seizuresCohort studyIndependent predictorsStatus epilepticusEEG findingsElectroencephalographic abnormalitiesBrief potentially ictal rhythmic discharges and paroxysmal fast activity as scalp electroencephalographic biomarkers of seizure activity and seizure onset zone
Yoo JY, Jetté N, Kwon C, Young J, Marcuse LV, Fields MC, Gaspard N, Hirsch LJ. Brief potentially ictal rhythmic discharges and paroxysmal fast activity as scalp electroencephalographic biomarkers of seizure activity and seizure onset zone. Epilepsia 2021, 62: 742-751. PMID: 33576500, DOI: 10.1111/epi.16822.Peer-Reviewed Original ResearchConceptsParoxysmal fast activitySeizure onset zoneIctal rhythmic dischargesClinical significanceElectrographic seizuresSeizure activityRhythmic dischargesFast activityOnset zoneUncontrolled seizure activityPosterior dominant rhythmSimilar clinical significancePatient demographicsElectroencephalographic biomarkerLocalizing signFocal slowingClinical historySeizure riskEEG backgroundPatientsAdult cohortDominant rhythmSeizuresDistinct entityEEG biomarkersVideo quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study
Tatum WO, Hirsch LJ, Gelfand MA, Acton EK, LaFrance WC, Duckrow RB, Chen D, Blum AS, Hixson J, Drazkowski J, Benbadis S, Cascino GD, Collaborators T. Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study. European Journal Of Neurology 2021, 28: 1453-1462. PMID: 33465822, DOI: 10.1111/ene.14744.Peer-Reviewed Original ResearchConceptsPsychogenic nonepileptic attacksNeurologic eventsEpileptic seizuresInpatient video-electroencephalography (EEG) monitoringPhysiologic nonepileptic eventsMulticenter cohort studyMajority of patientsVideo-electroencephalography monitoringVideo-EEG monitoringSimilar diagnostic accuracyHome video recordingEpilepsy outpatientsNeurological disease statesCohort studyNeurological eventsNonepileptic eventsNonepileptic attacksUnknown diagnosisAdequate durationClinical informationPatientsSenior neurology residentsAccurate diagnosisDiagnostic accuracyNeurology residents
2020
Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy
Nair DR, Laxer KD, Weber PB, Murro AM, Park YD, Barkley GL, Smith BJ, Gwinn RP, Doherty MJ, Noe KH, Zimmerman RS, Bergey GK, Anderson WS, Heck C, Liu CY, Lee RW, Sadler T, Duckrow RB, Hirsch LJ, Wharen RE, Tatum W, Srinivasan S, McKhann GM, Agostini MA, Alexopoulos AV, Jobst BC, Roberts DW, Salanova V, Witt TC, Cash SS, Cole AJ, Worrell GA, Lundstrom BN, Edwards JC, Halford JJ, Spencer DC, Ernst L, Skidmore CT, Sperling MR, Miller I, Geller EB, Berg MJ, Fessler AJ, Rutecki P, Goldman AM, Mizrahi EM, Gross RE, Shields DC, Schwartz TH, Labar DR, Fountain NB, Elias WJ, Olejniczak PW, Villemarette-Pittman NR, Eisenschenk S, Roper SN, Boggs JG, Courtney TA, Sun FT, Seale CG, Miller KL, Skarpaas TL, Morrell MJ. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology 2020, 95: 10.1212/wnl.0000000000010154. PMID: 32690786, PMCID: PMC7538230, DOI: 10.1212/wnl.0000000000010154.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedDepressive DisorderDrug Resistant EpilepsyElectric Stimulation TherapyEpilepsies, PartialFemaleFollow-Up StudiesHumansImplantable NeurostimulatorsIntracranial HemorrhagesMaleMemory DisordersMiddle AgedProspective StudiesProsthesis-Related InfectionsQuality of LifeRandomized Controlled Trials as TopicStatus EpilepticusSudden Unexpected Death in EpilepsySuicideTreatment OutcomeYoung AdultConceptsBrain-responsive neurostimulationQuality of lifeFocal onset seizuresAdverse eventsSeizure frequencyIntractable focal onset seizuresProspective open-label trialOverall QOLOpen-label trialSerious adverse eventsClass IV evidenceMedian percent reductionSudden unexplained deathMedian percent changeSeizure-free periodQOLIE-89SUDEP ratesLabel trialSeizure freedomEpilepsy ratesFocal seizuresOnset seizuresEpilepsy InventoryAcceptable safetyFocal epilepsyEvaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study.
Vespa PM, Olson DM, John S, Hobbs KS, Gururangan K, Nie K, Desai MJ, Markert M, Parvizi J, Bleck TP, Hirsch LJ, Westover MB. Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study. Critical Care Medicine 2020, 48: 1249-1257. PMID: 32618687, PMCID: PMC7735649, DOI: 10.1097/ccm.0000000000004428.Peer-Reviewed Original ResearchConceptsNonconvulsive seizuresSeizure diagnosisTreatment planProspective observational clinical studyDiagnostic assessmentObservational clinical studyAssessment of patientsCritical care settingSerious adverse effectsTherapeutic decision makingProspective multicenterSecondary outcomesICU patientsPrimary outcomeStatus epilepticusHigh suspicionElectroencephalography assessmentAcademic hospitalBedside assessmentClinical impactClinical studiesObservational studyCare settingsPhysician confidencePatientsValidation 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 timeAssessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures
Tatum WO, Hirsch LJ, Gelfand MA, Acton EK, LaFrance WC, Duckrow RB, Chen DK, Blum AS, Hixson JD, Drazkowski JF, Benbadis SR, Cascino GD. Assessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures. JAMA Neurology 2020, 77: 593-600. PMID: 31961382, PMCID: PMC6990754, DOI: 10.1001/jamaneurol.2019.4785.Peer-Reviewed Original ResearchConceptsPhysical examination resultsPsychogenic nonepileptic attacksVideo electroencephalogram monitoringEpileptic seizuresVideo electroencephalogramEpilepsy centersPhysical examinationElectroencephalogram monitoringNonepileptic attacksCorrect diagnosisPhysiologic nonepileptic eventsEvaluation of epilepsyExamination resultsMisdiagnosis of epilepsyDiagnostic accuracy studiesPsychogenic attacksMotor signsNonepileptic eventsDefinitive diagnosisPatient historyMAIN OUTCOMEClinic outpatientsPredictive valueSeizuresDiagnosisDeep Versus Lobar Intraparenchymal Hemorrhage: Seizures, Hyperexcitable Patterns, and Clinical Outcomes.
Sheikh ZB, Stretz C, Maciel CB, Dhakar MB, Orgass H, Petroff OA, Hirsch LJ, Gilmore EJ. Deep Versus Lobar Intraparenchymal Hemorrhage: Seizures, Hyperexcitable Patterns, and Clinical Outcomes. Critical Care Medicine 2020, 48: e505-e513. PMID: 32301843, DOI: 10.1097/ccm.0000000000004317.Peer-Reviewed Original ResearchConceptsDeep intraparenchymal hemorrhageElectrographic seizuresIntraparenchymal hemorrhageRhythmic delta activityTemporal lobe involvementPoor outcomeLobar groupThalamic involvementClinical outcomesLobe involvementDelta activityTertiary academic medical centerNontraumatic intraparenchymal hemorrhagesConsecutive adult patientsRetrospective cohort studyFisher's exact testMann-Whitney U testAcademic medical centerSpike-wave complexesIntraparenchymal hemorrhage volumeAdult patientsCohort studyMultivariable analysisHematoma volumeInsular involvementAssessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction
Struck AF, Tabaeizadeh M, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T, Hernandez C, Kaleem S, Haider HA, Cissé AF, Dhakar MB, Hirsch LJ, Rosenthal ES, Zafar SF, Gaspard N, Westover MB. Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction. JAMA Neurology 2020, 77: 500-507. PMID: 31930362, PMCID: PMC6990873, DOI: 10.1001/jamaneurol.2019.4656.Peer-Reviewed Original ResearchConceptsContinuous electroencephalogramValidation cohortMAIN OUTCOMEEEG monitoringRetrospective medical record reviewKaplan-Meier survival analysisPatients 18 yearsMedical record reviewRisk of seizuresHigh-risk groupFirst hourEpileptiform EEG patternCEEG useClinical seizuresPrimary outcomeHospitalized patientsRecord reviewRisk stratificationEpileptiform findingsCardiac arrestSeizure riskClinical indicationsInclusion criteriaIndependent cohortAdequate screenMesial temporal resection following long‐term ambulatory intracranial EEG monitoring with a direct brain‐responsive neurostimulation system
Hirsch LJ, Mirro EA, Salanova V, Witt TC, Drees CN, Brown M, Lee RW, Sadler TL, Felton EA, Rutecki P, Shin HW, Hadar E, Hegde M, Rao VR, Mnatsakanyan L, Madhavan DS, Zakaria TJ, Liu AA, Heck CN, Greenwood JE, Bigelow JK, Nair DR, Alexopoulos AV, Mackow M, Edwards JC, Sotudeh N, Kuzniecky RI, Gwinn RP, Doherty MJ, Geller EB, Morrell MJ. Mesial temporal resection following long‐term ambulatory intracranial EEG monitoring with a direct brain‐responsive neurostimulation system. Epilepsia 2020, 61: 408-420. PMID: 32072621, PMCID: PMC7154711, DOI: 10.1111/epi.16442.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnterior Temporal LobectomyDrug Resistant EpilepsyElectric Stimulation TherapyElectrocorticographyEpilepsy, Temporal LobeFemaleHumansImplantable NeurostimulatorsMaleMiddle AgedMonitoring, AmbulatoryNeurosurgical ProceduresRetrospective StudiesTemporal LobeTreatment OutcomeYoung AdultConceptsMTL resectionElectrographic seizuresTemporal lobe seizure onsetClinical seizure reductionMesial temporal resectionIntracranial EEG monitoringRNS SystemBitemporal epilepsySeizure reductionSeizure outcomeTemporal resectionPrimary outcomeRefractory epilepsyAdditional patientsEpilepsy centersUnilateral onsetBilateral onsetIcEEG recordingsSeizure onsetMTL epilepsyMedian reductionResectionPatientsEEG monitoringIcEEG data
2019
Continuous EEG Findings in Autoimmune Encephalitis.
Moise AM, Karakis I, Herlopian A, Dhakar M, Hirsch LJ, Cotsonis G, LaRoche S, Cabrera Kang CM, Westover B, Rodriguez A. Continuous EEG Findings in Autoimmune Encephalitis. Journal Of Clinical Neurophysiology 2019, 38: 124-129. PMID: 31800465, PMCID: PMC7263965, DOI: 10.1097/wnp.0000000000000654.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusRefractory status epilepticusRhythmic delta activityGeneralized rhythmic delta activityAutoimmune encephalitisStatus epilepticusDelta activityPoor outcomeAE subtypeFast activityAntibody-negative autoimmune encephalitisN-methyl-D-aspartate receptorsDefinite limbic encephalitisExtreme delta brushMulticenter retrospective reviewNew-onset seizuresContinuous EEG monitoringGlutamic acid decarboxylaseVoltage-gated potassium channelsLimbic encephalitisRetrospective reviewAE patientsElectrographic seizuresDelta brushEEG findingsQuantitative Electroencephalogram Trends Predict Recovery in Hypoxic-Ischemic Encephalopathy.
Ghassemi MM, Amorim E, Alhanai T, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hirsch LJ, Scirica BM, Biswal S, Moura Junior V, Cash SS, Brown EN, Mark RG, Westover MB. Quantitative Electroencephalogram Trends Predict Recovery in Hypoxic-Ischemic Encephalopathy. Critical Care Medicine 2019, 47: 1416-1423. PMID: 31241498, PMCID: PMC6746597, DOI: 10.1097/ccm.0000000000003840.Peer-Reviewed Original ResearchConceptsHypoxic-ischemic encephalopathyNeurologic outcomeElectroencephalogram featuresAcute hypoxic-ischemic encephalopathyAcademic medical centerBetter prognostic predictionReceiver operator curveNeurologic recoveryComatose patientsPrognostic implicationsCardiac arrestMedical CenterPrognostication performancePrognostic predictionOperator curveLogistic regressionSequential logistic regressionSpecificity thresholdEncephalopathyStatistical associationOutcomesComparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit
Owusu KA, Dhakar MB, Bautista C, McKimmy D, Cotugno S, Sukumar N, Deng Y, Farooque P, Hirsch LJ, Maciel CB. Comparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit. Epilepsy & Behavior 2019, 98: 161-167. PMID: 31374472, DOI: 10.1016/j.yebeh.2019.07.021.Peer-Reviewed Original ResearchConceptsEpilepsy monitoring unitAdult epilepsy monitoring unitIntravenous lorazepamIntensive care unitIntranasal midazolamRescue therapySeizure clustersSeizure terminationSingle tertiary academic centerStandard rescue therapyDouble-blind studyTertiary academic centerIndex seizureAdverse eventsBaseline characteristicsConsecutive adultsMedian durationRetrospective cohortRecurrent seizuresStatus epilepticusCare unitRetrospective studyEpilepsy severityBenzodiazepine administrationMedian numberTreatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings
Nune G, Arcot Desai S, Razavi B, Agostini MA, Bergey GK, Herekar AA, Hirsch LJ, Lee RW, Rutecki PA, Srinivasan S, Van Ness PC, Tcheng TK, Morrell MJ. Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings. Clinical Neurophysiology 2019, 130: 1196-1207. PMID: 31163364, DOI: 10.1016/j.clinph.2019.04.706.Peer-Reviewed Original ResearchConceptsPeriventricular nodular heterotopiaClinical seizure frequencySeizure frequencySeizure rateNodular heterotopiaDirect brain-responsive neurostimulationBrain-responsive neurostimulationDrug-resistant epilepsyEffective treatment optionSeizure-onset patternsSeizure propagation patternsChronic electrophysiological recordingsSeizure reductionClinical seizuresSuch patientsElectrographic seizuresPattern of spreadIntractable seizuresTreatment optionsEpileptogenic networksSeizure generationOnset typeMean reductionLead locationPatientsRandomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures
Tolchin B, Baslet G, Suzuki J, Martino S, Blumenfeld H, Hirsch LJ, Altalib H, Dworetzky BA. Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures. Epilepsia 2019, 60: 986-995. PMID: 30980679, DOI: 10.1111/epi.14728.Peer-Reviewed Original ResearchConceptsPsychogenic nonepileptic seizuresQuality of lifeMI participantsPNES frequencyMotivational interviewingControl participantsNonepileptic seizuresQuaternary care medical centerEmergency department visitsEmergency department utilizationSingle neurologistDepartment visitsTreatment adherenceControl armMedical CenterMI armsSeizuresVisitsTrialsAdherenceParticipantsPsychotherapyAdherentArmReferral