2024
Seizure 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 ResearchMeSH KeywordsAdultAgedComparative Effectiveness ResearchElectroencephalographyFemaleHumansMaleMiddle AgedRetrospective StudiesSeizuresConceptsMonitoring 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
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 ResearchMeSH KeywordsBrain Injuries, TraumaticCase-Control StudiesElectroencephalographyEpilepsy, Post-TraumaticHumansRetrospective StudiesConceptsPost-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 analysisAssociation 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 studyFactors Predicting Outcome After Intracranial EEG Evaluation in Patients With Medically Refractory Epilepsy
Sivaraju A, Hirsch L, Gaspard N, Farooque P, Gerrard J, Xu Y, Deng Y, Damisah E, Blumenfeld H, Spencer DD. Factors Predicting Outcome After Intracranial EEG Evaluation in Patients With Medically Refractory Epilepsy. Neurology 2022, 99: e1-e10. PMID: 35508395, PMCID: PMC9259091, DOI: 10.1212/wnl.0000000000200569.Peer-Reviewed Original ResearchMeSH KeywordsDrug Resistant EpilepsyElectrocorticographyElectroencephalographyHumansMagnetic Resonance ImagingRetrospective StudiesTreatment OutcomeConceptsTemporal lobe onsetSeizure freedomResective surgeryIndependent predictorsLesional MRIUnfavorable predictorRefractory epilepsyContinued medical treatmentEpilepsy surgical evaluationFactors Predicting OutcomeIntracranial EEG evaluationNonlesional extratemporal epilepsySubsequent seizure freedomSustained seizure freedomThorough presurgical evaluationSeizure-free outcomeClass II evidenceMedically Refractory EpilepsyRetrospective chart reviewKaplan-Meier curvesSelect clinical scenariosMultivariable regression analysisBest multivariable modelIntracranial EEGSeizure onset localizationPregabalin for Recurrent Seizures in Critical Illness: A Promising Adjunctive Therapy, Especially for cyclic Seizures
Busl KM, Fong MWK, Newcomer Z, Patel M, Cohen SA, Jadav R, Smith CN, Mitropanopoulos S, Bruzzone M, Hella M, Eisenschenk S, Robinson CP, Roth WH, Ameli PA, Babi MA, Pizzi MA, Gilmore EJ, Hirsch LJ, Maciel CB. Pregabalin for Recurrent Seizures in Critical Illness: A Promising Adjunctive Therapy, Especially for cyclic Seizures. Neurocritical Care 2022, 37: 140-148. PMID: 35217998, DOI: 10.1007/s12028-022-01459-6.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnticonvulsantsCritical IllnessFemaleHumansMalePregabalinRetrospective StudiesSeizuresConceptsCyclic seizuresSeizure burdenSeizure frequencyRecurrent seizuresMin/hourAntiseizure medicationsElectrographic seizure burdenMedian seizure frequencyNeurocritical care settingPromising adjunctive therapyEffective adjunctive treatmentVoltage-gated calcium channelsNeurointensive care unitRetrospective case seriesTreatment of seizuresAlpha2-delta subunitExcitatory neurotransmitter releaseCoprimary outcomesIll cohortPGB administrationAntiseizure effectsSeizure recurrenceAdjunctive therapyCritical illnessRefractory seizures
2021
Combining Transcranial Doppler and EEG Data to Predict Delayed Cerebral Ischemia After Subarachnoid Hemorrhage
Chen HY, Elmer J, Zafar SF, Ghanta M, Moura Junior V, Rosenthal ES, Gilmore EJ, Hirsch LJ, Zaveri HP, Sheth KN, Petersen NH, Westover MB, Kim JA. Combining Transcranial Doppler and EEG Data to Predict Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Neurology 2021, 98: e459-e469. PMID: 34845057, PMCID: PMC8826465, DOI: 10.1212/wnl.0000000000013126.Peer-Reviewed Original ResearchSimulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment
Kumar A, Martin R, Chen W, Bauerschmidt A, Youngblood MW, Cunningham C, Si Y, Ezeani C, Kratochvil Z, Bronen J, Thomson J, Riordan K, Yoo JY, Shirka R, Manganas L, Krestel H, Hirsch LJ, Blumenfeld H. Simulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment. Epilepsia 2021, 63: e30-e34. PMID: 34816425, PMCID: PMC8883409, DOI: 10.1111/epi.17136.Peer-Reviewed Original ResearchMeSH KeywordsConsciousnessElectroencephalographyEpilepsyHumansMotor DisordersRetrospective StudiesSeizuresConceptsSeizure typesFocal seizuresMotor functionMotor impairmentYale-New Haven HospitalVideo-electroencephalographic monitoringAbnormal motor functionEpilepsy monitoring unitNew Haven HospitalImpaired consciousnessMyoclonic seizuresRetrospective studySeizure characteristicsMotor involvementIctal eventsImpaired drivingLarge cohortSeizuresImpairmentPatientsResponsivenessDriving restrictionsVideo reviewMonitoring unitEpilepsyHospital 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 ResearchMeSH KeywordsAgedAged, 80 and overEpilepsyFemaleHumansIschemic StrokeMaleMiddle AgedPatient ReadmissionRetrospective StudiesConceptsIschemic 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 dataPatientsElectroencephalographic 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 ResearchMeSH KeywordsAgedCOVID-19ElectroencephalographyFemaleHumansMaleMiddle AgedRetrospective StudiesRisk FactorsSeizuresTreatment OutcomeConceptsNonconvulsive 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 abnormalitiesHigh epileptiform discharge burden predicts delayed cerebral ischemia after subarachnoid hemorrhage
Kim JA, Zheng WL, Elmer J, Jing J, Zafar SF, Ghanta M, Moura V, Gilmore EJ, Hirsch LJ, Patel A, Rosenthal E, Westover MB. High epileptiform discharge burden predicts delayed cerebral ischemia after subarachnoid hemorrhage. Clinical Neurophysiology 2021, 141: 139-146. PMID: 33812771, PMCID: PMC8429508, DOI: 10.1016/j.clinph.2021.01.022.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCerebral InfarctionHumansPeriodicityRetrospective StudiesSubarachnoid HemorrhageConceptsED burdenSubarachnoid hemorrhageEpileptiform dischargesCerebral ischemiaSAH patientsHigh riskOnset of DCIMajor risk periodContinuous EEG recordingsDCI patientsDCI riskRetrospective analysisNovel biomarkersGroup-based trajectory analysisRisk periodPatientsDay 3.5DCIBurdenHemorrhageIschemiaRiskEEG recordingsBurden rateUseful parameterBrief 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 ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overBiomarkersElectroencephalographyFemaleHumansMaleMiddle AgedRetrospective StudiesSeizuresYoung AdultConceptsParoxysmal 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 biomarkers
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 ResearchMeSH KeywordsCritical IllnessElectroencephalographyHumansMagnetic Resonance ImagingNeuroimagingRetrospective StudiesConceptsRhythmic 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 significanceMRINonepileptic Electroencephalographic Correlates of Episodic Increases in Intracranial Pressure
Sheikh ZB, Maciel CB, Dhakar MB, Hirsch LJ, Gilmore EJ. Nonepileptic Electroencephalographic Correlates of Episodic Increases in Intracranial Pressure. Journal Of Clinical Neurophysiology 2020, 39: 149-158. PMID: 32701765, DOI: 10.1097/wnp.0000000000000750.Peer-Reviewed Original ResearchMeSH KeywordsElectroencephalographyHumansIntracranial HypertensionIntracranial PressureRetrospective StudiesBeyond implantation effect? Long-term seizure reduction and freedom following intracranial monitoring without additional surgical interventions
Percy J, Zaveri H, Duckrow RB, Gerrard J, Farooque P, Hirsch LJ, Spencer DD, Sivaraju A. Beyond implantation effect? Long-term seizure reduction and freedom following intracranial monitoring without additional surgical interventions. Epilepsy & Behavior 2020, 111: 107231. PMID: 32615416, DOI: 10.1016/j.yebeh.2020.107231.Peer-Reviewed Original ResearchConceptsLong-term seizure freedomSeizure freedomSeizure frequencyElectrode implantationIntracranial studiesLong-term seizure reductionAdditional surgical interventionSeizure onset localizationIntracranial electroencephalogram monitoringSeizure reductionConsecutive patientsSurgical interventionEpileptogenic networksElectroencephalogram monitoringNeuromodulatory effectsRetrospective analysisIntracranial monitoringTransient improvementDepth electrodesPatientsYear 4ImplantationAdequate dataYearsDeep 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 ResearchMeSH KeywordsAdultBrainElectroencephalographyFemaleHumansInpatientsMaleMiddle AgedMonitoring, PhysiologicRetrospective StudiesRisk AssessmentSeizuresConceptsContinuous 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 dataDiagnostic 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 ResearchMeSH KeywordsAdultCritical IllnessElectrodesElectroencephalographyHumansRetrospective StudiesSeizuresConceptsDiagnostic 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
2019
Early detection rate changes from a brain‐responsive neurostimulation system predict efficacy of newly added antiseizure drugs
Quraishi IH, Mercier MR, Skarpaas TL, Hirsch LJ. Early detection rate changes from a brain‐responsive neurostimulation system predict efficacy of newly added antiseizure drugs. Epilepsia 2019, 61: 138-148. PMID: 31849045, PMCID: PMC7003822, DOI: 10.1111/epi.16412.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsClinical Trials as TopicDrug Resistant EpilepsyElectric Stimulation TherapyElectrocorticographyHumansRetrospective StudiesTreatment OutcomeConceptsPositive predictive valueEpisode startsLonger episodesSystem patientsPredictive valueFirst weekLong-term treatment trialsBrain-responsive neurostimulationSingle epilepsy centerSingle-center cohortRefractory focal epilepsyGreater reductionMedication adjustmentsClinical improvementClinical responseSeizure frequencyAntiseizure drugsCenter cohortMulticenter cohortEpilepsy centersMedication trialsEffective medicationsEfficacy measuresTreatment trialsFocal epilepsyContinuous 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 findings