2024
Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher‐level emergency: Consensus recommendations of an expert working group
Pina‐Garza J, Chez M, Cloyd J, Hirsch L, Kälviäinen R, Klein P, Lagae L, Sankar R, Specchio N, Strzelczyk A, Toledo M, Trinka E. Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher‐level emergency: Consensus recommendations of an expert working group. Epileptic Disorders 2024, 26: 484-497. PMID: 38813941, DOI: 10.1002/epd2.20243.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsConsensusDelphi TechniqueDisease ProgressionHumansOutpatientsSeizuresStatus EpilepticusConceptsExpert working groupDefinition of PSSeizure action planWorking GroupEvidence-based guidanceProlonged seizuresSeizure clustersManaging PSStatus epilepticusExpert recommendationsTreatment goalsConsensus recommendationsOutpatient managementConsensus definitionAction planMedicationManagement of acute seizuresRecommendationsIdeal medicationAcute seizuresPrevent progressionSevere seizuresSeizure activityGroup membersSeizure termination
2022
Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure Cluster Study
Jafarpour S, Fong MWK, Detyniecki K, Khan A, Jackson-Shaheed E, Wang X, Lewis S, Benjamin R, Gaínza-Lein M, O'Bryan J, Hirsch LJ, Loddenkemper T. Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure Cluster Study. Pediatric Neurology 2022, 137: 22-29. PMID: 36208614, DOI: 10.1016/j.pediatrneurol.2022.08.014.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsBrain Damage, ChronicChildEpilepsyEpilepsy, GeneralizedHumansPrevalenceRisk FactorsStatus EpilepticusConceptsSeizure clustersRescue medicationPediatric patientsSeizure frequencyIntermediate-risk groupEmergency department visitsHigh seizure frequencyTwo-center studyEmergency room visitsHigh-risk groupActive seizuresMore seizuresDepartment visitsStatus epilepticusRoom visitsAdverse outcomesEpilepsy severityIsolated seizureSeizure diariesRisk factorsRisk groupsGreater oddsPatientsMedicationsSeizuresAssociation 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 studyElectroencephalogram 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 ResearchMeSH KeywordsBrain InjuriesElectroencephalographyHumansIntensive Care UnitsSeizuresStatus EpilepticusConceptsAcute 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 electroencephalographyUpdated review of rescue treatments for seizure clusters and prolonged seizures
Blond BN, Hirsch LJ. Updated review of rescue treatments for seizure clusters and prolonged seizures. Expert Review Of Neurotherapeutics 2022, 22: 567-577. PMID: 35862983, DOI: 10.1080/14737175.2022.2105207.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsEpilepsyEpilepsy, GeneralizedHumansQuality of LifeSeizuresStatus EpilepticusConceptsRescue medicationProlonged seizuresSeizure clustersTreatment of epilepsyQuality of lifeOngoing seizuresFurther seizuresRefractory seizuresRecurrent seizuresRescue treatmentSeizure activitySeizure episodesIntranasal formulationRisk factorsClinical careEffective treatmentMedicationsSeizuresEpilepsyMorbidityClinical opportunitiesAdverse effectsTreatmentReviewEpidemiology
2021
Pharmacotherapy for Nonconvulsive Seizures and Nonconvulsive Status Epilepticus
Bravo P, Vaddiparti A, Hirsch LJ. Pharmacotherapy for Nonconvulsive Seizures and Nonconvulsive Status Epilepticus. Drugs 2021, 81: 749-770. PMID: 33830480, DOI: 10.1007/s40265-021-01502-4.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusAntiseizure medicationsNonconvulsive seizuresStatus epilepticusIll patientsRefractory nonconvulsive status epilepticusFurther neurological injuryMultiple antiseizure medicationsAdverse neurological outcomesContinuous electroencephalogram monitoringLong-term outcomesHemodynamic labilityRecent neurosurgerySeizure burdenNeurological outcomePharmacological managementBrain infectionGlobal hypoxiaNeurological injuryEarly recognitionMost seizuresUnderlying conditionClinical trialsElectroencephalogram monitoringHepatic function
2020
When and How to Treat Status Epilepticus: The Tortoise or the Hare?
Fong MWK, Hirsch LJ. When and How to Treat Status Epilepticus: The Tortoise or the Hare? Journal Of Clinical Neurophysiology 2020, 37: 393-398. PMID: 32890060, DOI: 10.1097/wnp.0000000000000656.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsElectroencephalographyForecastingHumansHypnotics and SedativesSeizuresStatus EpilepticusTime FactorsTreatment OutcomeConceptsType of SEStatus epilepticusTreatment of SECessation of seizuresCurrent treatment guidelinesConvulsive status epilepticusTreatment guidelinesFull dosesNeuronal responsesVariety of subtypesPromising future approachUnnecessary harmEpilepticusPatientsTherapyTreatmentFuture approachesCollective termNine-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 epilepsyChoosing Anticonvulsant Medications to Manage Status Epilepticus
Wu K, Hirsch LJ, Babl FE, Josephson SA. Choosing Anticonvulsant Medications to Manage Status Epilepticus. New England Journal Of Medicine 2020, 382: 2569-2572. PMID: 32579819, DOI: 10.1056/nejmclde2004317.Peer-Reviewed Original ResearchAuthor response: New onset refractory status epilepticus research: What is on the horizon?
Gofton TE, Hirsch LJ. Author response: New onset refractory status epilepticus research: What is on the horizon? Neurology 2020, 94: 596. PMID: 32229639, DOI: 10.1212/wnl.0000000000009187.Peer-Reviewed Original Research
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 findingsComparison 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 numberCommunication Challenges: A Spotlight on New-Onset Refractory Status Epilepticus
Gofton TE, Wong N, Hirsch LJ, Hocker SE. Communication Challenges: A Spotlight on New-Onset Refractory Status Epilepticus. Mayo Clinic Proceedings 2019, 94: 857-863. PMID: 30935709, DOI: 10.1016/j.mayocp.2018.12.004.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusRefractory status epilepticusClinical courseStatus epilepticusCritical care supportPalliative care servicesHealth care team membersUnpredictable clinical courseContinuity of careCare team membersCurative intentHealthy patientsDevastating conditionOngoing therapyResponsible physicianMultiple specialistsCare servicesCare supportMedical teamPatientsIndividual hospitalsYoung adultsEpilepticusEarly involvementCareNew onset refractory status epilepticus research: What is on the horizon?
Gofton TE, Gaspard N, Hocker SE, Loddenkemper T, Hirsch LJ. New onset refractory status epilepticus research: What is on the horizon? Neurology 2019, 92: 802-810. PMID: 30894443, DOI: 10.1212/wnl.0000000000007322.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusRefractory status epilepticusStatus epilepticusFebrile infection-related epilepsy syndromeMore rescue medicationsRescue medicationNew onsetActive epilepsyClinical featuresClinical presentationEpilepsy syndromesMetabolic causesNeurologic disordersPediatric EvaluationSpecific diagnosisAge groupsEpilepticusFamily supportFuture collaborative researchMedicationsPatientsFeverEpilepsyPathophysiologySyndrome
2018
Clinical Correlates of Periodic Discharges and Nonconvulsive Seizures in Posterior Reversible Encephalopathy Syndrome (PRES)
Bastide L, Legros B, Rampal N, Gilmore EJ, Hirsch LJ, Gaspard N. Clinical Correlates of Periodic Discharges and Nonconvulsive Seizures in Posterior Reversible Encephalopathy Syndrome (PRES). Neurocritical Care 2018, 29: 481-490. PMID: 29949000, DOI: 10.1007/s12028-018-0548-2.Peer-Reviewed Original ResearchConceptsPosterior reversible encephalopathy syndromeReversible encephalopathy syndromeContinuous electroencephalography monitoringGlasgow Outcome ScaleNonconvulsive seizuresPeriodic dischargesEncephalopathy syndromeRisk factorsWorse outcomesEpileptiform patternsMagnetic resonance imaging (MRI) abnormalitiesRetrospective cohort studyCEEG findingsEligible patientsRelated seizuresCohort studyHospital dischargeLow disabilityIll patientsImaging abnormalitiesMedical chartsClinical featuresPathophysiological mechanismsEEG findingsFunctional outcomeNew‐onset refractory status epilepticus (NORSE) and febrile infection–related epilepsy syndrome (FIRES): State of the art and perspectives
Gaspard N, Hirsch LJ, Sculier C, Loddenkemper T, van Baalen A, Lancrenon J, Emmery M, Specchio N, Farias‐Moeller R, Wong N, Nabbout R. New‐onset refractory status epilepticus (NORSE) and febrile infection–related epilepsy syndrome (FIRES): State of the art and perspectives. Epilepsia 2018, 59: 745-752. PMID: 29476535, DOI: 10.1111/epi.14022.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsConsensusDrug Resistant EpilepsyElectroencephalographyEpileptic SyndromesHumansStatus EpilepticusConceptsNew-onset refractory status epilepticusFebrile infection-related epilepsy syndromeRefractory status epilepticusStatus epilepticusCytokine-mediated mechanismOptimal treatment optionsAdult-onset formStrong scientific evidenceStandardized consensus definitionsMulticenter registryPrompt treatmentKetogenic dietUncontrolled trialsEpilepsy syndromesImmune therapyTreatment optionsEarly recognitionClinical careConsensus definitionClinical situationsPatient careEpilepticusStandardized definitionsElectroencephalography featuresScientific evidenceProposed consensus definitions for new‐onset refractory status epilepticus (NORSE), febrile infection‐related epilepsy syndrome (FIRES), and related conditions
Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T, Navarro V, Specchio N, Lagae L, Rossetti AO, Hocker S, Gofton TE, Abend NS, Gilmore EJ, Hahn C, Khosravani H, Rosenow F, Trinka E. Proposed consensus definitions for new‐onset refractory status epilepticus (NORSE), febrile infection‐related epilepsy syndrome (FIRES), and related conditions. Epilepsia 2018, 59: 739-744. PMID: 29399791, DOI: 10.1111/epi.14016.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusFebrile infection-related epilepsy syndromeRefractory status epilepticusStatus epilepticusConsensus definitionEpilepsy syndromesFebrile infectionsCritical Care EEG Monitoring Research ConsortiumSuper-refractory status epilepticusRelated conditionsHemiconvulsion-HemiplegiaNew onsetActive epilepsyImproved communicationClinical presentationNeurocritical careMetabolic causesPediatric expertsEpilepticusRelevant neurological disordersConsensus conferenceSpecific diagnosisNeurological disordersMulticenter researchSyndrome
2017
Surgical outcome in adolescents with mesial temporal sclerosis: Is it different?
Farooque P, Hirsch L, Levy S, Testa F, Mattson R, Spencer D. Surgical outcome in adolescents with mesial temporal sclerosis: Is it different? Epilepsy & Behavior 2017, 69: 24-27. PMID: 28235653, DOI: 10.1016/j.yebeh.2016.10.028.Peer-Reviewed Original ResearchConceptsMesial temporal sclerosisTemporal sclerosisStatus epilepticusTemporal lobectomySurgical outcomesAdolescent patientsIctal onsetMore lobesEpilepsy surgery databaseScalp EEGSeizure freedomPatient populationSurgery DatabaseRisk factorsPatientsElectrographic dataLobectomyEpilepticusTwo yearsSclerosisHypometabolismNovel findingsAdolescentsMRIOutcomes
2015
New-onset refractory status epilepticus
Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, Meyers E, Espinera A, Haas KF, Schmitt SE, Gerard EE, Gofton T, Kaplan PW, Lee JW, Legros B, Szaflarski JP, Westover BM, LaRoche SM, Hirsch LJ, Fertig E, Herman S, Huh L, Lee J, Loddenkemper T, Chapman K, Abend N, Carpenter J, Hantus S, Claassen J, Husain A, Gaspard N, LaRoche S, Ritzl E, Gofton T, Wusthoff C, Goldstein J, Westover B, Hocker S, Halford J, Jones J, Gerard E, Schmitt S, Williams K, Hahn C, Szaflarski J, Kramer A, Rudzinski L, Hopp J, Mani R, Kalamangalam G, Gupta P, Quigg M, Haas K, Ostendorf A, Zutshi D, Hirsch L. New-onset refractory status epilepticus. Neurology 2015, 85: 1604-1613. PMID: 26296517, PMCID: PMC4642147, DOI: 10.1212/wnl.0000000000001940.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAnestheticsAnticonvulsantsAnti-N-Methyl-D-Aspartate Receptor EncephalitisAutoantibodiesCohort StudiesEncephalitisEncephalitis, Herpes SimplexFemaleHashimoto DiseaseHumansLength of StayMaleMiddle AgedParaneoplastic Syndromes, Nervous SystemPotassium Channels, Voltage-GatedPrognosisRetrospective StudiesStatus EpilepticusTime FactorsTreatment OutcomeYoung AdultConceptsNew-onset refractory status epilepticusRefractory status epilepticusStatus epilepticusPoor outcomeTherapy warrants further investigationInflammatory CSF changesHours of admissionPrimary outcome measurePoor functional outcomePredictors of outcomeAcademic medical centerWarrants further investigationUse of anestheticsRole of anestheticsAutoimmune encephalitisAntiseizure medicationsCryptogenic casesParaneoplastic encephalitisMedical complicationsRetrospective reviewAvailable followClinical featuresImmune therapyFunctional outcomeFunctional statusStatus epilepticus epidemiology—tracking a moving target
Gilmore EJ, Hirsch LJ. Status epilepticus epidemiology—tracking a moving target. Nature Reviews Neurology 2015, 11: 377-378. PMID: 26100743, DOI: 10.1038/nrneurol.2015.104.Peer-Reviewed Original Research