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 ResearchCyclic Alternating EEG Patterns: From Sleep to Encephalopathy
Misirocchi F, Mutti C, Hirsch L, Parrino L, Florindo I. Cyclic Alternating EEG Patterns: From Sleep to Encephalopathy. Journal Of Clinical Neurophysiology 2024, 41: 485-494. PMID: 39186585, DOI: 10.1097/wnp.0000000000001082.Peer-Reviewed Original ResearchConceptsCyclic alternating patternStandardized Critical Care EEG TerminologyCritical care EEG terminologyNon-rapid eye movement sleepAmerican Clinical Neurophysiology SocietyEye movement sleepCritically ill patientsEEG terminologyPrognostic significancePrognostic valueMovement sleepClinical significanceImpact of confounding factorsSleep instabilityCritical care settingIll patientsClinical importanceEEG activityEEG phenomenaSedative agentsElectrophysiological biomarkersAlternating patternEncephalopathySleepCare settingsSeizure 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 riskOutpatient 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 ResearchConceptsExpert 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 terminationSeizing Control: Primary Visual Cortex Epilepsy Treated With Resection and Responsive Neurostimulation: 2-Dimensional Operative Video
Merenzon M, Lamsam L, McGrath H, Sivaraju A, Hirsch L, Cukiert A, Zibly Z, Spencer D, Damisah E. Seizing Control: Primary Visual Cortex Epilepsy Treated With Resection and Responsive Neurostimulation: 2-Dimensional Operative Video. Operative Neurosurgery 2024, 27: 262-263. PMID: 39007609, DOI: 10.1227/ons.0000000000001109.Peer-Reviewed Original Research
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 analysisElectronic seizure diaries for clinical care and research
Gray TE, Hirsch LJ, Quraishi IH. Electronic seizure diaries for clinical care and research. Epileptic Disorders 2022, 24: 803-811. PMID: 35811431, DOI: 10.1684/epd.2022.1451.Peer-Reviewed Original ResearchPrevalence 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 ResearchConceptsSeizure 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 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 electroencephalographyHippocampal recording via the RNS system reveals marked ipsilateral activation of epileptiform activity during Wada testing
Quraishi IH, Brown FC, Johnson MH, Hirsch LJ. Hippocampal recording via the RNS system reveals marked ipsilateral activation of epileptiform activity during Wada testing. Epilepsy & Behavior 2022, 134: 108854. PMID: 35905518, DOI: 10.1016/j.yebeh.2022.108854.Peer-Reviewed Original ResearchConceptsResponsive neurostimulation systemWada testingEpileptiform activityElicitation of seizuresTemporal lobe resectionInternal carotid arteryMedial temporal structuresHippocampal vasculatureIpsilateral activationLobe resectionPosterior circulationElectrographic seizuresTemporal lobectomyElectrographic changesIntractable epilepsyClinical correlatesWada testCarotid arteryHippocampal spikesNegative findingsNeurostimulation systemHippocampal EEGHippocampal activityPatientsTransient increaseUpdated 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 ResearchConceptsRescue medicationProlonged seizuresSeizure clustersTreatment of epilepsyQuality of lifeOngoing seizuresFurther seizuresRefractory seizuresRecurrent seizuresRescue treatmentSeizure activitySeizure episodesIntranasal formulationRisk factorsClinical careEffective treatmentMedicationsSeizuresEpilepsyMorbidityClinical opportunitiesAdverse effectsTreatmentReviewEpidemiologyFactors 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 ResearchConceptsTemporal 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 ResearchConceptsCyclic 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 seizuresAcute symptomatic seizures: an educational, evidence‐based review
Mauritz M, Hirsch LJ, Camfield P, Chin R, Nardone R, Lattanzi S, Trinka E. Acute symptomatic seizures: an educational, evidence‐based review. Epileptic Disorders 2022, 24: 26-49. PMID: 34789447, DOI: 10.1684/epd.2021.1376.Peer-Reviewed Original ResearchDeveloping a Standardized Approach to Grading the Level of Brain Dysfunction on EEG
Dhakar MB, Sheikh ZB, Desai M, Desai RA, Sternberg EJ, Popescu C, Baron-Lee J, Rampal N, Hirsch LJ, Gilmore EJ, Maciel CB. Developing a Standardized Approach to Grading the Level of Brain Dysfunction on EEG. Journal Of Clinical Neurophysiology 2022, 40: 553-561. PMID: 35239553, DOI: 10.1097/wnp.0000000000000919.Peer-Reviewed Original ResearchConceptsCerebral dysfunctionCritical Care EEG Monitoring Research ConsortiumInterrater agreementGrading scaleStandardized approachDegree of dysfunctionKappa statisticsStandardized grading scalePosterior dominant rhythmElectroencephalogram (EEG) background activityLevel of dysfunctionOverall interrater agreementNeuromonitoring toolsFleiss kappa statisticEEG findingsBrain dysfunction
2021
International Post Stroke Epilepsy Research Consortium (IPSERC): A consortium to accelerate discoveries in preventing epileptogenesis after stroke
Mishra NK, Engel J, Liebeskind DS, Sharma VK, Hirsch LJ, Kasner SE, French JA, Devinsky O, Friedman A, Dawson J, Quinn TJ, Selim M, de Havenon A, Yasuda CL, Cendes F, Benninger F, Zaveri HP, Burneo JG, Srivastava P, Singh M, Bhatia R, Vishnu VY, Bentes C, Ferro J, Weiss S, Sivaraju A, Kim JA, Galovic M, Gilmore EJ, Pitkänen A, Davis K, Sansing LH, Sheth KN, Paz JT, Singh A, Sheth S, Worrall BB, Grotta JC, Casillas-Espinos PM, Chen Z, Nicolo JP, Yan B, Kwan P, Consortium F. International Post Stroke Epilepsy Research Consortium (IPSERC): A consortium to accelerate discoveries in preventing epileptogenesis after stroke. Epilepsy & Behavior 2021, 127: 108502. PMID: 34968775, DOI: 10.1016/j.yebeh.2021.108502.Peer-Reviewed Original ResearchHemisphere-Dependent Ictal Tachycardia Versus Ictal Bradycardia in a Critically Ill Patient
Fong MWK, Norris S, Percy J, Hirsch LJ, Herlopian A. Hemisphere-Dependent Ictal Tachycardia Versus Ictal Bradycardia in a Critically Ill Patient. Journal Of Clinical Neurophysiology 2021, 39: e15-e18. PMID: 34860703, DOI: 10.1097/wnp.0000000000000873.Peer-Reviewed Original ResearchConceptsIctal bradycardiaIll patientsNeuro-intensive care unitTemporal regionsStandard clinical monitoringHigh-risk patientsOvert clinical signsRight-handed manLeft temporal regionRight temporal regionMild tachycardiaSinus bradycardiaSinus pausesCare unitIntraparenchymal hemorrhageSinus tachycardiaIctal phenomenaCardiac investigationsAutonomic changesClinical signsHeart rateClinical monitoringBradycardiaSeizuresIndependent seizuresCombining 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 ResearchThe rescue therapy in epilepsy project Part 2: Insights from people with epilepsy and families on expert-derived preferred practices
Shafer PO, Santilli N, Buchhalter J, Gilchrist B, Kukla A, French JA, Hirsch LJ. The rescue therapy in epilepsy project Part 2: Insights from people with epilepsy and families on expert-derived preferred practices. Epilepsy & Behavior 2021, 125: 108444. PMID: 34839243, DOI: 10.1016/j.yebeh.2021.108444.Peer-Reviewed Original Research