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
Electroencephalogram 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 implicationsOutcomesAssociation between death and loss of stage N2 sleep features among critically Ill patients with delirium
Knauert MP, Gilmore EJ, Murphy TE, Yaggi HK, Van Ness PH, Han L, Hirsch LJ, Pisani MA. Association between death and loss of stage N2 sleep features among critically Ill patients with delirium. Journal Of Critical Care 2018, 48: 124-129. PMID: 30179762, PMCID: PMC6226351, DOI: 10.1016/j.jcrc.2018.08.028.Peer-Reviewed Original ResearchConceptsICU patientsIll patientsOdds ratioHigher oddsSleep spindlesIntensive care unit outcomesGrade of encephalopathySignificant sleep disruptionWorse ICU outcomeMedical ICU patientsAcute brain injuryObservational cohort studySedative-hypnotic useImportant prognostic valueLength of stayStage N2 sleepK-complexesCohort studyCritical illnessHospital dischargeRankin ScaleICU outcomesPrognostic valueSevere gradesMedical recordsDefinition 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
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 likelihood
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 flow
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 state
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
2009
Intracortical electroencephalography in acute brain injury
Waziri A, Claassen J, Stuart RM, Arif H, Schmidt JM, Mayer SA, Badjatia N, Kull LL, Connolly ES, Emerson RG, Hirsch LJ. Intracortical electroencephalography in acute brain injury. Annals Of Neurology 2009, 66: 366-377. PMID: 19798724, DOI: 10.1002/ana.21721.Peer-Reviewed Original ResearchConceptsSecondary neurological complicationsElectrographic seizuresIctal activityNeurological complicationsScalp electroencephalographyNeurological injuryBrain injuryIntracortical EEGIntensive care unit settingSecondary neurological injurySecondary neuronal injuryAcute brain injuryIll neurological patientsIntracortical electroencephalographyClinical deteriorationNeuronal injuryInvasive neuromonitoringUnderwent implantationNeuromonitoring modalitiesBedside placementIctal dischargesRhythmic deltaUnit settingAcute changesContinuous electroencephalography
2006
In Nonconvulsive Status Epilepticus (NCSE), Treat to Burst‐Suppression: Pro and Con
Jordan KG, Hirsch LJ. In Nonconvulsive Status Epilepticus (NCSE), Treat to Burst‐Suppression: Pro and Con. Epilepsia 2006, 47: 41-45. PMID: 17044825, DOI: 10.1111/j.1528-1167.2006.00659.x.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusNonconvulsive seizuresRefractory nonconvulsive status epilepticusPermanent neuronal injuryAcute brain injuryIntensive care interventionsHigh mortality rateNeuronal injuryStatus epilepticusIatrogenic complicationsBrain damageBrain injuryCare interventionsDr. HirschBurst suppressionMortality rateExpert managementSeizuresInjuryMost casesEpilepticusMedicationsComplicationsDr. Jordan
2005
Continuous electroencephalogram monitoring in the critically III
Wittman JJ, Hirsch LJ. Continuous electroencephalogram monitoring in the critically III. Neurocritical Care 2005, 2: 330-341. PMID: 16159085, DOI: 10.1385/ncc:2:3:330.Peer-Reviewed Original Research
2004
Stimulus‐induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs): A Common EEG Phenomenon in the Critically Ill
Hirsch LJ, Claassen J, Mayer SA, Emerson RG. Stimulus‐induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs): A Common EEG Phenomenon in the Critically Ill. Epilepsia 2004, 45: 109-123. PMID: 14738418, DOI: 10.1111/j.0013-9580.2004.38103.x.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringIctal dischargesEEG patternsClinical status epilepticusAcute brain injuryPeriodic epileptiform dischargesEEG phenomenaPrior epilepsyEncephalopathic patientsAcute illnessClinical seizuresConsecutive patientsIll patientsSpontaneous seizuresStatus epilepticusPatients stimulationBrain injuryEpileptiform dischargesSIRPIDsPatientsEEG monitoringTherapeutic significanceSeizuresSignificant differencesStimulation