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
Hippocampal 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 increase
2021
Electroencephalographic 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 biomarkers
2020
Validation 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 timeDeep 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 involvementValidation 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 totalMesial 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 findingsTreatment 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 locationPatients
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 implicationsOutcomesSeizures, periodic and rhythmic patterns in primary intraventricular hemorrhage
Stretz C, Sheikh Z, Maciel CB, Hirsch LJ, Gilmore EJ. Seizures, periodic and rhythmic patterns in primary intraventricular hemorrhage. Annals Of Clinical And Translational Neurology 2018, 5: 1104-1111. PMID: 30250866, PMCID: PMC6144442, DOI: 10.1002/acn3.627.Peer-Reviewed Original ResearchPrimary intraventricular hemorrhageFrequency of seizuresIctal-interictal continuumAntiseizure medicationsIntraventricular hemorrhageCEEG monitoringExternal ventricular drain placementPresence of hydrocephalusRhythmic EEG patternsVentricular drain placementCEEG durationCEEG patternsMedian ageNeuronal injuryElectrographic seizuresDrain placementRisk factorsOnly significant differenceGraeb scoreContinuous electroencephalographyCEEG recordingsSeizuresPatientsPeriodic dischargesEEG patternsRandomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures
Husain AM, Lee JW, Kolls BJ, Hirsch LJ, Halford JJ, Gupta PK, Minazad Y, Jones JM, LaRoche SM, Herman ST, Swisher CB, Sinha SR, Palade A, Dombrowski KE, Gallentine WB, Hahn CD, Gerard EE, Bhapkar M, Lokhnygina Y, Westover MB, Consortium F. Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures. Annals Of Neurology 2018, 83: 1174-1185. PMID: 29733464, PMCID: PMC6785201, DOI: 10.1002/ana.25249.Peer-Reviewed Original ResearchConceptsTreatment-emergent adverse eventsNonconvulsive seizuresContinuous electroencephalographyConfidence intervalsEmergent adverse eventsAnn NeurolPrimary endpointAdverse eventsAntiseizure drugsIll patientsElectrographic seizuresMean ageTreatment trialsOptimal treatmentRisk ratioRelative riskComparative effectivenessSeizuresFosphenytoinNoninferiorityPatientsTreatmentTrialsEquivalents/SubjectsBilateral independent periodic discharges are associated with electrographic seizures and poor outcome: a case-control study (P3.276)
Osman G, Rahangdale R, Britton J, Gilmore E, Haider H, Hantus S, Herlopian A, Hocker S, Lee J, Legros B, Punia V, Rampal N, Szaflarski J, Wallace A, Westover M, Hirsch L, Gaspard N. Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: a case-control study (P3.276). Neurology 2018, 90 DOI: 10.1212/wnl.90.15_supplement.p3.276.Peer-Reviewed Original ResearchBilateral independent periodic dischargesCase-control studyElectrographic seizuresPoor outcomePeriodic discharges
2017
Cyclic seizures in critically ill patients: Clinical correlates, DC recordings and outcomes
Pinto LF, Gilmore EJ, Petroff OA, Sivaraju A, Rampal N, Hirsch LJ, Gaspard N. Cyclic seizures in critically ill patients: Clinical correlates, DC recordings and outcomes. Clinical Neurophysiology 2017, 128: 1083-1090. PMID: 28214108, DOI: 10.1016/j.clinph.2017.01.015.Peer-Reviewed Original ResearchConceptsCyclic seizuresProgressive brain injuryStatus epilepticusIll patientsClinical correlatesBrain injuryDC recordingsNon-convulsive status epilepticusEEG baselineNonconvulsive status epilepticusOlder patientsElectrographic seizuresWorse prognosisFocal onsetPoor outcomePrognostic significanceSeizure initiationPatientsInfraslow activitySeizuresCommon formEpilepticusFurther studiesPosterior regionInjury
2015
Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography
King-Stephens D, Mirro E, Weber PB, Laxer KD, Van Ness PC, Salanova V, Spencer DC, Heck CN, Goldman A, Jobst B, Shields DC, Bergey GK, Eisenschenk S, Worrell GA, Rossi MA, Gross RE, Cole AJ, Sperling MR, Nair DR, Gwinn RP, Park YD, Rutecki PA, Fountain NB, Wharen RE, Hirsch LJ, Miller IO, Barkley GL, Edwards JC, Geller EB, Berg MJ, Sadler TL, Sun FT, Morrell MJ. Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography. Epilepsia 2015, 56: 959-967. PMID: 25988840, PMCID: PMC4676303, DOI: 10.1111/epi.13010.Peer-Reviewed Original ResearchConceptsMesial temporal lobe epilepsyChronic ambulatory electrocorticographyElectrographic seizuresTemporal lobe epilepsyMTL epilepsySeizure lateralizationLobe epilepsyTreatment decisionsMTL seizuresInpatient video-electroencephalography (EEG) monitoringIctal ECoG activityInpatient video-EEG monitoringVideo-electroencephalography monitoringVideo-EEG monitoringIntractable epilepsySeizure focusECoG activityLarge cohortAmbulatory settingResponsive neurostimulationPatientsSeizuresEpilepsyIntracranial electrodesECoG
2014
Interrater agreement for Critical Care EEG Terminology
Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB, Consortium T. Interrater agreement for Critical Care EEG Terminology. Epilepsia 2014, 55: 1366-1373. PMID: 24888711, PMCID: PMC4879939, DOI: 10.1111/epi.12653.Peer-Reviewed Original ResearchConceptsCritical care EEG terminologyEEG terminologyClinical significanceInterrater agreementAmerican Clinical Neurophysiology SocietyUncertain clinical significanceSupporting Information sectionElectrographic seizuresTriphasic morphologyHigh interrater agreementMulticenter researchEEG patternsSeizuresElectroencephalography studyStandardized terminologyInformation sectionIdentical questionsTraining slidesWeb-based testEEG samplesBrief Potentially Ictal Rhythmic Discharges in Critically Ill Adults
Yoo JY, Rampal N, Petroff OA, Hirsch LJ, Gaspard N. Brief Potentially Ictal Rhythmic Discharges in Critically Ill Adults. JAMA Neurology 2014, 71: 454-462. PMID: 24535702, DOI: 10.1001/jamaneurol.2013.6238.Peer-Reviewed Original ResearchConceptsIctal rhythmic dischargesRhythmic dischargesIll patientsContinuous electroencephalographyCritically Ill AdultsPrevalence of seizuresGlasgow Outcome ScaleLarge prospective studiesSingle focal lesionCerebral injuryIll adultsElectrographic seizuresPrognostic significanceProspective studyFunctional outcomeSubclinical seizuresOutcome ScalePrimary diagnosisWorse outcomesHigh prevalenceEarly predictorMAIN OUTCOMEFocal lesionsPatientsSeizures
2010
Urgent Continuous EEG (cEEG) Monitoring Leads to Changes in Treatment in Half of Cases
Hirsch LJ. Urgent Continuous EEG (cEEG) Monitoring Leads to Changes in Treatment in Half of Cases. Epilepsy Currents 2010, 10: 82-85. PMID: 20697500, PMCID: PMC2912537, DOI: 10.1111/j.1535-7511.2010.01364.x.Peer-Reviewed Original ResearchContinuous electroencephalographic monitoringIntensive care unitAED therapyElectroencephalographic monitoringCare unitElectrographic seizuresNeuroscience intensive care unitAntiepileptic drug therapyRetrospective cohort studyContinuous EEG monitoringAED prescribingAntiepileptic medicationsCohort studyElectroencephalographic findingsNeurological wardDrug therapyElectroencephalographic abnormalitiesInpatient settingAED changesEEG monitoringTherapySeizuresIndividual inpatientsPrescribingFindings
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