2024
Evaluating the Impact of Point-of-Care Electroencephalography on Length of Stay in the Intensive Care Unit: Subanalysis of the SAFER-EEG Trial
Desai M, Kalkach-Aparicio M, Sheikh I, Cormier J, Gallagher K, Hussein O, Cespedes J, Hirsch L, Westover B, Struck A. Evaluating the Impact of Point-of-Care Electroencephalography on Length of Stay in the Intensive Care Unit: Subanalysis of the SAFER-EEG Trial. Neurocritical Care 2024, 1-10. PMID: 38981999, DOI: 10.1007/s12028-024-02039-6.Peer-Reviewed Original ResearchIntensive care unitIntensive care unit LOSNonconvulsive seizuresClinical outcomesFunctional outcomesCare unitDetection of nonconvulsive seizuresInterquartile rangeAssociated with neuronal injuryDiagnose nonconvulsive seizuresIntensive care unit patientsUnfavorable functional outcomeMann-Whitney U testProlonged nonconvulsive seizuresPropensity score matchingDeleterious clinical outcomesClinical characteristicsAdult patientsRandomized studyConventional EEGICU LOSNeuronal injuryFunctional/clinical outcomesAcademic centersClinical covariates
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
2021
Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist
Katz JB, Owusu K, Nussbaum I, Beekman R, DeFilippo NA, Gilmore EJ, Hirsch LJ, Cervenka MC, Maciel CB. Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist. Journal Of Clinical Medicine 2021, 10: 881. PMID: 33671485, PMCID: PMC7926931, DOI: 10.3390/jcm10040881.Peer-Reviewed Original ResearchNew-onset refractory status epilepticusSuper-refractory status epilepticusMagnetic resonance imagingStatus epilepticusIntensive care unitKetogenic dietCryptogenic new-onset refractory status epilepticusCerebral spinal fluid (CSF) pleocytosisUse of KDDiffusion restrictionSerial magnetic resonance imagingAdult status epilepticusHospital day 28Non-ICU unitsSpinal fluid pleocytosisAggressive therapeutic approachRefractory status epilepticusSerum inflammatory markersResolution of edemaBeta-hydroxybutyrate levelsPoor nutritional stateTherapeutic comaBilateral oophorectomyInflammatory markersFebrile illness
2019
Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate
Rossetti AO, Hirsch LJ, Drislane FW. Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate. Clinical Neurophysiology Practice 2019, 4: 170-177. PMID: 31886441, PMCID: PMC6921236, DOI: 10.1016/j.cnp.2019.07.001.Peer-Reviewed Original ResearchComparison 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 number
2016
Sensitivity of quantitative EEG for seizure identification in the intensive care unit
Haider HA, Esteller R, Hahn CD, Westover MB, Halford JJ, Lee JW, Shafi MM, Gaspard N, Herman ST, Gerard EE, Hirsch LJ, Ehrenberg JA, LaRoche SM, Abend N, Nwankwo C, Politsky J, Herman S, Loddenkemper T, Huh L, Carpenter J, Hantus S, Claassen J, Husain A, Gaspard N, Gloss D, Ritzl E, Gofton T, Goldstein J, Hocker S, Hyslop A, Williams K, Bozarth X, Wusthoff C, Fernandez A, Szaflarski J, Kramer A, Foreman B, Korb P, Rudzinski L, Sainju R, Hopp J, Mani R, Davis K, Kalamangalam G, Ding K, Quigg M, Haas K, Ostendorf A, Zutshi D, Pargeon K. Sensitivity of quantitative EEG for seizure identification in the intensive care unit. Neurology 2016, 87: 935-944. PMID: 27466474, PMCID: PMC5035158, DOI: 10.1212/wnl.0000000000003034.Peer-Reviewed Original ResearchDevelopment and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research
Lee JW, LaRoche S, Choi H, Ruiz A, Fertig E, Politsky JM, Herman ST, Loddenkemper T, Sansevere AJ, Korb PJ, Abend NS, Goldstein JL, Sinha SR, Dombrowski KE, Ritzl EK, Westover MB, Gavvala JR, Gerard EE, Schmitt SE, Szaflarski JP, Ding K, Haas KF, Buchsbaum R, Hirsch LJ, Wusthoff CJ, Hopp JL, Hahn CD. Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research. Journal Of Clinical Neurophysiology 2016, 33: 133-140. PMID: 26943901, PMCID: PMC4878836, DOI: 10.1097/wnp.0000000000000230.Peer-Reviewed Original ResearchConceptsCritical Care EEG Monitoring Research ConsortiumAmerican Clinical Neurophysiology SocietyIncidence of seizuresMulticenter feasibility studyIntensive care unitLarge-volume centersInterictal epileptiform dischargesDaily clinical useMulticenter collaborative researchCare unitUnique patientsVolume centersElectroencephalogram monitoringDuration of recordingEpileptiform dischargesMulticenter research studiesRhythmic dischargesClinical reportsResearch DatabaseEEG monitoringClinical data repositoryClinical useConsortium databaseEEG reportsReporting tools
2015
Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part I
Herman ST, Abend NS, Bleck TP, Chapman KE, Drislane FW, Emerson RG, Gerard EE, Hahn CD, Husain AM, Kaplan PW, LaRoche SM, Nuwer MR, Quigg M, Riviello JJ, Schmitt SE, Simmons LA, Tsuchida TN, Hirsch LJ. Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part I. Journal Of Clinical Neurophysiology 2015, 32: 87-95. PMID: 25626778, PMCID: PMC4435533, DOI: 10.1097/wnp.0000000000000166.Peer-Reviewed Original ResearchConceptsIll adultsConsensus panelStatus epilepticusPatient populationMental statusAmerican Clinical Neurophysiology SocietyContinuous EEGCritically Ill AdultsIdentification of ischemiaNonconvulsive status epilepticusIntensive care unitEfficacy of therapyQuantitative EEG trendsExpert consensus recommendationsCerebral ischemiaIntravenous sedationNonconvulsive seizuresCare unitSecondary injuryCardiac arrestConsensus statementConsensus recommendationsHigh riskEEG trendsPatientsConsensus Statement on Continuous EEG in Critically Ill Adults and Children, Part II
Herman ST, Abend NS, Bleck TP, Chapman KE, Drislane FW, Emerson RG, Gerard EE, Hahn CD, Husain AM, Kaplan PW, LaRoche SM, Nuwer MR, Quigg M, Riviello JJ, Schmitt SE, Simmons LA, Tsuchida TN, Hirsch LJ. Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part II. Journal Of Clinical Neurophysiology 2015, 32: 96-108. PMID: 25626777, PMCID: PMC4434600, DOI: 10.1097/wnp.0000000000000165.Peer-Reviewed Original ResearchConceptsIll adultsConsensus panelAmerican Clinical Neurophysiology SocietyContinuous EEGCritically Ill AdultsIntensive care unitNon-physician personnelExpert consensus recommendationsNeurodiagnostic technologistsQuantitative EEG techniquesCare unitPatient selectionPatient populationMental statusConsensus statementConsensus recommendationsInfection controlBrain functionCommon procedureEEGTask ForceAdultsEEG techniquesChildrenAcute brain failure in severe sepsis: a prospective study in the medical intensive care unit utilizing continuous EEG monitoring
Gilmore EJ, Gaspard N, Choi HA, Cohen E, Burkart KM, Chong DH, Claassen J, Hirsch LJ. Acute brain failure in severe sepsis: a prospective study in the medical intensive care unit utilizing continuous EEG monitoring. Intensive Care Medicine 2015, 41: 686-694. PMID: 25763756, DOI: 10.1007/s00134-015-3709-1.Peer-Reviewed Original ResearchConceptsNonconvulsive seizuresSevere sepsisEEG reactivityPeriodic dischargesLate seizuresSOFA scoreAPACHE IIFunctional outcomeContinuous sedationHigh riskLower riskMedical intensive care unitLong-term cognitive outcomesPresence of sedationAPACHE II scoreGood functional outcomeNonconvulsive status epilepticusIntensive care unitContinuous EEG monitoringAcute brain failureAcademic medical centerNew epilepsyII scoreClinical seizuresMedical ICU
2013
Continuous electroencephalography in a surgical intensive care unit
Kurtz P, Gaspard N, Wahl AS, Bauer RM, Hirsch LJ, Wunsch H, Claassen J. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Medicine 2013, 40: 228-234. PMID: 24240843, DOI: 10.1007/s00134-013-3149-8.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusPeriodic epileptiform dischargesNonconvulsive seizuresPoor outcomeClinical seizuresSICU patientsRetrospective studyCEEG monitoringMental statusSurgical intensive care unit patientsIntensive care unit patientsSurgical intensive care unitCare unit patientsContinuous electroencephalography monitoringMajority of patientsIntensive care unitMultivariable logistic regressionLiver transplantationHospital dischargeUnit patientsAbdominal surgeryPrimary outcomeStatus epilepticusCare unitMean ageSimilarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients
Gaspard N, Manganas L, Rampal N, Petroff OA, Hirsch LJ. Similarity of Lateralized Rhythmic Delta Activity to Periodic Lateralized Epileptiform Discharges in Critically Ill Patients. JAMA Neurology 2013, 70: 1288-1295. PMID: 23921464, DOI: 10.1001/jamaneurol.2013.3475.Peer-Reviewed Original ResearchConceptsLateralized rhythmic delta activityRhythmic delta activityContinuous EEG monitoringIll patientsDelta activityPeriodic dischargesAcute seizuresClinical significanceIll subjectsEEG monitoringEEG patternsPeriodic lateralized epileptiform dischargesJuxtacortical white matterContinuous electroencephalography monitoringIntensive care unitCross-sectional prevalenceFocal EEG abnormalitiesAcademic medical centerSimilar clinical significanceRadiological correlatesEarly seizuresMost patientsAcute illnessDischarge groupIndependent predictors
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 inpatientsPrescribingFindingsIntracranial 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
Continuous Electroencephalogram Monitoring in the Intensive Care Unit
Friedman D, Claassen J, Hirsch LJ. Continuous Electroencephalogram Monitoring in the Intensive Care Unit. Anesthesia & Analgesia 2009, 109: 506-523. PMID: 19608827, DOI: 10.1213/ane.0b013e3181a9d8b5.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringNonconvulsive seizuresIll patientsIntracranial pressureBrain functionContinuous electroencephalogram monitoringConvulsive status epilepticusIntensive care unitMajority of seizuresMultimodality brain monitoringPharmacological comaNeurologic outcomeNeurologic statusNeuronal injuryBrain ischemiaStatus epilepticusCare unitSecondary injurySubarachnoid hemorrhageCEEG monitoringClinical examinationElectroencephalogram monitoringSystemic abnormalitiesIntracranial EEG recordingsHigh riskContinuous electroencephalography in the medical intensive care unit*
Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit*. Critical Care Medicine 2009, 37: 2051-2056. PMID: 19384197, DOI: 10.1097/ccm.0b013e3181a00604.Peer-Reviewed Original ResearchConceptsContinuous electroencephalography monitoringPeriodic epileptiform dischargesMajority of patientsElectrographic seizuresRetrospective studyMedical intensive care unit patientsIntensive care unit admissionMedical intensive care unitIntensive care unit patientsPeriodic dischargesAcute neurologic conditionsPrimary admission diagnosisCare unit admissionPercent of patientsAcute neurologic injuryCare unit patientsIntensive care unitOnly significant predictorUnit admissionAdmission diagnosisICU admissionMICU patientsHospital dischargeNeurologic injurySeptic patients
2008
Nonconvulsive Seizures in Traumatic Brain Injury: What You Don't See Can Hurt You
Hirsch LJ. Nonconvulsive Seizures in Traumatic Brain Injury: What You Don't See Can Hurt You. Epilepsy Currents 2008, 8: 97-99. PMID: 18596875, PMCID: PMC2442151, DOI: 10.1111/j.1535-7511.2008.00254.x.Peer-Reviewed Original ResearchLactate/pyruvate ratioPost-traumatic seizuresMicrodialysis lactate/pyruvate ratioTraumatic brain injury patientsBrain injury patientsIntracranial pressureTraumatic brain injuryPyruvate ratioSeizure groupInjury patientsBrain injuryMean lactate/pyruvate ratioSevere traumatic brain injury patientsNeurologic intensive care unitTraumatic brain injury (TBI) resultsHighest mean intracranial pressureIntensive care unitBrain injury resultsMean intracranial pressureRetrospective data analysisNonseizure patientsCerebral microdialysisNonconvulsive seizuresStatus epilepticusCare unit
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
Continuous EEG Monitoring in the Intensive Care Unit
Hirsch LJ, Kull LL. Continuous EEG Monitoring in the Intensive Care Unit. The Neurodiagnostic Journal 2004, 44: 137-158. PMID: 15521467, DOI: 10.1080/1086508x.2004.11079478.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringIntensive care unitCare unitEEG monitoringPrevention of strokeQuantitative EEG analysisCEEG interpretationCerebral ischemiaIll patientsNonconvulsive seizuresElectrographic seizuresAcute ischemiaClinical correlatesMental statusBrain injuryAlerting stimuliBrain functionEEG patternsEarly detectionEEG technologistsReversible stageIschemiaPatientsSeizuresTechnical difficultiesContinuous EEG Monitoring in the Intensive Care Unit: An Overview
Hirsch LJ. Continuous EEG Monitoring in the Intensive Care Unit: An Overview. Journal Of Clinical Neurophysiology 2004, 21: 332-340. PMID: 15592007, DOI: 10.1097/01.wnp.0000147129.80917.0e.Peer-Reviewed Original ResearchConceptsPeriodic epileptiform dischargesComatose patientsEpileptiform dischargesEEG patternsIntensive care unitLevel of sedationContinuous EEG monitoringMajority of seizuresHospital infarctionNoncomatose patientsRecent neurosurgeryClinical seizuresCNS infectionICU patientsIll patientsNonconvulsive seizuresCare unitWorse outcomesAutonomic changesParoxysmal spellsBrain tumorsPatientsEEG monitoringEEG trendsSeizures