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
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
Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study.
Vespa PM, Olson DM, John S, Hobbs KS, Gururangan K, Nie K, Desai MJ, Markert M, Parvizi J, Bleck TP, Hirsch LJ, Westover MB. Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study. Critical Care Medicine 2020, 48: 1249-1257. PMID: 32618687, PMCID: PMC7735649, DOI: 10.1097/ccm.0000000000004428.Peer-Reviewed Original ResearchConceptsNonconvulsive seizuresSeizure diagnosisTreatment planProspective observational clinical studyDiagnostic assessmentObservational clinical studyAssessment of patientsCritical care settingSerious adverse effectsTherapeutic decision makingProspective multicenterSecondary outcomesICU patientsPrimary outcomeStatus epilepticusHigh suspicionElectroencephalography assessmentAcademic hospitalBedside assessmentClinical impactClinical studiesObservational studyCare settingsPhysician confidencePatients
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 Research
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 outcomeRandomized 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/SubjectsDefinition 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
Generalized periodic discharges and ‘triphasic waves’: A blinded evaluation of inter-rater agreement and clinical significance
Foreman B, Mahulikar A, Tadi P, Claassen J, Szaflarski J, Halford JJ, Dean BC, Kaplan PW, Hirsch LJ, LaRoche S, Consortium C. Generalized periodic discharges and ‘triphasic waves’: A blinded evaluation of inter-rater agreement and clinical significance. Clinical Neurophysiology 2015, 127: 1073-1080. PMID: 26294138, DOI: 10.1016/j.clinph.2015.07.018.Peer-Reviewed Original ResearchConceptsTriphasic wavesClinical EEG interpretationInter-rater agreementCritical care EEG terminologyPeriodic dischargesToxic-metabolic encephalopathyPatient informationContinuous EEG monitoringSpecific clinical conditionsEEG interpretationEEG terminologyMetabolic encephalopathiesNonconvulsive seizuresClinical significanceBlinded evaluationClinical conditionsSimilar riskEEG monitoringSeizuresConsistency of usePatientsEncephalopathyEEG descriptorsAssociationDescriptive termsStatus 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 ResearchConsensus 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 trendsPatientsAcute 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 ageNonconvulsive 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 flowStatus Epilepticus
Hirsch LJ, Gaspard N. Status Epilepticus. CONTINUUM Lifelong Learning In Neurology 2013, 19: 767-794. PMID: 23739110, PMCID: PMC10564021, DOI: 10.1212/01.con.0000431395.16229.5a.Peer-Reviewed Original ResearchConceptsStatus epilepticusRapid Anticonvulsant MedicationRefractory status epilepticusNeurocritical Care SocietyArrival TrialAnticonvulsant medicationMedical complicationsNonconvulsive seizuresTreatment protocolEpilepticusCurrent evidenceAnesthetic drugsAvailable guidelinesRapid treatmentSuccessful managementEarly considerationTreatmentDiagnosisRecent findingsGuidelinesMedicationsComplicationsOvertreatmentSeizuresManagementPitfalls in ictal EEG interpretation
Gaspard N, Hirsch LJ. Pitfalls in ictal EEG interpretation. Neurology 2013, 80: s26-s42. PMID: 23267042, DOI: 10.1212/wnl.0b013e31827974f8.Peer-Reviewed Original Research
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 stateEpilepsy Emergencies: Diagnosis and Management
Foreman B, Hirsch LJ. Epilepsy Emergencies: Diagnosis and Management. Neurologic Clinics 2012, 30: 11-41. PMID: 22284053, DOI: 10.1016/j.ncl.2011.09.005.Peer-Reviewed Original ResearchConceptsStatus epilepticusLimited evidence-based guidanceIrreversible brain injuryNonconvulsive status epilepticusEvidence-based guidanceEpilepsy emergenciesNonconvulsive seizuresHigh morbidityBrain injuryEarly treatmentTreatment responseProlonged casesRefractory conditionEpilepticusPatientsPrognosisSeizuresTreatmentDiagnosisMorbidityComatoseInjuryMortality
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 injury
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 risk
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