2024
Treatment of Refractory Status Epilepticus With Continuous Intravenous Anesthetic Drugs
Au Y, Kananeh M, Rahangdale R, Moore T, Panza G, Gaspard N, Hirsch L, Fernandez A, Shah S. Treatment of Refractory Status Epilepticus With Continuous Intravenous Anesthetic Drugs. JAMA Neurology 2024, 81: 534-548. PMID: 38466294, DOI: 10.1001/jamaneurol.2024.0108.Peer-Reviewed Original ResearchAssociated with mortalityRefractory status epilepticusTreatment of refractory status epilepticusOutcome variablesPreferred Reporting ItemsAssociated with lower mortalityRisk of biasCompare outcome measuresPeer-reviewed studiesNon-English articlesStatus epilepticusBinary logistic regressionWeb of ScienceRSE etiologyReporting ItemsOutcome measuresStudy selectionPredictors of mortalitySystematic reviewLogistic regressionManual searchIntravenous anesthetic drugsRefractory status epilepticus treatmentTreatment goalsIndependent extractionComparative analysis of patients with new onset refractory status epilepticus preceded by fever (febrile infection‐related epilepsy syndrome) versus without prior fever: An interim analysis
Jimenez A, Gopaul M, Asbell H, Aydemir S, Basha M, Batra A, Damien C, Day G, Eka O, Eschbach K, Fatima S, Fields M, Foreman B, Gerard E, Gofton T, Haider H, Hantus S, Hocker S, Jongeling A, Aparicio M, Kandula P, Kang P, Kazazian K, Kellogg M, Kim M, Lee J, Marcuse L, McGraw C, Mohamed W, Orozco J, Pimentel C, Punia V, Ramirez A, Steriade C, Struck A, Taraschenko O, Treister A, Yoo J, Zafar S, Zhou D, Zutshi D, Gaspard N, Hirsch L, Hanin A. Comparative analysis of patients with new onset refractory status epilepticus preceded by fever (febrile infection‐related epilepsy syndrome) versus without prior fever: An interim analysis. Epilepsia 2024, 65: e87-e96. PMID: 38625055, DOI: 10.1111/epi.17988.Peer-Reviewed Original ResearchFebrile infection-related epilepsy syndromeRefractory status epilepticusMacrophage inflammatory protein-1 alphaOnset refractory status epilepticusStatus epilepticusCerebrospinal fluidFIRES patientsCerebrospinal fluid interleukin-6Magnetic resonance imaging findingsComparative analysis of patientsAnalysis of patientsChemokine ligand 2Presenting symptomsFebrile infectionsClinical featuresGastrointestinal prodromeImaging findingsInflammatory biomarkersAntiseizure medicationsInterleukin-6Epilepsy syndromesInterim analysisPatientsEpilepticusFeverSecond‐line immunotherapy in new onset refractory status epilepticus
Hanin A, Muscal E, Hirsch L. Second‐line immunotherapy in new onset refractory status epilepticus. Epilepsia 2024, 65: 1203-1223. PMID: 38430119, DOI: 10.1111/epi.17933.Peer-Reviewed Original ResearchFebrile infection-related epilepsy syndromeSecond-line immunotherapyOnset refractory status epilepticusRefractory status epilepticusIntrathecal dexamethasoneStatus epilepticusCytokine levelsFunctional outcomesCerebrospinal fluid cytokine levelsInitiation of anakinraReduction of seizure frequencyLong-term functional outcomeResponse to treatmentSE onsetElevated serumFebrile infectionsImmune dysregulationLong-term disabilityTreatment initiationCase reportCytokine measurementsProspective studyAnakinraImmunotherapyTocilizumab
2022
International consensus recommendations for management of new onset refractory status epilepticus (NORSE) including febrile infection‐related epilepsy syndrome (FIRES): Summary and clinical tools
Wickström R, Taraschenko O, Dilena R, Payne ET, Specchio N, Nabbout R, Koh S, Gaspard N, Hirsch LJ, Group T, Auvin S, van Baalen A, Beghi E, Benseler S, Bergin P, Bleck T, Brunklaus A, Caraballo R, Cervenka M, Costello D, Drislane F, Farias‐Moeller R, Gallantine W, Gilmore E, Gofton T, Jimenez M, Hocker S, Kaliakatsos M, Kellogg M, Lee J, Loddenkemper T, Meletti S, Mizugushi M, Muscal E, Riviello J, Rosenthal E, Rossetti A, Ruegg S, Said R, Sculier C, Schmitt S, Schuele S, Stredny C, Trinka E, Wainwright M, VanHaerents S, Wells E, Wirrell E, Zuberi S. International consensus recommendations for management of new onset refractory status epilepticus (NORSE) including febrile infection‐related epilepsy syndrome (FIRES): Summary and clinical tools. Epilepsia 2022, 63: 2827-2839. PMID: 35951466, PMCID: PMC9826478, DOI: 10.1111/epi.17391.Peer-Reviewed Original ResearchFebrile infection-related epilepsy syndromeNew-onset refractory status epilepticusAcute treatmentRecommendation statementMedian scoreRefractory status epilepticusManagement of adultsManagement of patientsPost-acute phaseConsensus-based recommendationsInternational consensus recommendationsBest available evidenceEvidence-based analysisPediatric patientsStatus epilepticusEpilepsy syndromesDisease characteristicsConsensus recommendationsDiagnostic testingClinical toolAvailable evidenceDiagnosisPatientsTreatmentDelphi methodologyElectroencephalogram 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
How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries
Kazazian K, Kellogg M, Wong N, Eschbach K, Moeller RF, Gaspard N, Hirsch LJ, Hocker S, Gofton T. How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries. Epilepsy Currents 2021, 21: 382-384. PMID: 33769129, PMCID: PMC8655258, DOI: 10.1177/15357597211002869.Peer-Reviewed Original ResearchHow to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries.
Kazazian K, Kellogg M, Wong N, Eschbach K, Moeller RF, Gaspard N, Hirsch LJ, Hocker S, Gofton T. How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries. Epilepsy Currents 2021, 1535759721998329. PMID: 33663265, DOI: 10.1177/1535759721998329.Peer-Reviewed Original ResearchFebrile infection-related epilepsy syndromeNew-onset refractory status epilepticusRefractory status epilepticusStatus epilepticusFamily RegistryRare clinical presentationPast medical historyQuality of lifeEpilepsy registryFebrile infectionsActive epilepsyDisease courseClinical outcomesClinical presentationEpilepsy syndromesMedical historyNeurologic disordersRigorous research studiesEpilepticusRegistryPatient enrollsFamily membersOutcomesMorbidityEpilepsyPearls 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
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 findingsCommunication Challenges: A Spotlight on New-Onset Refractory Status Epilepticus
Gofton TE, Wong N, Hirsch LJ, Hocker SE. Communication Challenges: A Spotlight on New-Onset Refractory Status Epilepticus. Mayo Clinic Proceedings 2019, 94: 857-863. PMID: 30935709, DOI: 10.1016/j.mayocp.2018.12.004.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusRefractory status epilepticusClinical courseStatus epilepticusCritical care supportPalliative care servicesHealth care team membersUnpredictable clinical courseContinuity of careCare team membersCurative intentHealthy patientsDevastating conditionOngoing therapyResponsible physicianMultiple specialistsCare servicesCare supportMedical teamPatientsIndividual hospitalsYoung adultsEpilepticusEarly involvementCareNew onset refractory status epilepticus research: What is on the horizon?
Gofton TE, Gaspard N, Hocker SE, Loddenkemper T, Hirsch LJ. New onset refractory status epilepticus research: What is on the horizon? Neurology 2019, 92: 802-810. PMID: 30894443, DOI: 10.1212/wnl.0000000000007322.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusRefractory status epilepticusStatus epilepticusFebrile infection-related epilepsy syndromeMore rescue medicationsRescue medicationNew onsetActive epilepsyClinical featuresClinical presentationEpilepsy syndromesMetabolic causesNeurologic disordersPediatric EvaluationSpecific diagnosisAge groupsEpilepticusFamily supportFuture collaborative researchMedicationsPatientsFeverEpilepsyPathophysiologySyndrome
2018
New‐onset refractory status epilepticus (NORSE) and febrile infection–related epilepsy syndrome (FIRES): State of the art and perspectives
Gaspard N, Hirsch LJ, Sculier C, Loddenkemper T, van Baalen A, Lancrenon J, Emmery M, Specchio N, Farias‐Moeller R, Wong N, Nabbout R. New‐onset refractory status epilepticus (NORSE) and febrile infection–related epilepsy syndrome (FIRES): State of the art and perspectives. Epilepsia 2018, 59: 745-752. PMID: 29476535, DOI: 10.1111/epi.14022.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusFebrile infection-related epilepsy syndromeRefractory status epilepticusStatus epilepticusCytokine-mediated mechanismOptimal treatment optionsAdult-onset formStrong scientific evidenceStandardized consensus definitionsMulticenter registryPrompt treatmentKetogenic dietUncontrolled trialsEpilepsy syndromesImmune therapyTreatment optionsEarly recognitionClinical careConsensus definitionClinical situationsPatient careEpilepticusStandardized definitionsElectroencephalography featuresScientific evidenceProposed consensus definitions for new‐onset refractory status epilepticus (NORSE), febrile infection‐related epilepsy syndrome (FIRES), and related conditions
Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T, Navarro V, Specchio N, Lagae L, Rossetti AO, Hocker S, Gofton TE, Abend NS, Gilmore EJ, Hahn C, Khosravani H, Rosenow F, Trinka E. Proposed consensus definitions for new‐onset refractory status epilepticus (NORSE), febrile infection‐related epilepsy syndrome (FIRES), and related conditions. Epilepsia 2018, 59: 739-744. PMID: 29399791, DOI: 10.1111/epi.14016.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusFebrile infection-related epilepsy syndromeRefractory status epilepticusStatus epilepticusConsensus definitionEpilepsy syndromesFebrile infectionsCritical Care EEG Monitoring Research ConsortiumSuper-refractory status epilepticusRelated conditionsHemiconvulsion-HemiplegiaNew onsetActive epilepsyImproved communicationClinical presentationNeurocritical careMetabolic causesPediatric expertsEpilepticusRelevant neurological disordersConsensus conferenceSpecific diagnosisNeurological disordersMulticenter researchSyndrome
2015
New-onset refractory status epilepticus
Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, Meyers E, Espinera A, Haas KF, Schmitt SE, Gerard EE, Gofton T, Kaplan PW, Lee JW, Legros B, Szaflarski JP, Westover BM, LaRoche SM, Hirsch LJ, Fertig E, Herman S, Huh L, Lee J, Loddenkemper T, Chapman K, Abend N, Carpenter J, Hantus S, Claassen J, Husain A, Gaspard N, LaRoche S, Ritzl E, Gofton T, Wusthoff C, Goldstein J, Westover B, Hocker S, Halford J, Jones J, Gerard E, Schmitt S, Williams K, Hahn C, Szaflarski J, Kramer A, Rudzinski L, Hopp J, Mani R, Kalamangalam G, Gupta P, Quigg M, Haas K, Ostendorf A, Zutshi D, Hirsch L. New-onset refractory status epilepticus. Neurology 2015, 85: 1604-1613. PMID: 26296517, PMCID: PMC4642147, DOI: 10.1212/wnl.0000000000001940.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAnestheticsAnticonvulsantsAnti-N-Methyl-D-Aspartate Receptor EncephalitisAutoantibodiesCohort StudiesEncephalitisEncephalitis, Herpes SimplexFemaleHashimoto DiseaseHumansLength of StayMaleMiddle AgedParaneoplastic Syndromes, Nervous SystemPotassium Channels, Voltage-GatedPrognosisRetrospective StudiesStatus EpilepticusTime FactorsTreatment OutcomeYoung AdultConceptsNew-onset refractory status epilepticusRefractory status epilepticusStatus epilepticusPoor outcomeTherapy warrants further investigationInflammatory CSF changesHours of admissionPrimary outcome measurePoor functional outcomePredictors of outcomeAcademic medical centerWarrants further investigationUse of anestheticsRole of anestheticsAutoimmune encephalitisAntiseizure medicationsCryptogenic casesParaneoplastic encephalitisMedical complicationsRetrospective reviewAvailable followClinical featuresImmune therapyFunctional outcomeFunctional status
2013
High-dose midazolam infusion for refractory status epilepticus
Fernandez A, Lantigua H, Lesch C, Shao B, Foreman B, Schmidt JM, Hirsch LJ, Mayer SA, Claassen J. High-dose midazolam infusion for refractory status epilepticus. Neurology 2013, 82: 359-365. PMID: 24363133, PMCID: PMC3929199, DOI: 10.1212/wnl.0000000000000054.Peer-Reviewed Original ResearchConceptsHigh-dose groupRefractory status epilepticusLow-dose groupStatus epilepticusLower mortalityHigh-dose midazolam infusionLower seizure ratesStatus epilepticus onsetClass III evidenceLow-dose protocolHigher infusion ratesHospital complicationsHospital courseSeizure recurrenceBaseline characteristicsSeizure controlWithdrawal seizuresMedian timeDischarge mortalityMidazolam dosesMidazolam infusionSeizure rateWorse outcomesTreatment protocolInfusion rateIntravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study
Gaspard N, Foreman B, Judd LM, Brenton JN, Nathan BR, McCoy BM, Al‐Otaibi A, Kilbride R, Fernández IS, Mendoza L, Samuel S, Zakaria A, Kalamangalam GP, Legros B, Szaflarski JP, Loddenkemper T, Hahn CD, Goodkin HP, Claassen J, Hirsch LJ, LaRoche SM. Intravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study. Epilepsia 2013, 54: 1498-1503. PMID: 23758557, PMCID: PMC3731413, DOI: 10.1111/epi.12247.Peer-Reviewed Original ResearchConceptsRefractory status epilepticusTreatment of RSEIntravenous ketamineStatus epilepticusBrain injuryEpisodes of RSEPostanoxic brain injuryAnoxic brain injuryMulticenter retrospective reviewRetrospective multicenter studyRole of ketaminePossible adverse eventsAcademic medical centerKetamine initiationProspective trialAdverse eventsRetrospective reviewRetrospective seriesSE onsetMulticenter studyLast drugMedical recordsMedical CenterSafe drugConcurrent drugsStatus 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 findingsGuidelinesMedicationsComplicationsOvertreatmentSeizuresManagement
2008
Levitating Levetiracetam's Status for Status Epilepticus
Hirsch LJ. Levitating Levetiracetam's Status for Status Epilepticus. Epilepsy Currents 2008, 8: 125-126. PMID: 18852834, PMCID: PMC2566612, DOI: 10.1111/j.1535-7511.2008.00266.x.Peer-Reviewed Original ResearchTreatment of SEStatus epilepticusBenzodiazepine-refractory status epilepticusRefractory focal status epilepticusNew anticonvulsive drugsRefractory status epilepticusFocal status epilepticusSevere side effectsCombination of drugsIntravenous levetiracetamAntiepileptic medicationsOral medicationsAnticonvulsive drugsIntravenous formulationSide effectsPatientsEpileptic seizuresEpilepticusMedicationsLevetiracetamTreatmentDrugsEpisodesStatusSeizures
2002
The current state of treatment of status epilepticus
Hirsch LJ, Claassen J. The current state of treatment of status epilepticus. Current Neurology And Neuroscience Reports 2002, 2: 345-356. PMID: 12044254, DOI: 10.1007/s11910-002-0010-9.Peer-Reviewed Original ResearchConceptsStatus epilepticusRefractory status epilepticusConvulsive status epilepticusNonconvulsive status epilepticusCertain EEG patternsAmbulatory patientsConfusional stateIll patientsClinical trialsEarly treatmentAnesthetic agentsEpilepticusClinical careEEG patternsPatientsTreatmentElectroencephalogram (EEG) recordingsMidazolamPropofolDiagnosisTreatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review
Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review. Epilepsia 2002, 43: 146-153. PMID: 11903460, DOI: 10.1046/j.1528-1157.2002.28501.x.Peer-Reviewed Original ResearchConceptsRefractory status epilepticusEEG background suppressionTreatment of RSEContinuous EEG monitoringChoice of agentTitration goalsEEG monitoringSystematic reviewBreakthrough seizuresStatus epilepticusTreatment failureShort-term treatment failureFrequency of hypotensionImmediate treatment failureTitration of treatmentPercent of patientsUse of midazolamMain outcome measuresEfficacy of midazolamRSE patientsSE refractoryStandard AEDsAdult patientsAntiepileptic drugsPTB treatment