2022
Association of Serum Pyridoxal Phosphate Levels with Established Status Epilepticus
Rubinos C, Bruzzone MJ, Blodgett C, Tsai C, Patel P, Hianik R, Jadav R, Boudesseul J, Liu C, Zhu H, Wilson SE, Olm-Shipman C, Meeker R, Hirsch LJ. Association of Serum Pyridoxal Phosphate Levels with Established Status Epilepticus. Neurocritical Care 2022, 38: 41-51. PMID: 36071331, DOI: 10.1007/s12028-022-01579-z.Peer-Reviewed Original ResearchConceptsStatus epilepticusPyridoxal phosphate levelsPLP levelsPyridoxine deficiencyHigh prevalenceControl groupMethodsThis retrospective cohort studyIntensive care unit patientsYale-New Haven HospitalCritical illness severitySerum PLP levelsRetrospective cohort studyCare unit patientsNon-ICU inpatientsPhosphate levelsHistory of epilepsyRole of pyridoxineNorth Carolina HospitalsNew Haven HospitalUnit patientsCohort studyMedian ageIllness severityPyridoxine supplementationProspective study
2021
Combining Transcranial Doppler and EEG Data to Predict Delayed Cerebral Ischemia After Subarachnoid Hemorrhage
Chen HY, Elmer J, Zafar SF, Ghanta M, Moura Junior V, Rosenthal ES, Gilmore EJ, Hirsch LJ, Zaveri HP, Sheth KN, Petersen NH, Westover MB, Kim JA. Combining Transcranial Doppler and EEG Data to Predict Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Neurology 2021, 98: e459-e469. PMID: 34845057, PMCID: PMC8826465, DOI: 10.1212/wnl.0000000000013126.Peer-Reviewed Original ResearchA systematic review of seizure clusters: Prevalence, risk factors, burden of disease and treatment patterns
Chung S, Szaflarski JP, Choi EJ, Wilson JC, Kharawala S, Kaur G, Hirsch LJ. A systematic review of seizure clusters: Prevalence, risk factors, burden of disease and treatment patterns. Epilepsy Research 2021, 177: 106748. PMID: 34521043, DOI: 10.1016/j.eplepsyres.2021.106748.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsChildCost of IllnessHumansPrevalenceProspective StudiesQuality of LifeRisk FactorsSeizuresConceptsSeizure action planRescue medicationSeizure clustersStatus epilepticusTreatment patternsSeizure remissionTreatment resistanceHigh riskPoor physician-patient communicationSeizure-related hospitalizationHigh seizure frequencyBurden of diseaseProductivity of patientsPhysician-patient communicationNon-SC patientsQuality of lifeSystematic literature searchConsecutive seizuresSeizure frequencyTreatment guidelinesProspective studySC patientsCaregiver QOLDisease burdenRisk factorsVideo quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study
Tatum WO, Hirsch LJ, Gelfand MA, Acton EK, LaFrance WC, Duckrow RB, Chen D, Blum AS, Hixson J, Drazkowski J, Benbadis S, Cascino GD, Collaborators T. Video quality using outpatient smartphone videos in epilepsy: Results from the OSmartViE study. European Journal Of Neurology 2021, 28: 1453-1462. PMID: 33465822, DOI: 10.1111/ene.14744.Peer-Reviewed Original ResearchMeSH KeywordsAdultCohort StudiesElectroencephalographyEpilepsyFemaleHumansMiddle AgedOutpatientsProspective StudiesSmartphoneConceptsPsychogenic nonepileptic attacksNeurologic eventsEpileptic seizuresInpatient video-electroencephalography (EEG) monitoringPhysiologic nonepileptic eventsMulticenter cohort studyMajority of patientsVideo-electroencephalography monitoringVideo-EEG monitoringSimilar diagnostic accuracyHome video recordingEpilepsy outpatientsNeurological disease statesCohort studyNeurological eventsNonepileptic eventsNonepileptic attacksUnknown diagnosisAdequate durationClinical informationPatientsSenior neurology residentsAccurate diagnosisDiagnostic accuracyNeurology residents
2020
Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy
Nair DR, Laxer KD, Weber PB, Murro AM, Park YD, Barkley GL, Smith BJ, Gwinn RP, Doherty MJ, Noe KH, Zimmerman RS, Bergey GK, Anderson WS, Heck C, Liu CY, Lee RW, Sadler T, Duckrow RB, Hirsch LJ, Wharen RE, Tatum W, Srinivasan S, McKhann GM, Agostini MA, Alexopoulos AV, Jobst BC, Roberts DW, Salanova V, Witt TC, Cash SS, Cole AJ, Worrell GA, Lundstrom BN, Edwards JC, Halford JJ, Spencer DC, Ernst L, Skidmore CT, Sperling MR, Miller I, Geller EB, Berg MJ, Fessler AJ, Rutecki P, Goldman AM, Mizrahi EM, Gross RE, Shields DC, Schwartz TH, Labar DR, Fountain NB, Elias WJ, Olejniczak PW, Villemarette-Pittman NR, Eisenschenk S, Roper SN, Boggs JG, Courtney TA, Sun FT, Seale CG, Miller KL, Skarpaas TL, Morrell MJ. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology 2020, 95: 10.1212/wnl.0000000000010154. PMID: 32690786, PMCID: PMC7538230, DOI: 10.1212/wnl.0000000000010154.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedDepressive DisorderDrug Resistant EpilepsyElectric Stimulation TherapyEpilepsies, PartialFemaleFollow-Up StudiesHumansImplantable NeurostimulatorsIntracranial HemorrhagesMaleMemory DisordersMiddle AgedProspective StudiesProsthesis-Related InfectionsQuality of LifeRandomized Controlled Trials as TopicStatus EpilepticusSudden Unexpected Death in EpilepsySuicideTreatment OutcomeYoung AdultConceptsBrain-responsive neurostimulationQuality of lifeFocal onset seizuresAdverse eventsSeizure frequencyIntractable focal onset seizuresProspective open-label trialOverall QOLOpen-label trialSerious adverse eventsClass IV evidenceMedian percent reductionSudden unexplained deathMedian percent changeSeizure-free periodQOLIE-89SUDEP ratesLabel trialSeizure freedomEpilepsy ratesFocal seizuresOnset seizuresEpilepsy InventoryAcceptable safetyFocal epilepsyEvaluating 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
Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures.
Tolchin B, Dworetzky BA, Martino S, Blumenfeld H, Hirsch LJ, Baslet G. Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures. Neurology 2019, 92: e675-e679. PMID: 30610097, PMCID: PMC6382361, DOI: 10.1212/wnl.0000000000006848.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAdult Survivors of Child AbuseAgedAged, 80 and overCohort StudiesConversion DisorderEmergency Service, HospitalEthnicityFemaleFollow-Up StudiesHumansMaleMiddle AgedMinority GroupsOdds RatioProspective StudiesPsychotherapyQuality of LifeSeizuresTreatment Adherence and ComplianceTreatment OutcomeYoung AdultConceptsPsychogenic nonepileptic seizuresQuality of lifePNES frequencyNonepileptic seizuresProspective cohort studyEmergency department utilizationTime of referralBaseline characteristicsCohort studyED visitsSeizure frequencyED utilizationPotential confoundersWomen's HospitalTreatment outcomesMedium effect sizeLocal therapistsMultivariate modelAdherenceChildhood abuseSeizuresHospitalSignificant reductionOutcomesEffect size
2018
Prevalence and predictors of seizure clusters: A prospective observational study of adult patients with epilepsy
Detyniecki K, O'Bryan J, Choezom T, Rak G, Ma C, Zhang S, Bonito J, Hirsch LJ. Prevalence and predictors of seizure clusters: A prospective observational study of adult patients with epilepsy. Epilepsy & Behavior 2018, 88: 349-356. PMID: 30344026, DOI: 10.1016/j.yebeh.2018.09.035.Peer-Reviewed Original ResearchConceptsRescue medication useProspective observational studyEmergency department visitsHigh seizure frequencySeizure clustersAdult patientsRescue medicationClinical characteristicsSeizure frequencyActive epilepsyDepartment visitsMedication useObservational studyExact testSeizure-related outcomesFisher's exact testLogistic regression modelsSeizure clusteringAdverse outcomesEpilepsy severitySeizure diariesIndividual patientsPatientsEpilepsyFinal analysisThe epilepsy bioinformatics study for anti-epileptogenic therapy (EpiBioS4Rx) clinical biomarker: Study design and protocol
Vespa PM, Shrestha V, Abend N, Agoston D, Au A, Bell MJ, Bleck TP, Blanco MB, Claassen J, Diaz-Arrastia R, Duncan D, Ellingson B, Foreman B, Gilmore EJ, Hirsch L, Hunn M, Kamnaksh A, McArthur D, Morokoff A, O'Brien T, O'Phelan K, Robertson CL, Rosenthal E, Staba R, Toga A, Willyerd FA, Zimmermann L, Yam E, Martinez S, Real C, Engel J. The epilepsy bioinformatics study for anti-epileptogenic therapy (EpiBioS4Rx) clinical biomarker: Study design and protocol. Neurobiology Of Disease 2018, 123: 110-114. PMID: 30048805, PMCID: PMC6344322, DOI: 10.1016/j.nbd.2018.07.025.Peer-Reviewed Original ResearchConceptsPost-traumatic epilepsyTraumatic brain injuryIncidence of PTELongitudinal prospective observational studyAnti-epileptogenic therapiesEpilepsy Bioinformatics StudyProspective observational studyFuture interventional studiesModerate-severe TBI patientsHemorrhagic contusionAcute evaluationTBI patientsBlood biomarkersDiscovery of biomarkersInterventional studyBrain injuryElectroencephalographic monitoringObservational studyInternational cohortAnimal modelsClinical biomarkersStudy designBiomarkersMultidisciplinary approachNational InstituteRandomized 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/Subjects
2017
Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients
Struck AF, Ustun B, Ruiz AR, Lee JW, LaRoche SM, Hirsch LJ, Gilmore EJ, Vlachy J, Haider HA, Rudin C, Westover MB. Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients. JAMA Neurology 2017, 74: 1419-1424. PMID: 29052706, PMCID: PMC5822188, DOI: 10.1001/jamaneurol.2017.2459.Peer-Reviewed Original ResearchConceptsIll patientsSeizure riskContinuous EEGRisk factorsMAIN OUTCOMEScoring systemBilateral independent periodic dischargesEpilepsy Monitoring Unit (EMU) admissionPeriodic dischargesBrief rhythmic dischargesProspective multicenter databaseSeizure risk factorsSporadic epileptiform dischargesRisk of seizuresRhythmic delta activitySimple scoring systemEligible patientsProbability of seizuresUnit admissionAcute illnessHospitalized patientsMulticenter databasePrior seizuresClinical historyClinical indicationsTime‐dependent risk of seizures in critically ill patients on continuous electroencephalogram
Struck AF, Osman G, Rampal N, Biswal S, Legros B, Hirsch LJ, Westover MB, Gaspard N. Time‐dependent risk of seizures in critically ill patients on continuous electroencephalogram. Annals Of Neurology 2017, 82: 177-185. PMID: 28681492, PMCID: PMC5842678, DOI: 10.1002/ana.24985.Peer-Reviewed Original ResearchConceptsEpileptiform EEG abnormalitiesClinical factorsIll patientsEpileptiform findingsRisk factorsEEG abnormalitiesEEG risk factorsClinical risk factorsRisk of seizuresHistory of seizuresPresence of comaDuration of monitoringGreater predictive valueTime-dependent riskAnn NeurolSeizure incidenceAcute illnessPrior seizuresClinical variablesEEG findingsProspective dataSeizure riskBaseline riskMultistate survival modelsPredictive value
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 likelihoodGeneralized 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 termsPrognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome
Sivaraju A, Gilmore EJ, Wira CR, Stevens A, Rampal N, Moeller JJ, Greer DM, Hirsch LJ, Gaspard N. Prognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome. Intensive Care Medicine 2015, 41: 1264-1272. PMID: 25940963, DOI: 10.1007/s00134-015-3834-x.Peer-Reviewed Original ResearchConceptsBetter outcomesPoor outcomeEpileptiform dischargesPost-cardiac arrest comatose patientsCritical care EEG terminologyPost-cardiac arrest comaMethodsProspective cohort studyContinuous EEG monitoringLow-voltage EEGPositive predictive valueAbsence of reactivityEEG terminologyCohort studySpontaneous circulationBrainstem reflexesClinical outcomesComatose patientsFalse positive ratePoor prognosisPrognostic significanceSuppression burstsClinical variablesClinical correlatesElectroencephalographic patternsElectroencephalographic predictorsAcute 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 ResearchMeSH KeywordsAgedAPACHEElectroencephalographyFemaleHumansIntensive Care UnitsMaleMiddle AgedPrevalenceProspective StudiesSeizuresSepsisStatus EpilepticusConceptsNonconvulsive 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 ICULong-term treatment with responsive brain stimulation in adults with refractory partial seizures
Bergey GK, Morrell MJ, Mizrahi EM, Goldman A, King-Stephens D, Nair D, Srinivasan S, Jobst B, Gross RE, Shields DC, Barkley G, Salanova V, Olejniczak P, Cole A, Cash SS, Noe K, Wharen R, Worrell G, Murro AM, Edwards J, Duchowny M, Spencer D, Smith M, Geller E, Gwinn R, Skidmore C, Eisenschenk S, Berg M, Heck C, Van Ness P, Fountain N, Rutecki P, Massey A, O'Donovan C, Labar D, Duckrow RB, Hirsch LJ, Courtney T, Sun FT, Seale CG. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology 2015, 84: 810-817. PMID: 25616485, PMCID: PMC4339127, DOI: 10.1212/wnl.0000000000001280.Peer-Reviewed Original ResearchConceptsRefractory partial-onset seizuresPartial-onset seizuresRefractory partial seizuresOnset seizuresQuality of lifePartial seizuresResponsive neurostimulatorSerious device-related adverse eventsMedian percent seizure reductionGeneralized tonic-clonic seizuresOpen-label safety studyDevice-related adverse eventsImplant site infectionPercent seizure reductionResponsive brain stimulationClass IV evidenceTonic-clonic seizuresDirect cortical stimulationLong-term efficacyLong-term treatmentRNS SystemDirect neurostimulationSeizure reductionAdverse eventsSite infection
2014
Brief 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
2012
Prospective assessment of ictal behavior using the revised Responsiveness in Epilepsy Scale (RES-II)
Bauerschmidt A, Koshkelashvili N, Ezeani CC, Yoo JY, Zhang Y, Manganas LN, Kapadia K, Palenzuela D, Schmidt C, Lief R, Kiely BT, Choezom T, McClurkin M, Shorten A, Detyniecki K, Hirsch LJ, Giacino JT, Blumenfeld H. Prospective assessment of ictal behavior using the revised Responsiveness in Epilepsy Scale (RES-II). Epilepsy & Behavior 2012, 26: 25-28. PMID: 23201609, PMCID: PMC3741052, DOI: 10.1016/j.yebeh.2012.10.022.Peer-Reviewed Original Research
2006
Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage
Claassen J, Hirsch LJ, Frontera JA, Fernandez A, Schmidt M, Kapinos G, Wittman J, Connolly ES, Emerson RG, Mayer SA. Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage. Neurocritical Care 2006, 4: 103-112. PMID: 16627897, DOI: 10.1385/ncc:4:2:103.Peer-Reviewed Original ResearchConceptsModified Rankin ScalePeriodic lateralized epileptiform dischargesSubarachnoid hemorrhageHess gradePoor outcomeEEG findingsCEEG monitoringEpileptiform dischargesPoor-grade subarachnoid hemorrhageMultivariate logistic regression analysisAdmission CT scanPeriodic epileptiform dischargesLogistic regression analysisRankin ScaleIll patientsIntraventricular hemorrhageMRS 4Functional outcomeSleep architectureEEG reactivityCT scanPatientsOutcomesHemorrhageRegression analysis