2024
Cyclic Alternating EEG Patterns: From Sleep to Encephalopathy
Misirocchi F, Mutti C, Hirsch L, Parrino L, Florindo I. Cyclic Alternating EEG Patterns: From Sleep to Encephalopathy. Journal Of Clinical Neurophysiology 2024, 41: 485-494. PMID: 39186585, DOI: 10.1097/wnp.0000000000001082.Peer-Reviewed Original ResearchConceptsCyclic alternating patternStandardized Critical Care EEG TerminologyCritical care EEG terminologyNon-rapid eye movement sleepAmerican Clinical Neurophysiology SocietyEye movement sleepCritically ill patientsEEG terminologyPrognostic significancePrognostic valueMovement sleepClinical significanceImpact of confounding factorsSleep instabilityCritical care settingIll patientsClinical importanceEEG activityEEG phenomenaSedative agentsElectrophysiological biomarkersAlternating patternEncephalopathySleepCare settingsSeizure Assessment and Forecasting With Efficient Rapid-EEG
Kalkach-Aparicio M, Fatima S, Selte A, Sheikh I, Cormier J, Gallagher K, Avagyan G, Cespedes J, Krishnamurthy P, Elazim A, Khan N, Hussein O, Maganti R, Larocque J, Holla S, Desai M, Westover B, Hirsch L, Struck A. Seizure Assessment and Forecasting With Efficient Rapid-EEG. Neurology 2024, 103: e209621. PMID: 38875512, DOI: 10.1212/wnl.0000000000209621.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedComparative Effectiveness ResearchElectroencephalographyFemaleHumansMaleMiddle AgedRetrospective StudiesSeizuresConceptsMonitoring of at-risk patientsRecords of patientsTertiary care centerReceiver operating characteristic curveCritically ill patientsAt-risk patientsClass II evidenceDiagnostic accuracy studiesOperating characteristics curveMedian ageSecondary endpointsPrevent overtreatmentNo significant differenceEEG reviewRisk stratificationNoninferiority marginAntiseizure medicationsClinical correlatesPrimary outcomeII evidenceEEG technologistsSeizure assessmentIll patientsComparative effectiveness studiesLow risk
2022
Quantitative epileptiform burden and electroencephalography background features predict post-traumatic epilepsy
Chen Y, Li S, Ge W, Jing J, Chen HY, Doherty D, Herman A, Kaleem S, Ding K, Osman G, Swisher CB, Smith C, Maciel CB, Alkhachroum A, Lee JW, Dhakar MB, Gilmore EJ, Sivaraju A, Hirsch LJ, Omay SB, Blumenfeld H, Sheth KN, Struck AF, Edlow BL, Westover MB, Kim JA. Quantitative epileptiform burden and electroencephalography background features predict post-traumatic epilepsy. Journal Of Neurology Neurosurgery & Psychiatry 2022, 94: 245-249. PMID: 36241423, PMCID: PMC9931627, DOI: 10.1136/jnnp-2022-329542.Peer-Reviewed Original ResearchMeSH KeywordsBrain Injuries, TraumaticCase-Control StudiesElectroencephalographyEpilepsy, Post-TraumaticHumansRetrospective StudiesConceptsPost-traumatic epilepsyTraumatic brain injuryCT abnormalitiesElectroencephalography featuresAdmission Glasgow Coma Scale scoreGlasgow Coma Scale scoreRetrospective case-control studyMultivariable logistic regression analysisRisk stratification modelCase-control studyLogistic regression analysisTBI admissionsSevere complicationsFuture trialsBrain injuryCT reportsSeizure diagnosisPredictive valueScale scorePatientsLogistic regressionStratification modelQuantitative electroencephalogramTBI mechanismsRegression analysisElectroencephalogram 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 ResearchMeSH KeywordsBrain InjuriesElectroencephalographyHumansIntensive Care UnitsSeizuresStatus EpilepticusConceptsAcute 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 electroencephalographyHippocampal 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 ResearchMeSH KeywordsElectroencephalographyEpilepsy, Temporal LobeFunctional LateralityHippocampusHumansMethohexitalSeizuresConceptsResponsive 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 increaseFactors Predicting Outcome After Intracranial EEG Evaluation in Patients With Medically Refractory Epilepsy
Sivaraju A, Hirsch L, Gaspard N, Farooque P, Gerrard J, Xu Y, Deng Y, Damisah E, Blumenfeld H, Spencer DD. Factors Predicting Outcome After Intracranial EEG Evaluation in Patients With Medically Refractory Epilepsy. Neurology 2022, 99: e1-e10. PMID: 35508395, PMCID: PMC9259091, DOI: 10.1212/wnl.0000000000200569.Peer-Reviewed Original ResearchMeSH KeywordsDrug Resistant EpilepsyElectrocorticographyElectroencephalographyHumansMagnetic Resonance ImagingRetrospective StudiesTreatment OutcomeConceptsTemporal lobe onsetSeizure freedomResective surgeryIndependent predictorsLesional MRIUnfavorable predictorRefractory epilepsyContinued medical treatmentEpilepsy surgical evaluationFactors Predicting OutcomeIntracranial EEG evaluationNonlesional extratemporal epilepsySubsequent seizure freedomSustained seizure freedomThorough presurgical evaluationSeizure-free outcomeClass II evidenceMedically Refractory EpilepsyRetrospective chart reviewKaplan-Meier curvesSelect clinical scenariosMultivariable regression analysisBest multivariable modelIntracranial EEGSeizure onset localizationDeveloping a Standardized Approach to Grading the Level of Brain Dysfunction on EEG
Dhakar MB, Sheikh ZB, Desai M, Desai RA, Sternberg EJ, Popescu C, Baron-Lee J, Rampal N, Hirsch LJ, Gilmore EJ, Maciel CB. Developing a Standardized Approach to Grading the Level of Brain Dysfunction on EEG. Journal Of Clinical Neurophysiology 2022, 40: 553-561. PMID: 35239553, DOI: 10.1097/wnp.0000000000000919.Peer-Reviewed Original ResearchMeSH KeywordsBrainBrain DiseasesCritical CareElectroencephalographyHumansObserver VariationSurveys and QuestionnairesConceptsCerebral dysfunctionCritical Care EEG Monitoring Research ConsortiumInterrater agreementGrading scaleStandardized approachDegree of dysfunctionKappa statisticsStandardized grading scalePosterior dominant rhythmElectroencephalogram (EEG) background activityLevel of dysfunctionOverall interrater agreementNeuromonitoring toolsFleiss kappa statisticEEG findingsBrain dysfunction
2021
Hemisphere-Dependent Ictal Tachycardia Versus Ictal Bradycardia in a Critically Ill Patient
Fong MWK, Norris S, Percy J, Hirsch LJ, Herlopian A. Hemisphere-Dependent Ictal Tachycardia Versus Ictal Bradycardia in a Critically Ill Patient. Journal Of Clinical Neurophysiology 2021, 39: e15-e18. PMID: 34860703, DOI: 10.1097/wnp.0000000000000873.Peer-Reviewed Original ResearchMeSH KeywordsAgedBradycardiaCritical IllnessElectroencephalographyHeart ArrestHumansMaleSeizuresTachycardiaConceptsIctal bradycardiaIll patientsNeuro-intensive care unitTemporal regionsStandard clinical monitoringHigh-risk patientsOvert clinical signsRight-handed manLeft temporal regionRight temporal regionMild tachycardiaSinus bradycardiaSinus pausesCare unitIntraparenchymal hemorrhageSinus tachycardiaIctal phenomenaCardiac investigationsAutonomic changesClinical signsHeart rateClinical monitoringBradycardiaSeizuresIndependent seizuresCombining 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 ResearchSimulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment
Kumar A, Martin R, Chen W, Bauerschmidt A, Youngblood MW, Cunningham C, Si Y, Ezeani C, Kratochvil Z, Bronen J, Thomson J, Riordan K, Yoo JY, Shirka R, Manganas L, Krestel H, Hirsch LJ, Blumenfeld H. Simulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment. Epilepsia 2021, 63: e30-e34. PMID: 34816425, PMCID: PMC8883409, DOI: 10.1111/epi.17136.Peer-Reviewed Original ResearchMeSH KeywordsConsciousnessElectroencephalographyEpilepsyHumansMotor DisordersRetrospective StudiesSeizuresConceptsSeizure typesFocal seizuresMotor functionMotor impairmentYale-New Haven HospitalVideo-electroencephalographic monitoringAbnormal motor functionEpilepsy monitoring unitNew Haven HospitalImpaired consciousnessMyoclonic seizuresRetrospective studySeizure characteristicsMotor involvementIctal eventsImpaired drivingLarge cohortSeizuresImpairmentPatientsResponsivenessDriving restrictionsVideo reviewMonitoring unitEpilepsyThe Utility of Quantitative EEG in Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
Baang HY, Chen HY, Herman AL, Gilmore EJ, Hirsch LJ, Sheth KN, Petersen NH, Zafar SF, Rosenthal ES, Westover MB, Kim JA. The Utility of Quantitative EEG in Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. Journal Of Clinical Neurophysiology 2021, 39: 207-215. PMID: 34510093, PMCID: PMC8901442, DOI: 10.1097/wnp.0000000000000754.Peer-Reviewed Original ResearchPharmacotherapy 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 functionElectroencephalographic 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 ResearchMeSH KeywordsAgedCOVID-19ElectroencephalographyFemaleHumansMaleMiddle AgedRetrospective StudiesRisk FactorsSeizuresTreatment OutcomeConceptsNonconvulsive 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 abnormalitiesAssessment of a Study of Continuous vs Repeat-Spot Electroencephalography in Patients With Critical Illness
Gaspard N, Westover MB, Hirsch LJ. Assessment of a Study of Continuous vs Repeat-Spot Electroencephalography in Patients With Critical Illness. JAMA Neurology 2021, 78: 369-369. PMID: 33523103, PMCID: PMC8136812, DOI: 10.1001/jamaneurol.2020.5348.Peer-Reviewed Original ResearchBrief 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 ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overBiomarkersElectroencephalographyFemaleHumansMaleMiddle AgedRetrospective StudiesSeizuresYoung AdultConceptsParoxysmal 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 biomarkersVideo 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
Neuroimaging Correlates of Lateralized Rhythmic Delta Activity, Lateralized Periodic Discharges, and Generalized Rhythmic Delta Activity on EEG in Critically Ill Patients
Alzawahmah M, Fong MWK, Gilmore EJ, Hirsch LJ. Neuroimaging Correlates of Lateralized Rhythmic Delta Activity, Lateralized Periodic Discharges, and Generalized Rhythmic Delta Activity on EEG in Critically Ill Patients. Journal Of Clinical Neurophysiology 2020, 39: 228-234. PMID: 33235178, DOI: 10.1097/wnp.0000000000000763.Peer-Reviewed Original ResearchMeSH KeywordsCritical IllnessElectroencephalographyHumansMagnetic Resonance ImagingNeuroimagingRetrospective StudiesConceptsRhythmic delta activityDelta activityMRI abnormalitiesNormal MRIGeneralized rhythmic delta activityLateralized rhythmic delta activityLateralized periodic dischargesCritically Ill PatientsMajority of patientsMultifocal abnormalitiesIll patientsFocal findingsMRI characteristicsFocal abnormalitiesLRDAPatientsDiscordant findingsEpileptiform patternsMost abnormalitiesContinuous EEGPeriodic dischargesAbnormalitiesEEG patternsStatistical significanceMRIWhen and How to Treat Status Epilepticus: The Tortoise or the Hare?
Fong MWK, Hirsch LJ. When and How to Treat Status Epilepticus: The Tortoise or the Hare? Journal Of Clinical Neurophysiology 2020, 37: 393-398. PMID: 32890060, DOI: 10.1097/wnp.0000000000000656.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsElectroencephalographyForecastingHumansHypnotics and SedativesSeizuresStatus EpilepticusTime FactorsTreatment OutcomeConceptsType of SEStatus epilepticusTreatment of SECessation of seizuresCurrent treatment guidelinesConvulsive status epilepticusTreatment guidelinesFull dosesNeuronal responsesVariety of subtypesPromising future approachUnnecessary harmEpilepticusPatientsTherapyTreatmentFuture approachesCollective termDetecting Seizures and Epileptiform Abnormalities in Acute Brain Injury
Singla S, Garcia GE, Rovenolt GE, Soto AL, Gilmore EJ, Hirsch LJ, Blumenfeld H, Sheth KN, Omay SB, Struck AF, Westover MB, Kim JA. Detecting Seizures and Epileptiform Abnormalities in Acute Brain Injury. Current Neurology And Neuroscience Reports 2020, 20: 42. PMID: 32715371, PMCID: PMC9353690, DOI: 10.1007/s11910-020-01060-4.Peer-Reviewed Original ResearchConceptsIctal-interictal continuumBrain injuryAcute brain injuryBetter clinical outcomesTraumatic brain injuryRecent FindingsCurrent literatureIncreased morbidityClinical outcomesEpileptiform abnormalitiesEEG findingsMortality riskEEG monitoringEpileptiform patternsPrognostic modelSeizuresClinical settingInjuryLogistical barriersElectroencephalogram studyUse of EEGABIPractical barriersEEG analysisEEGMorbidityNonepileptic Electroencephalographic Correlates of Episodic Increases in Intracranial Pressure
Sheikh ZB, Maciel CB, Dhakar MB, Hirsch LJ, Gilmore EJ. Nonepileptic Electroencephalographic Correlates of Episodic Increases in Intracranial Pressure. Journal Of Clinical Neurophysiology 2020, 39: 149-158. PMID: 32701765, DOI: 10.1097/wnp.0000000000000750.Peer-Reviewed Original ResearchMeSH KeywordsElectroencephalographyHumansIntracranial HypertensionIntracranial PressureRetrospective Studies