2022
Pregabalin for Recurrent Seizures in Critical Illness: A Promising Adjunctive Therapy, Especially for cyclic Seizures
Busl KM, Fong MWK, Newcomer Z, Patel M, Cohen SA, Jadav R, Smith CN, Mitropanopoulos S, Bruzzone M, Hella M, Eisenschenk S, Robinson CP, Roth WH, Ameli PA, Babi MA, Pizzi MA, Gilmore EJ, Hirsch LJ, Maciel CB. Pregabalin for Recurrent Seizures in Critical Illness: A Promising Adjunctive Therapy, Especially for cyclic Seizures. Neurocritical Care 2022, 37: 140-148. PMID: 35217998, DOI: 10.1007/s12028-022-01459-6.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnticonvulsantsCritical IllnessFemaleHumansMalePregabalinRetrospective StudiesSeizuresConceptsCyclic seizuresSeizure burdenSeizure frequencyRecurrent seizuresMin/hourAntiseizure medicationsElectrographic seizure burdenMedian seizure frequencyNeurocritical care settingPromising adjunctive therapyEffective adjunctive treatmentVoltage-gated calcium channelsNeurointensive care unitRetrospective case seriesTreatment of seizuresAlpha2-delta subunitExcitatory neurotransmitter releaseCoprimary outcomesIll cohortPGB administrationAntiseizure effectsSeizure recurrenceAdjunctive therapyCritical illnessRefractory seizures
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 seizuresPharmacotherapy 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 functionAssessment 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 Research
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 significanceMRIValidation of an algorithm of time-dependent electro-clinical risk stratification for electrographic seizures (TERSE) in critically ill patients
Cissé FA, Osman GM, Legros B, Depondt C, Hirsch LJ, Struck AF, Gaspard N. Validation of an algorithm of time-dependent electro-clinical risk stratification for electrographic seizures (TERSE) in critically ill patients. Clinical Neurophysiology 2020, 131: 1956-1961. PMID: 32622337, DOI: 10.1016/j.clinph.2020.05.031.Peer-Reviewed Original ResearchConceptsElectrographic seizuresRisk stratificationIll patientsAcute brain injuryContinuous electroencephalography monitoringElectrographic status epilepticusSubgroup of patientsDuration of EEGClinical seizuresConsecutive patientsStatus epilepticusElectroencephalography monitoringBrain injuryMedical recordsSubstantial burdenPatientsClinical practiceCEEGClinical neurophysiologistsSeizuresClinical implementationEEG recordingsTwo-thirdsFuture studiesEEG timeDiagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients
Westover MB, Gururangan K, Markert MS, Blond BN, Lai S, Benard S, Bickel S, Hirsch LJ, Parvizi J. Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients. Neurocritical Care 2020, 33: 479-490. PMID: 32034656, PMCID: PMC7416437, DOI: 10.1007/s12028-019-00911-4.Peer-Reviewed Original ResearchMeSH KeywordsAdultCritical IllnessElectrodesElectroencephalographyHumansRetrospective StudiesSeizuresConceptsDiagnostic valueAncillary clinical informationCritical care settingMassachusetts General HospitalGold standard diagnosisSame raterIll patientsSeizure activityGeneral HospitalIntra-rater agreementCare settingsHospital cliniciansClinical informationInter-rater variabilitySeizuresStandard diagnosisPathological activityEEG patternsPhase IGold standardHigh concordancePhase IIElectroencephalographyDiagnosisPresent study
2019
Communication 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 involvementCare
2018
Association between death and loss of stage N2 sleep features among critically Ill patients with delirium
Knauert MP, Gilmore EJ, Murphy TE, Yaggi HK, Van Ness PH, Han L, Hirsch LJ, Pisani MA. Association between death and loss of stage N2 sleep features among critically Ill patients with delirium. Journal Of Critical Care 2018, 48: 124-129. PMID: 30179762, PMCID: PMC6226351, DOI: 10.1016/j.jcrc.2018.08.028.Peer-Reviewed Original ResearchConceptsICU patientsIll patientsOdds ratioHigher oddsSleep spindlesIntensive care unit outcomesGrade of encephalopathySignificant sleep disruptionWorse ICU outcomeMedical ICU patientsAcute brain injuryObservational cohort studySedative-hypnotic useImportant prognostic valueLength of stayStage N2 sleepK-complexesCohort studyCritical illnessHospital dischargeRankin ScaleICU outcomesPrognostic valueSevere gradesMedical recordsClinical 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 outcome
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 valueAssociation of Periodic and Rhythmic Electroencephalographic Patterns With Seizures in Critically Ill Patients
Ruiz A, Vlachy J, Lee JW, Gilmore EJ, Ayer T, Haider HA, Gaspard N, Ehrenberg JA, Tolchin B, Fantaneanu TA, Fernandez A, Hirsch LJ, LaRoche S. Association of Periodic and Rhythmic Electroencephalographic Patterns With Seizures in Critically Ill Patients. JAMA Neurology 2017, 74: 181-188. PMID: 27992625, DOI: 10.1001/jamaneurol.2016.4990.Peer-Reviewed Original ResearchMeSH KeywordsBrain WavesCohort StudiesCritical IllnessElectroencephalographyFemaleHumansMalePeriodicitySeizuresConceptsRhythmic delta activityDelta activityPeriodic dischargesIll patientsSeizure riskElectroencephalographic patternsStimulation-induced patternsCritically Ill PatientsRisk of seizuresHigher seizure riskAcademic medical centerFrequency-dependent mannerSeizure incidenceIll adultsRisk stratificationHigh prevalenceMedical CenterMAIN OUTCOMEContinuous electroencephalographySeizuresPattern prevalenceMultivariate analysisPatientsClinical decisionRhythmic patternsCyclic seizures in critically ill patients: Clinical correlates, DC recordings and outcomes
Pinto LF, Gilmore EJ, Petroff OA, Sivaraju A, Rampal N, Hirsch LJ, Gaspard N. Cyclic seizures in critically ill patients: Clinical correlates, DC recordings and outcomes. Clinical Neurophysiology 2017, 128: 1083-1090. PMID: 28214108, DOI: 10.1016/j.clinph.2017.01.015.Peer-Reviewed Original ResearchConceptsCyclic seizuresProgressive brain injuryStatus epilepticusIll patientsClinical correlatesBrain injuryDC recordingsNon-convulsive status epilepticusEEG baselineNonconvulsive status epilepticusOlder patientsElectrographic seizuresWorse prognosisFocal onsetPoor outcomePrognostic significanceSeizure initiationPatientsInfraslow activitySeizuresCommon formEpilepticusFurther studiesPosterior regionInjury
2016
Review of the Utility of Prophylactic Anticonvulsant Use in Critically Ill Patients With Intracerebral Hemorrhage
Gilmore EJ, Maciel CB, Hirsch LJ, Sheth KN. Review of the Utility of Prophylactic Anticonvulsant Use in Critically Ill Patients With Intracerebral Hemorrhage. Stroke 2016, 47: 2666-2672. PMID: 27608820, DOI: 10.1161/strokeaha.116.012410.Peer-Reviewed Original Research
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 ResearchMeSH KeywordsAdultBrain DiseasesChildCritical CareCritical IllnessElectroencephalographyFemaleHumansMaleMonitoring, PhysiologicConceptsIll 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 ResearchMeSH KeywordsAdultBrain DiseasesChildCritical CareCritical IllnessElectroencephalographyFemaleHumansMaleMonitoring, PhysiologicConceptsIll 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 techniquesChildren
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
2013
Similarity 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
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 state