2022
Electroencephalogram 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
2020
Detecting 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 analysisEEGMorbidityAssessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction
Struck AF, Tabaeizadeh M, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T, Hernandez C, Kaleem S, Haider HA, Cissé AF, Dhakar MB, Hirsch LJ, Rosenthal ES, Zafar SF, Gaspard N, Westover MB. Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction. JAMA Neurology 2020, 77: 500-507. PMID: 31930362, PMCID: PMC6990873, DOI: 10.1001/jamaneurol.2019.4656.Peer-Reviewed Original ResearchConceptsContinuous electroencephalogramValidation cohortMAIN OUTCOMEEEG monitoringRetrospective medical record reviewKaplan-Meier survival analysisPatients 18 yearsMedical record reviewRisk of seizuresHigh-risk groupFirst hourEpileptiform EEG patternCEEG useClinical seizuresPrimary outcomeHospitalized patientsRecord reviewRisk stratificationEpileptiform findingsCardiac arrestSeizure riskClinical indicationsInclusion criteriaIndependent cohortAdequate screenValidation of the 2HELPS2B Seizure Risk Score in Acute Brain Injury Patients
Moffet EW, Subramaniam T, Hirsch LJ, Gilmore EJ, Lee JW, Rodriguez-Ruiz AA, Haider HA, Dhakar MB, Jadeja N, Osman G, Gaspard N, Struck AF. Validation of the 2HELPS2B Seizure Risk Score in Acute Brain Injury Patients. Neurocritical Care 2020, 33: 701-707. PMID: 32107733, DOI: 10.1007/s12028-020-00939-x.Peer-Reviewed Original ResearchConceptsAcute brain injuryClinical factorsContinuous EEG monitoringTraumatic brain injurySeizure incidenceEEG findingsClinical seizuresPrimary outcomeSubdural hematomaBrain injuryEEG monitoringAcute brain injury patientsRisk of seizuresBrain injury patientsReceiver operator characteristic curveOperator characteristic curveABI patientsPatient ageHospitalized patientsElectrographic seizuresInjury patientsIntraparenchymal hemorrhageClinical findingsSubarachnoid hemorrhageResultsA totalMesial temporal resection following long‐term ambulatory intracranial EEG monitoring with a direct brain‐responsive neurostimulation system
Hirsch LJ, Mirro EA, Salanova V, Witt TC, Drees CN, Brown M, Lee RW, Sadler TL, Felton EA, Rutecki P, Shin HW, Hadar E, Hegde M, Rao VR, Mnatsakanyan L, Madhavan DS, Zakaria TJ, Liu AA, Heck CN, Greenwood JE, Bigelow JK, Nair DR, Alexopoulos AV, Mackow M, Edwards JC, Sotudeh N, Kuzniecky RI, Gwinn RP, Doherty MJ, Geller EB, Morrell MJ. Mesial temporal resection following long‐term ambulatory intracranial EEG monitoring with a direct brain‐responsive neurostimulation system. Epilepsia 2020, 61: 408-420. PMID: 32072621, PMCID: PMC7154711, DOI: 10.1111/epi.16442.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnterior Temporal LobectomyDrug Resistant EpilepsyElectric Stimulation TherapyElectrocorticographyEpilepsy, Temporal LobeFemaleHumansImplantable NeurostimulatorsMaleMiddle AgedMonitoring, AmbulatoryNeurosurgical ProceduresRetrospective StudiesTemporal LobeTreatment OutcomeYoung AdultConceptsMTL resectionElectrographic seizuresTemporal lobe seizure onsetClinical seizure reductionMesial temporal resectionIntracranial EEG monitoringRNS SystemBitemporal epilepsySeizure reductionSeizure outcomeTemporal resectionPrimary outcomeRefractory epilepsyAdditional patientsEpilepsy centersUnilateral onsetBilateral onsetIcEEG recordingsSeizure onsetMTL epilepsyMedian reductionResectionPatientsEEG monitoringIcEEG data
2018
Electro-clinical characteristics and prognostic significance of post anoxic myoclonus
Dhakar MB, Sivaraju A, Maciel CB, Youn TS, Gaspard N, Greer DM, Hirsch LJ, Gilmore EJ. Electro-clinical characteristics and prognostic significance of post anoxic myoclonus. Resuscitation 2018, 131: 114-120. PMID: 29964146, DOI: 10.1016/j.resuscitation.2018.06.030.Peer-Reviewed Original ResearchConceptsPost-anoxic myoclonusRecovery of consciousnessElectro-clinical characteristicsComatose cardiac arrest survivorsLow voltage backgroundRetrospective chart reviewCardiac arrest survivorsElectro-clinical correlationsTime of dischargeContinuous EEG monitoringRelevant clinical variablesChart reviewHospital dischargeSpontaneous circulationArrest survivorsBrainstem reflexesCA survivorsPrognostic implicationsPrognostic significanceClinical variablesEEG findingsMyoclonusEEG monitoringPatientsLack of recovery
2017
The use and yield of continuous EEG in critically ill patients: A comparative study of three centers
Alvarez V, Ruiz A, LaRoche S, Hirsch LJ, Parres C, Voinescu PE, Fernandez A, Petroff OA, Rampal N, Haider HA, Lee JW, Consortium T. The use and yield of continuous EEG in critically ill patients: A comparative study of three centers. Clinical Neurophysiology 2017, 128: 570-578. PMID: 28231475, DOI: 10.1016/j.clinph.2017.01.001.Peer-Reviewed Original ResearchConceptsHigh-volume centersIll patientsVolume centersDoses of levetiracetamTertiary care sitesContinuous EEG monitoringDetection rateCEEG useSeizure frequencyFirst seizureMedian timeSeizure detection rateCEEG monitoringRecent guidelinesPatient managementCare sitesValproic acidASD useEEG monitoringDrug usageContinuous EEGSignificant differencesPatientsReporting toolsCEEG
2016
The relationship between seizures, interictal spikes and antiepileptic drugs
Goncharova II, Alkawadri R, Gaspard N, Duckrow RB, Spencer DD, Hirsch LJ, Spencer SS, Zaveri HP. The relationship between seizures, interictal spikes and antiepileptic drugs. Clinical Neurophysiology 2016, 127: 3180-3186. PMID: 27292227, DOI: 10.1016/j.clinph.2016.05.014.Peer-Reviewed Original ResearchConceptsFirst seizureSeizure occurrenceAED taperSpike rateEEG monitoringMarker of inhibitionIntracranial EEG monitoringOccurrence of seizuresScalp EEG monitoringConsecutive patientsAntiepileptic drugsDrug taperHigh spike ratesInterictal spikesSeizuresDay 4Intracranial electrodesPatientsAEDsSignificant relationshipDevelopment and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research
Lee JW, LaRoche S, Choi H, Ruiz A, Fertig E, Politsky JM, Herman ST, Loddenkemper T, Sansevere AJ, Korb PJ, Abend NS, Goldstein JL, Sinha SR, Dombrowski KE, Ritzl EK, Westover MB, Gavvala JR, Gerard EE, Schmitt SE, Szaflarski JP, Ding K, Haas KF, Buchsbaum R, Hirsch LJ, Wusthoff CJ, Hopp JL, Hahn CD. Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research. Journal Of Clinical Neurophysiology 2016, 33: 133-140. PMID: 26943901, PMCID: PMC4878836, DOI: 10.1097/wnp.0000000000000230.Peer-Reviewed Original ResearchConceptsCritical Care EEG Monitoring Research ConsortiumAmerican Clinical Neurophysiology SocietyIncidence of seizuresMulticenter feasibility studyIntensive care unitLarge-volume centersInterictal epileptiform dischargesDaily clinical useMulticenter collaborative researchCare unitUnique patientsVolume centersElectroencephalogram monitoringDuration of recordingEpileptiform dischargesMulticenter research studiesRhythmic dischargesClinical reportsResearch DatabaseEEG monitoringClinical data repositoryClinical useConsortium databaseEEG reportsReporting toolsProgressive change in sleep over multiple nights of intracranial EEG monitoring
Joshi RB, Gaspard N, Goncharova II, Pavlova M, Duckrow RB, Gerrard JL, Spencer DD, Hirsch LJ, Zaveri HP. Progressive change in sleep over multiple nights of intracranial EEG monitoring. Clinical Neurophysiology 2016, 127: 2302-2307. PMID: 27072103, DOI: 10.1016/j.clinph.2016.02.018.Peer-Reviewed Original Research
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 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 Research
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
2010
Urgent Continuous EEG (cEEG) Monitoring Leads to Changes in Treatment in Half of Cases
Hirsch LJ. Urgent Continuous EEG (cEEG) Monitoring Leads to Changes in Treatment in Half of Cases. Epilepsy Currents 2010, 10: 82-85. PMID: 20697500, PMCID: PMC2912537, DOI: 10.1111/j.1535-7511.2010.01364.x.Peer-Reviewed Original ResearchContinuous electroencephalographic monitoringIntensive care unitAED therapyElectroencephalographic monitoringCare unitElectrographic seizuresNeuroscience intensive care unitAntiepileptic drug therapyRetrospective cohort studyContinuous EEG monitoringAED prescribingAntiepileptic medicationsCohort studyElectroencephalographic findingsNeurological wardDrug therapyElectroencephalographic abnormalitiesInpatient settingAED changesEEG monitoringTherapySeizuresIndividual inpatientsPrescribingFindingsUse of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists
Abend NS, Dlugos DJ, Hahn CD, Hirsch LJ, Herman ST. Use of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists. Neurocritical Care 2010, 12: 382-389. PMID: 20198513, PMCID: PMC2944658, DOI: 10.1007/s12028-010-9337-2.Peer-Reviewed Original ResearchConceptsNon-convulsive seizuresIll patientsEEG monitoringPhenytoin/fosphenytoinCritically Ill PatientsAbnormal eye movementsFurther prospective studiesCommon clinical problemSurvey of neurologistsCEEG indicationsCEEG utilizationResultsThree hundredStatus epilepticusProspective studyMental statusCommon anticonvulsantsClinical problemPatientsAreas of uncertaintyPrior convulsionsCurrent practiceEye movementsLevetiracetamSeizuresNeurologists
2005
Continuous electroencephalogram monitoring in critically ill patients
Jette N, Hirsch LJ. Continuous electroencephalogram monitoring in critically ill patients. Current Neurology And Neuroscience Reports 2005, 5: 312-321. PMID: 15987616, DOI: 10.1007/s11910-005-0077-1.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringIll patientsPermanent neuronal injuryContinuous electroencephalogram monitoringStandard of careRhythmic EEG patternsNeuronal injuryCerebral ischemiaNonconvulsive seizuresNeurologic impairmentClinical managementContinuous brain monitoringElectroencephalogram monitoringEEG monitoringPatientsEEG patternsBrain monitoringFurther studiesSeizuresIndicationsRemarkable advancesIschemiaInjuryPrognosticationImpairmentContinuous EEG Monitoring in Patients With Subarachnoid Hemorrhage
Claassen J, Mayer SA, Hirsch LJ. Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage. Journal Of Clinical Neurophysiology 2005, 22: 92-98. PMID: 15805808, DOI: 10.1097/01.wnp.0000145006.02048.3a.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringSubarachnoid hemorrhageEEG monitoringPoor-grade subarachnoid hemorrhageAdditional diagnostic interventionsQuantitative EEG analysisCEEG findingsCerebral ischemiaNeurological examComatose patientsSAH patientsCEEG monitoringClinical correlatesDiagnostic interventionsClinical examPatientsEEG changesIschemiaSeizuresReversible stageVasospasmHemorrhageRiskLimited utilityEEG analysisThe ACNS Subcommittee on Research Terminology for Continuous EEG Monitoring: Proposed Standardized Terminology for Rhythmic and Periodic EEG Patterns Encountered in Critically Ill Patients
Hirsch LJ, Brenner RP, Drislane FW, So E, Kaplan PW, Jordan KG, Herman ST, LaRoche SM, Young B, Bleck TP, Scheuer ML, Emerson RG. The ACNS Subcommittee on Research Terminology for Continuous EEG Monitoring: Proposed Standardized Terminology for Rhythmic and Periodic EEG Patterns Encountered in Critically Ill Patients. Journal Of Clinical Neurophysiology 2005, 22: 128-135. PMID: 15805813, DOI: 10.1097/01.wnp.0000158701.89576.4c.Peer-Reviewed Original Research