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
2021
Pharmacotherapy 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 ResearchConceptsNonconvulsive 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 abnormalities
2019
Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate
Rossetti AO, Hirsch LJ, Drislane FW. Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate. Clinical Neurophysiology Practice 2019, 4: 170-177. PMID: 31886441, PMCID: PMC6921236, DOI: 10.1016/j.cnp.2019.07.001.Peer-Reviewed Original Research
2017
Cyclic 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
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 ResearchConceptsIll 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 trendsPatientsAcute 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 ResearchConceptsNonconvulsive 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 ICU
2013
Continuous electroencephalography in a surgical intensive care unit
Kurtz P, Gaspard N, Wahl AS, Bauer RM, Hirsch LJ, Wunsch H, Claassen J. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Medicine 2013, 40: 228-234. PMID: 24240843, DOI: 10.1007/s00134-013-3149-8.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusPeriodic epileptiform dischargesNonconvulsive seizuresPoor outcomeClinical seizuresSICU patientsRetrospective studyCEEG monitoringMental statusSurgical intensive care unit patientsIntensive care unit patientsSurgical intensive care unitCare unit patientsContinuous electroencephalography monitoringMajority of patientsIntensive care unitMultivariable logistic regressionLiver transplantationHospital dischargeUnit patientsAbdominal surgeryPrimary outcomeStatus epilepticusCare unitMean age
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 stateEpilepsy Emergencies: Diagnosis and Management
Foreman B, Hirsch LJ. Epilepsy Emergencies: Diagnosis and Management. Neurologic Clinics 2012, 30: 11-41. PMID: 22284053, DOI: 10.1016/j.ncl.2011.09.005.Peer-Reviewed Original ResearchConceptsStatus epilepticusLimited evidence-based guidanceIrreversible brain injuryNonconvulsive status epilepticusEvidence-based guidanceEpilepsy emergenciesNonconvulsive seizuresHigh morbidityBrain injuryEarly treatmentTreatment responseProlonged casesRefractory conditionEpilepticusPatientsPrognosisSeizuresTreatmentDiagnosisMorbidityComatoseInjuryMortality
2008
Focal motor seizures induced by alerting stimuli in critically ill patients
Hirsch LJ, Pang T, Claassen J, Chang C, Khaled KA, Wittman J, Emerson RG. Focal motor seizures induced by alerting stimuli in critically ill patients. Epilepsia 2008, 49: 968-973. PMID: 18177364, DOI: 10.1111/j.1528-1167.2007.01481.x.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAnticonvulsantsArousalBrain Damage, ChronicBrain StemChildCritical CareDominance, CerebralElectroencephalographyEpilepsy, Partial, MotorEpilepsy, ReflexFemaleFrontal LobeHumansMagnetic Resonance ImagingMaleMiddle AgedRisk FactorsSubstance Withdrawal SyndromeTemporal LobeThalamusVideo RecordingConceptsFocal motor seizuresMotor seizuresIll patientsEEG findingsTertiary care medical centerVideo-EEG findingsNonconvulsive status epilepticusReview of chartsElectrographic seizure activityFocal EEG findingsArousal circuitryHyperexcitable cortexEncephalopathic patientsAcute illnessClinical seizuresStatus epilepticusBilateral thalamusComatose patientsElectrographic seizuresUpper brainstemSeizure activityClinical correlatesEpileptiform activityMotor pathwaysNeurological ICU
2006
In Nonconvulsive Status Epilepticus (NCSE), Treat to Burst‐Suppression: Pro and Con
Jordan KG, Hirsch LJ. In Nonconvulsive Status Epilepticus (NCSE), Treat to Burst‐Suppression: Pro and Con. Epilepsia 2006, 47: 41-45. PMID: 17044825, DOI: 10.1111/j.1528-1167.2006.00659.x.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusNonconvulsive seizuresRefractory nonconvulsive status epilepticusPermanent neuronal injuryAcute brain injuryIntensive care interventionsHigh mortality rateNeuronal injuryStatus epilepticusIatrogenic complicationsBrain damageBrain injuryCare interventionsDr. HirschBurst suppressionMortality rateExpert managementSeizuresInjuryMost casesEpilepticusMedicationsComplicationsDr. JordanNonconvulsive Status Epilepticus in Children: Clinical and EEG Characteristics
Tay SK, Hirsch LJ, Leary L, Jette N, Wittman J, Akman CI. Nonconvulsive Status Epilepticus in Children: Clinical and EEG Characteristics. Epilepsia 2006, 47: 1504-1509. PMID: 16981867, DOI: 10.1111/j.1528-1167.2006.00623.x.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusConvulsive status epilepticusPeriodic lateralized epileptiform dischargesPediatric patientsStatus epilepticusEpileptiform dischargesDiagnosis of NCSEAcute hypoxic-ischemic injuryAntiepileptic drug regimenAcute medical illnessHypoxic-ischemic injuryComprehensive Epilepsy CenterContinuous electroencephalographic monitoringPeriodic epileptiform dischargesHeterogeneous clinical conditionYears of ageFrequent etiologyNeurological outcomeChart reviewDrug regimenAcute infectionAcute settingConvulsive seizuresPrompt recognitionRefractory epilepsy
2005
Treatment of convulsive and nonconvulsive status epilepticus
Pang T, Hirsch LJ. Treatment of convulsive and nonconvulsive status epilepticus. Current Treatment Options In Neurology 2005, 7: 247-259. PMID: 15967088, DOI: 10.1007/s11940-005-0035-x.Peer-Reviewed Original ResearchContinuous intravenous midazolamOpinion statementStatus epilepticusNonconvulsive status epilepticusDrug of choiceRectal benzodiazepinesBuccal midazolamIntravenous midazolamProlonged seizuresRisk patientsIntravenous accessPrehospital treatmentStatus epilepticusHospital protocolInitial treatmentRandomized trialsRectal diazepamMental statusPoor responseWorse outcomesFull dosesBest treatmentEpilepticusTreatmentPatientsMidazolam
2002
Nonconvulsive Status Epilepticus after Subarachnoid Hemorrhage
Dennis LJ, Claassen J, Hirsch LJ, Emerson RG, Connolly ES, Mayer SA. Nonconvulsive Status Epilepticus after Subarachnoid Hemorrhage. Neurosurgery 2002, 51: 1136. PMID: 12383358, DOI: 10.1097/00006123-200211000-00006.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusAneurysmal subarachnoid hemorrhageSubarachnoid hemorrhageCEEG monitoringUnexplained comaNeurological deteriorationStatus epilepticusRefractory nonconvulsive status epilepticusNeurological intensive care unitProphylactic anticonvulsant therapyHours of hospitalizationContinuous electroencephalographic monitoringIntensive care unitAnticonvulsant administrationHospital seizuresAnticonvulsant therapyCerebral edemaClinical improvementHess gradeCare unitClinical featuresComatose patientsElectrographic seizuresVentricular drainageMidazolam therapyThe 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) recordingsMidazolamPropofolDiagnosis