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 analysisEEGMorbidity
2019
Quantitative Electroencephalogram Trends Predict Recovery in Hypoxic-Ischemic Encephalopathy.
Ghassemi MM, Amorim E, Alhanai T, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hirsch LJ, Scirica BM, Biswal S, Moura Junior V, Cash SS, Brown EN, Mark RG, Westover MB. Quantitative Electroencephalogram Trends Predict Recovery in Hypoxic-Ischemic Encephalopathy. Critical Care Medicine 2019, 47: 1416-1423. PMID: 31241498, PMCID: PMC6746597, DOI: 10.1097/ccm.0000000000003840.Peer-Reviewed Original ResearchConceptsHypoxic-ischemic encephalopathyNeurologic outcomeElectroencephalogram featuresAcute hypoxic-ischemic encephalopathyAcademic medical centerBetter prognostic predictionReceiver operator curveNeurologic recoveryComatose patientsPrognostic implicationsCardiac arrestMedical CenterPrognostication performancePrognostic predictionOperator curveLogistic regressionSequential logistic regressionSpecificity thresholdEncephalopathyStatistical associationOutcomes
2018
EEG Reactivity Evaluation Practices for Adult and Pediatric Hypoxic-Ischemic Coma Prognostication in North America
Amorim E, Gilmore EJ, Abend NS, Hahn CD, Gaspard N, Herman ST, Hirsch LJ, Lee JW, Cash SS, Westover MB. EEG Reactivity Evaluation Practices for Adult and Pediatric Hypoxic-Ischemic Coma Prognostication in North America. Journal Of Clinical Neurophysiology 2018, 35: 510-514. PMID: 30216207, PMCID: PMC6424574, DOI: 10.1097/wnp.0000000000000517.Peer-Reviewed Original ResearchConceptsCardiac arrest prognosticationAcademic hospitalCritical Care EEG Monitoring Research ConsortiumNail bed pressureLight tactile stimuliMajority of hospitalsNeurodiagnostic technologistsPercent of respondentsPediatric hospitalMultiple-choice surveyPractice patternsEEG reactivityNational guidelinesComa prognosticationHospitalProcedure modalitiesReactivity testingPrognosticationEEG amplitudeMean numberTactile stimuliResearch ConsortiumSubstantial variabilityReactivity evaluationHypothermiaBilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study
Osman G, Rahangdale R, Britton JW, Gilmore EJ, Haider HA, Hantus S, Herlopian A, Hocker SE, Woo Lee J, Legros B, Mendoza M, Punia V, Rampal N, Szaflarski JP, Wallace AD, Westover MB, Hirsch LJ, Gaspard N. Bilateral independent periodic discharges are associated with electrographic seizures and poor outcome: A case-control study. Clinical Neurophysiology 2018, 129: 2284-2289. PMID: 30227348, PMCID: PMC6785981, DOI: 10.1016/j.clinph.2018.07.025.Peer-Reviewed Original ResearchConceptsBilateral independent periodic dischargesCase-control studyElectrographic seizuresPoor outcomePeriodic dischargesLPD groupBrain injuryRetrospective case-control studyAcute brain injuryAnoxic brain injuryCNS infectionsFrequent etiologyCerebral injuryIll patientsClinical managementPD groupLevel of alertnessHigh riskBetter outcomesPatientsMultivariate analysisSeizuresInjuryPotential important implicationsOutcomes
2015
New-onset refractory status epilepticus
Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, Meyers E, Espinera A, Haas KF, Schmitt SE, Gerard EE, Gofton T, Kaplan PW, Lee JW, Legros B, Szaflarski JP, Westover BM, LaRoche SM, Hirsch LJ, Fertig E, Herman S, Huh L, Lee J, Loddenkemper T, Chapman K, Abend N, Carpenter J, Hantus S, Claassen J, Husain A, Gaspard N, LaRoche S, Ritzl E, Gofton T, Wusthoff C, Goldstein J, Westover B, Hocker S, Halford J, Jones J, Gerard E, Schmitt S, Williams K, Hahn C, Szaflarski J, Kramer A, Rudzinski L, Hopp J, Mani R, Kalamangalam G, Gupta P, Quigg M, Haas K, Ostendorf A, Zutshi D, Hirsch L. New-onset refractory status epilepticus. Neurology 2015, 85: 1604-1613. PMID: 26296517, PMCID: PMC4642147, DOI: 10.1212/wnl.0000000000001940.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAnestheticsAnticonvulsantsAnti-N-Methyl-D-Aspartate Receptor EncephalitisAutoantibodiesCohort StudiesEncephalitisEncephalitis, Herpes SimplexFemaleHashimoto DiseaseHumansLength of StayMaleMiddle AgedParaneoplastic Syndromes, Nervous SystemPotassium Channels, Voltage-GatedPrognosisRetrospective StudiesStatus EpilepticusTime FactorsTreatment OutcomeYoung AdultConceptsNew-onset refractory status epilepticusRefractory status epilepticusStatus epilepticusPoor outcomeTherapy warrants further investigationInflammatory CSF changesHours of admissionPrimary outcome measurePoor functional outcomePredictors of outcomeAcademic medical centerWarrants further investigationUse of anestheticsRole of anestheticsAutoimmune encephalitisAntiseizure medicationsCryptogenic casesParaneoplastic encephalitisMedical complicationsRetrospective reviewAvailable followClinical featuresImmune therapyFunctional outcomeFunctional statusPrognostication 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 predictorsRates and predictors of patient-reported cognitive side effects of antiepileptic drugs: An extended follow-up
Javed A, Cohen B, Detyniecki K, Hirsch LJ, Legge A, Chen B, Bazil C, Kato K, Buchsbaum R, Choi H. Rates and predictors of patient-reported cognitive side effects of antiepileptic drugs: An extended follow-up. Seizure 2015, 29: 34-40. PMID: 26076842, DOI: 10.1016/j.seizure.2015.03.013.Peer-Reviewed Original ResearchConceptsCognitive side effectsAntiepileptic medicationsSide effectsMultiple logistic regression analysisMore antiepileptic medicationsLogistic regression analysisQuality of lifeIndependent predictorsRetrospective studyAntiepileptic drugsAdult outpatientsMedical recordsAdverse effectsIntellectual disabilityPolytherapyLevetiracetamGabapentinRegression analysisLamotrigineLower ratesPredictorsCarbamazepineMonotherapyMedicationsRelative frequency
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
Epilepsy 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
2010
Seizures and CNS Hemorrhage
Gilmore E, Choi HA, Hirsch LJ, Claassen J. Seizures and CNS Hemorrhage. The Neurologist 2010, 16: 165-175. PMID: 20445426, DOI: 10.1097/nrl.0b013e3181c7cd0b.Peer-Reviewed Original ResearchConceptsAneurysmal subarachnoid hemorrhageCentral nervous system hemorrhageShort-term prophylaxisNonconvulsive seizuresIntracerebral hemorrhageSpontaneous intracerebral hemorrhageSeizure prophylaxisASAH patientsAdditional injuriesAcute brain injuryPoor clinical gradeEvidence-based guidelinesCommon neurologic conditionsDeleterious effectsAntiepileptic medicationsControlled TrialsConvulsive seizuresCNS hemorrhagePoor outcomeSubarachnoid hemorrhageNeurologic conditionsSurrogate markerBrain injuryClinical gradeRecent injury
2009
Intracortical electroencephalography in acute brain injury
Waziri A, Claassen J, Stuart RM, Arif H, Schmidt JM, Mayer SA, Badjatia N, Kull LL, Connolly ES, Emerson RG, Hirsch LJ. Intracortical electroencephalography in acute brain injury. Annals Of Neurology 2009, 66: 366-377. PMID: 19798724, DOI: 10.1002/ana.21721.Peer-Reviewed Original ResearchConceptsSecondary neurological complicationsElectrographic seizuresIctal activityNeurological complicationsScalp electroencephalographyNeurological injuryBrain injuryIntracortical EEGIntensive care unit settingSecondary neurological injurySecondary neuronal injuryAcute brain injuryIll neurological patientsIntracortical electroencephalographyClinical deteriorationNeuronal injuryInvasive neuromonitoringUnderwent implantationNeuromonitoring modalitiesBedside placementIctal dischargesRhythmic deltaUnit settingAcute changesContinuous electroencephalographyContinuous Electroencephalogram Monitoring in the Intensive Care Unit
Friedman D, Claassen J, Hirsch LJ. Continuous Electroencephalogram Monitoring in the Intensive Care Unit. Anesthesia & Analgesia 2009, 109: 506-523. PMID: 19608827, DOI: 10.1213/ane.0b013e3181a9d8b5.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringNonconvulsive seizuresIll patientsIntracranial pressureBrain functionContinuous electroencephalogram monitoringConvulsive status epilepticusIntensive care unitMajority of seizuresMultimodality brain monitoringPharmacological comaNeurologic outcomeNeurologic statusNeuronal injuryBrain ischemiaStatus epilepticusCare unitSecondary injurySubarachnoid hemorrhageCEEG monitoringClinical examinationElectroencephalogram monitoringSystemic abnormalitiesIntracranial EEG recordingsHigh riskContinuous electroencephalography in the medical intensive care unit*
Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit*. Critical Care Medicine 2009, 37: 2051-2056. PMID: 19384197, DOI: 10.1097/ccm.0b013e3181a00604.Peer-Reviewed Original ResearchConceptsContinuous electroencephalography monitoringPeriodic epileptiform dischargesMajority of patientsElectrographic seizuresRetrospective studyMedical intensive care unit patientsIntensive care unit admissionMedical intensive care unitIntensive care unit patientsPeriodic dischargesAcute neurologic conditionsPrimary admission diagnosisCare unit admissionPercent of patientsAcute neurologic injuryCare unit patientsIntensive care unitOnly significant predictorUnit admissionAdmission diagnosisICU admissionMICU patientsHospital dischargeNeurologic injurySeptic patients
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. JordanPrognostic 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
2005
Continuous electroencephalogram monitoring in the critically III
Wittman JJ, Hirsch LJ. Continuous electroencephalogram monitoring in the critically III. Neurocritical Care 2005, 2: 330-341. PMID: 16159085, DOI: 10.1385/ncc:2:3:330.Peer-Reviewed Original Research
2004
Brain monitoring: the next frontier of ICU monitoring.
Hirsch LJ. Brain monitoring: the next frontier of ICU monitoring. Journal Of Clinical Neurophysiology 2004, 21: 305-6. PMID: 15592004.Peer-Reviewed Original ResearchContinuous EEG Monitoring in the Intensive Care Unit: An Overview
Hirsch LJ. Continuous EEG Monitoring in the Intensive Care Unit: An Overview. Journal Of Clinical Neurophysiology 2004, 21: 332-340. PMID: 15592007, DOI: 10.1097/01.wnp.0000147129.80917.0e.Peer-Reviewed Original ResearchConceptsPeriodic epileptiform dischargesComatose patientsEpileptiform dischargesEEG patternsIntensive care unitLevel of sedationContinuous EEG monitoringMajority of seizuresHospital infarctionNoncomatose patientsRecent neurosurgeryClinical seizuresCNS infectionICU patientsIll patientsNonconvulsive seizuresCare unitWorse outcomesAutonomic changesParoxysmal spellsBrain tumorsPatientsEEG monitoringEEG trendsSeizures
2003
Treatment of status epilepticus: a survey of neurologists
Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. Journal Of The Neurological Sciences 2003, 211: 37-41. PMID: 12767495, DOI: 10.1016/s0022-510x(03)00036-4.Peer-Reviewed Original ResearchConceptsAntiepileptic drugsStatus epilepticusCurrent treatment preferencesElimination of seizuresFourth-line treatmentTreatment of RSESecond-line therapyConvulsive status epilepticusFirst-line therapyNew antiepileptic drugsTraditional treatment paradigmSurvey of neurologistsIntravenous lorazepamSE refractoryTitration goalsMulticenter trialTreatment paradigmTreatment preferencesCritical careValproic acidBurst suppressionAmerican AcademyEpilepticusEpilepsy SectionTherapy