2024
Seizure 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 ResearchConceptsMonitoring 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 riskOutpatient management of prolonged seizures and seizure clusters to prevent progression to a higher‐level emergency: Consensus recommendations of an expert working group
Pina‐Garza J, Chez M, Cloyd J, Hirsch L, Kälviäinen R, Klein P, Lagae L, Sankar R, Specchio N, Strzelczyk A, Toledo M, Trinka E. Outpatient management of prolonged seizures and seizure clusters to prevent progression to a higher‐level emergency: Consensus recommendations of an expert working group. Epileptic Disorders 2024, 26: 484-497. PMID: 38813941, DOI: 10.1002/epd2.20243.Peer-Reviewed Original ResearchConceptsExpert working groupDefinition of PSSeizure action planWorking GroupEvidence-based guidanceProlonged seizuresSeizure clustersManaging PSStatus epilepticusExpert recommendationsTreatment goalsConsensus recommendationsOutpatient managementConsensus definitionAction planMedicationManagement of acute seizuresRecommendationsIdeal medicationAcute seizuresPrevent progressionSevere seizuresSeizure activityGroup membersSeizure termination
2022
Electronic seizure diaries for clinical care and research
Gray TE, Hirsch LJ, Quraishi IH. Electronic seizure diaries for clinical care and research. Epileptic Disorders 2022, 24: 803-811. PMID: 35811431, DOI: 10.1684/epd.2022.1451.Peer-Reviewed Original ResearchElectroencephalogram 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 ResearchConceptsResponsive 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 increaseUpdated review of rescue treatments for seizure clusters and prolonged seizures
Blond BN, Hirsch LJ. Updated review of rescue treatments for seizure clusters and prolonged seizures. Expert Review Of Neurotherapeutics 2022, 22: 567-577. PMID: 35862983, DOI: 10.1080/14737175.2022.2105207.Peer-Reviewed Original ResearchMeSH KeywordsAnticonvulsantsEpilepsyEpilepsy, GeneralizedHumansQuality of LifeSeizuresStatus EpilepticusConceptsRescue medicationProlonged seizuresSeizure clustersTreatment of epilepsyQuality of lifeOngoing seizuresFurther seizuresRefractory seizuresRecurrent seizuresRescue treatmentSeizure activitySeizure episodesIntranasal formulationRisk factorsClinical careEffective treatmentMedicationsSeizuresEpilepsyMorbidityClinical opportunitiesAdverse effectsTreatmentReviewEpidemiologyPregabalin 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 ResearchConceptsCyclic 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 seizuresAcute symptomatic seizures: an educational, evidence‐based review
Mauritz M, Hirsch LJ, Camfield P, Chin R, Nardone R, Lattanzi S, Trinka E. Acute symptomatic seizures: an educational, evidence‐based review. Epileptic Disorders 2022, 24: 26-49. PMID: 34789447, DOI: 10.1684/epd.2021.1376.Peer-Reviewed Original Research
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 ResearchConceptsIctal 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 seizuresThe rescue therapy in epilepsy project Part 2: Insights from people with epilepsy and families on expert-derived preferred practices
Shafer PO, Santilli N, Buchhalter J, Gilchrist B, Kukla A, French JA, Hirsch LJ. The rescue therapy in epilepsy project Part 2: Insights from people with epilepsy and families on expert-derived preferred practices. Epilepsy & Behavior 2021, 125: 108444. PMID: 34839243, DOI: 10.1016/j.yebeh.2021.108444.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultCaregiversEpilepsyHealth PersonnelHumansSeizuresSurveys and QuestionnairesSimulated 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 ResearchConceptsSeizure 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 unitEpilepsyNeuromodulation in epilepsy: state-of-the-art approved therapies
Ryvlin P, Rheims S, Hirsch LJ, Sokolov A, Jehi L. Neuromodulation in epilepsy: state-of-the-art approved therapies. The Lancet Neurology 2021, 20: 1038-1047. PMID: 34710360, DOI: 10.1016/s1474-4422(21)00300-8.Peer-Reviewed Original ResearchConceptsVagus nerve stimulationANT-DBSAdverse eventsNeuromodulation therapiesResponsive neurostimulationCurative surgical treatmentFrequent adverse eventsRefractory focal epilepsyHigh-level evidenceDeep brain stimulationForms of neuromodulationClosed-loop therapyAntiepileptic treatmentSeizure frequencySurgical treatmentNerve stimulationIntracranial hemorrhageIntractable seizuresEpileptogenic zoneFocal epilepsyAnterior nucleusLong-term reductionBrain stimulationTherapyImplant sitesA systematic review of seizure clusters: Prevalence, risk factors, burden of disease and treatment patterns
Chung S, Szaflarski JP, Choi EJ, Wilson JC, Kharawala S, Kaur G, Hirsch LJ. A systematic review of seizure clusters: Prevalence, risk factors, burden of disease and treatment patterns. Epilepsy Research 2021, 177: 106748. PMID: 34521043, DOI: 10.1016/j.eplepsyres.2021.106748.Peer-Reviewed Original ResearchConceptsSeizure action planRescue medicationSeizure clustersStatus epilepticusTreatment patternsSeizure remissionTreatment resistanceHigh riskPoor physician-patient communicationSeizure-related hospitalizationHigh seizure frequencyBurden of diseaseProductivity of patientsPhysician-patient communicationNon-SC patientsQuality of lifeSystematic literature searchConsecutive seizuresSeizure frequencyTreatment guidelinesProspective studySC patientsCaregiver QOLDisease burdenRisk factorsPatient‐detectable responsive neurostimulation as a seizure warning system
Quraishi IH, Hirsch LJ. Patient‐detectable responsive neurostimulation as a seizure warning system. Epilepsia 2021, 62: e110-e116. PMID: 34018182, PMCID: PMC8629031, DOI: 10.1111/epi.16933.Peer-Reviewed Original ResearchConceptsResponsive neurostimulation systemFocal impaired awareness seizuresProportion of patientsQuality of lifeSeizure warningTolerable symptomsClinical seizuresLatter therapySelect patientsAwareness seizuresEpileptiform activityEarly recognitionResponsive neurostimulationEpileptiform patternsCognitive impairmentPatientsNeurostimulation systemSymptomsSeizuresTherapyTreatment of clustersStimulationSeizure warning systemSeizure recognitionEpilepsyPharmacotherapy 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 functionIntrastimulation discharges during electrical stimulation mapping May help identify seizure onset network
Sivaraju A, Spencer DD, Hirsch LJ. Intrastimulation discharges during electrical stimulation mapping May help identify seizure onset network. Brain Stimulation 2021, 14: 652-654. PMID: 33826933, DOI: 10.1016/j.brs.2021.04.003.Peer-Reviewed Original ResearchElectroencephalographic 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 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 ResearchAnti-seizure medications and efficacy against focal to bilateral tonic-clonic seizures: A systematic review with relevance for SUDEP prevention
Cutillo G, Tolba H, Hirsch LJ. Anti-seizure medications and efficacy against focal to bilateral tonic-clonic seizures: A systematic review with relevance for SUDEP prevention. Epilepsy & Behavior 2021, 117: 107815. PMID: 33640562, DOI: 10.1016/j.yebeh.2021.107815.Peer-Reviewed Original ResearchConceptsAnti-seizure medicationsBilateral tonic-clonic seizuresTonic-clonic seizuresSUDEP preventionSystematic reviewPlacebo-controlled clinical trialFocal impaired awareness seizuresRisk of SUDEPSudden unexpected deathMajor risk factorAwareness seizuresRisk factorsClinical trialsUnexpected deathFBTCSHigh dosesSeizuresStrong associationSUDEPPreventionMedicationsTiagabineEfficacyLamotrigineBrivaracetamPreferred practices for rescue treatment of seizure clusters: A consensus-driven, multi-stakeholder approach
Buchhalter J, Shafer PO, Buelow JM, French JA, Gilchrist B, Hirsch LJ, Nasuta M, Santilli N. Preferred practices for rescue treatment of seizure clusters: A consensus-driven, multi-stakeholder approach. Epilepsy & Behavior 2021, 117: 107836. PMID: 33640567, DOI: 10.1016/j.yebeh.2021.107836.Peer-Reviewed Original ResearchConceptsSeizure action planRescue therapySeizure clustersConsensus-derived recommendationsCare of peoplePreferred termPhase 2Seizure frequencyPreferred practicesRescue treatmentEpilepsy expertsRescue medicineSpecialist physiciansTreatment interventionsEpilepsyHealthcare professionalsEpilepsy FoundationPWEIndividualized mannerShort durationTherapyFinal consensusPhase 1Education/communicationCaregivers