2020
Validation 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 total
2019
Continuous EEG Findings in Autoimmune Encephalitis.
Moise AM, Karakis I, Herlopian A, Dhakar M, Hirsch LJ, Cotsonis G, LaRoche S, Cabrera Kang CM, Westover B, Rodriguez A. Continuous EEG Findings in Autoimmune Encephalitis. Journal Of Clinical Neurophysiology 2019, 38: 124-129. PMID: 31800465, PMCID: PMC7263965, DOI: 10.1097/wnp.0000000000000654.Peer-Reviewed Original ResearchConceptsNew-onset refractory status epilepticusRefractory status epilepticusRhythmic delta activityGeneralized rhythmic delta activityAutoimmune encephalitisStatus epilepticusDelta activityPoor outcomeAE subtypeFast activityAntibody-negative autoimmune encephalitisN-methyl-D-aspartate receptorsDefinite limbic encephalitisExtreme delta brushMulticenter retrospective reviewNew-onset seizuresContinuous EEG monitoringGlutamic acid decarboxylaseVoltage-gated potassium channelsLimbic encephalitisRetrospective reviewAE patientsElectrographic seizuresDelta brushEEG findings
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
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 ResearchConceptsStatus epilepticusContinuous EEG monitoringIll patientsNonconvulsive seizuresEpilepticusEEG monitoringPatientsHigh rateHospitalizationSeizuresMortalityPrognostication 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 predictorsAcute 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
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 inpatientsPrescribingFindings
2009
Continuous 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 risk
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
2004
Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage
Claassen J, Hirsch LJ, Kreiter KT, Du EY, Connolly ES, Emerson RG, Mayer SA. Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage. Clinical Neurophysiology 2004, 115: 2699-2710. PMID: 15546778, DOI: 10.1016/j.clinph.2004.06.017.Peer-Reviewed Original ResearchConceptsPoor-grade subarachnoid hemorrhageDetection of DCISAH patientsSubarachnoid hemorrhageCerebral ischemiaQEEG parametersClinical examHunt-Hess grade 4Poor-grade SAH patientsPost-operative day 2Continuous EEG monitoringInitiation of interventionsAlpha/delta ratioQuantitative EEG parametersNeurological morbidityDCI patientsNeuro-ICUMedian decreasePatientsDay 1EEG monitoringDay 2Day 14Day 4Reasonable specificityContinuous EEG Monitoring in the Intensive Care Unit
Hirsch LJ, Kull LL. Continuous EEG Monitoring in the Intensive Care Unit. The Neurodiagnostic Journal 2004, 44: 137-158. PMID: 15521467, DOI: 10.1080/1086508x.2004.11079478.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringIntensive care unitCare unitEEG monitoringPrevention of strokeQuantitative EEG analysisCEEG interpretationCerebral ischemiaIll patientsNonconvulsive seizuresElectrographic seizuresAcute ischemiaClinical correlatesMental statusBrain injuryAlerting stimuliBrain functionEEG patternsEarly detectionEEG technologistsReversible stageIschemiaPatientsSeizuresTechnical difficultiesStimulus‐induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs): A Common EEG Phenomenon in the Critically Ill
Hirsch LJ, Claassen J, Mayer SA, Emerson RG. Stimulus‐induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs): A Common EEG Phenomenon in the Critically Ill. Epilepsia 2004, 45: 109-123. PMID: 14738418, DOI: 10.1111/j.0013-9580.2004.38103.x.Peer-Reviewed Original ResearchConceptsContinuous EEG monitoringIctal dischargesEEG patternsClinical status epilepticusAcute brain injuryPeriodic epileptiform dischargesEEG phenomenaPrior epilepsyEncephalopathic patientsAcute illnessClinical seizuresConsecutive patientsIll patientsSpontaneous seizuresStatus epilepticusPatients stimulationBrain injuryEpileptiform dischargesSIRPIDsPatientsEEG monitoringTherapeutic significanceSeizuresSignificant differencesStimulationContinuous 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