2024
Outpatient 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
Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure Cluster Study
Jafarpour S, Fong MWK, Detyniecki K, Khan A, Jackson-Shaheed E, Wang X, Lewis S, Benjamin R, Gaínza-Lein M, O'Bryan J, Hirsch LJ, Loddenkemper T. Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure Cluster Study. Pediatric Neurology 2022, 137: 22-29. PMID: 36208614, DOI: 10.1016/j.pediatrneurol.2022.08.014.Peer-Reviewed Original ResearchConceptsSeizure clustersRescue medicationPediatric patientsSeizure frequencyIntermediate-risk groupEmergency department visitsHigh seizure frequencyTwo-center studyEmergency room visitsHigh-risk groupActive seizuresMore seizuresDepartment visitsStatus epilepticusRoom visitsAdverse outcomesEpilepsy severityIsolated seizureSeizure diariesRisk factorsRisk groupsGreater oddsPatientsMedicationsSeizuresUpdated 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 ResearchConceptsRescue medicationProlonged seizuresSeizure clustersTreatment of epilepsyQuality of lifeOngoing seizuresFurther seizuresRefractory seizuresRecurrent seizuresRescue treatmentSeizure activitySeizure episodesIntranasal formulationRisk factorsClinical careEffective treatmentMedicationsSeizuresEpilepsyMorbidityClinical opportunitiesAdverse effectsTreatmentReviewEpidemiology
2021
The 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 ResearchA 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 factorsPreferred 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
2020
Seizure clusters, rescue treatments, seizure action plans: Unmet needs and emerging formulations
Gidal B, Klein P, Hirsch LJ. Seizure clusters, rescue treatments, seizure action plans: Unmet needs and emerging formulations. Epilepsy & Behavior 2020, 112: 107391. PMID: 32898744, DOI: 10.1016/j.yebeh.2020.107391.Peer-Reviewed Original Research
2019
Comparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit
Owusu KA, Dhakar MB, Bautista C, McKimmy D, Cotugno S, Sukumar N, Deng Y, Farooque P, Hirsch LJ, Maciel CB. Comparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit. Epilepsy & Behavior 2019, 98: 161-167. PMID: 31374472, DOI: 10.1016/j.yebeh.2019.07.021.Peer-Reviewed Original ResearchConceptsEpilepsy monitoring unitAdult epilepsy monitoring unitIntravenous lorazepamIntensive care unitIntranasal midazolamRescue therapySeizure clustersSeizure terminationSingle tertiary academic centerStandard rescue therapyDouble-blind studyTertiary academic centerIndex seizureAdverse eventsBaseline characteristicsConsecutive adultsMedian durationRetrospective cohortRecurrent seizuresStatus epilepticusCare unitRetrospective studyEpilepsy severityBenzodiazepine administrationMedian number
2018
Prevalence and predictors of seizure clusters: A prospective observational study of adult patients with epilepsy
Detyniecki K, O'Bryan J, Choezom T, Rak G, Ma C, Zhang S, Bonito J, Hirsch LJ. Prevalence and predictors of seizure clusters: A prospective observational study of adult patients with epilepsy. Epilepsy & Behavior 2018, 88: 349-356. PMID: 30344026, DOI: 10.1016/j.yebeh.2018.09.035.Peer-Reviewed Original ResearchConceptsRescue medication useProspective observational studyEmergency department visitsHigh seizure frequencySeizure clustersAdult patientsRescue medicationClinical characteristicsSeizure frequencyActive epilepsyDepartment visitsMedication useObservational studyExact testSeizure-related outcomesFisher's exact testLogistic regression modelsSeizure clusteringAdverse outcomesEpilepsy severitySeizure diariesIndividual patientsPatientsEpilepsyFinal analysisSeizure cluster: Definition, prevalence, consequences, and management
Jafarpour S, Hirsch LJ, Gaínza-Lein M, Kellinghaus C, Detyniecki K. Seizure cluster: Definition, prevalence, consequences, and management. Seizure 2018, 68: 9-15. PMID: 29871784, DOI: 10.1016/j.seizure.2018.05.013.Peer-Reviewed Original ResearchConceptsRescue medicationSeizure clustersAcute managementEpilepsy patientsRectal diazepam gelTertiary epilepsy centerEmergency room visitsHealth care utilizationRefractory epilepsy patientsQuality of lifeAcute seizuresBuccal midazolamClinical characteristicsMost patientsCare utilizationEpilepsy centersRoom visitsRisk factorsOnly FDAHigh riskMedicationsPatientsSeizuresPrevalenceCaregivers
2017
Prevalence and risk factors of seizure clusters in adult patients with epilepsy
Chen B, Choi H, Hirsch LJ, Katz A, Legge A, Wong RA, Jiang A, Kato K, Buchsbaum R, Detyniecki K. Prevalence and risk factors of seizure clusters in adult patients with epilepsy. Epilepsy Research 2017, 133: 98-102. PMID: 28475999, DOI: 10.1016/j.eplepsyres.2017.04.016.Peer-Reviewed Original ResearchConceptsSymptomatic generalized epilepsyIdiopathic generalized epilepsySeizure clustersEpilepsy typeStatus epilepticusCortical dysplasiaGeneralized epilepsyFocal epilepsySeizure onsetCNS infectionSeizure freedomMore AEDsRisk factorsCentral nervous system infectionCongenital brain injuryEpilepsy risk factorsNervous system infectionPotential clinical factorsComplex partial seizuresEarly seizure onsetEpilepsy detailsRescue medicationAdult patientsPatient demographicsSystem infection
2016
Seizure clusters: A common, understudied and undertreated phenomenon in refractory epilepsy
Komaragiri A, Detyniecki K, Hirsch LJ. Seizure clusters: A common, understudied and undertreated phenomenon in refractory epilepsy. Epilepsy & Behavior 2016, 59: 83-86. PMID: 27116535, DOI: 10.1016/j.yebeh.2016.02.030.Peer-Reviewed Original Research