2022
Developing a Standardized Approach to Grading the Level of Brain Dysfunction on EEG
Dhakar MB, Sheikh ZB, Desai M, Desai RA, Sternberg EJ, Popescu C, Baron-Lee J, Rampal N, Hirsch LJ, Gilmore EJ, Maciel CB. Developing a Standardized Approach to Grading the Level of Brain Dysfunction on EEG. Journal Of Clinical Neurophysiology 2022, 40: 553-561. PMID: 35239553, DOI: 10.1097/wnp.0000000000000919.Peer-Reviewed Original ResearchMeSH KeywordsBrainBrain DiseasesCritical CareElectroencephalographyHumansObserver VariationSurveys and QuestionnairesConceptsCerebral dysfunctionCritical Care EEG Monitoring Research ConsortiumInterrater agreementGrading scaleStandardized approachDegree of dysfunctionKappa statisticsStandardized grading scalePosterior dominant rhythmElectroencephalogram (EEG) background activityLevel of dysfunctionOverall interrater agreementNeuromonitoring toolsFleiss kappa statisticEEG findingsBrain dysfunction
2020
Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study.
Vespa PM, Olson DM, John S, Hobbs KS, Gururangan K, Nie K, Desai MJ, Markert M, Parvizi J, Bleck TP, Hirsch LJ, Westover MB. Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study. Critical Care Medicine 2020, 48: 1249-1257. PMID: 32618687, PMCID: PMC7735649, DOI: 10.1097/ccm.0000000000004428.Peer-Reviewed Original ResearchConceptsNonconvulsive seizuresSeizure diagnosisTreatment planProspective observational clinical studyDiagnostic assessmentObservational clinical studyAssessment of patientsCritical care settingSerious adverse effectsTherapeutic decision makingProspective multicenterSecondary outcomesICU patientsPrimary outcomeStatus epilepticusHigh suspicionElectroencephalography assessmentAcademic hospitalBedside assessmentClinical impactClinical studiesObservational studyCare settingsPhysician confidencePatients
2019
Comparison of machine learning models for seizure prediction in hospitalized patients
Struck AF, Rodriguez‐Ruiz A, Osman G, Gilmore EJ, Haider HA, Dhakar MB, Schrettner M, Lee JW, Gaspard N, Hirsch LJ, Westover MB, Consortium C. Comparison of machine learning models for seizure prediction in hospitalized patients. Annals Of Clinical And Translational Neurology 2019, 6: 1239-1247. PMID: 31353866, PMCID: PMC6649418, DOI: 10.1002/acn3.50817.Peer-Reviewed Original ResearchConceptsLow-risk patientsNegative predictive valueEvaluation cohortContinuous EEGElastic net logistic regressionMulticenter databaseRisk stratificationSeizure riskPatientsPredictive valueComparable AUCSecondary analysisLogistic regressionCohortFirst hourSeizure predictionEEG recordingsEEGRisk calibrationLarge proportionSeizuresComplex neural networksGeneralized Periodic Discharges With and Without Triphasic Morphology
Fong MWK, Gaspard N, Hirsch LJ. Generalized Periodic Discharges With and Without Triphasic Morphology. Journal Of Clinical Neurophysiology 2019, 36: 173-174. PMID: 30550491, DOI: 10.1097/wnp.0000000000000549.Peer-Reviewed Original Research
2018
Association between death and loss of stage N2 sleep features among critically Ill patients with delirium
Knauert MP, Gilmore EJ, Murphy TE, Yaggi HK, Van Ness PH, Han L, Hirsch LJ, Pisani MA. Association between death and loss of stage N2 sleep features among critically Ill patients with delirium. Journal Of Critical Care 2018, 48: 124-129. PMID: 30179762, PMCID: PMC6226351, DOI: 10.1016/j.jcrc.2018.08.028.Peer-Reviewed Original ResearchConceptsICU patientsIll patientsOdds ratioHigher oddsSleep spindlesIntensive care unit outcomesGrade of encephalopathySignificant sleep disruptionWorse ICU outcomeMedical ICU patientsAcute brain injuryObservational cohort studySedative-hypnotic useImportant prognostic valueLength of stayStage N2 sleepK-complexesCohort studyCritical illnessHospital dischargeRankin ScaleICU outcomesPrognostic valueSevere gradesMedical recordsDefinition and Classification of Periodic and Rhythmic Patterns
Maciel CB, Hirsch LJ. Definition and Classification of Periodic and Rhythmic Patterns. Journal Of Clinical Neurophysiology 2018, 35: 179-188. PMID: 29718827, DOI: 10.1097/wnp.0000000000000462.Peer-Reviewed Original ResearchMeSH KeywordsBrainCritical CareElectroencephalographyHumansNervous System DiseasesPeriodicityTerminology as TopicConceptsAmerican Clinical Neurophysiology SocietyContinuous video-EEG recordingOverall clinical implicationsAcute brain injuryRhythmic delta activityVideo-EEG recordingsEpileptogenic potentialTherapeutic algorithmAbnormal findingsNonconvulsive seizuresComatose patientsBrain injuryClinical indicationsInpatient settingDelta activityClinical implicationsMorphologic featuresPeriodic dischargesStandardized definitionsPatientsPrevalence of occurrenceDefinitive evidenceExcellent temporal resolutionIschemia detectionOfficial guidelines
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 regionInjuryThe 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
2016
Review of the Utility of Prophylactic Anticonvulsant Use in Critically Ill Patients With Intracerebral Hemorrhage
Gilmore EJ, Maciel CB, Hirsch LJ, Sheth KN. Review of the Utility of Prophylactic Anticonvulsant Use in Critically Ill Patients With Intracerebral Hemorrhage. Stroke 2016, 47: 2666-2672. PMID: 27608820, DOI: 10.1161/strokeaha.116.012410.Peer-Reviewed Original ResearchDevelopment and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research
Lee JW, LaRoche S, Choi H, Ruiz A, Fertig E, Politsky JM, Herman ST, Loddenkemper T, Sansevere AJ, Korb PJ, Abend NS, Goldstein JL, Sinha SR, Dombrowski KE, Ritzl EK, Westover MB, Gavvala JR, Gerard EE, Schmitt SE, Szaflarski JP, Ding K, Haas KF, Buchsbaum R, Hirsch LJ, Wusthoff CJ, Hopp JL, Hahn CD. Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research. Journal Of Clinical Neurophysiology 2016, 33: 133-140. PMID: 26943901, PMCID: PMC4878836, DOI: 10.1097/wnp.0000000000000230.Peer-Reviewed Original ResearchConceptsCritical Care EEG Monitoring Research ConsortiumAmerican Clinical Neurophysiology SocietyIncidence of seizuresMulticenter feasibility studyIntensive care unitLarge-volume centersInterictal epileptiform dischargesDaily clinical useMulticenter collaborative researchCare unitUnique patientsVolume centersElectroencephalogram monitoringDuration of recordingEpileptiform dischargesMulticenter research studiesRhythmic dischargesClinical reportsResearch DatabaseEEG monitoringClinical data repositoryClinical useConsortium databaseEEG reportsReporting tools
2015
Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part II
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 II. Journal Of Clinical Neurophysiology 2015, 32: 96-108. PMID: 25626777, PMCID: PMC4434600, DOI: 10.1097/wnp.0000000000000165.Peer-Reviewed Original ResearchMeSH KeywordsAdultBrain DiseasesChildCritical CareCritical IllnessElectroencephalographyFemaleHumansMaleMonitoring, PhysiologicConceptsIll adultsConsensus panelAmerican Clinical Neurophysiology SocietyContinuous EEGCritically Ill AdultsIntensive care unitNon-physician personnelExpert consensus recommendationsNeurodiagnostic technologistsQuantitative EEG techniquesCare unitPatient selectionPatient populationMental statusConsensus statementConsensus recommendationsInfection controlBrain functionCommon procedureEEGTask ForceAdultsEEG techniquesChildrenConsensus 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 ResearchMeSH KeywordsAdultBrain DiseasesChildCritical CareCritical IllnessElectroencephalographyFemaleHumansMaleMonitoring, PhysiologicConceptsIll 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 trendsPatients
2014
Interrater agreement for Critical Care EEG Terminology
Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB, Consortium T. Interrater agreement for Critical Care EEG Terminology. Epilepsia 2014, 55: 1366-1373. PMID: 24888711, PMCID: PMC4879939, DOI: 10.1111/epi.12653.Peer-Reviewed Original ResearchConceptsCritical care EEG terminologyEEG terminologyClinical significanceInterrater agreementAmerican Clinical Neurophysiology SocietyUncertain clinical significanceSupporting Information sectionElectrographic seizuresTriphasic morphologyHigh interrater agreementMulticenter researchEEG patternsSeizuresElectroencephalography studyStandardized terminologyInformation sectionIdentical questionsTraining slidesWeb-based testEEG samples
2013
American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology
Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB, Drislane FW. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology. Journal Of Clinical Neurophysiology 2013, 30: 1-27. PMID: 23377439, DOI: 10.1097/wnp.0b013e3182784729.Peer-Reviewed Original ResearchPitfalls in ictal EEG interpretation
Gaspard N, Hirsch LJ. Pitfalls in ictal EEG interpretation. Neurology 2013, 80: s26-s42. PMID: 23267042, DOI: 10.1212/wnl.0b013e31827974f8.Peer-Reviewed Original Research
2010
Intracortical EEG for the Detection of Vasospasm in Patients with Poor-Grade Subarachnoid Hemorrhage
Stuart RM, Waziri A, Weintraub D, Schmidt MJ, Fernandez L, Helbok R, Kurtz P, Lee K, Badjatia N, Emerson R, Mayer SA, Connolly ES, Hirsch LJ, Claassen J. Intracortical EEG for the Detection of Vasospasm in Patients with Poor-Grade Subarachnoid Hemorrhage. Neurocritical Care 2010, 13: 355-358. PMID: 20652443, DOI: 10.1007/s12028-010-9414-6.Peer-Reviewed Original ResearchConceptsPoor-grade SAH patientsAlpha/delta ratioDetection of vasospasmSAH patientsPoor-grade subarachnoid hemorrhageIntracortical electroencephalographyQuantitative EEG parametersQuantitative EEG analysisAngiographic confirmationAngiographic vasospasmSubarachnoid hemorrhageSustained decreaseVasospasmPatientsBaseline EEGPercent changeDepth electrodesQEEG recordingsLarger studySurface EEGDelta ratioIntracortical EEGEEG parametersAlarm criteriaBaselineUse of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists
Abend NS, Dlugos DJ, Hahn CD, Hirsch LJ, Herman ST. Use of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists. Neurocritical Care 2010, 12: 382-389. PMID: 20198513, PMCID: PMC2944658, DOI: 10.1007/s12028-010-9337-2.Peer-Reviewed Original ResearchConceptsNon-convulsive seizuresIll patientsEEG monitoringPhenytoin/fosphenytoinCritically Ill PatientsAbnormal eye movementsFurther prospective studiesCommon clinical problemSurvey of neurologistsCEEG indicationsCEEG utilizationResultsThree hundredStatus epilepticusProspective studyMental statusCommon anticonvulsantsClinical problemPatientsAreas of uncertaintyPrior convulsionsCurrent practiceEye movementsLevetiracetamSeizuresNeurologists
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
2008
Updates in the Management of Seizures and Status Epilepticus in Critically Ill Patients
Khaled K, Hirsch LJ. Updates in the Management of Seizures and Status Epilepticus in Critically Ill Patients. Neurologic Clinics 2008, 26: 385-408. PMID: 18514819, DOI: 10.1016/j.ncl.2008.03.017.Peer-Reviewed Original ResearchConceptsStatus epilepticusIll patientsManagement of seizuresOrgan transplant patientsRenal failure patientsReversal of factorsFirstline treatmentSystemic sequelaeTransplant patientsAntiseizure medicationsFailure patientsSeizure thresholdEarly recognitionElectroencephalogram monitoringMaximal responseSpecific treatmentPatientsMetabolic imbalanceEpilepticusMedicationsSeizuresTreatmentSequelaeFeverHypoxiaFocal 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