Publications by authors named "Hirsch L"

Objective: To describe the lived experience of patients with NORSE and explore quality of life (QOL) for patients and their caregivers.

Background: NORSE is a rare condition characterized by refractory status epilepticus, often of unknown cause, in a previously neurologically healthy individual. Febrile infection-related epilepsy syndrome (FIRES) is a subset of NORSE.

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Background And Objectives: The use of rapid response EEG (rr-EEG) has recently expanded in limited-resource settings and as a supplement to conventional EEG to rapidly detect and treat nonconvulsive status epilepticus. The study objective was to test the accuracy of an rr-EEG's automated seizure burden estimator (ASBE).

Methods: This is a retrospective observational study using multiple blinded reviewers.

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Roughly 80% of the global burden of epilepsy resides in low- and middle-income countries (LMICs; WHO, 2022). Despite numerous new therapies for the treatment of epilepsy, the number of patients who remain resistant to available medications is unchanged. Additionally, no therapy has yet been clinically proven to prevent or attenuate the development of epilepsy in at-risk individuals.

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Background: Epilepsy is highly heritable, with numerous known genetic risk loci. However, the genetic predisposition's role in poststroke epilepsy (PSE) remains understudied. This study assesses whether a higher genetic predisposition to epilepsy raises poststroke survivor's risk of PSE.

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Article Synopsis
  • Continuous EEG monitoring (cEEG) allows for the tracking of EEG patterns in patients with acute brain injuries, but detailed trends during this phase have not been thoroughly studied.
  • A retrospective review of 101 patients who underwent cEEG highlighted a significant percentage showing improvement or resolution of epileptic EEG findings by discharge, although certain patterns like lateralized periodic discharges persisted or worsened.
  • The findings suggest a general trend towards normalization of most epileptiform patterns over time, indicating a need for further exploration of their clinical implications regarding treatment and patient outcomes.
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Rationale And Objectives: To develop and evaluate an AI algorithm that detects breast cancer in MRI scans up to one year before radiologists typically identify it, potentially enhancing early detection in high-risk women.

Materials And Methods: A convolutional neural network (CNN) AI model, pre-trained on breast MRI data, was fine-tuned using a retrospective dataset of 3029 MRI scans from 910 patients. These contained 115 cancers that were diagnosed within one year of a negative MRI.

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Slow waves are a distinguishing feature of non-rapid-eye-movement (NREM) sleep, an evolutionarily conserved process critical for brain function. Non-human studies suggest that the claustrum, a small subcortical nucleus, coordinates slow waves. We show that, in contrast to neurons from other brain regions, claustrum neurons in the human brain increase their spiking activity and track slow waves during NREM sleep, suggesting that the claustrum plays a role in coordinating human sleep architecture.

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  • Patients experiencing post-anoxic status epilepticus (PASE) after cardiac arrest face poor outcomes due to a combination of therapeutic nihilism and the difficulty in managing their seizures, which creates a bleak outlook.
  • This negative cycle is exacerbated by the exclusion of hypoxic-ischemic causes from clinical trials, limiting the development of effective treatments for these patients.
  • Early treatment with vigabatrin, which inhibits the breakdown of GABA, shows promise as it may enhance the effectiveness of other GABA-targeting medications in managing PASE.
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  • - Paralympic cross-country sit-skiing uses specialized sledges and involves athletes classified by functional abilities, employing a double poling technique to generate speed while sitting in different positions based on impairment.
  • - A study analyzed muscle activation patterns in able-bodied athletes using a treadmill in three sitting positions—knee-high, knee-low, and neutral—while measuring pole forces and muscle activity through surface EMG.
  • - Results indicated that muscle activation varies by individual; the knee-low position was found to be the most efficient for force application, while the next phase of research will focus on impaired athletes to deepen understanding of the poling movement's neurophysiology.
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  • This study evaluated an automated system for segmenting breast cancers in MRI scans and compared its effectiveness to that of radiologists across multiple clinical sites.
  • A 3D U-Net model was trained on a substantial dataset and validated against test data from different sites, showing similar performance between the AI and radiologists.
  • The findings indicate that the AI can match radiologists' segmentation accuracy and the code and model weights are shared publicly to encourage reproducibility in radiology AI research.
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It is increasingly understood that the epilepsies are characterized by network pathology that can span multiple spatial and temporal scales. Recent work indicates that infraslow (<0.2 Hz) envelope correlations may form a basis for distant spatial coupling in the brain.

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Background & Aims: We previously reported in the ELY prospective study that increased resting energy expenditure (REE) - so-called hypermetabolism - worsened tumor response, 6-month progression-free (PFS) and overall survival (OS) in metastatic non-small cell lung cancer (mNSCLC) patients treated with immune checkpoint inhibitors (ICI). Here, we investigated the effect of caloric coverage on the sensitivity to ICI.

Methods: We retrospectively analysed a multicentric database of mNSCLC patients treated with ICI.

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  • The NORSE/FIRES Family Registry aims to gather clinical and epidemiological data about individuals with new-onset refractory status epilepticus and febrile infection-related epilepsy syndrome.
  • Communication regarding diagnosis has improved post-2018, with more families being informed about NORSE/FIRES, although the quality of prognostic information is rated as moderate.
  • Palliative care involvement is low among patients, highlighting the need for better communication and support to enhance overall care and recovery for affected individuals and their families.
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In the 2021 version of the Standardized Critical Care EEG Terminology, the American Clinical Neurophysiology Society introduced new definitions, including for the cyclic alternating pattern of encephalopathy (CAPE). CAPE refers to changes in background EEG activity, with two patterns alternating spontaneously in a regular manner. CAPE shares remarkable similarities with the cyclic alternating pattern, a natural EEG phenomenon occurring in normal non-rapid eye movement sleep, considered the main electrophysiological biomarker of sleep instability.

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Background And Objectives: Patients with acute symptomatic seizures (ASyS) and acute epileptiform findings on EEG are common. They are often prescribed long-term antiseizure medications (ASMs); it is unknown whether or when this is necessary. Primary outcome was late unprovoked seizure occurrence and association with ASM taper.

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The bacterial anode of microbial electrolysis cells (MECs) is the limiting factor in a high hydrogen evolution reaction (HER). This study focused on improving biofilm attachment to a carbon-cloth anode using an alginate hydrogel. In addition, the modified bioanode was encapsulated by a filter bag that served as a physical barrier, to overcome its low mechanical strength and alginate degradation by certain bacterial species in wastewater.

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One of the main barriers to MEC applicability is the bacterial anode. Usually, the bacterial anode contains non-exoelectrogenic bacteria that act as a physical barrier by settling on the anode surface and displacing the exoelectrogenic microorganisms. Those non-exoelectrogens can also compete with exoelectrogenic microorganisms for nutrients and reduce hydrogen production.

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Background: Electroencephalography (EEG) is needed to diagnose nonconvulsive seizures. Prolonged nonconvulsive seizures are associated with neuronal injuries and deleterious clinical outcomes. However, it is uncertain whether the rapid identification of these seizures using point-of-care EEG (POC-EEG) can have a positive impact on clinical outcomes.

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Background And Objectives: Approximately 30% of critically ill patients have seizures, and more than half of these seizures do not have an overt clinical correlate. EEG is needed to avoid missing seizures and prevent overtreatment with antiseizure medications. Conventional-EEG (cEEG) resources are logistically constrained and unable to meet their growing demand for seizure detection even in highly developed centers.

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Objective: Medically refractory epilepsy (MRE) often requires resection of the seizure onset zone (SOZ) for effective treatment. However, when the SOZ is in functional cortex (FC), achieving complete and safe resection becomes difficult, due to the seizure network overlap with function. The authors aimed to assess the safety and outcomes of a combined approach involving partial resection combined with focal neuromodulation for FC refractory epilepsy.

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Article Synopsis
  • * A significant increase in the use of second-line immunotherapies (like anakinra) and the ketogenic diet was observed from 2022 to 2023, with 69% of patients receiving second-line immunotherapy compared to 40% before 2022.
  • * Early administration of certain therapies, particularly anakinra and tocilizumab, was linked to shorter durations of status epilepticus, suggesting a potential avenue for future research on treatment timing and patient outcomes.
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The cervical aortic arch (CAA) is an uncommon congenital anomaly in aortic development, characterized by an elongated aortic arch extending at or above the medial ends of the clavicles. Our objective was to examine the clinical and surgical characteristics of this infrequent condition in the adult population. PubMed, ScienceDirect, SciELO, DOAJ, and Cochrane Library databases were searched until December 2023 for case reports describing the presence of a cervical aortic arch in patients aged ≥18 years.

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