Effect of seizure timing on long-term survival in patients with brain tumor.

Objective: Seizures often occur in patients with primary brain tumor (BT). The aim of this study was to determine if there is an association between the time of occurrence of seizures during the course of BT and survival of these patients.

Methods: This retrospective cohort study at Henry Ford Hospital, an urban tertiary referral center, included all patients who were diagnosed with primary BTs at Henry Ford Health System between January 2006 and December 2014.

Seizures and the neurosurgical intensive care unit.

The cause of seizures in the neurosurgical intensive care unit (NICU) can be categorized as emanating from either a primary brain pathology or from physiologic derangements of critical care illness. Patients are typically treated with parenteral antiepileptic drugs. For early onset ICU seizures that are easily controlled, data support limited treatment.

Status epilepticus: an update.

Status epilepticus (SE) still results in significant mortality and morbidity. Whereas mortality depends mainly on the age of the patient as well as the cause, morbidity is often due to the myriad of complications that occur during prolonged admission to an intensive care environment. Although SE is a clinical diagnosis in most cases (convulsant), its treatment requires support by continuous electroencephalographic recording to ensure cessation of potential nonconvulsive elements of SE.

Management of status epilepticus in neurological versus medical intensive care unit: does it matter?

Background: Admission of patients with status epilepticus (SE) to the neurosciences intensive care unit (NICU) may improve management and outcomes compared to general ICUs.

Methods: We reviewed all patients with SE admitted to the NICU versus the Medical ICU in our institution between 2005 and 2008. We included only patients with definite or probable SE based on pre-defined criteria.

Developing a culture of safety in the epilepsy monitoring unit: a retrospective study of safety outcomes.

This study retrospectively reviewed 971 consecutive admissions to our epilepsy monitoring unit (EMU) from July 2007 to May 2011 to compare falls and missed seizures before and after implementing stricter safety processes in May 2009. New safety processes included enhanced staff education, a falls prevention signed contract with patient/family, observation of video-EEG monitors only by EEG technologists, hourly nurse rounding, standby assistance for hygiene needs, and immediate review of adverse events. Wilcoxon's two-sample tests were used for statistical analysis of the two groups.

An overview of third-generation antiseizure drugs: Clobazam, lacosamide, rufinamide, and vigabatrin.

Four antiseizure drugs have been approved in the United States since 2008. Clobazam, a 1,5-benzodiazepine, was approved in October 2011 as an adjunctive therapy for Lennox-Gastaut syndrome (LGS) in patients 2 years and older. Lacosamide, an amino acid that selectively enhances the slow inactivation of voltage-gated sodium channels, was approved in October 2008 as an add-on therapy for partial onset seizures in patients 17 years and older.

AAN Epilepsy Quality Measures in clinical practice: a survey of neurologists.

Epilepsy Quality Measures (EQM) were developed by the American Academy of Neurology (AAN) to convey standardization and eliminate gaps and variations in the delivery of epilepsy care (Fountain et al., 2011 [1]). The aim of this study was to identify adherence to these measures and other emerging practice standards in epilepsy care.

Withdrawal of life support in critically ill neurosurgical patients and in-hospital death after discharge from the neurosurgical intensive care unit. Clinical article.

Object: The aim of this study was to examine the variables influencing the mode and location of death in patients admitted to a neurosurgical intensive care unit (NICU), including the participation of a newly appointed neurointensivist (NI).

Methods: Data from all patients admitted to a university hospital NICU were prospectively collected and compared between 2 consecutive 19-month periods before and after the appointment of an NI.

Results: One thousand eighty-seven patients were admitted before and 1279 after the NI's appointment.

A survey of neurologists' views on epilepsy surgery and medically refractory epilepsy.

There is a 20-year delay between the diagnosis of epilepsy and surgical treatment. The aim of this study was to describe the different views held by neurologists regarding refractory epilepsy that may contribute to the delay in referring patients for epilepsy surgery. Neurologists in Michigan were mailed a 10-item survey inquiring about their definition of medically refractory epilepsy and their decision-making process in referring patients for epilepsy surgery.

The impact of a neuro-intensivist on patients with stroke admitted to a neurosciences intensive care unit.

Introduction: Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU).

Methods: Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI.

Vasovagal syncope misdiagnosed as epilepsy for 17 years: prime importance of clinical history.

Distinguishing epilepsy from syncope often can be challenging. We report a case of a 20-year-old patient with presumed refractory epilepsy since the age of 3 years. Although the clinical suspicion of syncope was raised at the age of 9 years, key historic features were not identified, cardiac work-up was not pursued and despite lack of electrographic evidence of epilepsy, he received anticonvulsant treatment.

Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus.

Background: Hydrocephalus may develop either early in the course of aneurysmal subarachnoid hemorrhage (SAH) or after the first 2 weeks. Because the amount of SAH is a predictor of hydrocephalus, the two available aneurysmal treatments, clipping or coiling, may lead to differences in the need for cerebrospinal fluid (CSF) diversion, as only surgery permits clot removal.

Methods: Hospital and University Hospitals Consortium (UHC) databases were used to retrieve data on all patients admitted to our hospital with aneurysmal SAH during the last 4 years.

Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit.

Object: The aim of this study was to evaluate the impact of a newly appointed neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU).

Methods: The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database.

Management of seizures in the critically ill.

Seizures in a critically ill patient are not infrequent phenomena. Physicians are perplexed by the wide range of possible cranial or extracranial etiologies, alerted by the risk for further crucial organ compromise if seizures recur, and confused about the treatment options in an environment rich in complex drug interactions and multiple organ dysfunction. The advent of an armamentarium containing multiple new antiepileptic medications complicates the situation further, since several of them have less known mechanisms of action, side effects, or interactions with other intensive care unit (ICU) medications.

Documentation in medical records improves after a neurointensivist's appointment.

Introduction: Medical documentation is important for communication among health care professionals, research, legal defense, and reimbursement. Previous studies have indicated insufficient documentation by health care providers and resistance among physicians to comply with the new guidelines. Data in the intensive care unit (ICU) subpopulation are scarce.

Intraventricular hemorrhage after aneurysmal subarachnoid hemorrhage: pilot study of treatment with intraventricular tissue plasminogen activator.

Objective: Intraventricular (IVen) hemorrhage is considered a predictor of poor outcome after subarachnoid hemorrhage (SAH). This prospective study examines the feasibility and outcome of administration of IVen tissue plasminogen activator (tPA) after aneurysmal SAH.

Methods: Ten patients with SAH who received IVen tPA after the aneurysm had been secured were compared with 10 age-, sex-, and Glasgow Coma Scale score-matched control patients.

The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit.

Objective: To evaluate the impact of a newly appointed neurointensivist on neurosciences intensive care unit (NICU) patient outcomes and quality of care variables.

Design: Observational cohort with historical controls.

Setting: Ten-bed neurointensive care unit in tertiary university hospital.

Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center.

Objective: This retrospective study documented long-term outcome of patients receiving vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy.

Methods: Medical charts of 28 patients implanted for 5 years or longer were reviewed for changes in seizure frequency after 1 year of VNS therapy and at follow up, which ranged from 5 to 7 years. Numbers of antiepileptic drugs (AEDs) taken by the patients were also computed at 1 year and follow up.

Emergent electroencephalogram in the intensive care unit: indications and diagnostic yield.

Our aim was to study the frequency and reasons an emergent electroencephalogram (EmEEG) is ordered in the ICUs compared to the hospital ward, examine its usefulness and find predictive variables for its results. We retrospectively identified all electroencephalograms ordered between December 1997 and March 2002 and performed within 1 hour. The tests ordered from four ICUs were compared with those ordered from the Ward beds, and predictive models were developed for the results based on clinical variables.

Simultaneous ERP and fMRI of the auditory cortex in a passive oddball paradigm.

Infrequent occurrences of a deviant sound within a sequence of repetitive standard sounds elicit the automatic mismatch negativity (MMN) event-related potential (ERP). The main MMN generators are located in the superior temporal cortex, but their number, precise location, and temporal sequence of activation remain unclear. In this study, ERP and functional magnetic resonance imaging (fMRI) data were obtained simultaneously during a passive frequency oddball paradigm.

Neuroimaging reveals automatic speech coding during perception of written word meaning.

The extent to which visual word perception engages speech codes (i.e., phonological recoding) remains a crucial question in understanding mechanisms of reading.