Management of status epilepticus in pregnancy: a clinician survey.

Background: Status epilepticus in pregnancy (SEP) is rare and life-threatening for both mother and fetus. There are well-established guidelines for the management of women with epilepsy during pregnancy; however, there is little evidence guiding the management of SEP, leading to uncertainty among treating physicians. Therefore, this survey aims to investigate the real-world practices of physicians treating SEP to explore management approaches for improvements in care.

Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury.

Electroencephalography (EEG) is a noninvasive tool that allows the monitoring of cerebral brain function in critically ill patients, aiding with diagnosis, management, and prognostication. Specific EEG features have shown utility in the prediction of outcomes in critically ill patients with status epilepticus, acute brain injury (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and traumatic brain injury), anoxic brain injury, and toxic-metabolic encephalopathy. Studies have also found an association between particular EEG patterns and long-term functional and cognitive outcomes as well as prediction of recovery of consciousness following acute brain injury.

Ellen R. Grass Lecture: Disparities in Access to Neurodiagnostic Testing.

Limited access to EEG services in rural areas creates health disparities in neurological care, including unnecessary transfers and delays in diagnosis and treatment. Rural facilities face several challenges to expanding EEG resources, including a lack of neurologists, technologists, EEG equipment, and adequate IT infrastructure. Potential solutions include investment in innovative technology, expansion of the workforce, and development of hub-and-spoke EEG networks.

Clinical and Electroencephalographic Predictors of Seizures and Status Epilepticus in 12,450 Critically Ill Adults: A Retrospective Cohort Study.

Objectives: Status epilepticus (SE) is associated with significantly higher morbidity and mortality than isolated seizures. Our objective was to identify clinical diagnoses and rhythmic and periodic electroencephalogram patterns (RPPs) associated with SE and seizures.

Design: Retrospective cohort study.

Clinical Neurophysiology Fellowship Program Directors Survey on a Standardized Fellowship Match Process: A Call for Action.

Purpose: To survey US Clinical Neurophysiology (CNP) fellowship program directors on the nature of CNP and related training programs, current recruitment cycle, and views for a standardized process.

Methods: A 23-question electronic survey was sent to all 93 US Accreditation Council for Graduate Medical Education-accredited CNP fellowship program directors from December 2020 to January 2021.

Results: The response rate was 60%.

Impact of the COVID-19 Pandemic on Continuous EEG Utilization.

Purpose: The coronavirus disease 2019 (COVID-19) has significantly impacted healthcare delivery and utilization. The aim of this article was to assess the impact of the COVID-19 pandemic on in-hospital continuous electroencephalography (cEEG) utilization and identify areas for process improvement.

Methods: A 38-question web-based survey was distributed to site principal investigators of the Critical Care EEG Monitoring Research Consortium, and institutional contacts for the Neurodiagnostic Credentialing and Accreditation Board.

Addressing the epilepsy surgery gap: Impact of community/tertiary epilepsy center collaboration.

To assess whether a formal collaboration between a non-surgical, community epilepsy center and a surgical, tertiary-care epilepsy center can improve patient progress throughout the pre-surgical referral process, and to elucidate predictors of referral completion among inter-center referrals. The inter-center referral process was tracked, and the number of patients completing surgical conference (primary outcome) and epilepsy surgery at the tertiary center were collected and compared in the 45-month immediate pre/post-collaboration periods. Demographic and clinical variables were collected on post-collaboration inter-center patient referrals to explore factors associated with completion of the referral process.

Stigma and functional neurological disorder: a research agenda targeting the clinical encounter.

Stigma against patients with functional neurological disorder (FND) presents obstacles to diagnosis, treatment, and research. The lack of biomarkers and the potential for symptoms to be misunderstood, invalidated, or dismissed can leave patients, families, and healthcare professionals at a loss. Stigma exacerbates suffering and unmet needs of patients and families, and can result in poor clinical management and prolonged, repetitive use of healthcare resources.

Continuous EEG Findings in Autoimmune Encephalitis.

Purpose: Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE.

Methods: Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring.

Results: We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients.

Interictal Epileptiform Discharge Detection in EEG in Different Practice Settings.

Objective: The goal of the study was to measure the performance of academic and private practice (PP) neurologists in detecting interictal epileptiform discharges in routine scalp EEG recordings.

Methods: Thirty-five EEG scorers (EEGers) participated (19 academic and 16 PP) and marked the location of ETs in 200 30-second EEG segments using a web-based EEG annotation system. All participants provided board certification status, years of Epilepsy Fellowship Training (EFT), and years in practice.

Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures.

Objective: The optimal treatment of nonconvulsive seizures in critically ill patients is uncertain. We evaluated the comparative effectiveness of the antiseizure drugs lacosamide (LCM) and fosphenytoin (fPHT) in this population.

Methods: The TRENdS (Treatment of Recurrent Electrographic Nonconvulsive Seizures) study was a noninferiority, prospective, multicenter, randomized treatment trial of patients diagnosed with nonconvulsive seizures (NCSs) by continuous electroencephalography (cEEG).

Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients.

Importance: Continuous electroencephalography (EEG) use in critically ill patients is expanding. There is no validated method to combine risk factors and guide clinicians in assessing seizure risk.

Objective: To use seizure risk factors from EEG and clinical history to create a simple scoring system associated with the probability of seizures in patients with acute illness.

Disentangling Stigma from Functional Neurological Disorders: Conference Report and Roadmap for the Future.

A multidisciplinary expert review of key issues and future directions from the conference "Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms." On October 9 and 10, 2015, a conference entitled "" was held at the Center for Ethics, Emory University, Atlanta, GA, USA. This conference brought together a select group of 30 distinguished thought leaders and practitioners, including ethicists, researchers, clinicians, humanities scholars, and advocates to discuss the unique challenges and controversies related to the diagnosis, treatment, and stigma for patients with what is currently recognized as functional ("psychogenic") neurological disorders.

The use and yield of continuous EEG in critically ill patients: A comparative study of three centers.

Objective: Continuous EEG (cEEG) monitoring of critically ill patients has gained widespread use, but there is substantial reported variability in its use. We analyzed cEEG and antiseizure drug (ASD) usage at three high volume centers.

Methods: We utilized a multicenter cEEG database used daily as a clinical reporting tool in three tertiary care sites (Emory Hospital, Brigham and Women's Hospital and Yale - New Haven Hospital).

Survey of the diagnostic and therapeutic approach to new-onset refractory status epilepticus.

Purpose: We conducted a survey of providers to assess for practice patterns in diagnosing and treating new-onset refractory status epilepticus (NORSE). NORSE is the occurrence of prolonged seizures that are not responsive to initial therapies in otherwise healthy individuals without obvious cause on initial presentation. This entity is thought to have multiple etiologies, including autoimmune.

Association of Periodic and Rhythmic Electroencephalographic Patterns With Seizures in Critically Ill Patients.

Importance: Periodic and rhythmic electroencephalographic patterns have been associated with risk of seizures in critically ill patients. However, specific features that confer higher seizure risk remain unclear.

Objective: To analyze the association of distinct characteristics of periodic and rhythmic patterns with seizures.

Characteristics of EEG Interpreters Associated With Higher Interrater Agreement.

Purpose: The goal of the project is to determine characteristics of academic neurophysiologist EEG interpreters (EEGers), which predict good interrater agreement (IRA) and to determine the number of EEGers needed to develop an ideal standardized testing and training data set for epileptiform transient (ET) detection algorithms.

Methods: A three-phase scoring method was used. In phase 1, 19 EEGers marked the location of ETs in two hundred 30-second segments of EEG from 200 different patients.

Randomized double-blind comparison of cognitive and EEG effects of lacosamide and carbamazepine.

Differential effectiveness of antiepileptic drugs (AEDs) is more commonly determined by tolerability than efficacy. Cognitive effects of AEDs can adversely affect tolerability and quality of life. This study evaluated cognitive and EEG effects of lacosamide (LCM) compared with carbamazepine immediate-release (CBZ-IR).

Sensitivity of quantitative EEG for seizure identification in the intensive care unit.

Objective: To evaluate the sensitivity of quantitative EEG (QEEG) for electrographic seizure identification in the intensive care unit (ICU).

Methods: Six-hour EEG epochs chosen from 15 patients underwent transformation into QEEG displays. Each epoch was reviewed in 3 formats: raw EEG, QEEG + raw, and QEEG-only.

Ictal-interictal continuum: A proposed treatment algorithm.

The ictal-interictal continuum (IIC) is characterized by periodic and/or rhythmic EEG patterns that occur with relative high frequency in critically ill patients. Several studies have reported that some patterns seen within the continuum are independently associated with poor outcome. However there is no consensus regarding when to treat them or how aggressive treatment should be.

Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research.

Purpose: The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use.

A standardized diagnostic approach and ongoing feedback improves outcome in psychogenic nonepileptic seizures.

Introduction: Psychogenic nonepileptic seizures (PNES) are episodic alterations in behavior presumed to reflect a physical manifestation of underlying psychological distress. Standardized treatment approaches for PNES care are lacking. We evaluated common approaches to PNES management that do not require significant commitment of time and resources.

New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

Objectives: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.

Methods: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).

Generalized periodic discharges and 'triphasic waves': A blinded evaluation of inter-rater agreement and clinical significance.

Objectives: Generalized periodic discharges (GPDs) are associated with nonconvulsive seizures. Triphasic waves (TWs), a subtype of GPDs, have been described in relation to metabolic encephalopathy and not felt to be associated with seizures. We sought to establish the consistency of use of this descriptive term and its association with seizures.