Publications by authors named "Tiffani L McDonough"
Article Synopsis
- * Out of 293 children studied, many received multiple doses of BZDs, especially if seizures started outside of the hospital and if they delayed treatment — with 57.3% receiving BZDs beyond 30 minutes after the onset.
- * The findings suggest that more timely escalation from BZDs to non-BZD ASMs is needed, particularly for patients whose seizures began before they arrived at the hospital.
Article Synopsis
- The study aimed to examine long-term outcomes in pediatric patients experiencing refractory status epilepticus (RSE) and to identify factors linked to new neurological deficits following RSE.
- Data from 276 patients showed a 4% in-hospital mortality rate, with 62.9% of patients later developing unprovoked seizures and 39.3% of those with normal development before RSE acquiring new neurological deficits.
- Longer durations of electroclinical RSE were associated with higher risks of new deficits, and the study highlights that about one-third of previously seizure-free patients experienced recurrent seizures post-RSE.
Objectives: To characterize the pediatric super-refractory status epilepticus population by describing treatment variability in super-refractory status epilepticus patients and comparing relevant clinical characteristics, including outcomes, between super-refractory status epilepticus, and nonsuper-refractory status epilepticus patients.
Design: Retrospective cohort study with prospectively collected data between June 2011 and January 2019.
Setting: Seventeen academic hospitals in the United States.
Objective: We aimed to characterize the clinical profile and outcomes of new onset refractory status epilepticus (NORSE) in children, and investigated the relationship between fever onset and status epilepticus (SE).
Methods: Patients with refractory SE (RSE) between June 1, 2011 and October 1, 2016 were prospectively enrolled in the pSERG (Pediatric Status Epilepticus Research Group) cohort. Cases meeting the definition of NORSE were classified as "NORSE of known etiology" or "NORSE of unknown etiology.
Article Synopsis
- Pediatric patients with refractory status epilepticus experience delays in treatment, which varies depending on the day of the week or whether it's a holiday.
- A study analyzing 329 patients found that time to the first benzodiazepine (BZD) was longer during weekdays compared to weekends/holidays, with significant differences in time for non-BZD antiseizure medications, especially for cases that began in the hospital.
- Findings suggest that improving the response time for treatments during weekdays may enhance patient outcomes, highlighting the need for policies addressing treatment disparities based on the day of the week.
Article Synopsis
- The study aimed to identify reasons for low dosing of benzodiazepines (BZD) in children with refractory status epilepticus (RSE) and examine how this variability affects seizure cessation.
- Data from a retrospective analysis of 289 pediatric RSE patients revealed that 57.9% received a low initial BZD dose, with contributing factors being male sex, older age, no previous epilepsy diagnosis, and delayed treatment.
- Low total BZD dosing was found to significantly decrease the chances of achieving seizure cessation, indicating the need for more consistent dosing practices in both emergency and hospital settings.
Purpose: To evaluate whether the onset of pediatric refractory status epilepticus (rSE) is related to time of day.
Method: We analyzed the time of day for the onset of rSE in this prospective observational study performed from June 2011 to May 2019 in pediatric patients (1 month to 21 years of age). We evaluated the temporal distribution of pediatric rSE utilizing a cosinor analysis.
Objective: Sudden unexpected death in epilepsy (SUDEP) is an important cause of mortality in epilepsy. However, there is a gap in how often providers counsel patients about SUDEP. One potential solution is to electronically prompt clinicians to provide counseling via automated detection of risk factors in electronic medical records (EMRs).
View Article and Find Full Text PDFAims: We aimed to classify ictal onset patterns (IOPs) in pediatric patients undergoing intracranial electroencephalography (IEEG) to guide surgery for refractory epilepsy. We aimed to determine if morphology of IOPs can predict surgical outcome.
Materials And Methods: We performed a retrospective review of pediatric patients who underwent epilepsy surgery guided by subdural IEEG from 2007 to 2016.
Objective: We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline.
Methods: We undertook a descriptive analysis of recommended timing, dosing, and medication choices in 10 pSERG hospitals' status epilepticus treatment pathways.
Results: One pathway matched the timeline in the AES guideline; nine pathways described more rapid timings.
Identifying individuals with rare epilepsy syndromes in electronic data sources is difficult, in part because of missing codes in the International Classification of Diseases (ICD) system. Our objectives were the following: (1) to describe the representation of rare epilepsies in other medical vocabularies, to identify gaps; and (2) to compile synonyms and associated terms for rare epilepsies, to facilitate text and natural language processing tools for cohort identification and population-based surveillance. We describe the representation of 33 epilepsies in 3 vocabularies: Orphanet, SNOMED-CT, and UMLS-Metathesaurus.
View Article and Find Full Text PDFEpilepsy outcomes after therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy are understudied. The authors used multivariable logistic regression to predict epilepsy in neonates after selective head cooling. Sensitivity analyses used magnetic resonance imaging (MRI) and electroencephalogram (EEG) interpretations by different clinicians.
View Article and Find Full Text PDFObjective: To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).
Methods: This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE.
Results: We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.
Purpose Of Review: This article strives to review and summarize selected recent literature and topics contributing to a greater understanding of the diagnosis and treatments of neonatal seizures that have emerged in the past several years.
Recent Findings: Continuous EEG is recommended as the gold standard for neonatal seizure monitoring as it can provide additional information that may stratify patients by etiology, as well as identify at-risk groups of newborns for neuromonitoring. Investigations are moving beyond traditional antiepileptic agents in search of treatments with better efficacy and with less concern for developmental effects.