Deep learning-based detection of generalized convulsive seizures using a wrist-worn accelerometer.

Objective: To develop and validate a wrist-worn accelerometer-based, deep-learning tunable algorithm for the automated detection of generalized or bilateral convulsive seizures (CSs) to be integrated with off-the-shelf smartwatches.

Methods: We conducted a prospective multi-center study across eight European epilepsy monitoring units, collecting data from 384 patients undergoing video electroencephalography (vEEG) monitoring with a wrist-worn three dimensional (3D)-accelerometer sensor. We developed an ensemble-based convolutional neural network architecture with tunable sensitivity through quantile-based aggregation.

Association of early general anesthesia with outcome in adults with status epilepticus: A propensity-matched observational study.

General anesthesia (GA) earlier than recommended (as first- or second-line treatment) was recently described to improve status epilepticus (SE) outcome. We aimed to assess the impact of early GA on outcome in matched groups. Data from a multicenter, prospective cohort of 1179 SE episodes in 1049 adults were retrospectively analyzed.

Relevance of Continuous EEG versus Routine EEG for Outcome Prediction after Traumatic Brain Injury.

Introduction: In a cohort of adult patients with disturbance of consciousness after TBI, we aimed to explore the relationship of continuous video-EEG (cEEG) versus routine EEG (rEEG) with mortality and functional outcome.

Methods: This is a post hoc analysis of a randomized controlled trial (CERTA), in which adults with disorder of consciousness and needing EEG (excluding those with proven seizures/SE just before) were randomized 1:1 to cEEG or two rEEG. In TBI patients, correlation between EEG duration, mortality, and modified Rankin score (mRs, good 0-2) at 6 months was assessed.

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence.

Background: Electroencephalography (EEG) has long been used to detect seizures in patients with disorders of consciousness. In recent years, there has been a drastically increased adoption of continuous EEG (cEEG) in the intensive care units (ICUs). Given the resources necessary to record and interpret cEEG, this is still not available in every center and widespread recommendations to use continuous instead of routine EEG (typically lasting 20 min) are still a matter of some debate.

Staged treatment response in status epilepticus: Lessons from the SENSE registry.

Objectives: Although in epilepsy patients the likelihood of becoming seizure-free decreases substantially with each unsuccessful treatment, to our knowledge this has been poorly investigated in status epilepticus (SE). We aimed to evaluate the proportion of SE cessation and functional outcome after successive treatment steps.

Methods: We conducted a post hoc analysis of a prospective, observational, multicenter cohort (Sustained Effort Network for treatment of Status Epilepticus [SENSE]), in which 1049 incident adult SE episodes were prospectively recorded at nine European centers.

Outcome of comatose patients following cardiac arrest: When mRS completes CPC.

Aim: Good outcome in patients following cardiac arrest (CA) is usually defined as Cerebral Performance Category (CPC) 1-2, while CPC 3 is debated, and CPC 4-5 represent poor outcome. We aimed to assess when the modified Rankin Scale (mRS) can improve CPC outcome description, especially in CPC 3. We further aimed to correlate neuron specific enolase (NSE) with both functional measures to explore their relationship with neuronal damage.

Acute Valproate-Induced Encephalopathy in Status Epilepticus: A Registry-Based Assessment.

Background: Valproate-induced encephalopathy (VIE) affects between 0.1% and 2.5% of patients under long-term epilepsy treatment.

Clonazepam Loading Dose in Status Epilepticus: Is More Always Better?

Background And Objectives: Benzodiazepines are the first treatment line in status epilepticus (SE). Despite their well-established benefit, benzodiazepines are frequently underdosed with potential detrimental consequences. In some European countries, clonazepam (CLZ) is commonly used as the first line treatment.

[Neurology: what's new in 2022].

The year 2022 was marked by the development of numerous new treatments for refractory myasthenia gravis. The link between epilepsy and cerebrovascular disorder was studied and lamotrigine discovered to be the optimal treatment choice for epilepsy secondary to stroke to prevent mortality on patient of 45 years and older. New randomized study finally demonstrated the utility of thrombectomy in selected patients with basilar artery occlusion.

Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability.

Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action.

Refractory Status Epilepticus: Risk Factors and Analysis of Intubation in the Multicenter SENSE Registry.

Background And Objectives: Refractory status epilepticus (RSE) bears significant morbidity and mortality. Therapy escalation and in some cases intubation are recommended. Most existing studies are retrospective and focus on intensive care units.

Long-term efficacy, tolerability, and retention of brivaracetam in epilepsy treatment: A longitudinal multicenter study with up to 5 years of follow-up.

Objective: This study was undertaken to evaluate the long-term efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice.

Methods: A multicenter, retrospective cohort study recruited all patients who initiated BRV between February and November 2016, with observation until February 2021.

Results: Long-term data for 262 patients (mean age = 40 years, range = 5-81 years, 129 men) were analyzed, including 227 (87%) diagnosed with focal epilepsy, 19 (7%) with genetic generalized epilepsy, and 16 (6%) with other or unclassified epilepsy syndromes.

EEG patterns and their correlations with short- and long-term mortality in patients with hypoxic encephalopathy.

Objective: To analyze the association between electroencephalographic (EEG) patterns and overall, short- and long-term mortality in patients with hypoxic encephalopathy (HE).

Methods: Retrospective, mono-center analysis of 199 patients using univariate log-rank tests (LR) and multivariate cox regression (MCR).

Results: Short-term mortality, defined as death within 30-days post-discharge was 54.

Continuous Versus Routine Standardized Electroencephalogram for Outcome Prediction in Critically Ill Adults: Analysis From a Randomized Trial.

Objectives: To investigate electroencephalogram (EEG) features' relation with mortality or functional outcome after disorder of consciousness, stratifying patients between continuous EEG and routine EEG.

Design: Retrospective analysis of data from a randomized controlled trial.

Setting: Multiple adult ICUs.

EEG findings in CAR T-cell-associated neurotoxicity: Clinical and radiological correlations.

Background: While EEG is frequently reported as abnormal after chimeric antigen receptor (CAR) T-cell therapy, its clinical significance remains unclear. We aim to systematically describe EEG features in a large single-center cohort and correlate them with clinical and radiological findings.

Methods: We retrospectively identified patients undergoing CAR T-cell therapy who had continuous EEG.

Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists.

We aim to prospectively investigate, in a large and heterogeneous population, the electroencephalogram (EEG)-reading performances of EEG technologists. A total of 8 EEG technologists and 5 certified neurophysiologists independently analyzed 20-min EEG recordings. Interrater agreement (IRA) for predefined EEG pattern identification between EEG technologists and neurophysiologits was assessed using percentage of agreement (PA) and Gwet-AC1.

MRI-EEG correlation for outcome prediction in postanoxic myoclonus: A multicenter study.

Objective: To examine the prognostic ability of the combination of EEG and MRI in identifying patients with good outcome in postanoxic myoclonus (PAM) after cardiac arrest (CA).

Methods: Adults with PAM who had an MRI within 20 days after CA were identified in 4 prospective CA registries. The primary outcome measure was coma recovery to command following by hospital discharge.

EEG patterns associated with present cortical SSEP after cardiac arrest.

Background: After cardiac arrest (CA), present cortical somatosensory evoked potentials (N20 response of SSEPs) have low predictive value for good outcome and might be redundant with EEG.

Aims: To determine whether specific features, or rather global, standardized EEG assessments, are reliably associated with cortical SSEP occurrence after cardiac arrest (CA).

Methods: In a prospective CA registry, EEGs recorded within 72 hours were scored according to the ACNS nomenclature, and also categorized into "benign," "malignant," and "highly malignant.

Does continuous EEG influence prognosis in patients after cardiac arrest?

Aim: Electroencephalography (EEG) is a key modality for assessment of prognosis following cardiac arrest (CA); however, whether continuous EEG (cEEG) is superior to routine intermittent EEG (rEEG) remains debated. We examined the impact of cEEG (>18 h) vs. rEEG (<30 min) on outcome in comatose CA patients as part of multimodal prognostication.

Newer Antiepileptic Drugs for Status Epilepticus in Adults: What's the Evidence?

Status epilepticus (SE) is one of the most frequent neurological emergencies. Despite this, understanding of its pathophysiology and evidence regarding its management is limited. Rapid, effective, and well-tolerated treatment to achieve seizure cessation is advocated to prevent brain damage or potentially lethal outcomes.

Standardized EEG interpretation in patients after cardiac arrest: Correlation with other prognostic predictors.

Introduction: Standardized EEG patterns according to the American Clinical Neurophysiology Society (ACNS) ("highly malignant", "malignant" and "benign") demonstrated good correlation with outcome after cardiac arrest (CA). However, this approach relates to EEGs after target temperature management (TTM), and correlation to other recognized outcome predictors remains unknown.

Objectives: To investigate the relationship between categorized EEG and other outcome predictors, during and after TTM, at different temperatures.

Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents.

Introduction: Newer antiepileptic drugs (AEDs) are increasingly prescribed; however, relatively limited data are available regarding their use in status epilepticus (SE) and the impact on outcome.

Objectives: The aim of this study was to explore the evolution in prescription patterns of newer and traditional AEDs in this clinical setting, and their association with prognosis.

Methods: We analyzed our prospective adult SE registry over a 10-year period (2007-2016) and assessed the yearly use of newer and traditional AEDs and their association with mortality, return to baseline conditions at discharge, and SE refractoriness, defined as treatment resistance to two AEDs, including benzodiazepines.