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Book: Clinical neurophysiology in disorders of consciousness

Rossetti, Andrea O. / Laureys, Steven

brain function monitoring in the ICU and beyond

2015

Author's details	Andrea O. Rossetti ; Steven Laureys ed
Keywords	EEG ; EP ; consciousness ; correlation ; electrophysiology ; prognosis
Language	English
Size	VIII, 161 S. : Ill., graph. Darst.
Publisher	Springer
Publishing place	Wien u.a.
Publishing country	Austria
Document type	Book
HBZ-ID	HT018599403
ISBN	978-3-7091-1633-3 ; 3-7091-1633-3 ; 9783709116340 ; 3709116341
Database	Catalogue ZB MED Medicine, Health

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2015 A 1249	available for loan (reading room)	Lesesaal EG

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Article ; Online: Recent advances in clinical electroencephalography.

Frauscher, Birgit / Rossetti, Andrea O / Beniczky, Sándor

Current opinion in neurology

2024 Volume 37, Issue 2, Page(s) 134–140

Abstract: Purpose of review: Clinical electroencephalography (EEG) is a conservative medical field. This explains likely the significant gap between clinical practice and new research developments. This narrative review discusses possible causes of this ... ...

Abstract	Purpose of review: Clinical electroencephalography (EEG) is a conservative medical field. This explains likely the significant gap between clinical practice and new research developments. This narrative review discusses possible causes of this discrepancy and how to circumvent them. More specifically, we summarize recent advances in three applications of clinical EEG: source imaging (ESI), high-frequency oscillations (HFOs) and EEG in critically ill patients. Recent findings: Recently published studies on ESI provide further evidence for the accuracy and clinical utility of this method in the multimodal presurgical evaluation of patients with drug-resistant focal epilepsy, and opened new possibilities for further improvement of the accuracy. HFOs have received much attention as a novel biomarker in epilepsy. However, recent studies questioned their clinical utility at the level of individual patients. We discuss the impediments, show up possible solutions and highlight the perspectives of future research in this field. EEG in the ICU has been one of the major driving forces in the development of clinical EEG. We review the achievements and the limitations in this field. Summary: This review will promote clinical implementation of recent advances in EEG, in the fields of ESI, HFOs and EEG in the intensive care.
MeSH term(s)	Humans ; Electroencephalography/methods ; Epilepsy/surgery ; Drug Resistant Epilepsy
Language	English
Publishing date	2024-01-17
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	1182686-1
ISSN	1473-6551 ; 1350-7540
ISSN (online)	1473-6551
ISSN	1350-7540
DOI	10.1097/WCO.0000000000001246
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Article ; Online: Author Response: Prediction of Regaining Consciousness Despite an Early Epileptiform EEG After Cardiac Arrest.

Rossetti, Andrea O / Barbella, Giuseppina

Neurology

2021 Volume 96, Issue 9, Page(s) 459

MeSH term(s)	Coma ; Consciousness ; Electroencephalography ; Heart Arrest/complications ; Heart Arrest/diagnosis ; Humans
Language	English
Publishing date	2021-03-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000011536
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Article ; Online: Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence.

Fenter, Helene / Rossetti, Andrea O / Beuchat, Isabelle

European neurology

2023 Volume 87, Issue 1, Page(s) 17–25

Abstract: 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). ... ...

Abstract	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. Considering recent literature and personal experience, this review offers a rationale and practical advice to address this question. Summary: Despite the development of increasingly performant imaging techniques and several validated biomarkers, EEG remains central to clinicians in the intensive care unit and has been experiencing expanding popularity for at least 2 decades. Not only does EEG allow seizure or status epilepticus detection, which in the ICU often present without clinical movements, but it is also paramount for the prognostic evaluation of comatose patients, especially after cardiac arrest, and for detecting delayed ischemia after subarachnoid hemorrhage. At the end of the last Century, improvements of technical and digital aspects regarding recording and storage of EEG tracings have progressively led to the era of cEEG and automated quantitative analysis. Key messages: As compared to repeated rEEG, cEEG in comatose patients does not seem to improve clinical prognosis to a relevant extent, despite allowing a more performant of detection ictal events and consequent therapeutic modifications. The choice between cEEG and rEEG must therefore always be patient-tailored.
MeSH term(s)	Humans ; Coma ; Seizures/diagnosis ; Intensive Care Units ; Status Epilepticus/diagnosis ; Electroencephalography/methods ; Monitoring, Physiologic/methods
Language	English
Publishing date	2023-11-10
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	209426-5
ISSN	1421-9913 ; 0014-3022
ISSN (online)	1421-9913
ISSN	0014-3022
DOI	10.1159/000535085
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Article ; Online: Status epilepticus in the ICU.

Rossetti, Andrea O / Claassen, Jan / Gaspard, Nicolas

Intensive care medicine

2023 Volume 50, Issue 1, Page(s) 1–16

Abstract: Status epilepticus (SE) is a common medical emergency associated with significant morbidity and mortality. Management that follows published guidelines is best suited to improve outcomes, with the most severe cases frequently being managed in the ... ...

Abstract	Status epilepticus (SE) is a common medical emergency associated with significant morbidity and mortality. Management that follows published guidelines is best suited to improve outcomes, with the most severe cases frequently being managed in the intensive care unit (ICU). Diagnosis of convulsive SE can be made without electroencephalography (EEG), but EEG is required to reliably diagnose nonconvulsive SE. Rapidly narrowing down underlying causes for SE is crucial, as this may guide additional management steps. Causes may range from underlying epilepsy to acute brain injuries such as trauma, cardiac arrest, stroke, and infections. Initial management consists of rapid administration of benzodiazepines and one of the following non-sedating intravenous antiseizure medications (ASM): (fos-)phenytoin, levetiracetam, or valproate; other ASM are increasingly used, such as lacosamide or brivaracetam. SE that continues despite these medications is called refractory, and most commonly treated with continuous infusions of midazolam or propofol. Alternatives include further non-sedating ASM and non-pharmacologic approaches. SE that reemerges after weaning or continues despite management with propofol or midazolam is labeled super-refractory SE. At this step, management may include non-sedating or sedating compounds including ketamine and barbiturates. Continuous video EEG is necessary for the management of refractory and super-refractory SE, as these are almost always nonconvulsive. If possible, management of the underlying cause of seizures is crucial particularly for patients with autoimmune encephalitis. Short-term mortality ranges from 10 to 15% after SE and is primarily related to increasing age, underlying etiology, and medical comorbidities. Refractoriness of treatment is clearly related to outcome with mortality rising from 10% in responsive cases, to 25% in refractory, and nearly 40% in super-refractory SE.
MeSH term(s)	Humans ; Anticonvulsants/therapeutic use ; Midazolam ; Propofol ; Status Epilepticus/diagnosis ; Status Epilepticus/drug therapy ; Status Epilepticus/etiology ; Intensive Care Units
Chemical Substances	Anticonvulsants ; Midazolam (R60L0SM5BC) ; Propofol (YI7VU623SF)
Language	English
Publishing date	2023-12-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-023-07263-w
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Article ; Online: Status epilepticus prognosis following levetiracetam administration: Analysis of loading doses.

Kuffer, Ian / Novy, Jan / Rossetti, Andrea O

European journal of neurology

2023 Volume 30, Issue 7, Page(s) 1957–1962

Abstract: Background and purpose: Recommended loading doses of levetiracetam (LEV) for status epilepticus (SE) treatment have increased over time. However, this was not evidence-based, and the benefit of the increase remains unclear. The effect of different LEV ... ...

Abstract	Background and purpose: Recommended loading doses of levetiracetam (LEV) for status epilepticus (SE) treatment have increased over time. However, this was not evidence-based, and the benefit of the increase remains unclear. The effect of different LEV loading doses on SE prognosis was explored. Methods: This is a retrospective analysis of an SE adult registry (January 2016-December 2021), including patients receiving LEV as a second-line SE treatment. Patients were stratified according to LEV loading doses (threshold 35 mg/kg). Main outcomes were global mortality, LEV use as last SE treatment, and return to baseline conditions at discharge, exploring LEV as a dichotomized or continuous dose. Results: Among 202 patients, 44 received LEV at ≥35 mg/kg and 158 below it. Global mortality, adjusted for SE severity and potentially fatal aetiology, was more frequent in the high LEV dose group (27.2% vs. 17.1%, odds ratio 3.14, 95% confidence interval 1.23-8.06; p = 0.017), whilst LEV prescription as last treatment and return to baseline conditions were comparable. Considering continuous LEV dosages or mortality in ongoing SE, however, no outcome reached statistical significance. Conclusions: Lower LEV loading doses do not seem to correlate with worse clinical outcome, challenging current guidelines. Further studies, ideally prospective, are needed on this topic.
MeSH term(s)	Adult ; Humans ; Levetiracetam/therapeutic use ; Anticonvulsants/adverse effects ; Retrospective Studies ; Prospective Studies ; Status Epilepticus/drug therapy ; Prognosis ; Piracetam/therapeutic use ; Piracetam/adverse effects
Chemical Substances	Levetiracetam (44YRR34555) ; Anticonvulsants ; Piracetam (ZH516LNZ10)
Language	English
Publishing date	2023-04-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1280785-0
ISSN	1468-1331 ; 1351-5101 ; 1471-0552
ISSN (online)	1468-1331
ISSN	1351-5101 ; 1471-0552
DOI	10.1111/ene.15791
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Article ; Online: Letter to the editor regarding "early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study".

Alvarez, Vincent / Novy, Jan / Beuchat, Isabelle / Rossetti, Andrea O

Epilepsia

2023 Volume 64, Issue 9, Page(s) 2530–2531

MeSH term(s)	Humans ; Retrospective Studies ; Status Epilepticus/complications ; Anesthesia
Language	English
Publishing date	2023-07-22
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.17705
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Article ; Online: Place of neurosteroids in the treatment of status epilepticus.

Rossetti, Andrea O

Epilepsia

2018 Volume 59 Suppl 2, Page(s) 216–219

Abstract: The treatment of refractory or super-refractory status epilepticus (SE) currently relies on low-evidence strategies, including general anesthetics to induce pharmacologic coma, ketogenic diet, immunosuppression, and other physical measures. Besides the ... ...

Abstract	The treatment of refractory or super-refractory status epilepticus (SE) currently relies on low-evidence strategies, including general anesthetics to induce pharmacologic coma, ketogenic diet, immunosuppression, and other physical measures. Besides the formal uncertainty regarding efficacy, concerns have been about tolerability. In this situation, identification of alternative, higher evidence treatments is urgently needed. Allopregnanolone is an endogenous neurosteroid exerting a positive allosteric modulation on γ-aminobutyric acid (GABA)
MeSH term(s)	Animals ; Anticonvulsants/therapeutic use ; Clinical Trials as Topic/methods ; Humans ; Neurotransmitter Agents/therapeutic use ; Receptors, GABA-A/metabolism ; Status Epilepticus/drug therapy ; Treatment Outcome
Chemical Substances	Anticonvulsants ; Neurotransmitter Agents ; Receptors, GABA-A
Language	English
Publishing date	2018-08-29
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.14481
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Zs.MO 475: Show issues

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Article ; Online: What's new on EEG monitoring in the ICU.

Rossetti, Andrea O / Lee, Jong-Woo

Minerva anestesiologica

2021 Volume 87, Issue 10, Page(s) 1139–1145

Abstract: Continuous video-EEG (cEEG, lasting hours to several days) is increasingly used in ICU patients, as it is more sensitive than routine video-EEG (rEEG, lasting 20-30 min) to detect seizures or status epilepticus, and allows more frequent changes in ... ...

Abstract	Continuous video-EEG (cEEG, lasting hours to several days) is increasingly used in ICU patients, as it is more sensitive than routine video-EEG (rEEG, lasting 20-30 min) to detect seizures or status epilepticus, and allows more frequent changes in therapeutic regimens. However, cEEG is more resource-consuming, and its relationship to outcome compared to repeated rEEG has only been formally assessed very recently in a randomized controlled trial, which did not show any significant difference in terms of long-term mortality or functional outcome. Awaiting more refined trials, it seems therefore that using repeated rEEG in ICU patients may represent a reasonable alternative in resource-limited settings. Prolonged EEG has been used recently in patients with severe COVID-19 infection, the proportion of seizures seems albeit relatively low, and similar to ICU patients with medical conditions. As a timely EEG recording is recommended in the ICU in any case, recent technical developments may ease its use in clinical practice.
MeSH term(s)	COVID-19 ; Electroencephalography ; Humans ; Intensive Care Units ; Monitoring, Physiologic ; SARS-CoV-2 ; Seizures/diagnosis
Language	English
Publishing date	2021-03-10
Publishing country	Italy
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.21.15473-2
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Article ; Online: Update on the management of status epilepticus.

Rossetti, Andrea O / Alvarez, Vincent

Current opinion in neurology

2021 Volume 34, Issue 2, Page(s) 172–181

Abstract: Purpose of review: Randomized controlled trials investigating the initial pharmacological treatment of status epilepticus have been recently published. Furthermore, status epilepticus arising in comatose survivors after cardiac arrest has received ... ...

Abstract	Purpose of review: Randomized controlled trials investigating the initial pharmacological treatment of status epilepticus have been recently published. Furthermore, status epilepticus arising in comatose survivors after cardiac arrest has received increasing attention in the last years. This review offers an updated assessment of status epilepticus treatment in these different scenarios. Recent findings: Initial benzodiazepines underdosing is common and correlates with development of status epilepticus refractoriness. The recently published ESETT trial provides high-level evidence regarding the equivalence of fosphenytoin, valproate, and levetiracetam as a second-line option. Myoclonus or epileptiform transients on electroencephalography occur in up to 1/3 of patients surviving a cardiac arrest. Contrary to previous assumptions regarding an almost invariable association with death, at least 1/10 of them may awaken with reasonably good prognosis, if treated. Multimodal prognostication including clinical examination, EEG, somatosensory evoked potentials, biochemical markers, and neuroimaging help identifying patients with a chance to recover consciousness, in whom a trial with antimyoclonic compounds and at times general anesthetics is indicated. Summary: There is a continuous, albeit relatively slow progress in knowledge regarding different aspect of status epilepticus; recent findings refine some treatment strategies and help improving patients' outcomes. Further high-quality studies are clearly needed to further improve the management of these patients, especially those with severe, refractory status epilepticus forms.
MeSH term(s)	Anticonvulsants/therapeutic use ; Electroencephalography ; Humans ; Levetiracetam/therapeutic use ; Randomized Controlled Trials as Topic ; Status Epilepticus/diagnosis ; Status Epilepticus/drug therapy
Chemical Substances	Anticonvulsants ; Levetiracetam (44YRR34555)
Language	English
Publishing date	2021-03-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1182686-1
ISSN	1473-6551 ; 1350-7540
ISSN (online)	1473-6551
ISSN	1350-7540
DOI	10.1097/WCO.0000000000000899
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