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Article ; Online: Surgical Outcomes in Post-Traumatic Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis.

Ferreira, Liam D / Tabaeizadeh, Mohammad / Haneef, Zulfi

2023 Volume 41, Issue 3-4, Page(s) 319–330

Abstract: Epilepsy surgery provides excellent benefits in post-traumatic epilepsy of the temporal lobe (PTE-TL), but outcomes relative to non-traumatic epilepsy of the temporal lobe (NTE-TL) are less favorable. Large well-designed studies are recommended to ... ...

Abstract	Epilepsy surgery provides excellent benefits in post-traumatic epilepsy of the temporal lobe (PTE-TL), but outcomes relative to non-traumatic epilepsy of the temporal lobe (NTE-TL) are less favorable. Large well-designed studies are recommended to further clarify the role of epilepsy surgery in PTE. It is unclear whether epilepsy surgery outcomes in PTE are as robust as described for drug resistant epilepsy (DRE) in general. Prior outcome studies in PTE are limited by small numbers, lack of a control group, or both. We performed a meta-analysis of studies in temporal lobe epilepsy (TLE) to evaluate post-surgical outcomes in those with PTE-TL and compare outcomes to those with NTE-TL. PubMed, EMBASE, and Web of Science databases were queried for studies reporting epilepsy surgery outcomes separately for PTE-TL and NTE-TL. Outcomes were divided into favorable (Engel Class I) or unfavorable (Engel Class II-IV) for comparison. Meta-analyses were performed to evaluate: 1) the proportion of Class I outcomes following epilepsy surgery in PTE-TL; and 2) calculate the odds of Class I surgical outcomes in PTE-TL compared with NTE-TL. Of 3669 articles that reported surgical outcomes in epilepsy, nine studies (
MeSH term(s)	Humans ; Epilepsy, Temporal Lobe/surgery ; Epilepsy ; Drug Resistant Epilepsy ; Outcome Assessment, Health Care ; Treatment Outcome ; Retrospective Studies ; Epilepsy, Post-Traumatic
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0084
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Article ; Online: Anti-seizure medication treatment and outcomes in acute ischemic stroke patients undergoing continuous EEG monitoring.

Sanches, Paula R / Tabaeizadeh, Mohammad / Moura, Lidia M V R / Rosenthal, Eric S / Caboclo, Luis Otavio / Hsu, John / Patorno, Elisabetta / Westover, M Brandon / Zafar, Sahar F

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

2022 Volume 43, Issue 9, Page(s) 5441–5449

Abstract: Objectives: To determine the association of anti-seizure medication (ASM) treatment with outcomes in acute ischemic stroke (AIS) patients undergoing continuous electroencephalography (cEEG).: Methods: Retrospective analysis of AIS patients admitted ... ...

Abstract	Objectives: To determine the association of anti-seizure medication (ASM) treatment with outcomes in acute ischemic stroke (AIS) patients undergoing continuous electroencephalography (cEEG). Methods: Retrospective analysis of AIS patients admitted between 2012 and 2019. The following are the inclusion criteria: age ≥ 18 years and ≥ 16 h of cEEG within the first 7 days of admission. ASM treatment exposure was defined as > 48 h of treatment after the first 24 h of cEEG. The primary outcome measure was 90-day mortality, and the secondary outcome was 90-day functional recovery (Modified Ranking Scale 0-3). Propensity scores were used to adjust for baseline covariates and presence of epileptiform abnormalities (seizures, periodic and rhythmic patterns). Results: One hundred thirteen patients met the inclusion criteria; 39 (34.5%) were exposed to ASM. ASM treatment was not associated with 90-day mortality (propensity adjusted HR 1.0 [0.31-3.27], p = 0.999) or functional outcomes (adjusted HR 0.99 [0.32-3.02], p = 0.989), compared to no treatment. Conclusions: In our study, ASM treatment in AIS patients with cEEG abnormalities was not significantly associated with a change in 90-day mortality and functional recovery. Larger comparative effectiveness studies are indicated to identify which acute ischemic stroke patients with cEEG abnormalities benefit most from ASM treatment.
MeSH term(s)	Adolescent ; Electroencephalography ; Humans ; Ischemic Stroke ; Monitoring, Physiologic ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-06-17
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2016546-8
ISSN	1590-3478 ; 1590-1874
ISSN (online)	1590-3478
ISSN	1590-1874
DOI	10.1007/s10072-022-06183-9
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Zs.A 1877: Show issues

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Article ; Online: Rapid annotation of seizures and interictal-ictal-injury continuum EEG patterns.

Jing, Jin / d'Angremont, Emile / Ebrahim, Senan / Tabaeizadeh, Mohammad / Ng, Marcus / Herlopian, Aline / Dauwels, Justin / Brandon Westover, M

Journal of neuroscience methods

2020 Volume 347, Page(s) 108956

Abstract: Background: Manual annotation of seizures and interictal-ictal-injury continuum (IIIC) patterns in continuous EEG (cEEG) recorded from critically ill patients is a time-intensive process for clinicians and researchers. In this study, we evaluated the ... ...

Abstract	Background: Manual annotation of seizures and interictal-ictal-injury continuum (IIIC) patterns in continuous EEG (cEEG) recorded from critically ill patients is a time-intensive process for clinicians and researchers. In this study, we evaluated the accuracy and efficiency of an automated clustering method to accelerate expert annotation of cEEG. New method: We learned a local dictionary from 97 ICU patients by applying k-medoids clustering to 592 features in the time and frequency domains. We utilized changepoint detection (CPD) to segment the cEEG recordings. We then computed a bag-of-words (BoW) representation for each segment. We further clustered the segments by affinity propagation. EEG experts scored the resulting clusters for each patient by labeling only the cluster medoids. We trained a random forest classifier to assess validity of the clusters. Results: Mean pairwise agreement of 62.6% using this automated method was not significantly different from interrater agreements using manual labeling (63.8%), demonstrating the validity of the method. We also found that it takes experts using our method 5.31 ± 4.44 min to label the 30.19 ± 3.84 h of cEEG data, more than 45 times faster than unaided manual review, demonstrating efficiency. Comparison with existing methods: Previous studies of EEG data labeling have generally yielded similar human expert interrater agreements, and lower agreements with automated methods. Conclusions: Our results suggest that long EEG recordings can be rapidly annotated by experts many times faster than unaided manual review through the use of an advanced clustering method.
MeSH term(s)	Critical Illness ; Electroencephalography ; Humans ; Seizures/diagnosis
Language	English
Publishing date	2020-10-21
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	282721-9
ISSN	1872-678X ; 0165-0270
ISSN (online)	1872-678X
ISSN	0165-0270
DOI	10.1016/j.jneumeth.2020.108956
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Zs.A 1486: Show issues

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Article ; Online: Immunosuppressive Drugs, an Emerging Cause of Posterior Reversible Encephalopathy Syndrome: Case Series.

Harirchian, Mohammad Hossein / Ghaffarpour, Majid / Tabaeizadeh, Mohammad / Siroos, Bahaadin

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2015 Volume 24, Issue 8, Page(s) e191–5

Abstract: Background: Posterior reversible encephalopathy syndrome (PRES) is a well-recognized complication of hypertensive encephalopathy. Recently, pre-eclampsia, connective tissue disorders, and immunosuppressive drugs have been reported to be the etiologies ... ...

Abstract	Background: Posterior reversible encephalopathy syndrome (PRES) is a well-recognized complication of hypertensive encephalopathy. Recently, pre-eclampsia, connective tissue disorders, and immunosuppressive drugs have been reported to be the etiologies of this rare syndrome. Methods: We evaluated 9 cases of PRES whose diagnosis were confirmed based on clinical and radiologic evidence between July 2011 and December 2013 in a tertiary center, Imam Khomeini Hospital, Tehran, Iran. Results: Immunosuppressive drugs, especially cyclosporine, and hypertension were the main precipitating factors. In this study, seizure was the most common clinical presentation (100%), whereas other common clinical presentations were confusion (78%), visual loss (67%), and headaches (67%). With conservative management and elimination of predisposing factor, the patients improved gradually except for 2 cases who experienced prolonged recovery period because of delayed diagnosis. Conclusions: With timely diagnosis, PRES generally has a good prognosis with complete recovery. However, in missed conditions, it could be associated with catastrophic burden especially in organ transplantation after a prolonged time spending to find matched donors or in chronic immunosuppressive conditions. Thereupon, physicians should be aware of clinical and radiologic manifestations of this preventable but potentially disabling syndrome.
MeSH term(s)	Adolescent ; Adult ; Cyclosporine/adverse effects ; Female ; Humans ; Hypertension/complications ; Immunosuppressive Agents/adverse effects ; Male ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/chemically induced ; Posterior Leukoencephalopathy Syndrome/complications
Chemical Substances	Immunosuppressive Agents ; Cyclosporine (83HN0GTJ6D)
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2015.02.014
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Zs.A 3519: Show issues

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Article ; Online: Rapid Annotation of Seizures and Interictal-ictal Continuum EEG Patterns.

Jing, Jin / d’Angremont, Emile / Zafar, Sahar / Rosenthal, Eric S / Tabaeizadeh, Mohammad / Ebrahim, Senan / Dauwels, Justin / Westover, M Brandon

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2018 Volume 2018, Page(s) 3394–3397

Abstract: Seizures, status epilepticus, and seizure-like rhythmic or periodic activities are common, pathological, harmful states of brain electrical activity seen in the electroencephalogram (EEG) of patients during critical medical illnesses or acute brain ... ...

Abstract	Seizures, status epilepticus, and seizure-like rhythmic or periodic activities are common, pathological, harmful states of brain electrical activity seen in the electroencephalogram (EEG) of patients during critical medical illnesses or acute brain injury. Accumulating evidence shows that these states, when prolonged, cause neurological injury. In this study we developed a valid method to automatically discover a small number of homogeneous pattern clusters, to facilitate efficient interactive labelling by EEG experts. 592 time domain and spectral features were extracted from continuous EEG (cEEG) data of 369 ICU (intensive care unit) patients. For each patient, feature dimensionality was reduced using principal component analysis (PCA), retaining 95% of the variance. K-medoids clustering was applied to learn a local dictionary from each patient, consisting of k=100 exemplars/words. Changepoint detection (CPD) was utilized to break each EEG into segments. A bag-of-words (BoW) representation was computed for each segment, specifically, a normalized histogram of the words found within each segment. Segments were further clustered using the BoW histograms by Affinity Propagation (AP) using a χ
MeSH term(s)	Critical Illness ; Electroencephalography ; Humans ; Intensive Care Units ; Seizures
Language	English
Publishing date	2018-11-02
Publishing country	United States
Document type	Journal Article
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC.2018.8513059
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Article ; Online: Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction.

Struck, Aaron F / Tabaeizadeh, Mohammad / Schmitt, Sarah E / Ruiz, Andres Rodriguez / Swisher, Christa B / Subramaniam, Thanujaa / Hernandez, Christian / Kaleem, Safa / Haider, Hiba A / Cissé, Abbas Fodé / Dhakar, Monica B / Hirsch, Lawrence J / Rosenthal, Eric S / Zafar, Sahar F / Gaspard, Nicholas / Westover, M Brandon

JAMA neurology

2020 Volume 77, Issue 4, Page(s) 500–507

Abstract: Importance: Seizure risk stratification is needed to boost inpatient seizure detection and to improve continuous electroencephalogram (cEEG) cost-effectiveness. 2HELPS2B can address this need but requires validation.: Objective: To use an independent ...

Abstract	Importance: Seizure risk stratification is needed to boost inpatient seizure detection and to improve continuous electroencephalogram (cEEG) cost-effectiveness. 2HELPS2B can address this need but requires validation. Objective: To use an independent cohort to validate the 2HELPS2B score and develop a practical guide for its use. Design, setting, and participants: This multicenter retrospective medical record review analyzed clinical and EEG data from patients 18 years or older with a clinical indication for cEEG and an EEG duration of 12 hours or longer who were receiving consecutive cEEG at 6 centers from January 2012 to January 2019. 2HELPS2B was evaluated with the validation cohort using the mean calibration error (CAL), a measure of the difference between prediction and actual results. A Kaplan-Meier survival analysis was used to determine the duration of EEG monitoring to achieve a seizure risk of less than 5% based on the 2HELPS2B score calculated on first- hour (screening) EEG. Participants undergoing elective epilepsy monitoring and those who had experienced cardiac arrest were excluded. No participants who met the inclusion criteria were excluded. Main outcomes and measures: The main outcome was a CAL error of less than 5% in the validation cohort. Results: The study included 2111 participants (median age, 51 years; 1113 men [52.7%]; median EEG duration, 48 hours) and the primary outcome was met with a validation cohort CAL error of 4.0% compared with a CAL of 2.7% in the foundational cohort (P = .13). For the 2HELPS2B score calculated on only the first hour of EEG in those without seizures during that hour, the CAL error remained at less than 5.0% at 4.2% and allowed for stratifying patients into low- (2HELPS2B = 0; <5% risk of seizures), medium- (2HELPS2B = 1; 12% risk of seizures), and high-risk (2HELPS2B, ≥2; risk of seizures, >25%) groups. Each of the categories had an associated minimum recommended duration of EEG monitoring to achieve at least a less than 5% risk of seizures, a 2HELPS2B score of 0 at 1-hour screening EEG, a 2HELPS2B score of 1 at 12 hours, and a 2HELPS2B score of 2 or greater at 24 hours. Conclusions and relevance: In this study, 2HELPS2B was validated as a clinical tool to aid in seizure detection, clinical communication, and cEEG use in hospitalized patients. In patients without prior clinical seizures, a screening 1-hour EEG that showed no epileptiform findings was an adequate screen. In patients with any highly epileptiform EEG patterns during the first hour of EEG (ie, a 2HELPS2B score of ≥2), at least 24 hours of recording is recommended.
MeSH term(s)	Adult ; Brain/physiopathology ; Electroencephalography ; Female ; Humans ; Inpatients ; Male ; Middle Aged ; Monitoring, Physiologic ; Retrospective Studies ; Risk Assessment ; Seizures/diagnosis ; Seizures/physiopathology
Language	English
Publishing date	2020-01-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Validation Study
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2019.4656
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Article ; Online: Burden of Epileptiform Activity Predicts Discharge Neurologic Outcomes in Severe Acute Ischemic Stroke.

Tabaeizadeh, Mohammad / Aboul Nour, Hassan / Shoukat, Maryum / Sun, Haoqi / Jin, Jing / Javed, Farrukh / Kassa, Solomon / Edhi, Muhammad / Bordbar, Elahe / Gallagher, Justin / Moura, Valdery Junior / Ghanta, Manohar / Shao, Yu-Ping / Cole, Andrew J / Rosenthal, Eric S / Westover, M Brandon / Zafar, Sahar F

Neurocritical care

2020 Volume 32, Issue 3, Page(s) 697–706

Abstract: Background/objectives: Clinical seizures following acute ischemic stroke (AIS) appear to contribute to worse neurologic outcomes. However, the effect of electrographic epileptiform abnormalities (EAs) more broadly is less clear. Here, we evaluate the ... ...

Abstract	Background/objectives: Clinical seizures following acute ischemic stroke (AIS) appear to contribute to worse neurologic outcomes. However, the effect of electrographic epileptiform abnormalities (EAs) more broadly is less clear. Here, we evaluate the impact of EAs, including electrographic seizures and periodic and rhythmic patterns, on outcomes in patients with AIS. Methods: This is a retrospective study of all patients with AIS aged ≥ 18 years who underwent at least 18 h of continuous electroencephalogram (EEG) monitoring at a single center between 2012 and 2017. EAs were classified according to American Clinical Neurophysiology Society (ACNS) nomenclature and included seizures and periodic and rhythmic patterns. EA burden for each 24-h epoch was defined using the following cutoffs: EA presence, maximum daily burden < 10% versus > 10%, maximum daily burden < 50% versus > 50%, and maximum daily burden using categories from ACNS nomenclature ("rare" < 1%; "occasional" 1-9%; "frequent" 10-49%; "abundant" 50-89%; "continuous" > 90%). Maximum EA frequency for each epoch was dichotomized into ≥ 1.5 Hz versus < 1.5 Hz. Poor neurologic outcome was defined as a modified Rankin Scale score of 4-6 (vs. 0-3 as good outcome) at hospital discharge. Results: One hundred and forty-three patients met study inclusion criteria. Sixty-seven patients (46.9%) had EAs. One hundred and twenty-four patients (86.7%) had poor outcome. On univariate analysis, the presence of EAs (OR 3.87 [1.27-11.71], p = 0.024) and maximum daily burden > 10% (OR 12.34 [2.34-210], p = 0.001) and > 50% (OR 8.26 [1.34-122], p = 0.035) were associated with worse outcomes. On multivariate analysis, after adjusting for clinical covariates (age, gender, NIHSS, APACHE II, stroke location, stroke treatment, hemorrhagic transformation, Charlson comorbidity index, history of epilepsy), EA presence (OR 5.78 [1.36-24.56], p = 0.017), maximum daily burden > 10% (OR 23.69 [2.43-230.7], p = 0.006), and maximum daily burden > 50% (OR 9.34 [1.01-86.72], p = 0.049) were associated with worse outcomes. After adjusting for covariates, we also found a dose-dependent association between increasing EA burden and increasing probability of poor outcomes (OR 1.89 [1.18-3.03] p = 0.009). We did not find an independent association between EA frequency and outcomes (OR: 4.43 [.98-20.03] p = 0.053). However, the combined effect of increasing EA burden and frequency ≥ 1.5 Hz (EA burden * frequency) was significantly associated with worse outcomes (OR 1.64 [1.03-2.63] p = 0.039). Conclusions: Electrographic seizures and periodic and rhythmic patterns in patients with AIS are associated with worse outcomes in a dose-dependent manner. Future studies are needed to assess whether treatment of this EEG activity can improve outcomes.
MeSH term(s)	Aged ; Brain/physiopathology ; Electroencephalography ; Female ; Functional Status ; Humans ; Ischemic Stroke/physiopathology ; Ischemic Stroke/therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Seizures/physiopathology ; Thrombectomy ; Thrombolytic Therapy
Language	English
Publishing date	2020-04-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2381896-7
ISSN	1556-0961 ; 1541-6933
ISSN (online)	1556-0961
ISSN	1541-6933
DOI	10.1007/s12028-020-00944-0
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Article ; Online: Automated Annotation of Epileptiform Burden and Its Association with Outcomes.

Annals of neurology

2021 Volume 90, Issue 2, Page(s) 300–311

Abstract: Objective: This study was undertaken to determine the dose-response relation between epileptiform activity burden and outcomes in acutely ill patients.: Methods: A single center retrospective analysis was made of 1,967 neurologic, medical, and ... ...

Abstract	Objective: This study was undertaken to determine the dose-response relation between epileptiform activity burden and outcomes in acutely ill patients. Methods: A single center retrospective analysis was made of 1,967 neurologic, medical, and surgical patients who underwent >16 hours of continuous electroencephalography (EEG) between 2011 and 2017. We developed an artificial intelligence algorithm to annotate 11.02 terabytes of EEG and quantify epileptiform activity burden within 72 hours of recording. We evaluated burden (1) in the first 24 hours of recording, (2) in the 12-hours epoch with highest burden (peak burden), and (3) cumulatively through the first 72 hours of monitoring. Machine learning was applied to estimate the effect of epileptiform burden on outcome. Outcome measure was discharge modified Rankin Scale, dichotomized as good (0-4) versus poor (5-6). Results: Peak epileptiform burden was independently associated with poor outcomes (p < 0.0001). Other independent associations included age, Acute Physiology and Chronic Health Evaluation II score, seizure on presentation, and diagnosis of hypoxic-ischemic encephalopathy. Model calibration error was calculated across 3 strata based on the time interval between last EEG measurement (up to 72 hours of monitoring) and discharge: (1) <5 days between last measurement and discharge, 0.0941 (95% confidence interval [CI] = 0.0706-0.1191); 5 to 10 days between last measurement and discharge, 0.0946 (95% CI = 0.0631-0.1290); >10 days between last measurement and discharge, 0.0998 (95% CI = 0.0698-0.1335). After adjusting for covariates, increase in peak epileptiform activity burden from 0 to 100% increased the probability of poor outcome by 35%. Interpretation: Automated measurement of peak epileptiform activity burden affords a convenient, consistent, and quantifiable target for future multicenter randomized trials investigating whether suppressing epileptiform activity improves outcomes. ANN NEUROL 2021;90:300-311.
MeSH term(s)	Aged ; Artificial Intelligence ; Cohort Studies ; Cost of Illness ; Electroencephalography/methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Seizures/diagnosis ; Seizures/physiopathology ; Treatment Outcome
Language	English
Publishing date	2021-07-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80362-5
ISSN	1531-8249 ; 0364-5134
ISSN (online)	1531-8249
ISSN	0364-5134
DOI	10.1002/ana.26161
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Article ; Online: Burst Suppression: Causes and Effects on Mortality in Critical Illness.

Hogan, Jacob / Sun, Haoqi / Aboul Nour, Hassan / Jing, Jin / Tabaeizadeh, Mohammad / Shoukat, Maryum / Javed, Farrukh / Kassa, Solomon / Edhi, Muhammad M / Bordbar, Elahe / Gallagher, Justin / Junior, Valdery Moura / Ghanta, Manohar / Shao, Yu-Ping / Akeju, Oluwaseun / Cole, Andrew J / Rosenthal, Eric S / Zafar, Sahar / Westover, M Brandon

Neurocritical care

2020 Volume 33, Issue 2, Page(s) 565–574

Abstract: Background: Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst ... ...

Abstract	Background: Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst suppression, propofol, and critical illness to mortality; and whether preventing burst suppression might reduce mortality, have not been quantified. Methods: The dataset contains 471 adults from seven ICUs, after excluding anoxic encephalopathy due to cardiac arrest or intentional burst suppression for therapeutic reasons. We used multiple prediction and causal inference methods to estimate the effects connecting burst suppression, propofol, critical illness, and in-hospital mortality in an observational retrospective study. We also estimated the effects mediated by burst suppression. Sensitivity analysis was used to assess for unmeasured confounding. Results: The expected outcomes in a "counterfactual" randomized controlled trial (cRCT) that assigned patients to mild versus severe illness are expected to show a difference in burst suppression burden of 39%, 95% CI [8-66]%, and in mortality of 35% [29-41]%. Assigning patients to maximal (100%) burst suppression burden is expected to increase mortality by 12% [7-17]% compared to 0% burden. Burst suppression mediates 10% [2-21]% of the effect of critical illness on mortality. A high cumulative propofol dose (1316 mg/kg) is expected to increase burst suppression burden by 6% [0.8-12]% compared to a low dose (284 mg/kg). Propofol exposure has no significant direct effect on mortality; its effect is entirely mediated through burst suppression. Conclusions: Our analysis clarifies how important factors contribute to mortality in ICU patients. Burst suppression appears to contribute to mortality but is primarily an effect of critical illness rather than iatrogenic use of propofol.
MeSH term(s)	Adult ; Critical Care ; Critical Illness ; Humans ; Intensive Care Units ; Propofol/adverse effects ; Respiration, Artificial ; Retrospective Studies
Chemical Substances	Propofol (YI7VU623SF)
Language	English
Publishing date	2020-02-24
Publishing country	United States
Document type	Journal Article ; Observational Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2381896-7
ISSN	1556-0961 ; 1541-6933
ISSN (online)	1556-0961
ISSN	1541-6933
DOI	10.1007/s12028-020-00932-4
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Article ; Online: Development of Expert-Level Classification of Seizures and Rhythmic and Periodic Patterns During EEG Interpretation.

Jing, Jin / Ge, Wendong / Hong, Shenda / Fernandes, Marta Bento / Lin, Zhen / Yang, Chaoqi / An, Sungtae / Struck, Aaron F / Herlopian, Aline / Karakis, Ioannis / Halford, Jonathan J / Ng, Marcus C / Johnson, Emily L / Appavu, Brian L / Sarkis, Rani A / Osman, Gamaleldin / Kaplan, Peter W / Dhakar, Monica B / Arcot Jayagopal, Lakshman /

Sheikh, Zubeda / Taraschenko, Olga / Schmitt, Sarah / Haider, Hiba A / Kim, Jennifer A / Swisher, Christa B / Gaspard, Nicolas / Cervenka, Mackenzie C / Rodriguez Ruiz, Andres A / Lee, Jong Woo / Tabaeizadeh, Mohammad / Gilmore, Emily J / Nordstrom, Kristy / Yoo, Ji Yeoun / Holmes, Manisha G / Herman, Susan T / Williams, Jennifer A / Pathmanathan, Jay / Nascimento, Fábio A / Fan, Ziwei / Nasiri, Samaneh / Shafi, Mouhsin M / Cash, Sydney S / Hoch, Daniel B / Cole, Andrew J / Rosenthal, Eric S / Zafar, Sahar F / Sun, Jimeng / Westover, M Brandon

Neurology

2023 Volume 100, Issue 17, Page(s) e1750–e1762

Abstract: Background and objectives: Seizures (SZs) and other SZ-like patterns of brain activity can harm the brain and contribute to in-hospital death, particularly when prolonged. However, experts qualified to interpret EEG data are scarce. Prior attempts to ... ...

Abstract	Background and objectives: Seizures (SZs) and other SZ-like patterns of brain activity can harm the brain and contribute to in-hospital death, particularly when prolonged. However, experts qualified to interpret EEG data are scarce. Prior attempts to automate this task have been limited by small or inadequately labeled samples and have not convincingly demonstrated generalizable expert-level performance. There exists a critical unmet need for an automated method to classify SZs and other SZ-like events with expert-level reliability. This study was conducted to develop and validate a computer algorithm that matches the reliability and accuracy of experts in identifying SZs and SZ-like events, known as "ictal-interictal-injury continuum" (IIIC) patterns on EEG, including SZs, lateralized and generalized periodic discharges (LPD, GPD), and lateralized and generalized rhythmic delta activity (LRDA, GRDA), and in differentiating these patterns from non-IIIC patterns. Methods: We used 6,095 scalp EEGs from 2,711 patients with and without IIIC events to train a deep neural network, Results: SPaRCNet Discussion: SPaRCNet Classification of evidence: This study provides Class II evidence that among patients with epilepsy or critical illness undergoing EEG monitoring,
MeSH term(s)	Humans ; Reproducibility of Results ; Hospital Mortality ; Seizures ; Electroencephalography/methods ; Epilepsy/diagnosis
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000207127
Database	MEDical Literature Analysis and Retrieval System OnLINE

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