Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: April 23, 2025

Abstract The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon framework established in 2017. This revision, informed by implementation experience, involved a working group appointed ILAE Executive Committee. Comprising 37 members from all regions, utilized modified Delphi process, requiring consensus threshold more than two thirds for any proposal. Following public comments, Committee seven additional experts to revision task force address and incorporate issues raised, as appropriate. maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), Unclassified. Taxonomic rules distinguish classifiers, which are considered reflect biological classes directly impact clinical management, descriptors, indicate other important characteristics. Focal seizures those unknown origin further classified patient's state consciousness (impaired preserved) during seizure, defined operationally through assessment awareness responsiveness. If is undetermined, under parent term, that is, class (focal origin). Generalized grouped into absence generalized tonic–clonic now including recognition negative myoclonus type. Seizures described basic version with without observable manifestations, whereas an expanded utilizes chronological sequence semiology. comprises 21 types. Special emphasis was placed on ensuring translatability languages beyond English. Its aim establish common language health care professionals epilepsy care, resource‐limited areas highly specialized centers, provide accessible terms patients caregivers.

Language: Английский

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Decisions to withdraw or withhold life-sustaining therapies in patients with and without acute brain injury: a secondary analysis of two prospective cohort studies

The Lancet Respiratory Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Language: Английский

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Multimodal assessment improves neuroprognosis performance in clinically unresponsive critical-care patients with brain injury

Nature Medicine, Journal Year: 2024, Volume and Issue: 30(8), P. 2349 - 2355

Published: May 30, 2024

Abstract Accurately predicting functional outcomes for unresponsive patients with acute brain injury is a medical, scientific and ethical challenge. This prospective study assesses how multimodal approach combining various numbers of behavioral, neuroimaging electrophysiological markers affects the performance outcome predictions. We analyzed data from 349 admitted to tertiary neurointensive care unit between 2009 2021, categorizing prognoses as good, uncertain or poor, compared these predictions observed using Glasgow Outcome Scale–Extended (GOS-E, levels ranging 1 8, higher indicating better outcomes). After excluding cases life-sustaining therapy withdrawal mitigate self-fulfilling prophecy bias, our findings reveal that good prognosis, poor one, associated one-year (common odds ratio (95% CI) GOS-E: OR = 14.57 (5.70–40.32), P < 0.001; 2.9 (1.56–5.45), 0.001, respectively). Moreover, increasing number assessment modalities decreased uncertainty (OR 0.35 (0.21–0.59), 0.001) improved prognostic accuracy 2.72 (1.18–6.47), 0.011). Our results underscore value in refining neuroprognostic precision, thereby offering robust foundation clinical decision-making processes acutely brain-injured patients. ClinicalTrials.gov registration: NCT04534777 .

Language: Английский

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Reconstructing Covert Consciousness

Neurology, Journal Year: 2025, Volume and Issue: 104(4)

Published: Jan. 30, 2025

Determining the level of consciousness in patients with brain injury-and more fundamentally, establishing what they can experience-is ethically and clinically impactful. Patient behaviors may unreliably reflect their consciousness: a subset unresponsive demonstrate covert by willfully modulating activity to commands through fMRI or EEG. However, current paradigms for assessing remain fundamentally limited because are insensitive, rely on imperfect assumptions functional neuroanatomy, do not spectrum conscious experience. Neural decoding, which stimuli concepts reconstructed from activity, offers novel approach assessment that overcomes many these limitations. In this article, we discuss state assessments, shortcomings, science neural potential application decoding disorders consciousness, future directions help realize potential. To so, searched PubMed Google Scholar databases pertinent articles published between January 1990 September 2024, using search terms "covert consciousness," "cognitive motor dissociation," "neural decoding," "semantic decoding." Redefining improve sensitivity, enhance granularity, directly address question experience after injury.

Language: Английский

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Histopathological patterns of hypoxic-ischemic encephalopathy after cardiac arrest: A retrospective brain autopsy study of 319 patients

Resuscitation, Journal Year: 2025, Volume and Issue: unknown, P. 110608 - 110608

Published: April 1, 2025

Language: Английский

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The Recovery of Consciousness via Evidence-Based Medicine and Research (RECOVER) Program

Neurology Clinical Practice, Journal Year: 2024, Volume and Issue: 14(6)

Published: Aug. 16, 2024

Neuroprognostication for disorders of consciousness (DoC) after severe acute brain injury is a major challenge, and the conventional clinical approach struggles to keep pace with rapidly evolving literature. Lacking specialization, fragmented between providers, neuroprognostication variable, frequently incongruent guidelines, prone error, contributing avoidable mortality morbidity.

Language: Английский

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Neurologic prognostication in coma and disorders of consciousness

Handbook of clinical neurology, Journal Year: 2025, Volume and Issue: unknown, P. 237 - 264

Published: Jan. 1, 2025

Language: Английский

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A parameter estimation method for neural mass model based on the improved chimp optimization algorithm and Riemannian geometry

Chaos Solitons & Fractals, Journal Year: 2025, Volume and Issue: 194, P. 116219 - 116219

Published: Feb. 28, 2025

Language: Английский

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Acute biomarkers of consciousness are associated with recovery after severe traumatic brain injury

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: March 5, 2025

Abstract Objective Determine whether acute behavioral, electroencephalography (EEG), and functional MRI (fMRI) biomarkers of consciousness are associated with outcome after severe traumatic brain injury (TBI). Methods Patients TBI admitted consecutively to the intensive care unit (ICU) participated in a multimodal battery assessing behavioral level (Coma Recovery Scale-Revised [CRS-R]), cognitive motor dissociation (CMD; task-based EEG fMRI), covert cortical processing (CCP; stimulus-based default mode network connectivity (DMN; resting-state fMRI). The primary was 6-month Disability Rating Scale (DRS) total scores. Results We enrolled 55 patients TBI. Six-month available 45 (45.2±20.7 years old, 70% male), whom 10 died, all due withdrawal life-sustaining treatment (WLST). Behavioral presence command-following ICU were each lower (i.e., better) DRS scores (p=0.003, p=0.011). fMRI did not strengthen this relationship, but higher DMN better recovery on multiple secondary measures. In subsample participants without CRS-R, CMD (EEG:18%; fMRI:33%) CCP (EEG:91%; fMRI:79%) outcome, an unexpected result that may reflect high rate WLST. However, (ρ[95%CI]=-0.41[-0.707, -0.027]; p=0.046) group. Interpretation Standardized assessment improve prediction from Further research is required determine integrating EEG, more predictive than alone.

Language: Английский

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Implementation of a specialized neuroprognostication consultation program and associated provider attitudes: A survey-based study

Resuscitation Plus, Journal Year: 2025, Volume and Issue: unknown, P. 100932 - 100932

Published: March 1, 2025

Neuroprognostication for disorders of consciousness, particularly after cardiac arrest, is critical. However rapidly evolving research has translated little to clinical practice, with neuroprognostication frequently deviating from evidence and guidelines. We implemented a novel program that provides specialized, interdisciplinary, longitudinal care improve the practice neuroprognostication. The objective this study was evaluate impact on provider attitudes satisfaction towards arrest. disseminated surveys across our health system critical providers neurologists in years before (2021, 2022) (2023) implementation program. assessed perceptions of, with, used Fisher exact tests compare program-exposed respondents historical controls (2021 2022 respondents) contemporary (2023 without exposure). received 545 responses providers, including nurses, trainees, attendings. Program-exposed respondents, relative respectively, reported greater usefulness (94% reporting often or always useful, versus 69% [p < 0.01]) 68% 0.01]), comprehensiveness comprehensive, 76% = 0.02] 66% neuroprognostication, comparison conventional model (63% "much better"). Implementation specialized associated largely favorable among providers. These findings encourage further paradigm, consideration broader adoption

Language: Английский

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