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

Epilepsia, Год журнала: 2025, Номер unknown

Опубликована: Апрель 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.

Язык: Английский

---

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, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

Язык: Английский

---

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

Resuscitation, Год журнала: 2025, Номер unknown, С. 110608 - 110608

Опубликована: Апрель 1, 2025

Язык: Английский

---

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

Nature Medicine, Год журнала: 2024, Номер 30(8), С. 2349 - 2355

Опубликована: Май 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 .

Язык: Английский

---

Reconstructing Covert Consciousness

Neurology, Год журнала: 2025, Номер 104(4)

Опубликована: Янв. 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.

Язык: Английский

---

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

Neurology Clinical Practice, Год журнала: 2024, Номер 14(6)

Опубликована: Авг. 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.

Язык: Английский

---

Covert Consciousness in the ICU

Critical Care Medicine, Год журнала: 2024, Номер 52(9), С. 1414 - 1426

Опубликована: Авг. 15, 2024

OBJECTIVES: For critically ill patients with acute severe brain injuries, consciousness may reemerge before behavioral responsiveness. The phenomenon of covert (i.e., cognitive motor dissociation) be detected by advanced neurotechnologies such as task-based functional MRI (fMRI) and electroencephalography (EEG) in who appear unresponsive on the bedside examination. In this narrative review, we summarize state-of-the-science ICU detection consciousness. Further, consider prognostic therapeutic implications diagnosing ICU, well its potential to inform discussions about continuation life-sustaining therapy for injuries. DATA SOURCES: We reviewed salient medical literature regarding STUDY SELECTION: included clinical studies investigating diagnostic performance characteristics utility fMRI EEG. focus guidelines, professional society scientific statements, neuroethical analyses pertaining implementation detect EXTRACTION AND SYNTHESIS: extracted study results, guideline recommendations, statement recommendations diagnostic, prognostic, relevance care CONCLUSIONS: Emerging evidence indicates that is present approximately 15–20% Covert traumatic nontraumatic including whose examination suggests a comatose state. presence predict pace extent long-term recovery. Professional guidelines now recommend assessment using However, criteria patient selection investigations are uncertain global access limited.

Язык: Английский

---

Neurologic prognostication in coma and disorders of consciousness

Handbook of clinical neurology, Год журнала: 2025, Номер unknown, С. 237 - 264

Опубликована: Янв. 1, 2025

Язык: Английский

---

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

Chaos Solitons & Fractals, Год журнала: 2025, Номер 194, С. 116219 - 116219

Опубликована: Фев. 28, 2025

Язык: Английский

---

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

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown

Опубликована: Март 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.

Язык: Английский

---