Richard Choi, DO, FNCS

@HopkinsNCCU
@PulmCrit
@drdangayach
@neurochristiana
@nirmalregency
@interneurona
@MicieliA_MD
@mettermd
@oneDRwoman_

@a_charidimou
@EricLawson90
@CajalButterfly
@Capt_Ammonia
@DrAtulRamesh1
@RamaniBalu1
@DSandsmarkMDPhD
@PennNeurology
@TJUHNeuroCrit
@namorrismd
@ShadiYaghi2
@MDNeurocritcare

End/ What are your thoughts on this #neurocritcare? Do you do research on #DoC?

Comments always welcome

#CuringComa

@neurocritcarej
@swarnarmd
@aartisarwal
@alyssafloseldes
@caseyalbin
@JimmySuhMD
@JimSiegler
@medinariojaMD

11/ So clearly there is still much work that needs to be done in this area. The creation of a common consent elements for research is much needed and future research should ensure that these are used in consent forms! This is critical for #CuringComa

10/ Something else the authors discovered is that some promises may have been overpromising on the potential benefits to the subject and that caution must be exercised to avoid misconceptions of benefit

9/ Only 9% offered education or emotional support and only a minority discussed capacity evaluation if a patient were to regain consciousness and only a few included language for the person with #DoC with language specifying how it occurred and that they can unenroll

8/ Of studies with interventions, only 6% addressed limited understanding of risk given inability to understand this in this pt population and only 13% acknowledged risk of transport if neuroimaging was involved

7/ What was very interesting is that there were 6️⃣2️⃣ different terms used for #DoC including coma, DoC, unresponsive wakefulness, cute brain injury, unconscious… List goes on and on

6/ Authors were able to include 43 separate consent forms from all different types of studies out of which:
👉1/2 included an intervention
👉1/4 provided compensation
👉1/3 did not involve minimal risk

5/ Each consent form was reviewed by 2 randomly assigned reviewers and information was gathered including how the consent process worked and unique considerations such as:
👉 terminology
👉capacity
👉vulnerability
👉injury
👉education

4/ So how are we doing at present? That is what the authors set out to find out. Consents from prior studies were requested from the Curing Coma Campaign list serve in addition to a search of clinical studies

Ethics Along the Continuum of Research Involving Persons with Disorders of Consciousness Neurocritical Care - Interest in disorders of consciousness (DoC) has grown substantially over the past decade and has illuminated the importance of improving understanding of DoC biology; care...

3/ Ethical considerations in pts w/ #DOC include:
👉 Autonomy and respect for persons
👉 Balance of risks versus benefits
👉 Disclosure of results
👉 Justice and equity
These were previously described in this publication:

2/ The @neurocritical has dedicated resources to the promise of #CuringComa. Studying #DOC or disorders of consciousness is crucial to these efforts. However, how we do this matters.

Informed Consent Practices in Research Involving Persons with Disorders of Consciousness Neurocritical Care - The Curing Coma Campaign Ethics Working Group sought to understand informed consent practices for research involving persons with disorders of consciousness (DoC) to establish...

1/ 👋 there #neurotwitter #neurosky #neurocritcare, as part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/ar... about consent in research involving #DOC

@HopkinsNCCU
@PulmCrit
@drdangayach
@neurochristiana
@nirmalregency
@interneurona
@MicieliA_MD
@mettermd
@oneDRwoman_

@a_charidimou
@EricLawson90
@CajalButterfly
@Capt_Ammonia
@DrAtulRamesh1
@RamaniBalu1
@DSandsmarkMDPhD
@PennNeurology
@TJUHNeuroCrit
@namorrismd
@ShadiYaghi2
@MDNeurocritcare

End/ What are your thoughts on this #neurocritcare? Does this in combination with the 🍑 trial make you want to reconsider #ASM as #SeizureProphylaxis in #ICH?

@neurocritcarej
@swarnarmd
@aartisarwal
@alyssafloseldes
@caseyalbin
@JimmySuhMD
@JimSiegler
@medinariojaMD

6/ So overall, while #SeizureProphylaxis definitely made a dent on seizure frequency, the overall frequency of seizures was low

This data must be also viewed under the fact that this was a non randomized trial and #ASM use was at provider discretion

5/ Interesting findings:

👉About 1/5 patients with Lobar ICH had seizure

👉While #ASM prophylaxis ⬇️ sz frequency, age or hematoma size were NOT predictive of sz

👉5/11 patients with status were on #ASM

👉#SeizureProphylaxis did not appear to affect outcome at 3 months

4/ 300 patients from this 900 patient cohort had #LobarICH & were included, of which 143 pts got #SeizureProphylaxis

43 pts developed seizures, and 2 went into convulsive status and 11 into non-convulsive status, and all except 1 had a seizure within the first 7 days

3/ In this paper, the authors set to answer the question of whether #SeizureProphylaxis may be beneficial in some by retrospectively reviewing a prospectively collected cohort of #LobarICH patients, and more specifically its use to reduce early seizures (within 7 days)

2/ Do you routinely add #SeizureProphylaxis to #ICH patients?

Currently, the guidelines do not endorse this practice due to unclear benefit with some evidence of adverse effects (worse cognitive outcome) (Pic from AHA ICH 2022 guidelines)

Prophylactic Antiseizure Medication in Patients with Lobar Intracerebral Hemorrhage Neurocritical Care - Early seizures are a common complication after acute intracerebral hemorrhage (ICH). We tested the hypothesis of whether prophylactic antiseizure medication is associated with...

1/ 👋 there #neurotwitter #neurosky #neurocritcare, as part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/ar...

about #SeizureProphylaxis in #ICH

@namorrismd
@ShadiYaghi2
@MDNeurocritcare
@HopkinsNCCU
@PulmCrit
@drdangayach
@neurochristiana
@nirmalregency
@interneurona
@MicieliA_MD
@mettermd
@oneDRwoman_

@JimSiegler
@medinariojaMD
@a_charidimou
@EricLawson90
@CajalButterfly
@Capt_Ammonia
@DrAtulRamesh1
@RamaniBalu1
@DSandsmarkMDPhD
@PennNeurology
@TJUHNeuroCrit

End/ 🎩 off to the authors for this very exciting study, demonstrating proof of concept. What are your thoughts on this #neurocritcare? Will you ask your neurosurgery colleagues to try this?

@neurocritcarej
@swarnarmd
@aartisarwal
@alyssafloseldes
@caseyalbin
@JimmySuhMD

9/ The strength of the prognostication ability of infratentorial pressure held in multivariate logistic regression and the authors developed the #AIICS scoring system:

🤯 Age + 4(mean infratentorial pressure)

8/ 2 MAJOR findings:
👉 Supra- and Infra-tentorial pressures were different and infra was significantly ⬆️
👉Infratentorial pressures were significantly higher in those with poor outcome whereas supratentorial pressures did not

7/ In 🏥 ☠️ was 25% and at discharge, 51.4% had mRS 3-6 which remained relatively stable at 6 months

The complications associated with this were minor, involving some infection, probe displacement or malfunction or need to return to OR

6/ Outcomes were assessed at discharge and 6 months and good outcome was defined as mRS 0-2.

Authors enrolled 35 patients, 26 of whom had #ICH with a median age of 67.7 and 40% were 🚺

Median GCS on admission was 10, mean cerebellar lesion volume was 34.6mL