Papers by Jeanne Teitelbaum
Journal of pediatric neurology, Jun 2, 2017
Our goal was to perform a scoping systematic review of the literature on the use of intravenous i... more Our goal was to perform a scoping systematic review of the literature on the use of intravenous immunoglobulins (IVIG) for refractory status epilepticus (RSE) in adults. Method: Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to May 2016), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Twenty-four original articles were identified. A total of 33 adult patients were described as receiving IVIG for RSE. Seizure reduction/control with IVIG occurred in 15 of the 33 patients (45.4%), with 1 (3.0%) and 14 (42.4%) displaying partial and complete responses respectively. No adverse events were recorded. Conclusion: Oxford level 4, GRADE D evidence exists to suggest an unclear impact of IVIG therapy in adult RSE. Routine use of IVIG in adult RSE cannot be recommended at this time.
Canadian Journal of Neurological Sciences, May 1, 2015
Epilepsy Research and Treatment, Nov 22, 2015
Background. Our goal was to perform a systematic review on the use of repetitive transcranial mag... more Background. Our goal was to perform a systematic review on the use of repetitive transcranial magnetic stimulation (rTMS) in the treatment of status epilepticus (SE) and refractory status epilepticus (RSE). Methods. MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to August 2015), and gray literature were searched. The strength of evidence was adjudicated using Oxford and GRADE methodology. Results. We identified 11 original articles. Twenty-one patients were described, with 13 adult and 8 pediatric. All studies were retrospective. Seizure reduction/control with rTMS occurred in 15 of the 21 patients (71.4%), with 5 (23.8%) and 10 (47.6%) displaying partial and complete responses, respectively. Seizures recurred after rTMS in 73.3% of the patients who had initially responded. All studies were an Oxford level 4, GRADE D level of evidence. Conclusions. Oxford level 4, GRADE D evidence exists to suggest a potential impact on seizure control with the use of rTMS for FSE and FRSE, though durability of the therapy is short-lived. Routine use of rTMS in this context cannot be recommended at this time. Further prospective study of this intervention is warranted.
Seizure-european Journal of Epilepsy, Dec 1, 2016
Canadian Medical Association Journal, Mar 14, 2006
Canadian Journal of Neurological Sciences, Jun 1, 2022
Journal of Critical Care, Aug 1, 2016
Financial support No financial support was required in order to perform this review. Reprints No ... more Financial support No financial support was required in order to perform this review. Reprints No reprints are required.
Seizure-european Journal of Epilepsy, Dec 1, 2016
Seizure-european Journal of Epilepsy, Feb 1, 2016
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
ABSTRACT:Introduction:Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoi... more ABSTRACT:Introduction:Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. There is little high-quality evidence available to guide the management of DCI. The Canadian Neurosurgery Research Collaborative (CNRC) is comprised of resident physicians who are positioned to capture national, multi-site data. The objective of this study was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI.Methods:We performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. A 19-question electronic survey (Survey Monkey) was developed and validated by the CNRC following a DCI-related literature review (PubMed, Embase). The survey was distributed to members of the Canadian Neurosurgical Society and to Canadian members of the Neurocritical Care Society. Responses were analyzed using quantitative and qualitative me...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Seizure-european Journal of Epilepsy, Sep 1, 2015
Introduction: Our goal was to perform a systematic review of the literature on the use of intrave... more Introduction: Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in adults for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Overall, 13 studies were identified, with 11 manuscripts and 2 meeting abstracts. Seventy-six adult patients were treated for 82 episodes of SE/RSE. Patients had varying numbers of anti-epileptic drugs (AEDs), 1-12, on board prior to lidocaine therapy. During 69 of the 82 (84.1%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some utilizing bolus dosing alone; others utilizing a combination of bolus and infusion therapy. Overall, 70.7% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 64.1% and 6.1% respectively. Patient outcomes were sparingly reported. Conclusions: There currently exists level 4, GRADE C evidence to support the consideration of lidocaine for SE and RSE in the adult population. Thus there is currently weak evidence to support the use of lidocaine in this context. Further prospective studies of lidocaine administration in this setting are warranted.
Canadian Journal of Neurological Sciences, May 1, 2015
Suppl. 1-S24 skills, orientation was preserved, but decreased when compared to age-matched contro... more Suppl. 1-S24 skills, orientation was preserved, but decreased when compared to age-matched controls. Given its cognitive and neural complexity, topographical orientation may be used as a model for network plasticity after early injury.
Neurocritical Care, Apr 9, 2014
Our goal was to perform a systematic review of the literature on the use of tromethamine (THAM) a... more Our goal was to perform a systematic review of the literature on the use of tromethamine (THAM) and its effects on intracranial pressure (ICP) in patients with neurological illness. All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to February 2014), reference lists of relevant articles, and gray literature were searched. Two reviewers independently identified all manuscripts pertaining to the administration of THAM in human patients that recorded effects on ICP. Secondary outcomes of effect on cerebral perfusion pressure, mean arterial pressure, patient outcome, and adverse effects were recorded. Two reviewers independently extracted data including population characteristics and treatment characteristics. The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Our search strategy produced a total 2,268 citations. Twelve articles, 9 manuscripts, and 3 meeting proceedings were considered for the review with all utilizing THAM while documenting ICP in neurosurgical patients. All studies were prospective. Across all studies, there were a total of 488 patients studied, with 263 receiving THAM and 225 serving as controls in a variety of heterogeneous studies. All but one study documented a decrease in ICP with THAM administration, with both bolus and continuous infusions. One study documented a reduction in cerebral perfusion pressure. No significant renal dysfunction, hepatocellular injury, or hypoglycemia were reported. Three prospective randomized control trials displayed trends to improved outcome in severe traumatic brain injury (TBI) patients with THAM administration. There currently exists Oxford level 2b, GRADE B evidence to support that THAM reduces ICP in the TBI and malignant ischemic infarct population, with minimal side effects. The literature suggests THAM may be useful for ICP reduction in certain cases, though the safety of the compound in these circumstances is still unclear. Further prospective study is warranted.
Neurocritical Care, Feb 12, 2014
Refractory status epilepticus (RSE) poses significant challenge, with a variety of novel therapeu... more Refractory status epilepticus (RSE) poses significant challenge, with a variety of novel therapeutics employed. Our goal was to evaluate the effectiveness of N-methyl Daspartate (NMDA) receptor antagonists in the control of RSE. We performed a systematic review of all the literature, with all articles pulled from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to September 2013), reference lists of relevant articles, and gray literature. Two reviewers independently identified all manuscripts pertaining to the administration of NMDA receptor antagonists in humans for the purpose of controlling refractory seizures. Secondary outcome of adverse NMDA antagonist effects and patient outcome was assessed. Two reviewers independently extracted data including population characteristics, treatment characteristics, and outcomes. The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Our search strategy produced a total of 759 citations. Twenty-three articles, 16 manuscripts, and seven meeting proceedings, were considered for the review with all utilizing ketamine for seizure control. Only three studies were prospective studies. Fifteen and nine studies pertained to adults and pediatrics, respectively. Across all studies, of the 110 adult patients described, ketamine was attributed to electroencephalogram seizure response in 56.5 %, with a 63.5 % response in the 52 pediatric patients described. Adverse events related to ketamine were rare. Outcomes were poorly documented in the majority of the studies. There currently exists Oxford level 4, GRADE C evidence to support the use of ketamine for refractory seizures in the adult and pediatric populations. Further prospective study of early ketamine administration is warranted.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
This 2023 Clinical Practice Guideline provides the biomedical definition of death based on perman... more This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential.
Neurology
Background and Objectives Despite decades of increasingly sophisticated neurocritical care, patie... more Background and Objectives Despite decades of increasingly sophisticated neurocritical care, patient outcomes after spontaneous intracerebral hemorrhage (ICH) remain dismal. Whether this reflects therapeutic nihilism or the effects of the primary injury has been questioned. In this contemporary cohort, we determined the 30- and 90-day mortality, cause-specific mortality, functional outcome, and the effect of surgical intervention in a culture of aggressive medical and surgical support. Methods This was a retrospective cohort study of consecutive adult patients with spontaneous ICH admitted to a tertiary neurocritical care unit. Patients with secondary ICH and those subject to limitation of care before 72 hours were excluded. For each ICH score, mortality at 30- and 90-days, and the modified Rankin Scale (mRS) within 1-year were examined. The effect of craniotomy/craniectomy ± hematoma evacuation on the outcome of supratentorial ICH was determined using propensity score matching. Medi...
Stroke
Background: In the SPOTLIGHT trial (Spot Sign Selection of Intracerebral Hemorrhage to Guide Hemo... more Background: In the SPOTLIGHT trial (Spot Sign Selection of Intracerebral Hemorrhage to Guide Hemostatic Therapy), patients with a computed tomography (CT) angiography spot-sign positive acute intracerebral hemorrhage were randomized to rFVIIa (recombinant activated factor VIIa; 80 μg/kg) or placebo within 6 hours of onset, aiming to limit hematoma expansion. Administration of rFVIIa did not significantly reduce hematoma expansion. In this prespecified analysis, we aimed to investigate the impact of delays from baseline imaging to study drug administration on hematoma expansion. Methods: Hematoma volumes were measured on the baseline CT, early post-dose CT, and 24 hours CT scans. Total hematoma volume (intracerebral hemorrhage+intraventricular hemorrhage) change between the 3 scans was calculated as an estimate of how much hematoma expansion occurred before and after studying drug administration. Results: Of the 50 patients included in the trial, 44 had an early post-dose CT scan. Me...
Stroke, 2022
Background and Objectives: CT findings of acute and chronic ischemia are associated with stroke r... more Background and Objectives: CT findings of acute and chronic ischemia are associated with stroke risk. We sought to validate these associations in a large prospective cohort of patients with TIA or minor stroke. Methods: We included prospectively enrolled emergency department patients from 13 centers with a final ED diagnosis of TIA or non-disabling stroke who had a computed tomography (CT) within 24 hours. Primary outcome was stroke within 90 days. Secondary outcomes were stroke within 2 or 7 days. CT findings were abstracted from the radiology report and classified for the presence of acute ischemia, chronic ischemia or microangiopathy. Multivariable logistic regression was used to test associations with primary and secondary endpoints. Results: In total 8,670 patients were enrolled between May 2010 to May 2017 and 8,382 had a CT within 24 hours. 4,547 patients had evidence of acute ischemia, chronic ischemia, or microangiopathy on CT imaging, of whom 175 had a subsequent stroke wi...
Stroke, 2016
Introduction: Vasospasm causing delayed cerebral ischemia (DCI) remains a leading cause of morbid... more Introduction: Vasospasm causing delayed cerebral ischemia (DCI) remains a leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). Our previously reported series detailed the safety and efficacy of cardiac doses of milrinone in DCI. Since 2007, we have been treating refractory delayed cerebral ischemia (RDCI) with very large doses of IV milrinone. We report the safety and clinical effect of high-dose milrinone in aSAH with RDCI. Methods: Retrospective single center analysis of all patients treated between October 2014 and July 2015 for vasospasm refractory to the MNH protocol (RDCI). RDCI patients received a bolus and perfusion that were increased incrementally until resolution of signs. If 2 boluses and 2 increases in perfusion were unsuccessful, patients underwent angiogram for intra-arterial (IA) milrinone and possible angioplasty. Results: 40 patients were admitted for acute aSAH. Vasospasm was diagnosed clinically in 26 (65%). Initial milrinone the...
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Papers by Jeanne Teitelbaum