Jane Boggs - Academia.edu (original) (raw)

Papers by Jane Boggs

The Neurohospitalist

Background and Purpose: Describe an inpatient teleneurology consultation service novel to our hos... more Background and Purpose: Describe an inpatient teleneurology consultation service novel to our hospital system, and capture feedback from patients, ordering providers, and consulting neurologists. Methods : A single cohort of teleneurology consult patients was surveyed via telephone. Ordering and consulting providers completed online surveys. Quantitative survey data was reported using descriptive statistics and free-response survey data was summarized. Patient demographics and consult data were gathered via retrospective chart review. Results : Telephone survey was obtained from 25 of 53 patients receiving teleneurology consults from June 1–September 30, 2020. Patient-reported benefits included better understanding of condition (72%) and ability to remain close to home. Online surveys were completed by 11 ordering providers and by consulting neurologists on 20 telemedicine encounters. Ordering providers reported they were likely to use the service again (98.7%), agreed it added valu...

Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people wit... more Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people withdrug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessfulsurgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted todetermine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) forthe management of adults with DRE.A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print,Embase, and the Cochrane library databases. Outcomes examined included reduction in seizurefrequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs).Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy.Four RCTs and six comparative observational studies were identified for inclusion. Against comparators,individuals treated with VNS had a significantly better odds of experiencing a ≥50% reduction in seizurefreq...

Supplementary_Appendix for Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive... more Supplementary_Appendix for Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive Review by the American Epilepsy Society Treatments Committee by David G. Vossler, Jacquelyn L. Bainbridge, Jane G. Boggs, Edward J. Novotny, Tobias Loddenkemper, Edward Faught, Marta Amengual-Gual, Sarah N. Fischer, David S. Gloss, Donald M. Olson, Alan R. Towne, Dean Naritoku and Timothy E. Welty in Epilepsy Currents

New England Journal of Medicine, 1998

The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt gene... more The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt generalized convulsive status epilepticus, lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam and phenytoin, it is easier to use. (N Engl

New England Journal of Medicine, 1998

The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt gene... more The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt generalized convulsive status epilepticus, lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam and phenytoin, it is easier to use. (N Engl

OBJECTIVE: To evaluate concordance of scalp EEG with intracranial EEG, MRI, PET, SPECT, MEG in po... more OBJECTIVE: To evaluate concordance of scalp EEG with intracranial EEG, MRI, PET, SPECT, MEG in post-surgical epilepsy outcomes. BACKGROUND: Multiple tests are used in presurgical evaluations. Initial video EEG monitoring and MRI are supplemented by PET, SPECT, MEG, and invasive monitoring. However, not all testing is completed in all patients. Optimized presurgical evaluation based on highly concordant test results should lead to cost effectiveness, as measured in Engel class I/II surgical outcomes. DESIGN/METHODS: We conducted a retrospective review of adult and pediatric epilepsy surgical evaluations including scalp +/- invasive EEG, MRI, MEG, PET and SPECT. Study included 24 patients at Wake Forest Baptist Hospital between 2010 and 2013. Surgeries include resections and laser ablation, but excluded corpus callosotomies. We reviewed chart notes for subsequent seizure control. We compared localization by testing with temporal or extratemporal surgical location. RESULTS: Of 24 patie...

Neurology, 2012

Objective: This review sought to determine the diagnostic utility of inpatient epilepsy monitorin... more Objective: This review sought to determine the diagnostic utility of inpatient epilepsy monitoring in patients in the Wake Forest Baptist Health Comprehensive Epilepsy Center (WFUBH). Background A primary goal of routine inpatient long term monitoring (LTM) is to diagnose patients who have epilepsy. While the National Association of Epilepsy Centers (NAEC) publishes guidelines for Epilepsy Centers, there is no required supervising body overseeing quality of routine LTMs. Many more hospitals conduct this procedure (CPT 95951) than are members of the NAEC. There is variation in LTM procedural methods, experience of personnel, and neurologists9 qualifications for interpreting LTMs. A high rate of nondiagnostic LTMs indicates problems with methodolgy or underutilization, while a rate of nearly all diagnostic LTMs likely indicates overutilization. We propose collecting epilepsy center data on optimal diagnostic yield as a simple direct indicator for quality standards of LTM. Design/Methods: We reviewed all patients referred to WFBH for LTM during 2008. LTMs were categorized on discharge as diagnostic or nondiagnostic. Nondiagnostic stays failed to record typical events. Diagnostic stays were subdivided into those with recorded epileptic events, nonepiileptic events or both. The percentage of diagnostic stays, length of stay and time to first event for epilepsy and non-epilepsy LTMs were compared. Results: 856 patients underwent LTM at WFBH in 2008. Of these, 478 patients were idenitfied who underwent LTM to differentiate epileptic or nonepileptic events. 349 had diagnostic stays (73%), the majority of whom had epileptic events. Time to first event was shorter in the nonepilepsy group and length of stay was longer in the epileptic group. Conclusions: This retrospective study documents an optimal rate of successful diagnostic LTMs at WFBH. The current lack of published quality standards for LTM may contribute to less optimal rates in in other centers. Carefullly developed and regulated standards should be developed for all hospitals performing LTM. Disclosure: Dr. Boggs has nothing to disclose. Dr. Boggs has nothing to disclose.

Current Treatment Options in Neurology

Purpose of this review This review presents current therapy for seizures in the intensive care un... more Purpose of this review This review presents current therapy for seizures in the intensive care unit. The reader is provided with recent evidence regarding the use of EEG in determining treatment for acute seizures. Proposed treatment approaches for seizures and status epilepticus are provided. Controversies and complexity of selecting treatments are discussed. Recent findings Critical Care EEG Monitoring Research Consortium analyzed the association of periodic and rhythmic electroencephalographic patterns with seizures and found that lateralized and generalized periodic discharges and lateralized rhythmic delta were associated with increased seizure risk. Applications using modified EEG techniques have demonstrated more rapid feedback to the ICU than was previously possible. Summary Accurate diagnosis and efficient treatment of seizures in the ICU is challenging due to patient factors, complexities of antiepileptic drug therapy, and the required expertise for EEG interpretation. Selection of optimally effective therapy for seizures or status epilepticus depends on multiple factors, making collaboration between neurophysiologists and the ICU team of paramount importance.

Neurology

Objective.Prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adul... more Objective.Prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adults with medically intractable focal onset seizures (FOS) over 9 years.Methods.Adults treated with brain-responsive neurostimulation within 2 year feasibility or randomized controlled trials enrolled into a long-term prospective open label trial (LTT) to assess safety, efficacy, and quality of life (QOL) over an additional 7 years. Safety was assessed as adverse events (AEs), efficacy as median percent change in seizure frequency and responder rate, and QOL using the quality of life in epilepsy (QOLIE-89) inventory.Results.230 of 256 patients treated in the initial trials participated in the LTT. At 9 years, the median percent reduction in seizure frequency was 75% (p<0.0001; Wilcoxon Signed Rank), responder rate was 73%, and 35% had a ≥90% reduction in seizure frequency. 18.4% (47/256) experienced ≥1 year of seizure freedom with 62% (29/47) seizure free at last follow-up and an averag...

Epilepsia, Jun 7, 2017

Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with... more Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset. There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LO...

Puzzling Cases of Epilepsy, 2008

Puzzling Cases of Epilepsy, 2008

The Neurohospitalist

Background and Purpose: Describe an inpatient teleneurology consultation service novel to our hos... more Background and Purpose: Describe an inpatient teleneurology consultation service novel to our hospital system, and capture feedback from patients, ordering providers, and consulting neurologists. Methods : A single cohort of teleneurology consult patients was surveyed via telephone. Ordering and consulting providers completed online surveys. Quantitative survey data was reported using descriptive statistics and free-response survey data was summarized. Patient demographics and consult data were gathered via retrospective chart review. Results : Telephone survey was obtained from 25 of 53 patients receiving teleneurology consults from June 1–September 30, 2020. Patient-reported benefits included better understanding of condition (72%) and ability to remain close to home. Online surveys were completed by 11 ordering providers and by consulting neurologists on 20 telemedicine encounters. Ordering providers reported they were likely to use the service again (98.7%), agreed it added valu...

Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people wit... more Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people withdrug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessfulsurgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted todetermine the treatment effects of VNS Therapy as an adjunct to anti-seizure medications (ASMs) forthe management of adults with DRE.A literature search was performed in August 2020 of the Medline®, Medline® Epub Ahead of Print,Embase, and the Cochrane library databases. Outcomes examined included reduction in seizurefrequency, seizure freedom, ASM load, discontinuations, and serious adverse events (SAEs).Comparators included best medical practice, ASMs, low-stimulation or sham VNS Therapy.Four RCTs and six comparative observational studies were identified for inclusion. Against comparators,individuals treated with VNS had a significantly better odds of experiencing a ≥50% reduction in seizurefreq...

Supplementary_Appendix for Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive... more Supplementary_Appendix for Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive Review by the American Epilepsy Society Treatments Committee by David G. Vossler, Jacquelyn L. Bainbridge, Jane G. Boggs, Edward J. Novotny, Tobias Loddenkemper, Edward Faught, Marta Amengual-Gual, Sarah N. Fischer, David S. Gloss, Donald M. Olson, Alan R. Towne, Dean Naritoku and Timothy E. Welty in Epilepsy Currents

New England Journal of Medicine, 1998

The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt gene... more The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt generalized convulsive status epilepticus, lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam and phenytoin, it is easier to use. (N Engl

New England Journal of Medicine, 1998

The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt gene... more The New Eng land Jour nal of Medicine Conclusions As initial intravenous treatment for overt generalized convulsive status epilepticus, lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam and phenytoin, it is easier to use. (N Engl

OBJECTIVE: To evaluate concordance of scalp EEG with intracranial EEG, MRI, PET, SPECT, MEG in po... more OBJECTIVE: To evaluate concordance of scalp EEG with intracranial EEG, MRI, PET, SPECT, MEG in post-surgical epilepsy outcomes. BACKGROUND: Multiple tests are used in presurgical evaluations. Initial video EEG monitoring and MRI are supplemented by PET, SPECT, MEG, and invasive monitoring. However, not all testing is completed in all patients. Optimized presurgical evaluation based on highly concordant test results should lead to cost effectiveness, as measured in Engel class I/II surgical outcomes. DESIGN/METHODS: We conducted a retrospective review of adult and pediatric epilepsy surgical evaluations including scalp +/- invasive EEG, MRI, MEG, PET and SPECT. Study included 24 patients at Wake Forest Baptist Hospital between 2010 and 2013. Surgeries include resections and laser ablation, but excluded corpus callosotomies. We reviewed chart notes for subsequent seizure control. We compared localization by testing with temporal or extratemporal surgical location. RESULTS: Of 24 patie...

Neurology, 2012

Objective: This review sought to determine the diagnostic utility of inpatient epilepsy monitorin... more Objective: This review sought to determine the diagnostic utility of inpatient epilepsy monitoring in patients in the Wake Forest Baptist Health Comprehensive Epilepsy Center (WFUBH). Background A primary goal of routine inpatient long term monitoring (LTM) is to diagnose patients who have epilepsy. While the National Association of Epilepsy Centers (NAEC) publishes guidelines for Epilepsy Centers, there is no required supervising body overseeing quality of routine LTMs. Many more hospitals conduct this procedure (CPT 95951) than are members of the NAEC. There is variation in LTM procedural methods, experience of personnel, and neurologists9 qualifications for interpreting LTMs. A high rate of nondiagnostic LTMs indicates problems with methodolgy or underutilization, while a rate of nearly all diagnostic LTMs likely indicates overutilization. We propose collecting epilepsy center data on optimal diagnostic yield as a simple direct indicator for quality standards of LTM. Design/Methods: We reviewed all patients referred to WFBH for LTM during 2008. LTMs were categorized on discharge as diagnostic or nondiagnostic. Nondiagnostic stays failed to record typical events. Diagnostic stays were subdivided into those with recorded epileptic events, nonepiileptic events or both. The percentage of diagnostic stays, length of stay and time to first event for epilepsy and non-epilepsy LTMs were compared. Results: 856 patients underwent LTM at WFBH in 2008. Of these, 478 patients were idenitfied who underwent LTM to differentiate epileptic or nonepileptic events. 349 had diagnostic stays (73%), the majority of whom had epileptic events. Time to first event was shorter in the nonepilepsy group and length of stay was longer in the epileptic group. Conclusions: This retrospective study documents an optimal rate of successful diagnostic LTMs at WFBH. The current lack of published quality standards for LTM may contribute to less optimal rates in in other centers. Carefullly developed and regulated standards should be developed for all hospitals performing LTM. Disclosure: Dr. Boggs has nothing to disclose. Dr. Boggs has nothing to disclose.

Current Treatment Options in Neurology

Purpose of this review This review presents current therapy for seizures in the intensive care un... more Purpose of this review This review presents current therapy for seizures in the intensive care unit. The reader is provided with recent evidence regarding the use of EEG in determining treatment for acute seizures. Proposed treatment approaches for seizures and status epilepticus are provided. Controversies and complexity of selecting treatments are discussed. Recent findings Critical Care EEG Monitoring Research Consortium analyzed the association of periodic and rhythmic electroencephalographic patterns with seizures and found that lateralized and generalized periodic discharges and lateralized rhythmic delta were associated with increased seizure risk. Applications using modified EEG techniques have demonstrated more rapid feedback to the ICU than was previously possible. Summary Accurate diagnosis and efficient treatment of seizures in the ICU is challenging due to patient factors, complexities of antiepileptic drug therapy, and the required expertise for EEG interpretation. Selection of optimally effective therapy for seizures or status epilepticus depends on multiple factors, making collaboration between neurophysiologists and the ICU team of paramount importance.

Neurology

Objective.Prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adul... more Objective.Prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adults with medically intractable focal onset seizures (FOS) over 9 years.Methods.Adults treated with brain-responsive neurostimulation within 2 year feasibility or randomized controlled trials enrolled into a long-term prospective open label trial (LTT) to assess safety, efficacy, and quality of life (QOL) over an additional 7 years. Safety was assessed as adverse events (AEs), efficacy as median percent change in seizure frequency and responder rate, and QOL using the quality of life in epilepsy (QOLIE-89) inventory.Results.230 of 256 patients treated in the initial trials participated in the LTT. At 9 years, the median percent reduction in seizure frequency was 75% (p<0.0001; Wilcoxon Signed Rank), responder rate was 73%, and 35% had a ≥90% reduction in seizure frequency. 18.4% (47/256) experienced ≥1 year of seizure freedom with 62% (29/47) seizure free at last follow-up and an averag...

Epilepsia, Jun 7, 2017

Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with... more Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset. There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LO...

Puzzling Cases of Epilepsy, 2008

Puzzling Cases of Epilepsy, 2008