We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Brief Rhythmic Discharges in Electroencephalography on an Interictal to Ictal Continuum—Reply

Nicolas Gaspard, MD, PhD1,2; Ji Yeoun Yoo, MD3; Lawrence J. Hirsch, MD1
[+] Author Affiliations
1Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
2Department of Neurology, Hôpital Erasme, Brussels, Belgium
3Department of Neurology, Mount Sinai Hospital, New York, New York
JAMA Neurol. 2014;71(9):1193-1194. doi:10.1001/jamaneurol.2014.1865.
Text Size: A A A
Published online


In Reply We appreciate Dr Sethi’s interest in our work. Dr Sethi’s concerns have already been addressed at length in the original article.1 We would like to reemphasize the following points. In neonates with brain injury, brief potentially ictal rhythmic discharges (B[I]RDs) are independently associated with poor outcome to the same extent as full-length seizures.2,3 We found a similar trend toward worse outcome in patients with B(I)RDs, although this did not reach statistical significance, probably owing to the small size of our cohort. Many careful investigations have documented that nonconvulsive seizures/status epilepticus are responsible for acute adverse metabolic and hemodynamic derangements4 and are independently associated with worse short- and long-term outcomes.5,6 Because most (>90%) patients with B(I)RDs will also exhibit full-length seizures, for which treatment is accepted, the decision to treat B(I)RDs or not is moot—they need treatment for their seizures whether you have already documented their existence or not.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





September 1, 2014
Nitin K. Sethi, MD
1New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
JAMA Neurol. 2014;71(9):1193. doi:10.1001/jamaneurol.2014.1862.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...