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    • Functional connectivity in self-limited epilepsy with centrotemporal spikes increases with epilepsy duration and interictal spike exposure.

      Vasitas, M. E., Menchaca, M. S., Goad, B. S., She, X., Lee-Messer, C., He, Z., Baumer, F. M.

      Epilepsia

      ABSTRACT
      To determine whether persistent exposure to interictal spikes is associated with progressive changes in functional connectivity in children with self-limited epilepsy with centrotemporal spikes (SeLECTS).Connectivity was calculated from electroencephalograms (EEGs) of 68 children with SeLECTS and 65 age- and sex-matched controls using the weighted phase lag index. First, we assessed whether connectivity increased with longer epilepsy duration, categorizing duration based on time since first seizure (less vs. greater than 6 months). Second, in a subset of 19 SeLECTS children with repeated EEGs, we assessed whether trajectory of connectivity over time differed based on persistence versus resolution of spikes. Connectivity during sleep and wakefulness was examined separately.During sleep, connectivity was lowest in controls, intermediate in patients with recent onset epilepsy, and highest in those with longer epilepsy duration. Elevations in connectivity were greatest within the right occipital region at onset and became more widespread with longer epilepsy duration, especially increasing in the left temporal region. During wakefulness, connectivity in recent onset epilepsy trended lower than controls, whereas longer duration epilepsy trended higher, such that the two epilepsy groups differed significantly from each other but not from controls. In the cohort of children with repeated EEGs, patients with persistent spikes showed increasing connectivity over time in sleep, whereas those with spike resolution demonstrated decreasing connectivity over time. There were no significant changes in awake connectivity over time regardless of spike persistence or resolution.Functional connectivity in SeLECTS increases progressively with longer duration of spike exposure, suggesting that ongoing spikes drive neural network alterations. Spikes are a potential treatment target to prevent progressive brain network disruption and preserve cognitive outcomes.
      https://www.ncbi.nlm.nih.gov/pubmed/41910930 https://doi.org/10.1002/epi.70212
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    • TMS timed to interictal epileptiform discharges.

      Makkonen, M., Kahilakoski, O. P., Menchaca, M., Zubarev, I., Siljamo, O., Hassan, U., She, X., Qi, W., Mutanen, T. P., Ilmoniemi, R. J., Lioumis, P., Baumer, F. M.

      bioRxiv : the preprint server for biology

      ABSTRACT
      Interictal epileptiform discharges (IEDs) are pathological hypersynchronous bursts of electrical brain activity that occur between seizures in patients with epilepsy. IEDs are caused by transient brain states that are difficult to predict, making them a challenging neurophysiological and technological case for brain-state-dependent stimulation. Administering stimulation at IED onset may provide insight into the epileptic network and optimize neurostimulation therapies. Here, we assessed the feasibility of IED-triggered transcranial magnetic stimulation (TMS) in two children with self-limited epilepsy with centrotemporal spikes (SeLECTS), a common pediatric epilepsy in which IEDs emerge from the motor cortex. A convolutional neural network (CNN) was trained on the participants' pre-recorded electroencephalography (EEG) data with IEDs annotated by an epileptologist. The CNN was integrated into an EEG-processing pipeline that classified EEG segments as "IED" or "non-IED" in real time. With this pipeline, TMS pulses were administered during IED or non-IED periods in an interleaved, randomized design. We stimulated both the motor cortex generating the IEDs and the contralateral motor cortex and tested the impact of IEDs on TMS-evoked potentials (TEPs). Our study demonstrated that TMS can be timed to IEDs and that there is a site-specific increase in TEP amplitude when stimulating during IEDs. Out of the TMS pulses aimed at an IED, 39% and 19% were successfully delivered during an IED for the two participants, respectively. For future research, we propose ways to address the methodological challenges of IED-timed TMS, enabling brain-state-dependent TMS for epilepsy research and treatment.
      https://www.ncbi.nlm.nih.gov/pubmed/41757039 https://doi.org/10.64898/2026.02.17.706146
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    • Language Dysfunction Associated with Pathological Brain Connectivity in Children with Epilepsy.

      She, X., Peony, O., Qi, W., Menchaca, M., Nix, K. C., Wu, W., He, Z., Baumer, F. M.

      bioRxiv : the preprint server for biology

      ABSTRACT
      Language impairment is common in childhood epilepsy and may arise in part from disruption of the distributed brain networks that support language. In self-limited epilepsy with centrotemporal spikes (SeLECTS)-the most common focal epilepsy of childhood-hyperconnectivity has been linked to poor language outcomes, but the specific network patterns associated with language dysfunction remain unclear, limiting the ability to target neurostimulation rationally. We recorded high-density EEG from 27 children with SeLECTS and 29 age-matched controls during verb generation and rest, and quantified functional connectivity across multiple frequency bands and bilateral frontal, temporal, occipital, and motor regions. Using multivariate pattern analysis, we identified connectivity patterns that predicted language ability, distinguished patterns shared across groups from those specific to SeLECTS and tested whether spatially specific connectivity provided information beyond whole-brain or hemispheric averages and conventional clinical variables. Frontal and occipitotemporal connectivity, particularly within the left hemisphere, predicted language ability across groups, whereas motor-network connectivity emerged as the dominant SeLECTS-specific predictor, linking the epileptogenic network to language dysfunction. Connectivity between specific regions outperformed averaged connectivity measures and predicted language beyond epilepsy diagnosis and antiseizure medication use. Task-based connectivity also outperformed resting-state connectivity. These findings show that language ability is associated with distributed yet spatially specific patterns of brain connectivity, while epilepsy introduces distinct alterations centered on the epileptogenic network. Identifying these disease-specific network patterns provides mechanistic insight into language dysfunction and a rational basis for spatially targeted neuromodulation.
      https://www.ncbi.nlm.nih.gov/pubmed/42812176 https://doi.org/10.64898/2026.07.26.740747
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    • Response: Lenses protecting against photosensitivity violate international driving regulations.

      Fisher, R., Takahashi, Y., Szaflarski, J., Baumer, F. M., Thio, L. L., Parisi, P., French, J., Tolchin, B., Trenite, D. K., Wilkins, A.

      Epilepsia

      https://www.ncbi.nlm.nih.gov/pubmed/41773810 https://doi.org/10.1002/epi.70167
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    • Clinical utility and prospective of TMS-EEG: Updated review from an international expert group.

      Ziemann, U., Bai, Y., Baumer, F. M., Beck, M. M., Belardinelli, P., Belvisi, D., Bender, S., Bergmann, T. O., Bortoletto, M., Casarotto, S., Casula, E., Chaves, A. R., de Andrade, D. C., Conte, A., Daskalakis, Z. J., Farzan, F., Ferrarelli, F., Fitzgerald, P. B., Gordon, P. C., Grefkes, C., Harquel, S., Hernandez-Pavon, J. C., Hill, A. T., Hoy, K. E., Hummel, F. C., Julkunen, P., Kallioniemi, E., Keller, C. J., Kimiskidis, V. K., Kirkovski, M., Koch, G., Leodori, G., Lioumis, P., Maatta, S., Maidan, I., Massimini, M., Mengel, A., Metsomaa, J., Miniussi, C., Mutanen, T. P., Noda, Y., Ozdemir, R. A., Raffin, E., Rocchi, L., Rogasch, N. C., Rosanova, M., Santarnecchi, E., Sarasso, S., Schabrun, S. M., Shafi, M. M., Siebner, H. R., Tolner, E. A., Tomasevic, L., Tremblay, S., Tscherpel, C., Veniero, D., Versace, V., Voineskos, D., Vucic, S., Zangen, A., Zrenner, C., Ilmoniemi, R. J.

      Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology

      ABSTRACT
      Transcranial magnetic stimulation (TMS) is a non-invasive technique to stimulate the brain, while electroencephalography (EEG) is a non-invasive technique to record its electrical activity. Their combined use (TMS-EEG) has been established only relatively recently, after successful development of TMS-compatible EEG amplifiers. TMS-EEG offers the unparalleled opportunity to directly perturb the brain with TMS and simultaneously record its response with EEG. This allows inferences on causal input-output relationships, therefore going critically beyond purely observational techniques, such as resting-state EEG or functional MRI, in the study of brain dynamics. This consensus review updates the work of Tremblay and coworkers [Clin Neurophysiol 2019; 130: 802-844]. Since then, substantial advances have been made in understanding contamination of TMS-EEG signals by physiological and non-physiological artifacts, as well as in developing strategies to avoid or control them. In parallel, new insights have emerged regarding the physiological mechanisms underlying TMS-EEG responses and their diagnostic and prognostic utility in a broad range of psychiatric and neurological disorders. As such, TMS-EEG is rapidly shaping a dynamic new field in clinical neurophysiology and neuroscience. This review provides a critical and comprehensive synthesis of current knowledge, including practical guidance for implementing TMS-EEG in the clinical setting.
      https://www.ncbi.nlm.nih.gov/pubmed/41688232 https://doi.org/10.1016/j.clinph.2025.2111487
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    • Elevated Connectivity During Language Processing Is Associated With Cognitive Performance in SeLECTS.

      Qi, W., Lee, K., Nix, K. C., Menchaca, M., Shé, X., Santa Maria, L., Wu, W., He, Z., Baumer, F. M.

      Annals of clinical and translational neurology

      ABSTRACT
      Self-Limited Epilepsy with Centrotemporal Spikes (SeLECTS) is associated with language impairments despite seizures originating in the motor cortex, suggesting aberrant cross-network interactions. Here we tested whether functional connectivity in SeLECTS during language tasks predicts language performance.We recorded high-density EEG from right-handed children with SeLECTS (n = 31) and age-matched controls (n = 32) during verb generation, repetition, and resting tasks. Phonological awareness was assessed using the Comprehensive Test of Phonological Processing-2. Connectivity between bilateral motor cortices and language regions (the left inferior frontal and superior temporal cortices and their right hemisphere homologs) was measured using the weighted Phase Lag Index (wPLI).Children with SeLECTS demonstrated significantly elevated connectivity between motor and language regions during language processing. Motor-to-frontal connectivity was higher in SeLECTS during both verb generation and repetition tasks. Frontal-to-temporal connectivity was elevated specifically during verb generation. Exploratory analyses suggest high interhemispheric connectivity (between the left and right hemispheres) during language tasks is associated with poor phonological awareness in children with SeLECTS, but not controls. Together, we found that children with SeLECTS exhibited pathologically elevated connectivity between motor and language networks that was strongly associated with impaired phonological awareness.These findings establish task-specific connectivity abnormalities as a characteristic feature of SeLECTS and suggest interhemispheric connectivity patterns may relate to language outcomes, warranting further investigation as potential targets for therapeutic neuromodulation.
      https://www.ncbi.nlm.nih.gov/pubmed/42011727 https://doi.org/10.1002/acn3.70369
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    • American Clinical Neurophysiology Society Technical Standards for Electrical Stimulation With Intracranial Electrodes for Functional Brain Mapping and Seizure Induction.

      Arya, R., Baumer, F. M., Chauvel, P., Frauscher, B., Jayakar, P., Kheder, A., Lega, B., Lesser, R. P., Miller, K. J., Nuwer, M. R., Pedersen, N. P., Ritaccio, A. L., Sabsevitz, D. S., Sinha, S. R., So, E. L., Tatum, W. O., Templer, J. W., Schuele, S. U.

      Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society

      ABSTRACT
      These American Clinical Neurophysiology Society technical standards suggest best practices for electrical stimulation mapping (ESM) with subdural and stereotactic depth electrodes for seizure induction and mapping of brain function.A working group was convened from American Clinical Neurophysiology Society membership with expertise in ESM. PubMed searches were performed to identify pertinent peer-reviewed literature. Recurrent meetings reviewed progress, built consensus by discussion, and developed evidence-based recommendations to the extent possible.Stimulators used for ESM should have sufficient dynamic range, ability to interrupt a stimulus train, and ictal disrupt mechanism(s). Charge density should be calculated for the specific electrodes and ESM settings, the maximum safe limits being 52 to 57 μC/cm2/phase for subdural electrodes and not established for stereotactic depth electrodes. Subdural ESM for functional mapping is typically performed at 50-Hz pulse frequency, 200- to 300-µs pulse width, 2- to 8-s train duration, and 1- to 20-mA current strength. Stereo ESM is commonly performed using 2 different pulse frequencies: 1 Hz (300-500 µs pulse width, train duration up to 30 s, and often a constant current of 3-5 mA), and 50 Hz (100-500 µs pulse width, train duration 2-8 s, and 0.5-10 mA current intensity).This guideline provides technical standards for the performance of ESM, which will likely evolve over time with advances in technology and additional evidence (also see Graphical Abstract).
      https://www.ncbi.nlm.nih.gov/pubmed/39946166 https://doi.org/10.1097/WNP.0000000000001149
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    • Elevated thalamic blood flow in self-limited epilepsy with centrotemporal spikes.

      Iasinovschi, N., Tong, E., Bicknell, L., Baumer, F. M.

      Epilepsy research

      ABSTRACT
      Children with self-limited epilepsy syndrome with centrotemporal spikes (SeLECTS) exhibit altered thalamocortical connectivity, but whether thalamic function itself is abnormal remains unclear. We investigated whether thalamic blood flow, a marker of metabolism, differs between children with SeLECTS and controls, and examined the effects of spike distribution and antiseizure medications (ASMs) on thalamic perfusion. In this retrospective cohort study, we identified consecutive children with SeLECTS who underwent magnetic resonance imaging (MRI) for epilepsy evaluation (n = 44) and age- and sex-matched children who underwent MRI for non-epilepsy indications (n = 35). We quantified thalamic blood flow via manual segmentation of cerebral blood flow (CBF) sequences obtained from arterial spin labeling MRI. Clinical variables including sedation use during MRI, daily ASM use, and spike distribution (unilateral or bilateral) were extracted from medical records. Children with SeLECTS demonstrated elevated thalamic blood flow compared to controls, with the most pronounced differences in specific subgroups. Children with unilateral spikes showed the highest CBF, particularly in the thalamus contralateral to spike activity. ASM use significantly modulated thalamic blood flow: children taking oxcarbazepine showed the highest CBF, while those on levetiracetam had CBF similar to controls. Unmedicated children showed intermediate elevations. These findings demonstrate that elevated thalamic blood flow may be intrinsic to SeLECTS pathophysiology, with different ASMs producing distinct neurobiological effects. The differential medication effects may relate to their clinical efficacy and provide neurobiological rationale for treatment selection in this common childhood epilepsy syndrome.
      https://www.ncbi.nlm.nih.gov/pubmed/41353983 https://doi.org/10.1016/j.eplepsyres.2025.107716
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    • Frequently asked questions and answers on Visually-Provoked (Photosensitive) epilepsy.

      Kasteleijn-Nolst Trenité, D., Acharya, J., Baumer, F. M., Beran, R., Craiu, D., French, J., Parisi, P., Solodar, J., Szaflarski, J. P., Takahashi, Y., Thio, L. L., Tolchin, B., Wilkins, A., Fisher, R. S.

      Epilepsy & behavior reports

      ABSTRACT
      Clinical experts associated with national epilepsy-related societies, led by the Epilepsy Foundation, collected, collated and answered "Frequently asked questions (FAQ)" of broad interest pertaining to visually-provoked seizures. Questions emerged from people with epilepsy, caretakers and healthcare professionals from different countries around the world. Focus is on practical implications of visually-provoked seizures. The top 5 most frequently asked questions were.1.How does a doctor make a diagnosis of visually-provoked seizures?2.What can I do in general to prevent visually-provoked seizures?3.Will I need antiseizure medications for my visually-provoked seizures?"4.Will I outgrow visually-provoked seizures? How will I know if I've outgrown them?5.How do I enable safety features to block content that could trigger seizures on social media, websites, phones, laptops and tablets?Answers were based on scientific evidence, where such information was available [1] and expert opinion when formal evidence was insufficient. Key answers included distinction of photoparoxysmal EEG findings versus light-provoked seizures. Typical provocation is by flashes at 10-25 per second or certain moving patterns. There is a genetic risk, which is outgrown in about half. Covering one or both eyes can prevent a light-provoked seizure. TV, videogames, virtual reality and 3D images are not in themselves provocative, but their content can be. Topics covered included: 1. Photosensitive epilepsy diagnosis; 2. Preventing visually-provoked seizures; 3. Do treatments help; 4. Life and behavioral decisions; 5. School; 6. Multi-media; 7. Children and youth.
      https://www.ncbi.nlm.nih.gov/pubmed/40230985 https://doi.org/10.1016/j.ebr.2025.100753
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    • The Lifeline

      Baumer, F.

      LANCET NEUROLOGY

    • Visually-provoked seizures: Consensus of the Epilepsy Foundation Working Group.

      Fisher, R. S., Wilkins, A., Takahashi, Y., Thio, L. L., Acharya, J., Alkhaldi, M., Baumer, F. M., Beran, R. G., Craiu, D., French, J., Mirza, N., Parisi, P., Solodar, J., Szaflarski, J. P., Tolchin, B., Trenite, D. K.

      Epilepsia

      ABSTRACT
      In 2005, the Epilepsy Foundation published an expert consensus (Epilepsia 2005; 46:1423-1425) on actions to minimize risks of visually-provoked (photosensitive) seizures (VPS). Since then, technology, scientific information, and experience have greatly expanded. An international expert panel convened by the Epilepsy Foundation collated literature, information, and opinions regarding VPS. Consensus guidelines are divided into advice for: patients and families, clinicians, designers of video games, architects, and regulatory agencies. No attempt was made to develop a formal systematic review. Patients are advised about symptoms and epilepsy syndromes that relate to VPS. Commonly used medications and useful behavioral modifications are reviewed. Clinicians are advised on an approach to events that are concerning for VPS, including how to use history and electroencephalography (EEG) to assess whether an event was a seizure (vs another neurologic symptom) and what visual stimuli (light or patterns) provoked it. The utility of magnetic resonance imaging (MRI) to assess for an epileptogenic lesion, routine blood tests, and genetic studies is discussed. Media designers of video games, movies, TV productions, web videos, and artificial or virtual reality images are advised to avoid bright flashing patterns in the 10-20 Hz range, repetitive color flashes, and oscillating or static stripes of ~1-8 cycles per visual degree. Signal analysis or trained human inspectors can identify provocative visual patterns. Architects and designers of public spaces should be aware that some striped patterns can provoke seizures. Government and regulatory agencies require screening of potentially provocative media in some nations. VPS are both an individual and public health problem. The Epilepsy Foundation encourages further research and efforts to minimize risks of seizures provoked by visual stimuli.
      https://www.ncbi.nlm.nih.gov/pubmed/41283196 https://doi.org/10.1111/epi.18702
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    • Repetitive Transcranial Magnetic Stimulation Modulates Brain Connectivity in Children with Self-limited Epilepsy with Centrotemporal Spikes.

      She, X., Qi, W., Nix, K. C., Menchaca, M., Cline, C. C., Wu, W., He, Z., Baumer, F. M.

      Brain stimulation

      ABSTRACT
      Self-limited epilepsy with centrotemporal spikes (SeLECTS) is a common pediatric syndrome in which interictal epileptiform discharges (IEDs) emerge from the motor cortex and children often develop language deficits. IEDs may induce these language deficits by pathologically enhancing brain connectivity. Using a sham-controlled design, we test the impact of inhibitory low-frequency repetitive transcranial magnetic stimulation (rTMS) on connectivity and IEDs in SeLECTS.Nineteen children participated in a cross-over study comparing active vs. sham motor cortex rTMS. Single pulses of TMS combined with EEG (spTMS-EEG) were applied to the motor cortex before and after rTMS to probe connectivity. Connectivity was quantified by calculating the weighted phase lag index (wPLI) between six regions of interest: bilateral motor cortices (implicated in SeLECTS) and bilateral inferior frontal and superior temporal regions (important for language). IED frequency before and after rTMS was also quantified.Active, but not sham, rTMS decreased wPLI connectivity between multiple regions, with the greatest reductions seen in superior temporal connections in the stimulated hemisphere. IED frequency decreased after active but not sham rTMS.Low-frequency rTMS reduces pathologic hyperconnectivity and IEDs in children with SeLECTS, making it a promising avenue for therapeutic interventions for SeLECTS and potentially other pediatric epilepsy syndromes.
      https://www.ncbi.nlm.nih.gov/pubmed/40010636 https://doi.org/10.1016/j.brs.2025.02.018
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    • Rebuilding the Tower of Babel: The Current Landscape and Emerging Opportunities in DEE-SWAS.

      Stowe, R. C., Kelley, S. A., Bhatia, S., McLaren, J. R., Rao, L. M., Patel, S. H., Fine, A. L., Baumer, F., Duong, P., Pavuluri, S., Liu, V. B., Phillips, D. J.

      Epilepsy currents

      ABSTRACT
      Developmental/epileptic encephalopathy with spike-wave activation in sleep (DEE-SWAS) is newly proposed nomenclature put forth by the International League Against Epilepsy (ILAE) to replace the problematic electrographic and/or clinical phenotypes of electrical status epilepticus of sleep (ESES) and continuous spike-wave in sleep (CSWS). The nomenclature update represents a noble effort to minimize the confusion of how to define and appropriately utilize this alphabet soup of acronyms, thereby aiding in future clinical and research efforts. The name change fails to capture greater challenges within the field, which still plague diagnosis and treatment and stagnates substantive research advancements. Through a directed literature review of DEE-SWAS with emphasis on the new ILAE nomenclature and the RESCUE-ESES trial, we will highlight major persistent quandaries in the field. These include inadequate or insufficient diagnostic biomarkers (ie, the spike wave index), the highly variable clinical manifestations, ranging from dubious associations to profound developmental regression, presumptively caused by spike-wave activation in sleep, and variable and often ineffective treatment paradigms. We will also review the broader diagnostic evaluation of DEE-SWAS. By doing so, we aim to shed light on crucial research and clinical questions that could advance our understanding of diagnosing and treating children with DEE-SWAS, as well as addressing the uncertainty surrounding the neurological effects of sleep-activated epileptiform discharges.
      https://www.ncbi.nlm.nih.gov/pubmed/40502808 https://doi.org/10.1177/15357597251344191
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    • Stability of transcranial magnetic stimulation electroencephalogram evoked potentials in pediatric epilepsy.

      She, X., Nix, K. C., Cline, C. C., Qi, W., Tugin, S., He, Z., Baumer, F. M.

      Scientific reports

      ABSTRACT
      Transcranial magnetic stimulation paired with electroencephalography (TMS-EEG) can measure local excitability and functional connectivity. To address trial-to-trial variability, responses to multiple TMS pulses are recorded to obtain an average TMS evoked potential (TEP). Balancing adequate data acquisition to establish stable TEPs with feasible experimental duration is critical when applying TMS-EEG to clinical populations. Here we aim to investigate the minimum number of pulses (MNP) required to achieve stable TEPs in children with epilepsy. Eighteen children with Self-Limited Epilepsy with Centrotemporal Spikes, a common epilepsy arising from the motor cortices, underwent multiple 100-pulse blocks of TMS to both motor cortices over two days. TMS was applied at 120% of resting motor threshold (rMT) up to a maximum of 100% maximum stimulator output. The average of all 100 pulses was used as a "gold-standard" TEP to which we compared "candidate" TEPs obtained by averaging subsets of pulses. We defined TEP stability as the MNP needed to achieve a concordance correlation coefficient of 80% between the candidate and "gold-standard" TEP. We additionally assessed whether experimental or clinical factors affected TEP stability. Results show that stable TEPs can be derived from fewer than 100 pulses, a number typically used for designing TMS-EEG experiments. The early segment (15-80 ms) of the TEP was less stable than the later segment (80-350 ms). Global mean field amplitude derived from all channels was less stable than local TEP derived from channels overlying the stimulated site. TEP stability did not differ depending on stimulated hemisphere, block order, or antiseizure medication use, but was greater in older children. Stimulation administered with an intensity above the rMT yielded more stable local TEPs. Studies of TMS-EEG in pediatrics have been limited by the complexity of experimental set-up and time course. This study serves as a critical starting point, demonstrating the feasibility of designing efficient TMS-EEG studies that use a relatively small number of pulses to study pediatric epilepsy and potentially other pediatric groups.
      https://www.ncbi.nlm.nih.gov/pubmed/38641629 https://doi.org/10.1038/s41598-024-59468-8
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    • Detection of Language Lateralization Using Spectral Analysis of EEG.

      Nix, K. C., Oh, A., Goad, B. S., Wu, W., Lucas, M. V., Baumer, F. M.

      Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society

      ABSTRACT
      Language lateralization relies on expensive equipment and can be difficult to tolerate. We assessed if lateralized brain responses to a language task can be detected with spectral analysis of electroencephalography (EEG).Twenty right-handed, neurotypical adults (28 ± 10 years; five males) performed a verb generation task and two control tasks (word listening and repetition). We measured changes in EEG activity elicited by tasks (the event-related spectral perturbation [ERSP]) in the theta, alpha, beta, and gamma frequency bands in two language (superior temporal and inferior frontal [ST and IF]) and one control (occipital [Occ]) region bilaterally. We tested whether language tasks elicited (1) changes in spectral power from baseline (significant ERSP) at any region or (2) asymmetric ERSPs between matched left and right regions.Left IF beta power (-0.37±0.53, t = -3.12, P = 0.006) and gamma power in all regions decreased during verb generation. Asymmetric ERSPs (right > left) occurred between the (1) IF regions in the beta band (right vs. left difference of 0.23±0.37, t(19) = -2.80, P = 0.0114) and (2) ST regions in the alpha band (right vs. left difference of 0.48±0.63, t(19) = -3.36, P = 0.003). No changes from baseline or hemispheric asymmetries were noted in language regions during control tasks. On the individual level, 16 (80%) participants showed decreased left IF beta power from baseline, and 16 showed ST alpha asymmetry. Eighteen participants (90%) showed one of these two findings.Spectral EEG analysis detects lateralized responses during language tasks in frontal and temporal regions. Spectral EEG analysis could be developed into a readily available language lateralization modality.
      https://www.ncbi.nlm.nih.gov/pubmed/38710040 https://doi.org/10.1097/WNP.0000000000000988
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    • Repetitive Transcranial Magnetic Stimulation Modulates Brain Connectivity in Children with Self-Limited Epilepsy with Centrotemporal Spikes

      Baumer, F. M., She, X., Nix, K., Nix, K., Qi, W.

    • Sunflower Syndrome: A Survey of Provider Awareness and Management Preferences.

      Baumer, F. M., Julich, K., Friedman, J., Nespeca, M., Thiele, E. A., Bhatia, S., Joshi, C.

      Pediatric neurology

      ABSTRACT
      Sunflower syndrome is a rare photosensitive pediatric epilepsy characterized by stereotyped hand-waving in response to bright lights. These stereotyped movements with maintained awareness can be mistaken for a movement disorder. This study assessed neurology providers' diagnostic reasoning, evaluation, and treatment of Sunflower syndrome.A 32-question anonymized electronic survey, including a clinical vignette and video of hand-waving in sunlight, was distributed to child neurology providers to assess (1) initial diagnosis and evaluation based on clinical information, (2) updated diagnosis and management after electroencephalography (EEG), and (3) prior experience with Sunflower syndrome.Among 277 viewed surveys, 211 respondents provided information about initial diagnosis and evaluation, 200 about updated diagnosis, 191 about management, and 189 about prior clinical experience. Most providers (135, 64%) suspected seizure, whereas fewer suspected movement disorders (29, 14%) or were unsure of the diagnosis (37, 22%). EEG was recommended by 180 (85%). After EEG, 189 (95%) diagnosed epilepsy, 111 of whom specifically diagnosed Sunflower syndrome. The majority (149, 78%) recommended antiseizure medications (ASMs) and sun avoidance (181, 95%). Only 103 (55%) had managed Sunflower syndrome. Epileptologists and those with prior clinical experience were more likely to suspect a seizure, order an EEG, and offer ASMs than those without prior experience.Although many providers had not managed Sunflower syndrome, the majority recognized this presentation as concerning for epilepsy. Epilepsy training and prior clinical experience are associated with improved recognition and appropriate treatment. Educational initiatives that increase awareness of Sunflower syndrome may improve patient care.
      https://www.ncbi.nlm.nih.gov/pubmed/38295719 https://doi.org/10.1016/j.pediatrneurol.2023.11.013
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    • Visually sensitive seizures: An updated review by the Epilepsy Foundation.

      Fisher, R. S., Acharya, J. N., Baumer, F. M., French, J. A., Parisi, P., Solodar, J. H., Szaflarski, J. P., Thio, L. L., Tolchin, B., Wilkins, A. J., Kasteleijn-Nolst Trenite, D.

      Epilepsia

      ABSTRACT
      Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms "photosensitive" and "epilepsy." The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m2 at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
      https://www.ncbi.nlm.nih.gov/pubmed/35132632 https://doi.org/10.1111/epi.17175
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    • Association of Time to Clinical Remission With Sustained Resolution in Children With New-Onset Infantile Spasms.

      Yuskaitis, C. J., Mytinger, J. R., Baumer, F. M., Zhang, B., Liu, S., Samanta, D., Hussain, S. A., Yozawitz, E. G., Keator, C. G., Joshi, C., Singh, R. K., Bhatia, S., Bhalla, S., Shellhaas, R., Harini, C., Pediatric Epilepsy Research Consortium

      Neurology

      ABSTRACT
      BACKGROUND AND OBJECTIVE: Standard therapies (ACTH, oral steroids, or vigabatrin) fail to control infantile spasms in almost half of children. Early identification of non-responders could enable rapid initiation of sequential therapy. We aimed to determine the time to clinical remission after appropriate infantile spasms treatment initiation and identify predictors of the time to infantile spasms treatment response.METHODS: The National Infantile Spasms Consortium prospectively followed children aged 2-24 months with new onset infantile spasms at 23 US centers (2012-2018). We included children treated with standard therapy (adrenocorticotropic hormone (ACTH), oral steroids, or vigabatrin). Sustained treatment response was defined as having the last clinically recognized infantile spasms on or before treatment day 14, absence of hypsarrhythmia on EEG 2-4 weeks post-treatment, and persistence of remission to day 30. We analyzed the time to treatment response and assessed clinical characteristics to predict sustained treatment response.RESULTS: Among 395 infants, clinical infantile spasms remission occurred in 43% (n=171) within the first two weeks of treatment, of which 81% (138/171) responded within the first week of treatment. There was no difference in the median time to response across standard therapies (ACTH: median 4 days, interquartile range (IQR) 3-7; oral steroids: median 3 days, IQR 2-5; vigabatrin: median 3 days, IQR 1-6). Individuals without hypsarrhythmia on the pre-treatment EEG (i.e., abnormal but not hypsarrhythmia) were more likely to have early treatment response than infants with hypsarrhythmia at infantile spasms onset (hazard ratio 2.23, 95% confidence interval 1.39-3.57). No other clinical factors predicted early responders to therapy.CONCLUSIONS: Remission after first infantile spasms treatment can be identified by treatment day 7 in most children. Given the importance of early and effective treatment, these data suggest that children who do not respond to standard infantile spasms therapy within 1 week should be reassessed immediately for additional standard treatment. This approach could optimize outcomes by facilitating early sequential therapy for children with infantile spasms.
      https://www.ncbi.nlm.nih.gov/pubmed/36038267 https://doi.org/10.1212/WNL.0000000000201232
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    • Inequities in therapy for infantile spasms: a call to action.

      Baumer, F. M., Mytinger, J. R., Neville, K., Briscoe Abath, C., Gutierrez, C. A., Numis, A. L., Harini, C., He, Z., Hussain, S. A., Berg, A. T., Chu, C. J., Gaillard, W. D., Loddenkemper, T., Pasupuleti, A., Samanata, D., Singh, R. K., Singhal, N. S., Wusthoff, C. J., Wirrell, E. C., Yozawitz, E., Knupp, K. G., Shellhaas, R. A., Grinspan, Z. M., Pediatric Epilepsy Research Consortium and National Infantile Spasms Consortium

      Annals of neurology

      ABSTRACT
      OBJECTIVE: To determine whether selection of treatment for children with infantile spasms (IS) varies by race/ethnicity.METHODS: The prospective US National Infantile Spasms Consortium database includes children with IS treated from 2012-2018. We examined the relationship between race/ethnicity and receipt of standard IS therapy (prednisolone, adrenocorticotropic hormone, vigabatrin), adjusting for demographic and clinical variables using logistic regression. Our primary outcome was treatment course, which considered therapy prescribed for the first and, when needed, the second IS treatment together.RESULTS: Of 555 children, 324 (58%) were Non-Hispanic white, 55 (10%) Non-Hispanic Black, 24 (4%) Non-Hispanic Asian, 80 (14%) Hispanic, and 72 (13%) Other/Unknown. Most (398, 72%) received a standard treatment course. Insurance type, geographic location, history of prematurity, prior seizures, developmental delay or regression, abnormal head circumference, hypsarrhythmia, and IS etiologies were associated with standard therapy. In adjusted models, Non-Hispanic Black children had lower odds of receiving a standard treatment course compared with Non-Hispanic white children (OR 0.42, 95% CI 0.20-0.89, p=0.02). Adjusted models also showed that children with public (vs. private) insurance had lower odds of receiving standard therapy for treatment 1 (OR 0.42, CI 0.21-0.84, p=0.01).INTERPRETATION: Non-Hispanic Black children were more often treated with non-standard IS therapies than Non-Hispanic white children. Likewise, children with public (vs. private) insurance were less likely to receive standard therapies. Investigating drivers of inequities, and understanding the impact of racism on treatment decisions, are critical next steps to improve care for patients with IS. This article is protected by copyright. All rights reserved.
      https://www.ncbi.nlm.nih.gov/pubmed/35388521 https://doi.org/10.1002/ana.26363
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