Bio

Bio


Dr. Walter received her MD from Georgetown University in Washington, DC. She stayed at Georgetown for her internship in Internal Medicine and then moved to New York City to complete her residency in Neurology at the Icahn School of Medicine at Mount Sinai. She went on to pursue a Clinical Neurophysiology Fellowship at Rush University in Chicago, IL, training in both EEG and EMG. Due to her particular interest in Epilepsy she went on to become the first Epilepsy Fellow at Rush University. Dr. Walter provides clinical care to general neurology patients as well as patients with epilepsy and enjoys teaching residents and medical students. She also has a particular interest in dietary treatments for epilepsy and clinical research.

Clinical Focus


  • Neurology
  • Epilepsy
  • Dietary Treatments of Epilepsy (ketogenic, modified atkins)

Academic Appointments


Honors & Awards


  • Fellows Program, American Epilepsy Society (AES) (2015-2016)
  • Epilepsy Program, J. Kiffin Penry (2012)
  • Intramural Training Award Recipient (IRTA), National Institutes of Health (NIH) (2005-2006)

Boards, Advisory Committees, Professional Organizations


  • Member, American Epilepsy Society (2015 - Present)
  • Member, American Clinical Neurophysiological Society (2015 - Present)
  • Member, American Academy of Neurology (2011 - Present)

Professional Education


  • Fellowship:Rush University Epilepsy Fellowship (2016) IL
  • Fellowship:Rush University Clinical Neurophysiology Fellowship (2015) IL
  • Internship:Georgetown University Internal Medicine Residency (2011) DC
  • Board Certification: Epilepsy, American Board of Psychiatry and Neurology (2017)
  • Board Certifications, American Board of Psychiatry and Neurology (ABPN), Neurology, Clinical Neurophysiology
  • Board Certification: Clinical Neurophysiology, American Board of Psychiatry and Neurology (2015)
  • Fellowship, Rush University Medical Center (Chicago, IL), Neurophysiology (2015), Epilepsy (2016)
  • Residency, Mount Sinai Medical Center/Icahn School of Medicine (New York, NY), Neurology (2014)
  • Residency:Icahn School of Medicine at Mount Sinai Neurology Residency (2014) NY
  • Internship, Georgetown University Hospital Center/Medstar (Washington, DC), Internal Medicine (2011)
  • MD, Georgetown University School of Medicine (Washington, DC) (2010)
  • Medical Education:Georgetown University School of Medicine (2010) DC
  • Undergrad, Yale University (New Haven, CT), Cognitive Science (2005)

Research & Scholarship

Clinical Trials


  • Inpatient, Dose-Ranging Study of Staccato Alprazolam in Epilepsy With Predictable Seizure Pattern Recruiting

    This is a multi-center, double-blind, randomized, parallel group, dose-ranging study to investigate the efficacy and clinical usability of STAP-001 in adult (18 years of age and older) subjects with epilepsy with a predictable seizure pattern. These subjects have an established diagnosis of focal or generalized epilepsy with a documented history of predictable seizure episodes. This is an in-patient study. The subjects will be admitted to a Clinical Research Unit (CRU) or Epilepsy Monitoring Unit (EMU) for study participation. The duration of the stay in the in-patient unit will be 2-8 days. One seizure event per subject will be treated with study medication. The duration and timing of the seizure event and occurrence of subsequent seizures will be assessed by the Staff Caregiver(s)1 through clinical observation and confirmed with video electroencephalogram (EEG).

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Publications

All Publications


  • Comparative neuropsychological effects of carbamazepine and eslicarbazepine acetate EPILEPSY & BEHAVIOR Meador, K. J., Seliger, J., Boyd, A., Razavi, B., Falco-Walter, J., Le, S., Loring, D. W. 2019; 94: 151–57
  • Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life EPILEPSY & BEHAVIOR Roehl, K., Falco-Walter, J., Ouyang, B., Balabanov, A. 2019; 93: 113–18
  • Comparative neuropsychological effects of carbamazepine and eslicarbazepine acetate. Epilepsy & behavior : E&B Meador, K. J., Seliger, J., Boyd, A., Razavi, B., Falco-Walter, J., Le, S., Loring, D. W. 2019; 94: 151–57

    Abstract

    People with epilepsy are at increased risk for neuropsychological dysfunction due to multiple factors, of which the most amendable are antiseizure medications (ASMs). Antiseizure medication effectiveness is frequently determined by tolerability. In this study, we compared the neuropsychological effects of eslicarbazepine acetate (ESL) and carbamazepine immediate-release (CBZ) using a randomized, double-blind, crossover design in healthy volunteers with a 2-week titration and 4-week maintenance phase in each treatment arm (CBZ = 400 mg BID and ESL = 800 mg qAM). Neuropsychological testing was performed at the initial visit, repeated at 1st baseline nondrug condition, end treatment #1, 2nd nondrug condition one month after treatment #1, end treatment #2, and 3rd nondrug condition one month after treatment #2. Neuropsychological testing was conducted 2 h after morning dose and included computer (i.e., dual task test, selective attention test, symbol digit, verbal memory, visuospatial memory, and 1- & 2-back continuous performance) and noncomputer tasks (i.e., Medical College of Georgia (MCG) paragraph memory, Stroop, Symbol Digit Modalities Test, Profile of Mood States). z-Scores calculated from nondrug conditions were used to compare ESL and CBZ for the 23 completers. Follow-up analyses included individual test scores and distribution of individual raw means. Mean blood levels on test day were CBZ = 8.9 mug/ml and ESL = 15.3 mug/ml. Omnibus z-score was significantly better for ESL (p = .0001). For individual measures, executive function and selective attention tests were statistically significantly better for ESL. Individual test raw means favored ESL over CBZ on 22 of 30 measures (p = .016, 2-tailed sign test). Eslicarbazepine acetate demonstrated less adverse neuropsychological effects than CBZ.

    View details for PubMedID 30939410

  • Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy & behavior : E&B Roehl, K., Falco-Walter, J., Ouyang, B., Balabanov, A. 2019

    Abstract

    OBJECTIVE: This study evaluates the efficacy of a modified ketogenic diet (MKD) on seizure frequency, severity, and quality of life (QOL), as well as potential complications of MKD therapy among adults with drug-resistant epilepsy (DRE).METHODS: Changes in seizure frequency, severity, QOL, and side effects were retrospectively examined among adults, ≥17 years of age, with DRE (≥2 antiepileptic drugs [AEDs]), after 3 months of MKD therapy. Attention was paid to medication or vagus nerve stimulator (VNS) changes as well to evaluate potential confounders.RESULTS: A total of 60% (n = 33) of the 55 individuals reported ≥50% seizure frequency improvement, 42 (76%) reported improvement in seizure severity, and 48 (87%) reported improvement in QOL. More patients following a modified ketogenic diet - 15 g net carbohydrate daily (MKD-15) (95%) compared with a MKD-50 (69%) reported improvement in QOL (p = 0.02). Weight among the entire sample declined from 77.5 (20) kg to 73.9 (19.0) kg (p < 0.0001), and total cholesterol (TC), low density lipoprotein (LDL), and total cholesterol:high density lipoprotein (TC:HDL) increased significantly (p = 0.03, p = 0.04, and p = 0.02, respectively). Free carnitine values were available for a select number of patients, 26 (47%) at baseline, and 7 (13%) at follow-up, of which 8 (31%) at baseline, and 2 (29%) at follow-up had carnitine deficiency (<25 nmol/mL). Constipation was noted in 5 patients (9%), and no kidney stones were reported during the study period. There were no statistical differences in number or dose changes for AED or VNS during the study period.SIGNIFICANCE: Modified ketogenic diet therapies reduce seizure frequency and severity and improve QOL among adults with DRE with few side effects outside of weight loss, a desired outcome among many adults with DRE. More restrictive MKDs may offer improved seizure severity and QOL. Modified ketogenic diet therapy increases LDL cholesterol, which may be cardioprotective if related to an increase in LDL particle size with high saturated fat intake; however, more research is needed examining LDL particle size changes among those receiving MKD therapy.

    View details for PubMedID 30867113

  • Do certain subpopulations of adults with drug-resistant epilepsy respond better to modified ketogenic diet treatments? Evaluation based on prior resective surgery, type of epilepsy, imaging abnormalities, and vagal nerve stimulation. Epilepsy & behavior : E&B Falco-Walter, J. J., Roehl, K., Ouyang, B., Balabanov, A. 2019

    Abstract

    OBJECTIVE: Adults with drug-resistant epilepsy (DRE) are among the most challenging to treat. This study assessed whether specific subpopulations of adult patients with refractory epilepsy responded differently to modified ketogenic diet (MKD) therapy.METHODS: Changes in seizure frequency, severity, and quality of life (QOL) were retrospectively analyzed based on pre-MKD surgical history, type of epilepsy, imaging findings, and vagal nerve stimulation (VNS) history among adults, ≥17 years of age, with DRE, receiving MKD therapy for three months. Additionally, particular attention was made to medication and VNS adjustments.RESULTS: Responder rates in seizure frequency, severity, and QOL reported among those with prior surgery were 56%, 75%, and 94%, respectively. Among those with focal epilepsy: 57%, 76%, and 76% had improvements in seizure frequency, seizure severity, and QOL, respectively whereas 83% improvement was seen for all three measures in those with generalized epilepsy. Among those with abnormal imaging: just over 50% reported improvements on all measures. For those with VNS, 53%, 63%, and 95% had improvements in seizure frequency, seizure severity, and QOL, respectively. No statistical differences in seizure frequency, severity, or QOL were noted between groups based on prediet surgical history, seizure type, imaging abnormalities, or VNS history. Compared with expected improvement from medication adjustment alone, significant improvement was seen for all groups; notably, the Z-test for proportions for the surgery group, when compared with placebo responder rates at 20%, was 3.6, p < 0.001.CONCLUSIONS: Modified ketogenic diet therapies are effective in improving seizure frequency, severity, and QOL and may offer the best chance for improvement among those whose seizures have persisted despite surgical intervention and VNS therapy. All types of epilepsy respond to MKDs, and possibly those with generalized epilepsy may respond better.

    View details for DOI 10.1016/j.yebeh.2019.01.010

    View details for PubMedID 30738724

  • The new definition and classification of seizures and epilepsy. Epilepsy research Falco-Walter, J. J., Scheffer, I. E., Fisher, R. S. 2018; 139: 73–79

    Abstract

    This review discusses the updated classifications of seizures and the epilepsies, which were recently published by the International League Against Epilepsy (ILAE). While it is always a challenge to learn a new classification system, particularly one that has remained essentially unchanged for over three decades, these new classifications allow for the inclusion of some previously unclassifiable seizure types and utilize more intuitive terminology. In this review, we specifically discuss the use of these new classifications for patients, clinicians, and researchers.

    View details for PubMedID 29197668

  • Magnetoencephalography and New Imaging Modalities in Epilepsy NEUROTHERAPEUTICS Falco-Walter, J., Owen, C., Sharma, M., Reggi, C., Yu, M., Stoub, T. R., Stein, M. A. 2017; 14 (1): 4-10

    Abstract

    The success of epilepsy surgery is highly dependent on correctly identifying the entire epileptogenic region. Current state-of-the-art for localizing the extent of surgically amenable areas involves combining high resolution three-dimensional magnetic resonance imaging (MRI) with electroencephalography (EEG) and magnetoencephalography (MEG) source modeling of interictal epileptiform activity. Coupling these techniques with newer quantitative structural MRI techniques, such as cortical thickness measurements, however, may improve the extent to which the abnormal epileptogenic region can be visualized. In this review we assess the utility of EEG, MEG and quantitative structural MRI methods for the evaluation of patients with epilepsy and introduce a novel method for the co-localization of a structural MRI measurement to MEG and EEG source modeling. When combined, these techniques may better identify the extent of abnormal structural and functional areas in patients with medically intractable epilepsy.

    View details for DOI 10.1007/s13311-016-0506-7

    View details for PubMedID 28054328

  • 'Tickling' seizures originating in the left frontoparietal region. Epilepsy & behavior case reports Falco-Walter, J. J., Stein, M., McNulty, M., Romantseva, L., Heydemann, P. 2016; 6: 49-51

    Abstract

    We report a 10-year-old boy with mild developmental delay and epilepsy with new events of right back tickling and emotional upset. These initially appeared behavioral, causing postulation of habit behaviors or psychogenic nonepileptic seizures. Several ictal and interictal EEGs were unrevealing. Continuous EEG revealed only poorly localized frontal ictal activity. Given that his clinical symptoms suggested a parietal localization, double-density EEG electrodes were placed to better localize the epileptogenic and symptomatogenic zones. These revealed evolution of left greater than right frontoparietal discharges consistent with seizures at the time of the attacks. Medical management has significantly reduced the patient's seizures.

    View details for DOI 10.1016/j.ebcr.2016.07.002

    View details for PubMedID 27579251

  • Treatment of Established Status Epilepticus. Journal of clinical medicine Falco-Walter, J. J., Bleck, T. 2016; 5 (5)

    Abstract

    Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.

    View details for DOI 10.3390/jcm5050049

    View details for PubMedID 27120626