Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Direct electrocortical stimulation (DES) is the gold standard for mapping eloquent cortex, yet existing functional atlases are limited by sampling biases and density-based methods that obscure a region's true functional probability. Consequently, interpatient variability and the functional contributions of nontraditional language areas, such as the middle frontal gyrus, remain poorly characterized, particularly in epilepsy populations where functional reorganization is common. We therefore developed a probabilistic functional atlas of extraoperative DES and applied data-driven methods to characterize the functional organization of language, motor, and sensory cortex. METHODS:This was a retrospective observational study of patients undergoing intracranial monitoring for drug-resistant epilepsy (2008-2023). Electrical stimulation was delivered to intracranial electrodes during language tasks, and language, motor, and sensory findings were recorded. Positive and negative stimulation sites were analyzed in standard patient space and using the Human Connectome Project parcellation atlas. A multilevel statistical framework, including probability mapping, bootstrapped region-of-interest analyses, and kernel density estimation, defined structure-function relationships. Generalized linear mixed-effects models assessed the influence of clinical variables on language disruption. RESULTS:= 0.003) independently predicted a lower probability of language disruption in the temporal lobe. DISCUSSION/CONCLUSIONS:This extraoperative DES atlas provides a comprehensive benchmark for understanding functional cortical organization in epilepsy. We add evidence to the growing literature that language and motor systems are more distributed and variable than classically described. Substantial interpatient variability underscores the necessity of individualized mapping to guide safe neurosurgical planning. Limitations include the retrospective design and sampling bias inherent to electrode placement.

Seizures are a common presentation in both emergency departments and general pediatric practices. Epilepsy affects more than 3.4 million people nationwide, of which approximately 500,000 are children, with greater than 200,000 first-time seizures each year.¹ Of the affected individuals, as many as 100,000 are estimated to experience status epilepticus (SE). Both general practitioners and neurologists alike must be able to define, recognize and treat seizure emergencies. This review article defines and describes SE, discusses the emergency evaluation and management of SE that is both new-onset and breakthrough in people with epilepsy, reviews the current treatment recommendations for SE in both the home and hospital settings, and introduces special populations that may be at high risk for SE or other seizure emergencies.

The term "concussion" is often ambiguous for patients and caregivers, and likewise for many practitioners the definition remains imprecise. Our understanding of concussion over the last several years has grown and evolved due to the extensive data that is now being collected, and similarly, our definition of the term should too. While there is now more data and literature becoming available regarding pediatric concussion, it seems that there remains a lack of clarity and agreement about the definition and classification of concussion. This article aims to provide a brief review of the available literature on pediatric concussion definition and classifications, and hopefully present the most recent precise and accepted definition and classification system. Surely the definition of concussion will continue to evolve as new knowledge develops.

Prolonged seizures during childhood are associated with behavior problems, memory impairment and school failure. No effective treatment currently exists after seizures to mitigate neuronal injury and long-term neurological sequelae for children with epilepsy. We studied the therapeutic efficacy of early-life environment on seizure-induced behavioral deficits, neuronal injury and the inflammatory reaction using the kainic acid (KA) seizure model. Two rearing conditions, maternal separation for 3 h daily versus maternal care in an enriched environment, were followed by single housing for the former (Deprived) and group housing in an enriched environment for the latter (Enriched). To examine the influence of differential rearing on the behavioral effects of early-life seizures, KA was injected on P21. On P28, marked reduction in exploratory behavior was noted after seizures only in the Deprived group. To investigate seizure-induced hippocampal injury, a separate group of rats were injected with KA on P35 since consistent seizure-induced neuronal injury is observed only in mature rats. Brains of rats sacrificed on P37 displayed a significant reduction in DNA fragmentation and microglial activation in Enriched compared to Deprived animals. Our results suggest that a nurturing early environment can enhance the ability of the developing brain to recover from seizures and provide a buffer against their damaging effects. While the nurturing environment was neuroprotective, the combination of deprived rearing and the insult of early-life seizures resulted in significant behavioral deficits, an increase in neuronal injury and activation of microglia in young rats.