American Board of Psychiatry and Neurology (Child and Adolescent Neurology)
American Board of Psychiatry and Neurology (Epilepsy)
Professional History
As a pediatrician, pediatric neurologist, and clinical neurophysiologist, with specific training in seizure monitoring and treatment, I spend approximately 40% of my time in investigation, 20% in direct clinical care, 10% in teaching activities, and 30% in significant supporting activities. My early research experience as a resident and fellow included observational and interventional studies on clinical seizure manifestations and treatment. Following my 2008 appointment as Assistant in Neurology at Boston Children’s Hospital, I expanded my research to include circadian variation of seizures and used this information to develop a patient-oriented medication treatment schedule. My research is focused on identifying the factors that determine epileptic encephalopathies and status epilepticus as well as functional outcome later in life. Repetitive seizures and epileptic encephalopathy can impair development, plasticity and cognitive function of eloquent areas including language and memory. Seizure frequency reduction and seizure freedom, in particular after epilepsy surgery, have been shown to improve neurocognitive and developmental outcome. By identifying biomarkers that indicate predictors of cerebral damage and developmental outcome in epileptic encephalopathies and status epilepticus, we intend to reduce the occurrence of brain damage and later developmental disabilities and aim to identify novel therapeutic approaches.
What are we doing?
- Comparative effectiveness and interventional clinical trials in pediatric status epilepticus and epileptic encephalopathies
How do we do it?
- Inventing, evaluating and implementing clinically relevant biomarkers and treatment paradigms to assess and benchmark these based on clinical data, neurophysiology, imaging, pharmacogenomics and genetics, in collaboration with basic researcher locally, nationally, and internationally.
- Developing and evaluating monitoring tools for clinical biomarkers to further clinical epilepsy outcome measures including seizure characterization, neuropsychological outcome assessment, and quality of life assessment by means of seizure sensors and electronic tools including ICISS, the RENCI seizure tracking and outcome prediction modeling software, and novel in- and outpatient monitoring devices and algorithms, and neurophysiological, biochemical and genetic periodicity markers and implement these techniques into clinical workflow.
- Research networks and collaborations are essential for our work, like the pediatric status epilepticus research group (www.pserg.org), the Pediatric Epilepsy Research Consortium , the pediatric critical care epilepsy research group, the Critical Care EEG consortium, the pediatric neurocritical care research group and other consortia.
Approach to Care
Within my Area of Excellence in Investigation I have an outstanding record of successful and productive research in areas of high relevance for our pediatric epilepsy population. My expertise and experience as an innovator and teacher place me in an excellent position to continue to make important contributions to the field directly, as well as to exert future influence in the field through the researchers I train.
Publications
Time to treatment in pediatric patients with repeated episodes of status epilepticus. View Abstract
Prioritising faster, individualised rescue treatment in status epilepticus - Authors' reply. View Abstract
Assessment of Seizure Action Plans in Pediatric Convulsive Status Epilepticus: Focus on Benzodiazepine-Responsive and Resistant Cases. View Abstract
Validation of a discrete electrographic seizure detection algorithm for extended-duration, reduced-channel wearable EEG. View Abstract
Treating seizures faster: The Quality Improvement in Time to Treat Status Epilepticus (QuITT-SE) multicenter randomized stepped wedge clinical trial protocol. View Abstract
Utilizing natural language processing to identify pediatric patients experiencing status epilepticus. View Abstract
Improving the health literacy of persons with epilepsy. View Abstract
Diagnosis and management of status epilepticus: improving the status quo. View Abstract
Lack of association of first and second-line medication dosing and progression to refractory status epilepticus in children. View Abstract
Effects of epileptic seizures on the quality of biosignals recorded from wearables. View Abstract
Autonomic biosignals, seizure detection, and forecasting. View Abstract
Veni, Vidi, Vici-When Is Home Video Seizure Monitoring Helpful? View Abstract
Minimum clinical utility standards for wearable seizure detectors: A simulation study. View Abstract
Ultradian rhythms in accelerometric and autonomic data vary based on seizure occurrence in paediatric epilepsy patients. View Abstract
Biologic Correlates and Consequences of the Social Determinants of Health and Disease. View Abstract
Review on the current long-term, limited lead electroencephalograms. View Abstract
Design, implementation, and inferential issues associated with clinical trials that rely on data in electronic medical records: a narrative review. View Abstract
Biases in Electronic Health Records Data for Generating Real-World Evidence: An Overview. View Abstract
Artificial intelligence-enhanced epileptic seizure detection by wearables. View Abstract
Natural language processing for identification of refractory status epilepticus in children. View Abstract
Development of a Multivariable Seizure Likelihood Assessment Based on Clinical Information and Short Autonomic Activity Recordings for Children With Epilepsy. View Abstract
Pediatric status epilepticus management by Emergency Medical Services (the pSERG cohort). View Abstract
Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children. View Abstract
Explainable AI for wearable seizure logging: Impact of data quality, patient age, and antiseizure medication on performance. View Abstract
Self-management education for children with epilepsy and their caregivers. A scoping review. View Abstract
Creation of a Novel Child Simulator and Curriculum to Optimize Administration of Seizure Rescue Medication. View Abstract
Survey of Pediatric ICU EEG Monitoring-Reassessment After a Decade. View Abstract
Detect, predict, and prevent acute seizures and status epilepticus. View Abstract
Systemic inflammation as a biomarker of seizure propensity and a target for treatment to reduce seizure propensity. View Abstract
Data quality evaluation in wearable monitoring. View Abstract
Challenges for Emergency Medical Services in Status Epilepticus Management. View Abstract
Genotype-phenotype correlations in SCN8A-related disorders reveal prognostic and therapeutic implications. View Abstract
Prevalence and Predictors of Seizure Clusters in Pediatric Patients With Epilepsy: The Harvard-Yale Pediatric Seizure Cluster Study. View Abstract
Seizure-related differences in biosignal 24-h modulation patterns. View Abstract
Measuring Real-Time Medication Effects From Electroencephalography. View Abstract
Inequities in Therapy for Infantile Spasms: A Call to Action. View Abstract
Identifying Barriers to Care in the Pediatric Acute Seizure Care Pathway. View Abstract
Wearable device assessments of antiseizure medication effects on diurnal patterns of electrodermal activity, heart rate, and heart rate variability. View Abstract
Coarse-graining and the Haar wavelet transform for multiscale analysis. View Abstract
Super-Refractory Status Epilepticus in Children: A Retrospective Cohort Study. View Abstract
Generalized tonic-clonic seizures are accompanied by changes of interrelations within the autonomic nervous system. View Abstract
Genomic analysis of "microphenotypes" in epilepsy. View Abstract
Comparative Effectiveness of Initial Treatment for Infantile Spasms in a Contemporary US Cohort. View Abstract
Wearable devices for seizure detection: Practical experiences and recommendations from the Wearables for Epilepsy And Research (WEAR) International Study Group. View Abstract
Benzodiazepine administration patterns before escalation to second-line medications in pediatric refractory convulsive status epilepticus. View Abstract
Prospective Study of a Multimodal Convulsive Seizure Detection Wearable System on Pediatric and Adult Patients in the Epilepsy Monitoring Unit. View Abstract
Association between semiologic, autonomic, and electrographic seizure characteristics in children with generalized tonic-clonic seizures. View Abstract
EEG Biomarkers of Repository Corticotropin Injection Treatment. View Abstract
Video-Based Detection of Generalized Tonic-Clonic Seizures Using Deep Learning. View Abstract
Seizure detection using wearable sensors and machine learning: Setting a benchmark. View Abstract
Factors associated with long-term outcomes in pediatric refractory status epilepticus. View Abstract
Measuring the effects of sleep on epileptogenicity with multifrequency entropy. View Abstract
Clinical presentation of new onset refractory status epilepticus in children (the pSERG cohort). View Abstract
Prediction of Seizure Recurrence. A Note of Caution. View Abstract
Time to Treatment in Pediatric Convulsive Refractory Status Epilepticus: The Weekend Effect. View Abstract
Author Response: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus. View Abstract
Evaluation and recommendations for effective data visualization for seizure forecasting algorithms. View Abstract
Twenty-four-hour patterns in electrodermal activity recordings of patients with and without epileptic seizures. View Abstract
Efficacy and Tolerability of Rufinamide in Epileptic Children Younger Than 4 Years. View Abstract
Status Epilepticus-Work-Up and Management in Children. View Abstract
Machine learning from wristband sensor data for wearable, noninvasive seizure forecasting. View Abstract
The burden of decisional uncertainty in the treatment of status epilepticus. View Abstract
First-line medication dosing in pediatric refractory status epilepticus. View Abstract
Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive Review by the American Epilepsy Society Treatments Committee. View Abstract
Photoplethysmography: A measure for the function of the autonomic nervous system in focal impaired awareness seizures. View Abstract
Retrospective observational study on hospital readmission for status epilepticus in the United States over 2016. View Abstract
Autonomic nervous system changes detected with peripheral sensors in the setting of epileptic seizures. View Abstract
Photoplethysmographic evaluation of generalized tonic-clonic seizures. View Abstract
EEG features of brain injury during extracorporeal membrane oxygenation in children. View Abstract
Slow wave activity during NREM sleep in patients with electrical status epilepticus in sleep. View Abstract
Association of guideline publication and delays to treatment in pediatric status epilepticus. View Abstract
Nonlinear Analysis of Visually Normal EEGs to Differentiate Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS). View Abstract
Mortality in infantile spasms: A hospital-based study. View Abstract
Electrocardiographic changes associated with epilepsy beyond heart rate and their utilization in future seizure detection and forecasting methods. View Abstract
Pharmacotherapy for Pediatric Convulsive Status Epilepticus. View Abstract
Timing in the treatment of status epilepticus: From basics to the clinic. View Abstract
Machine Learning for Outcome Prediction in Electroencephalograph (EEG)-Monitored Children in the Intensive Care Unit. View Abstract
Efficacy and safety of ketogenic diet for treatment of pediatric convulsive refractory status epilepticus. View Abstract
Different as night and day: Patterns of isolated seizures, clusters, and status epilepticus. View Abstract
Towards acute pediatric status epilepticus intervention teams: Do we need "Seizure Codes"? View Abstract
Factors associated with treatment delays in pediatric refractory convulsive status epilepticus. View Abstract
Association of Time to Treatment With Short-term Outcomes for Pediatric Patients With Refractory Convulsive Status Epilepticus. View Abstract
Comparative Effectiveness of Levetiracetam vs Phenobarbital for Infantile Epilepsy. View Abstract
Common data elements for epilepsy mobile health systems. View Abstract
Can a collaborative healthcare network improve the care of people with epilepsy? View Abstract
Conscious control of breathing: A key to prevention of sudden unexpected death in epilepsy? View Abstract
Why West? Comparisons of clinical, genetic and molecular features of infants with and without spasms. View Abstract
New-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES): State of the art and perspectives. View Abstract
Patterns of epileptic seizure occurrence. View Abstract
Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. View Abstract
Should patients with complex febrile seizure be admitted for further management? View Abstract
Devices for Ambulatory Monitoring of Sleep-Associated Disorders in Children with Neurological Diseases. View Abstract
The Need for Antiepileptic Drug Chronotherapy to Treat Selected Childhood Epilepsy Syndromes and Avert the Harmful Consequences of Drug Resistance. View Abstract
New-Onset Status Epilepticus in Pediatric Patients: Causes, Characteristics, and Outcomes. View Abstract
Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism. View Abstract
Response to clobazam in continuous spike-wave during sleep. View Abstract
Time to continuous electroencephalogram in repeated admissions to the pediatric intensive care unit. View Abstract
The impact of hypsarrhythmia on infantile spasms treatment response: Observational cohort study from the National Infantile Spasms Consortium. View Abstract
Behaviorally-determined sleep phenotypes are robustly associated with adaptive functioning in individuals with low functioning autism. View Abstract
Rescue Medications in Epilepsy Patients: A Family Perspective. View Abstract
Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus. View Abstract
Nonintravenous rescue medications for pediatric status epilepticus: A cost-effectiveness analysis. View Abstract
Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy. View Abstract
Use of EEG in critically ill children and neonates in the United States of America. View Abstract
Genetic and phenotypic heterogeneity suggest therapeutic implications in SCN2A-related disorders. View Abstract
Increasing Ketamine Use for Refractory Status Epilepticus in US Pediatric Hospitals. View Abstract
Genetics and genotype-phenotype correlations in early onset epileptic encephalopathy with burst suppression. View Abstract
Understanding Death in Children With Epilepsy. View Abstract
Time to electroencephalography is independently associated with outcome in critically ill neonates and children. View Abstract
Reduced thalamic volume in patients with Electrical Status Epilepticus in Sleep. View Abstract
Refractory status epilepticus in children with and without prior epilepsy or status epilepticus. View Abstract
Seizures caused by brain tumors in children. View Abstract
Texting Rhythm With Temporal Predominance. View Abstract
Refractory Status Epilepticus in Children: Intention to Treat With Continuous Infusions of Midazolam and Pentobarbital. View Abstract
Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort. View Abstract
Interictal epileptiform discharges and cognition. View Abstract
HHV-6 and seizure: A systematic review and meta-analysis. View Abstract
The future of medicine will be dark without international collaboration [corrected]. View Abstract
Automated seizure detection systems and their effectiveness for each type of seizure. View Abstract
Real-time multi-channel monitoring of burst-suppression using neural network technology during pediatric status epilepticus treatment. View Abstract
Clobazam higher-evening differential dosing as an add-on therapy in refractory epilepsy. View Abstract
2014 Epilepsy Benchmarks Area III: Improve Treatment Options for Controlling Seizures and Epilepsy-Related Conditions Without Side Effects. View Abstract
Effectiveness of once-daily high-dose ACTH for infantile spasms. View Abstract
Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research. View Abstract
Response to treatment in a prospective national infantile spasms cohort. View Abstract
Effectiveness of antiepileptic therapy in patients with PCDH19 mutations. View Abstract
Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus. View Abstract
aEEG and cEEG: Two complementary techniques to assess seizures and encephalopathy in neonates: Editorial on "Amplitude-integrated EEG for detection of neonatal seizures: A systematic review" by Rakshasbhuvankar et al. View Abstract
Utility of initial EEG in first complex febrile seizure. View Abstract
Treatment of electrical status epilepticus in sleep: A pooled analysis of 575 cases. View Abstract
Incidence, risk factors, and longitudinal outcome of seizures in long-term survivors of pediatric brain tumors. View Abstract
Should epileptiform discharges be treated? View Abstract
Outcomes in pediatric patients with nonconvulsive status epilepticus. View Abstract
Acute seizure suppression by transcranial direct current stimulation in rats. View Abstract
Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy. View Abstract
Seizures and brain regulatory systems: consciousness, sleep, and autonomic systems. View Abstract
Time from convulsive status epilepticus onset to anticonvulsant administration in children. View Abstract
Therapeutic choices in convulsive status epilepticus. View Abstract
Pediatric refractory epilepsy: A decision analysis comparing medical versus surgical treatment. View Abstract
Autonomic changes in psychogenic nonepileptic seizures: toward a potential diagnostic biomarker? View Abstract
Clinical and Neuroimaging Profile of Children with Lesions in the Corpus Callosum. View Abstract
Pediatric status epilepticus management. View Abstract
Febrile status epilepticus: time is of the essence. View Abstract
Development and validation of a seizure prediction model in critically ill children. View Abstract
Passive fMRI mapping of language function for pediatric epilepsy surgical planning: validation using Wada, ECS, and FMAER. View Abstract
Subunit composition of neurotransmitter receptors in the immature and in the epileptic brain. View Abstract
Seizure detection, seizure prediction, and closed-loop warning systems in epilepsy. View Abstract
Localization of sleep spindles, k-complexes, and vertex waves with subdural electrodes in children. View Abstract
Safety and retention rate of rufinamide in 300 patients: a single pediatric epilepsy center experience. View Abstract
Management of pediatric status epilepticus. View Abstract
Comparison of pediatric patients with status epilepticus lasting 5-29 min versus =30 min. View Abstract
Copy number variation plays an important role in clinical epilepsy. View Abstract
Treatment for continuous spikes and waves during sleep (CSWS): survey on treatment choices in North America. View Abstract
Comparison of risk factors for pediatric convulsive status epilepticus when defined as seizures = 5 min versus seizures = 30 min. View Abstract
Pediatric status epilepticus: how common is cerebrospinal fluid pleocytosis in the absence of infection? View Abstract
Predicting diurnal and sleep/wake seizure patterns in paediatric patients of different ages. View Abstract
Subunit composition of glutamate and gamma-aminobutyric acid receptors in status epilepticus. View Abstract
Clobazam: effect on frequency of seizures and safety profile in different subgroups of children with epilepsy. View Abstract
Development and implementation of a quality improvement curriculum for child neurology residents: lessons learned. View Abstract
Diagnostic delays in children with early onset epilepsy: impact, reasons, and opportunities to improve care. View Abstract
Electrocorticography for seizure foci mapping in epilepsy surgery. View Abstract
Electrographic seizures after convulsive status epilepticus in children and young adults: a retrospective multicenter study. View Abstract
Outcomes of vagal nerve stimulation in a pediatric population: a single center experience. View Abstract
Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). View Abstract
Long-term response to high-dose diazepam treatment in continuous spikes and waves during sleep. View Abstract
Clinical application and evaluation of the Bien diagnostic criteria for Rasmussen encephalitis. View Abstract
The diagnostic yield of pediatric polysomnography based on the professional background of referring physicians. View Abstract
Predictors of seizure occurrence in children undergoing pre-surgical monitoring. View Abstract
Electroencephalography in the pediatric emergency department: when is it most useful? View Abstract
Clinical practice guidelines and practice parameters for the child neurologist. View Abstract
Cardiopulmonary complications during pediatric seizures: a prelude to understanding SUDEP. View Abstract
Chronopharmacology of anti-convulsive therapy. View Abstract
Pediatric ICU EEG monitoring: current resources and practice in the United States and Canada. View Abstract
Should readmission within 30 days after discharge of children hospitalized for a neurologic disorder be considered a quality assurance failure? View Abstract
Electroencephalographic monitoring in the pediatric intensive care unit. View Abstract
Sturge-Weber syndrome: clinical and radiological correlates in 86 patients. View Abstract
Electrical status epilepticus in sleep: clinical presentation and pathophysiology. View Abstract
The tower of Babel: survey on concepts and terminology in electrical status epilepticus in sleep and continuous spikes and waves during sleep in North America. View Abstract
Risk factors associated with death in in-hospital pediatric convulsive status epilepticus. View Abstract
Clinical evolution of seizures: distribution across time of day and sleep/wakefulness cycle. View Abstract
Dacrystic seizures: demographic, semiologic, and etiologic insights from a multicenter study in long-term video-EEG monitoring units. View Abstract
Overcoming barriers to successful epilepsy management. View Abstract
Chrono-epileptology: time to reconsider seizure timing. View Abstract
Circadian patterns of generalized tonic-clonic evolutions in pediatric epilepsy patients. View Abstract
Effect of treatment of obstructive sleep apnea on seizure outcomes in children with epilepsy. View Abstract
Diurnal and sleep/wake patterns of epileptic spasms in different age groups. View Abstract
Clinical staging and electroencephalographic evolution of continuous spikes and waves during sleep. View Abstract
Outcomes of epileptic spasms in patients aged less than 3 years: single-center United States experience. View Abstract
Short-term response of sleep-potentiated spiking to high-dose diazepam in electric status epilepticus during sleep. View Abstract
Early thalamic lesions in patients with sleep-potentiated epileptiform activity. View Abstract
Autonomic changes with seizures correlate with postictal EEG suppression. View Abstract
Patients with electrical status epilepticus in sleep share similar clinical features regardless of their focal or generalized sleep potentiation of epileptiform activity. View Abstract
Convulsive seizure detection using a wrist-worn electrodermal activity and accelerometry biosensor. View Abstract
Analysis of EEG patterns and genotypes in patients with Angelman syndrome. View Abstract
Behavioral measures and EEG monitoring using the Brain Symmetry Index during the Wada test in children. View Abstract
Epileptic syndromes with focal seizures of childhood and adolescence. View Abstract
An electroencephalographic recording platform for real-time seizure detection. View Abstract
Signal subspace integration for improved seizure localization. View Abstract
Treatment of pediatric status epilepticus. View Abstract
Teaching NeuroImages: mesial temporal sclerosis after a prolonged unprovoked seizure in an infant. View Abstract
What is quality improvement and why should child neurologists care? View Abstract
Outcome of no resection after long-term subdural electroencephalography evaluation in children with epilepsy. View Abstract
Selective serotonin reuptake inhibitors and periodic limb movements of sleep. View Abstract
Necrotizing granulomatous meningoencephalitis due to Balamuthia in an immunocompetent child. View Abstract
Effect of continuous positive airway pressure treatment on seizure control in patients with obstructive sleep apnea and epilepsy. View Abstract
Sleep-wake patterns of seizures in children with lesional epilepsy. View Abstract
Experience with lacosamide in a series of children with drug-resistant focal epilepsy. View Abstract
Electroencephalogram monitoring during intracranial surgery for moyamoya disease. View Abstract
An empirical investigation of motion effects in eMRI of interictal epileptiform spikes. View Abstract
Localization of pediatric seizure semiology. View Abstract
Continuous spike and waves during sleep and electrical status epilepticus in sleep. View Abstract
Chronobiology of epilepsy: diagnostic and therapeutic implications of chrono-epileptology. View Abstract
Circadian distribution and sleep/wake patterns of generalized seizures in children. View Abstract
Can semiology predict psychogenic nonepileptic seizures? A prospective study. View Abstract
Treatment of malignant migrating partial epilepsy of infancy with rufinamide: report of five cases. View Abstract
Rufinamide for the treatment of epileptic spasms. View Abstract
Circadian patterns of pediatric seizures. View Abstract
Septo-optic dysplasia complicated by infantile spasms and bilateral choroidal fissure arachnoid cysts. View Abstract
Higher evening antiepileptic drug dose for nocturnal and early-morning seizures. View Abstract
Incidence and clinical decision making for the Wada test over one decade: 1997-2007. View Abstract
Experience with rufinamide in a pediatric population: a single center's experience. View Abstract
Surgical treatment of refractory status epilepticus in children: candidate selection and outcome. View Abstract
Fears and promises of comparative effectiveness research. View Abstract
Clinical correlations of midline spikes in children. View Abstract
Crying with left temporal lobe seizures and Wada testing. View Abstract
Neuroimaging findings in children with benign focal epileptiform discharges. View Abstract
Visual naming performance after ATL resection: impact of atypical language dominance. View Abstract
A self-administered screening instrument for psychogenic nonepileptic seizures. View Abstract
Continuous monitoring of electrodermal activity during epileptic seizures using a wearable sensor. View Abstract
Childhood absence epilepsy in patients with benign focal epileptiform discharges. View Abstract
Language assessment in Wada test: comparison of methohexital and amobarbital. View Abstract
Longer duration of epilepsy and earlier age at epilepsy onset correlate with impaired cognitive development in infancy. View Abstract
Memory performance is related to language dominance as determined by the intracarotid amobarbital procedure. View Abstract
Discontinuation of medications after successful epilepsy surgery in children. View Abstract
Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly - broadening the clinical spectrum of midline defects. View Abstract
Lateralization of interictal EEG findings. View Abstract
Risk factors for early visual deterioration in temporal arteritis. View Abstract
Developmental outcome after epilepsy surgery in infancy. View Abstract