Tag Archive for: Cohen

Dr. Gaillard, Dr. Schreiber and Dr. Cohen from Children’s National Hospital at the 2024 American Epilepsy Society meeting.

Advancing epilepsy care: Highlights from the 2024 American Epilepsy Society Conference

Dr. Gaillard, Dr. Schreiber and Dr. Cohen from Children’s National Hospital at the 2024 American Epilepsy Society meeting.

Dr. Gaillard, Dr. Schreiber and Dr. Cohen from Children’s National Hospital at the 2024 American Epilepsy Society meeting.

The 2024 American Epilepsy Society (AES) conference, held over five days, brought together healthcare professionals, scientists and industry leaders from around the globe. This annual event focuses on advancing outcomes for people with epilepsy through educational sessions, cutting-edge research and the latest technological innovations.

Recognized amongst his peers as an international leader in epilepsy research, William D. Gaillard, M.D., was honored with the 2024 Clinical Science Research Award at this year’s meeting. His pioneering work has significantly enhanced our understanding of epilepsy’s impact on brain structure and has led to improvements in surgical interventions and patient outcomes. Dr. Gaillard’s ongoing contributions to enhancing the lives of children with epilepsy earned him the Society’s most prestigious research award.

Dr. Gaillard serves as chief of the Divisions of Child Neurology and of Epilepsy and Neurophysiology, Director of the Comprehensive Pediatric Epilepsy Program and Associate Director of the Center for Neuroscience Research at Children’s National Hospital.

In addition to Dr. Gaillard, experts from the Comprehensive Pediatric Epilepsy Program at Children’s National were invited to present their research, insights and innovations during the conference. As a recognized Level 4 epilepsy center by the National Association of Epilepsy Centers, the program’s collaborative team is recognized worldwide for their leadership in improving the lives of children with epilepsy through personalized care, advanced technology and groundbreaking research.

Highlights from AES 2024 include:

Sanam Zarei, M.D., Children’s National Hospital Neurology fellow, presenting a poster at AES 2024.

Dr. Zarei, Children’s National Hospital Neurology fellow, presenting a poster at AES 2024.

Poster presentations:

  • Asymmetrical Hippocampal-cortical Connectivity Along Lateral-Medial Axis in Pediatric Focal Epilepsy Patients by Hua Xie, Ph.D., Chloe A. Hooker, William D. Gaillard, M.D.
  • Comorbidities and Concerns in Hypothalamic Hamartoma: Results of an International Caregiver Survey by Nathan Cohen, M.D.
  • Automated and Interpretable Detection of Hippocampal Sclerosis in temporal lobe epilepsy: AID-HS by Nathan Cohen, M.D.
  • Characteristics and Outcomes of Pediatric Patients with Prolonged Convulsive Status Epilepticus by William D. Gaillard, M.D.
  • High Accuracy for Detecting Tonic Clonic seizures (TCSs) Using an Apple Watch Seizure Detector by Dewi Depositario-Cabacar, M.D., William Gaillard, M.D.
  • Patient and Pre-surgical Testing Characteristics Contributing to Duration of Evaluation: Identifying Best Practices and Opportunities to Streamline Pediatric Epilepsy Surgery Evaluation by Dewi Depositario-Cabacar, M.D., William Gaillard, M.D.
  • Seizure Burden in Infants with Hemimegaloencephaly pre- and post Staged Transarterial Embolization by Ersida Buraniqi, M.D., Shani Israel, Lindsay Ruffini, CPNP, CPNP-AC, CPNP-PC, Tammy Tsuchida, M.D., Ph.D., Tayyba Anwar, M.D.
  • Acute Postoperative Seizures (APOS) in Pediatric Epilepsy Surgery Occurring Less Than 7 Days versus Greater Than 7 to 30 Days: Is There a Difference in Long Term Outcome? by Sanam Zarei, M.D., Kathryn Havens, PA-C, Nathan Cohen, M.D., John Schreiber, M.D., Thuy-Anh Vu, M.D., William Gaillard, M.D., Dewi Depositario-Cabacar, M.D.

Invited speakers and topics:

  • Speaker: John Schreiber, M.D., Moving Forward: Epilepsies with Concomitant Movement Disorders
  • Speaker: Laura Tochen, M.D., Moving Forward: Epilepsies with Concomitant Movement Disorders
  • Speaker: William Gaillard, M.D., US Health Care Inequities for People with Epilepsy
  • Session Moderator: Nathan Cohen, M.D., Neuroimaging

Learn more about the Comprehensive Pediatric Epilepsy Program at Children’s National Hospital.

Magnetic resonance imaging of a brain with seizures

Making pediatric epilepsy surgery more accessible

Magnetic resonance imaging of a brain with seizures

Pediatricians play a vital role in boosting the use of epilepsy surgery for better patient outcomes.

Despite proven safety, efficacy and cost effectiveness, surgery for pharmacoresistant epilepsy remains one of the most underutilized, evidence-based treatments in modern medicine. Pediatricians are key stakeholders for increasing epilepsy surgical utilization.

A recent commentary from Children’s National Hospital experts — led by Nathan Cohen, M.D., neurologist; Chima Oluigbo, M.D., neurosurgeon; and William D. Gaillard, M.D., chief of Neurology — offers a new perspective that highlights the issue and offers practical solutions to increase primary care physician comfort in the referral of patients for epilepsy surgery.

“Pediatricians should feel empowered to open discussions with epilepsy patients and their families about the possibility of surgery,” the authors write. “Through partnership with managing neurologists and early referral to epilepsy surgery centers, together we can begin to dismantle the significant barriers to access. Only by overcoming our own fears of initiating these discussions can we offer hope to those patients and families who need it the most.”

You can read the full commentary, “Breaking Barriers to Pediatric Epilepsy Surgery Utilization,” in The Journal of Pediatrics.

Illustration of brain and brainwaves

Risk factors for pharmacoresistant pediatric epilepsy

Illustration of brain and brainwaves

New study evaluates risk factors for the timing and development of drug-resistant pediatric epilepsy.

Focal cortical dysplasia (FCD) is the most common cause of surgically-treatable epilepsy in children. In a new study published in Neurology, researchers evaluated 143 children with confirmed FCD risk factors for the timing and development of pharmacoresistant epilepsy.

What this means

The current definition of pharmacoresistance requires failure of two appropriately-dosed and selected antiseizure medications before being able to be considered for epilepsy surgery.

“We found that the failure of just one antiseizure medication is associated with an enormous increased incidence and earlier development of pharmacoresistance,” says Nathan Cohen, M.D., neurologist at Children’s National and lead author of the study. “Our data supports the redefinition of pharmacoresistant epilepsy to the failure of just one antiseizure medication in this population, which would potentially allow these patients to benefit from earlier curative surgery.”

Why it matters

The findings showed that in children with FCD the failure of just one antiseizure medication is associated with an enormous risk and earlier incidence of pharmacoresistance. Therefore, the authors advocate for its redefinition in FCD-related epilepsy to the failure of just one antiseizure medication.

“This will allow children to be considered much earlier for potentially curative epilepsy surgery,” adds Dr. Cohen. “We find that the majority of FCD patients develop epilepsy and that the majority of those with epilepsy develop pharmacoresistance.”

In a multivariate analysis, the authors show that the FCD cortical lobar location, pathologic subtype, and age of seizure onset are not important factors in the development of pharmacoresistance.

What’s next

This data supports operational re-definition of pharmacoresistance for surgical planning in FCD-related epilepsy to the failure of one antiseizure medication, and support early, potentially curative surgery to improve outcomes in this patient population.

You can read the full study, Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia–Related Epilepsy, in Neurology.

Digital background depicting innovative technologies in (AI) artificial systems, neural interfaces and internet machine learning technologies

AI algorithm that detects brain abnormalities could help cure epilepsy

Digital background depicting innovative technologies in (AI) artificial systems, neural interfaces and internet machine learning technologies

A new AI algorithm can detect subtle brain abnormalities that cause epileptic seizures.

An artificial intelligence (AI) algorithm that can detect subtle brain abnormalities that cause epileptic seizures has been developed by a UCL-led team of international researchers, including Children’s National Hospital.

To do this, the team quantified features from MRI scans, such as how thick or folded the brain was at nearly 300,000 locations in each case.

They then trained the AI algorithm using examples labelled by expert radiologists as either a healthy brain or one with focal cortical dysplasia (FCD) based on their patterns and features.

The results, published in Brain, showed that in the main cohort of 538 patients, the algorithm was able to detect the FCD in 67% of cases.

“We put an emphasis on creating an AI algorithm that was interpretable and could help doctors make decisions. Showing doctors how the Multicentre Epilepsy Lesion Detection project (MELD) algorithm made its predictions was an essential part of that process,” said Mathilde Ripart, research assistant at UCL and the study’s co-first author.

Around 1% of the population have epilepsy and, of these, 20-30% do not respond to medications.

“We are excited to collaborate with MELD on ways to improve the treatment of pharmacoresistant epilepsy,” said Nathan Cohen, M.D., neurologist at Children’s National Hospital and co-author of the study. “This advanced imaging platform is open source and demonstrates the benefit of team science at the broadest scale.”

In children who have had surgery to control their epilepsy, FCD is the most common cause, and in adults it is the third most common cause.

Additionally, of patients who have epilepsy that have an abnormality in the brain that cannot be found on MRI scans, FCD is the most common cause.

You can read the full UCL press release here.

Little boy going to school with protective mask

Firearm injuries involving young children in the United States during the COVID-19 pandemic

Little boy going to school with protective mask

After seeing the surge of firearm injuries in young children and inflicted by young children during the first six months of the COVID-19 pandemic, the study’s experts are saying there is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.

A recent study pre-published in Pediatrics found that the COVID-19 pandemic is associated with a surge in fatal and nonfatal firearm injuries both in young children and inflicted by young children, correlating with a rise in firearm acquisitions.

The findings, led by Children’s National Hospital experts, show the risk was higher during the first six months of the COVID-19 pandemic as compared to the pre-COVID period.

“According to the Centers for Disease Control and Prevention, firearms are a leading cause of injury and death among youth,” said Monika K. Goyal, M.D., M.S.C.E., senior author of this study and associate  chief of Emergency Medicine and Trauma Services at Children’s National. “The pandemic has led to an increase in these preventable tragedies and it is incumbent upon us as a society to put appropriate measures in place to keep children safe.”

“Increased firearm purchases are one reason we have seen an increase in firearm injuries during the pandemic,” said Joanna S. Cohen, M.D., associate professor of Pediatrics and Emergency Medicine. “Increased purchases are likely related to the political unrest we recently witnessed and increased firearm injuries may be related to children being at home more. Whereas children were in school before, they might be home unsupervised while parents and caretakers are working.”

In addition, there has been an increase in domestic violence over the course of the pandemic which, according to Dr. Cohen, could be a reflection of the stress emerging from financial insecurity, joblessness, illness and other stressors deriving from the pandemic.

After seeing the surge of firearm injuries in young children and inflicted by young children during the first six months of the COVID-19 pandemic, the study’s experts are saying there is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.

“There is an urgent need for strategies to prevent further injuries,” Dr. Goyal said. “This includes counseling families on firearm safety at home, having more sensible gun laws and educating the public accordingly.”

In the past, if you were a new gun owner, you would have access to training on how to handle a gun and find safe storage. With all the sheltering in place due to the pandemic, those educational opportunities have fallen by the wayside. “Now you have more people who have become new gun owners but haven’t had the opportunity to get education on safe gun ownership, coinciding with more children staying at home because of the pandemic,” Dr. Goyal said.

The increase in domestic violence could also be a contributing factor. Children are often witnesses to violence at home, Dr. Cohen explained. In many cases, she said, if children see a parent being threatened with a gun, they might model that behavior without fully understanding the implications of holding a gun and the injury it can cause.