Kimford Meador

ObjectiveEpilepsy patients often report memory deficits despite normal objective testing, suggesting that available measures are insensitive or that non-mnemonic factors are involved. The Visual Paired Comparison Task (VPCT) assesses novelty preference, the tendency to fixate on novel images rather than previously viewed items, requiring recognition memory for the “old” images. As novelty preference is a sensitive measure of hippocampal-dependent memory function, we predicted impaired VPCT performance in epilepsy patients compared to healthy controls.MethodsWe assessed 26 healthy adult controls and 31 epilepsy patients (16 focal-onset, 13 generalized-onset, 2 unknown-onset) with the VPCT using delays of 2 or 30 s between encoding and recognition. Fifteen healthy controls and 17 epilepsy patients (10 focal-onset, 5 generalized-onset, 2 unknown-onset) completed the task at 2-, 5-, and 30-minute …

Risks of Fetal Exposure to Topiramate. - Abstract - Europe PMC Sign in | Create an account https://orcid.org Europe PMC Menu About Tools Developers Help Contact us Helpdesk Feedback Twitter Blog Tech blog Developer Forum Europe PMC plus Search life-sciences literature (43,815,450 articles, preprints and more) Search Advanced search Feedback This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Abstract Full text Citations & impact Risks of Fetal Exposure to Topiramate. Meador KJ 1 Author information Affiliations 1. From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA. (1 author) The New England Journal of Medicine, 01 Mar 2024, 390(12):1141-1142 https://doi.org/10.1056/nejme2401164 PMID: …

Objective Determine the correlation of electrical activity between brain regions during a simple cognitive task in healthy volunteers. Background High-density electroencephalography (HDEEG) recorded from scalp has been shown to provide utility for patients with medically refractory epilepsy undergoing pre-surgical planning. The two primary goals of pre-surgical planning are to identify a seizure onset zone, and to localize functional and dysfunctional regions. The latter is important to assess the potential risk of surgery. One main concern of epilepsy surgery is disrupting normal memory function. Currently, noninvasive tools to assess memory risks as part of pre-surgical workup are inadequate. In the current study, we recorded HDEEG during a simple cognitive task to assess network connectivity, which may elucidate widespread network dysfunction associated with cognitive problems. Design/Methods Eight …

This study explores natural direct and joint natural indirect effects (JNIE) of prenatal opioid exposure on neurodevelopmental disorders (NDDs) in children mediated through pregnancy complications, major and minor congenital malformations, and adverse neonatal outcomes, using Medicaid claims linked to vital statistics in Rhode Island, United States, 2008–2018. A Bayesian mediation analysis with elastic net shrinkage prior was developed to estimate mean time to NDD diagnosis ratio using posterior mean and 95% credible intervals (CrIs) from Markov chain Monte Carlo algorithms. Simulation studies showed desirable model performance. Of 11,176 eligible pregnancies, 332 had ≥2 dispensations of prescription opioids anytime during pregnancy, including 200 (1.8%) having ≥1 dispensation in the first trimester (T1), 169 (1.5%) in the second (T2), and 153 (1.4%) in the third (T3). A significant JNIE of …

Objective To compare age 6-years-old neurodevelopmental outcomes of children of women with epilepsy (WWE) vs. healthy women (HW). Background Antiseizure medications (ASMs) are all potential teratogens which might impair neurodevelopmental outcomes. Design/Methods The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational, multi-center investigation. WWE and HW were enrolled during pregnancy. The a priori primary neurodevelopmental outcome for children is age 6 Verbal Index score calculated by averaging Differential Ability Scales-II Word Definitions and Verbal Similarities subtests, Expressive One-Word Picture Vocabulary Test-4, Peabody Picture Vocabulary Test-4, and NeuroPSYchological Assessment-2 Phonological Processing, Comprehension of Instructions, and Sentence Repetition subtests. We compared the …

A variety of terms, such as “antiepileptic,” “anticonvulsant,” and “antiseizure” have been historically applied to medications for the treatment of seizure disorders. Terminology is important because using terms that do not accurately reflect the action of specific treatments may result in a misunderstanding of their effects and inappropriate use. The present International League Against Epilepsy (ILAE) position paper used a Delphi approach to develop recommendations on English‐language terminology applicable to pharmacological agents currently approved for treating seizure disorders. There was consensus that these medications should be collectively named “antiseizure medications”. This term accurately reflects their primarily symptomatic effect against seizures and reduces the possibility of health care practitioners, patients, or caregivers having undue expectations or an incorrect understanding of the real …

Objective Compare sex steroid hormone (SSH) serum concentrations in pregnant women with epilepsy (PWWE) on enzyme-inducing (EI) antiseizure medications (ASMs) to PWWE on non-EIASMs or no ASM. Background SSH concentrations dramatically increase throughout pregnancy. They and their neuroactive steroid metabolites may influence fetal neurodevelopment and seizure control in PWWE. EIASMs alter SSH concentrations in the non-pregnant state. This secondary analysis aims to evaluate this effect in PWWE. Design/Methods Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) is a prospective, observational, multi-center study of PWWE, enrolled≤ 20 weeks gestation. Serum progesterone, estradiol, and estrone concentrations were measured at enrollment, trimesters two and three and delivery. Some participants had multiple samples in the second and/or third …

ObjectiveMental illness and epilepsy are each associated with increased maternal morbidity and mortality, yet their joint effects are unknown. We evaluated the impact of concurrent mental illness on the relationship between epilepsy and non-transfusion severe maternal morbidity (SMM).Study DesignWe conducted a population-based cohort study of birth certificate (both live birth and fetal death) and hospital discharge records in California in 2007-2018. Epilepsy and mental health disorders at delivery hospitalization were identified using ICD-CM codes. Mental health disorders included depression, anxiety, bipolar disorder, post-traumatic stress disorder, and psychosis/delusions. Exposures were no epilepsy or mental health disorder (referent), mental health disorder alone, epilepsy alone, or both epilepsy and mental health disorder. The outcome was SMM—defined as presence of 1 of 20 indicators not including …

14.2 Study Design First, we start by reviewing critical aspects of prospective study design. 14.2. 1 Selection of Outcome Measures and How to Best Collect the Data For many studies in epilepsy, the outcome of interest is related to seizure occurrence or seizure frequency [11]. Some seizure-related metrics commonly used as study outcomes include the change in seizure frequency compared to the individual's baseline, achieving greater than 50% seizure reduction (or other percentages) within a pre-specified time frame, number of seizure-free days within a pre-specified time frame, rate of seizure freedom, and time-to-event measures such as rate of relapse or time to first seizure recurrence (see Chapter 6)[2]. Understanding the research question and analysis population is critical for determining the appropriate outcome for a given study. Factors that should be considered include study design considerations, such as the planned length of follow-up time, as well factors related to the study population, such as understanding of the seizure pathology studied and whether seizure events in the study population are expected to be rare or more frequent. Safety outcomes and outcomes related to quality of life and development of co-morbidities are also often included in epilepsy research. While seizure outcomes are common in epilepsy research and often the most clinically relevant outcome, reliable measurement and collection of seizure data are quite challenging. This is one of the biggest challenges for prospective studies in epilepsy. While the most common approach for collecting seizure data continues to be through patient self-report via online or …

ImportanceThe association of fetal exposure to antiseizure medications (ASMs) with outcomes in childhood are not well delineated.ObjectiveTo examine the association of fetal ASM exposure with subsequent adaptive, behavioral or emotional, and neurodevelopmental disorder outcomes at 2, 3, and 4.5 years of age.Design, Setting, and ParticipantsThe Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational cohort study conducted at 20 epilepsy centers in the US. A total of 456 pregnant women with epilepsy or without epilepsy were enrolled from December 19, 2012, to January 13, 2016. Children of enrolled women were followed up with formal assessments at 2, 3, 4.5, and 6 years of age. Statistical analysis took place from August 2022 to May 2023.ExposuresExposures included mother’s epilepsy status as well as mother’s ASM blood …

Background Stroke is one of the most common neurological conditions that often leads to upper limb motor impairments, significantly affecting individuals' quality of life. Rehabilitation strategies are crucial in facilitating post-stroke recovery and improving functional independence. Functional Electrical Stimulation (FES) systems have emerged as promising upper limb rehabilitation tools, offering innovative neuromuscular reeducation approaches. Objective The main objective of this paper is to provide a comprehensive systematic review of the start-of-the-art functional electrical stimulation (FES) systems for upper limb neurorehabilitation in post-stroke therapy. More specifically, this paper aims to review different types of FES systems, their feasibility testing, or randomized control trials (RCT) studies. Methods The FES systems classification is based on the involvement of patient feedback within the FES control, which mainly includes “Open-Loop FES Systems” (manually controlled) and “Closed-Loop FES Systems” (brain-computer interface-BCI and electromyography-EMG controlled). Thus, valuable insights are presented into the technological advantages and effectiveness of Manual FES, EEG-FES, and EMG-FES systems. Results and discussion The review analyzed 25 studies and found that the use of FES-based rehabilitation systems resulted in favorable outcomes for the stroke recovery of upper limb functional movements, as measured by the FMA (Fugl-Meyer Assessment) (Manually controlled FES: mean difference = 5.6, 95% CI (3.77, 7.5), P < 0.001; BCI-controlled FES: mean difference = 5.37, 95% CI (4.2, 6.6), P < 0.001; EMG-controlled …

The recent Burkle et al. article and accompanying editorial discuss brain death.[1, 2] The ethical issues related to brain death date only to the mid-twentieth century with the advent of modern respiratory support.[3, 4] Subsequent medical advances have further enhanced our ability to artificially sustain bodily functions in the absence of cerebral function.At the advent of modern science, Mary Shelley wrote a cautionary tale on the misuse of medical science. The prolonged support of a brain dead patient is a misuse of medical science. This important ethical point is only addressed tangentially by the recent Neurology article as" moral distress for professionals,"[1] and is not addressed by the associated editorial.[2] Further, this point is frequently not directly addressed in related literature. The misuse of medical science to provide prolonged support of a brain dead patient is not only an ethical issue for physicians, but …

ObjectivePeople with epilepsy are at increased risk of hemorrhage-related severe maternal morbidity (SMM) events, but little is known about the prevalence and drivers of cesarean births–a major contributor to hemorrhage–in this population. We therefore examined if cesarean birth differed among people with versus without epilepsy, and whether any differences were explained by patient or hospital level factors.Study DesignThis cohort study used linked birth certificate and hospital discharge data from nulliparous, term, singleton, vertex (NTSV) livebirths in California from 2007-2018 to compare the prevalence of cesarean birth among people with versus without epilepsy. Epilepsy was defined using diagnosis codes and categorized into generalized, focal, and other less specified subtypes. Poisson regression models with robust standard errors were conducted adjusting for potential confounders …

A recently published paper by Vegrim and colleagues 1 suggests that high-dose folic acid intake during pregnancy in women with epilepsy is associated with an increased risk of cancer in their offspring. The conclusion is drawn from data from an epidemiological study that analyzed large health care databases from Norway, Sweden, andDenmark. The study results have been noted by the public media with spreading concerns of a causal relationship. There are at least 15 million women with epilepsy of childbearing age worldwide for whom folic acid supplementation is recommended by evidence-based guidelines to reduce adverse fetal outcomes. 2–5 A reported increase

Dr. Gooch's review of a 2016 national survey of neurology department chairs revealed that most neurology faculty members are not on tenure track, and 38% of neurology departments have some clinical service faculty with no assigned educational or research duties.[1] Further, a separate 2016 survey of US neurologists, conducted by the American Academy of Neurology, showed that the overall effort by academic neurologists toward education and research has markedly dropped with an average of 16.4% of their time on research and 11.3% on teaching; the medians for both research and education are 10%.[2] In contrast, academic physicians spent 58% time on educational and research activities in 1984 compared to 27.7% in 2016.[3]Are the roles of academic neurology in our society appropriately balanced when, on average, faculty members spend only 27.7% of their time on education and research? As Dr …

Neuromodulation of the anterior nuclei of the thalamus (ANT) has shown to be efficacious in a subset of patients with refractory focal epilepsy. One important uncertainty is to what extent thalamic subregions other than the ANT could be recruited more prominently in the propagation of focal onset seizures. We designed the current study to simultaneously monitor the engagement of the ANT, mediodorsal (MD) and pulvinar (PUL) nuclei during seizures in patients who could be candidates for thalamic neuromodulation. We studied 11 patients with clinical manifestations of presumed temporal lobe epilepsy (TLE) undergoing invasive stereo-encephalography (sEEG) monitoring to confirm the source of their seizures. We extended cortical electrodes to reach the ANT, MD and PUL nuclei of the thalamus. More than one thalamic subdivision was simultaneously interrogated in nine patients. We recorded seizures …

Introduction and ObjectiveReceipt of opioid agonist treatment during early and late pregnancy for opioid use disorder may relate to varying perinatal risks. We aimed to assess the effect of time-varying prenatal exposure to opioid agonist treatment using buprenorphine or methadone on adverse neonatal and pregnancy outcomes.MethodsWe conducted a retrospective cohort study of pregnant women with opioid use disorder using Rhode Island Medicaid claims data and vital statistics during 2008–16. Time-varying exposure was evaluated in early (0–20 weeks) and late (≥ 21 weeks) pregnancy. Marginal structural models with inverse probability of treatment weighting were applied.ResultsOf 400 eligible pregnancies, 85 and 137 individuals received buprenorphine and methadone, respectively, during early pregnancy. Compared with 152 untreated pregnancies with opioid use disorders, methadone exposure in …

Background and ObjectivesBreastfeeding has important health benefits for both mother and child. We characterize breastfeeding initiation and duration in mothers with epilepsy relative to control mothers in a large prospective cohort.MethodsThe Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a prospective, multicenter observational, US cohort study. Pregnant individuals with and without epilepsy, aged 14–45 years, were enrolled between December 19, 2012, and February 11, 2016. Exclusion criteria included intelligence quotient (IQ) <70, and gestational age >20 weeks at enrollment. Breastfeeding was assessed through electronic diary and at study visits until 2 years postpartum. Odds of initiating breastfeeding was compared between cohorts using unadjusted and adjusted logistic regression models. Duration of breastfeeding was compared between cohorts using the log …

With more than 6000 attendees between in-person and virtual offerings, the American Epilepsy Society Meeting 2022 in Nashville, felt as busy as in prepandemic times. An ever-growing number of physicians, scientists, and allied health professionals gathered to learn a variety of topics about epilepsy. The program was carefully tailored to meet the needs of professionals with different interests and career stages. This article summarizes the different symposia presented at the meeting. Basic science lectures addressed the primary elements of seizure generation and pathophysiology of epilepsy in different disease states. Scientists congregated to learn about anti-seizure medications, mechanisms of action, and new tools to treat epilepsy including surgery and neurostimulation. Some symposia were also dedicated to discuss epilepsy comorbidities and practical issues regarding epilepsy care. An increasing number …

Holloway et al. provided an excellent description of conflicts of interest (COI) as they relate to AAN clinical practice guidelines.[1] Their thoughtful discussion addressed complicated issues surrounding COI and identified areas for improvement.Both research and clinical practice were more common COI than personal income from industry. This finding occurred despite the fact that the AAN requires reporting of all industry-related COI, but leaves the reporting of non-industry related COI to the opinion of the individual as to whether it constitutes a COI. This dichotomy is surprising given that there are psychological barriers to recognizing one’s own COI, which as the authors point out has been termed “COI anosognosia.”