Bio

Bio


Dr. Scheherazade Le is a General Neurologist with subspecialty training in Epilepsy/Electroencephalography (EEG) and Intra-operative Neuromonitoring (IONM). She has clinical interests in Tuberous Sclerosis and Autoimmune Epilepsy. Clinical research interests include biosensors and devices in epilepsy, intracranial neurophysiology, innovative therapies for epilepsy, autoimmune etiologies for epilepsy, and novel intra-operative monitoring techniques. She also is interested in Medical Education.

Clinical Focus


  • Epilepsy & Electroencephalography
  • Intra-Operative Neuromonitoring
  • Neurophysiology
  • Tuberous Sclerosis
  • Neurology
  • Medical Education
  • Autoimmune Epilepsy

Academic Appointments


Administrative Appointments


  • Chief Resident, Stanford Neurology Residency (2009 - 2010)
  • Neurology Teaching Assistant for Brain Block, Stanford Medical School (2011 - 2012)
  • Medical School Co-Course Director, Stanford Medical School (2015 - 2017)
  • Medical School Course Director HHD223 - Neurology, Stanford University Medical School (2016 - Present)
  • Epilepsy Education Director, Neurology Residency Program (2018 - Present)

Honors & Awards


  • Teaching & Mentoring Grant Recipient, Stanford Teaching & Mentoring Academy (2018-2019)
  • Teaching & Mentoring Grant Recipient, Stanford Teaching & Mentoring Academy (2017-2018)
  • Stanford Medical School HHD223 Neurology Course Teaching Award Nominee, Stanford School of Medicine (2016-2017)
  • Medical Student Scholarship, Vietnamese American Medical Association (VAMA) (2005)
  • Nomination for "Excellence in Humanism and Medical Teaching" at Stanford Hospital, Arnold P. Gold Foundation (2009)
  • Neurology Medical Student Clerkship Teaching Award, Stanford Department of Neurology (2007-2015)
  • J. Kiffin Penry Fellow, American Epilepsy Society (AES) Education Program (December 2010)
  • American Epilepsy Society Fellows Program, American Epilepsy Society (AES) (December 2011)

Boards, Advisory Committees, Professional Organizations


  • Professional Advisory Board & Clinic Co-Director, Tuberous Sclerosis Alliance Clinic (2014 - Present)

Professional Education


  • Fellowship: Stanford University Medical Center (2012) CA
  • Fellowship: Stanford University Medical Center (2011) CA
  • Residency: Stanford University Medical Center (2010) CA
  • Internship: Stanford University Medical Center (2007) CA
  • Board Certification: American Board of Psychiatry and Neurology, Epilepsy (2016)
  • Medical Education: University of California at San Francisco School of Medicine (2006) CA
  • Board Certification: American Board of Psychiatry and Neurology, Neurology (2010)
  • B.A., University of California, Berkeley, Political Science (2001)

Community and International Work


  • Avances Monitorizacion Neurofisiologica Intraoperatoria 2018, 2016, Madrid, Spain

    Topic

    Course on Advances in Neuro-Intraoperative Monitoring (IONM)

    Partnering Organization(s)

    Hospital Universitario Ramon y Cajal

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Jornada Neurofisiologia 2013, Ciudad Real, Spain

    Topic

    Course on Advances in Neuro-Intraoperative Monitoring (IONM)

    Partnering Organization(s)

    Hospital Ciudad Real

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Visiting Neurology Teaching Resident, Krakow, Poland

    Topic

    Neurology for Medical Students

    Partnering Organization(s)

    Jagiellonian Medical University

    Populations Served

    Jagiellonian Medical University Neurology Ward

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Medical Volunteer, Ho Chi Minh City, Vietnam

    Topic

    Medical Volunteer

    Partnering Organization(s)

    Hoan My Hospital

    Populations Served

    Ho Chi Minh City patients

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Dr. Le studies novel techniques for the treatment of epilepsy, intracranial neurophysiology and intraoperative neuromonitoring. She also studies use of biosensors to detect seizures and evaluate cognition during seizures. She has an interest in improved diagnosis and treatment of autoimmune epilepsy/encephalitis. Dr. Le is also developing curriculum innovations for medical education.

Teaching

2019-20 Courses


Graduate and Fellowship Programs


Publications

All Publications


  • Hybrid Fluoroscopic and Neurophysiological Targeting of Responsive Neurostimulation of the Rolandic Cortex. Operative neurosurgery (Hagerstown, Md.) Parker, J. J., Jamiolkowski, R. M., Grant, G. A., Le, S., Halpern, C. H. 2021

    Abstract

    BACKGROUND: Precise targeting of cortical surface electrodes to epileptogenic regions defined by anatomic and electrophysiological guideposts remains a surgical challenge during implantation of responsive neurostimulation (RNS) devices.OBJECTIVE: To describe a hybrid fluoroscopic and neurophysiological technique for targeting of subdural cortical surface electrodes to anatomic regions with limited direct visualization, such as the interhemispheric fissure.METHODS: Intraoperative two-dimensional (2D) fluoroscopy was used to colocalize and align an electrode for permanent device implantation with a temporary in Situ electrode placed for extraoperative seizure mapping. Intraoperative phase reversal mapping technique was performed to distinguish primary somatosensory and motor cortex.RESULTS: We applied these techniques to optimize placement of an interhemispheric strip electrode connected to a responsive neurostimulator system for detection and treatment of seizures arising from a large perirolandic cortical malformation. Intraoperative neuromonitoring (IONM) phase reversal technique facilitated neuroanatomic mapping and electrode placement.CONCLUSION: In challenging-to-access anatomic regions, fluoroscopy and intraoperative neurophysiology can be employed to augment targeting of neuromodulation electrodes to the site of seizure onset zone or specific neurophysiological biomarkers of clinical interest while minimizing brain retraction.

    View details for DOI 10.1093/ons/opab182

    View details for PubMedID 34133746

  • Brain-Responsive Neurostimulation for the treatment of adults with epilepsy in tuberous sclerosis complex: A case series. Epilepsia open McDermott, D. S., Mirro, E. A., Fetrow, K., Burdette, D. E., Chen, S., Hopp, J., Masel, T., Johnson, E. A., Elefant, F. M., Le, S., Patra, S. E., Brown, M., Haneef, Z. 2021

    Abstract

    OBJECTIVE: Tuberous sclerosis complex (TSC) is a genetic disorder primarily characterized by the development of multisystem benign tumors. Epilepsy is the most common neurologic manifestation, affecting 80%-90% of TSC patients. The diffuse structural brain abnormalities and the multifocal nature of epilepsy in TSC pose diagnostic challenges when evaluating patients for epilepsy surgery.METHODS: We retrospectively reviewed the safety experience and efficacy outcomes of five adult TSC patients who were treated with direct brain-responsive neurostimulation (RNS System, NeuroPace, Inc).RESULTS: The average follow-up duration was 20months. All five patients were responders (≥50% disabling seizure reduction) at last follow-up. The median reduction in disabling seizures was 58% at 1year and 88% at last follow-up. Three of the five patients experienced some period of seizure freedom ranging from 3months to over 1year.SIGNIFICANCE: In this small case series, we report the first safety experience and efficacy outcomes in patients with TSC-associated drug-resistant focal epilepsy treated with direct brain-responsive neurostimulation.

    View details for DOI 10.1002/epi4.12481

    View details for PubMedID 34033253

  • Sharps Injuries Related to Subdermal Needles in the Orbicularis Oris During Intraoperative Neurophysiologic Monitoring. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society Joshi, A., Aissa, Y., Le, S., Cho, S. C., Lee, L., Lopez, J. R. 2021

    Abstract

    PURPOSE: Little is known about the incidence and nature of sharps injuries caused by subdermal intraoperative neurophysiologic monitoring (IONM) needle electrodes. In their institution, the authors observed a series of sharps injuries attributed to placement of needles in the orbicularis oris (OO).METHODS: One large academic institution's sharps injury monitoring database was queried for all reported events over 3 years. The de-identified list was filtered for sharps events occurring in the operating room, and the descriptions of the sharps injuries were individually evaluated. Interventions were performed to attempt to decrease the number of sharps injuries from IONM needles, particularly those placed in OO. Similar data were then collected for 3 months post-intervention.RESULTS: Pre-intervention, 327 sharps injuries were reported over the span of 3 years, of which 13 (4.0%) were attributed to IONM needles not in OO and 5 (1.5%) were attributed to IONM needles in OO. Post-intervention, 41 sharps injuries were reported in 3 months, of which 5 (12.2%) were attributed to IONM needles not in OO and 1 (2.4%) was attributed to needles in OO.CONCLUSIONS: The placement of subdermal needles in the OO presents a disproportionately high risk of sharps injury. Interventions were performed to attempt to decrease the rate of sharps injuries from needles in OO; the post-intervention increase in events was likely skewed by small sample sizes. The implementation of these changes and the ongoing surveillance of injury cases may be important data to help decrease the number of sharps injuries attributed to IONM needles.

    View details for DOI 10.1097/WNP.0000000000000835

    View details for PubMedID 33675313

  • Antibody Prevalence in Epilepsy before Surgery (APES) in drug-resistant focal epilepsy. Epilepsia Li, Y., Tymchuk, S., Barry, J., Muppidi, S., Le, S. 2021

    Abstract

    OBJECTIVE: There is a growing recognition of immune-mediated causes in patients with focal drug-resistant epilepsy (DRE); however, they are not systematically assessed in the pre-surgical diagnostic workup. Early diagnosis and initiation of immunotherapy is associated with a favorable outcome in immune-mediated seizures. Patients with refractory focal epilepsy with neuronal antibodies (Abs) tend to have a worse surgical prognosis when compared to other etiologies.METHODS: We studied the prevalence of serum Abs in patients ≥18years of age with DRE of unknown cause before surgery. We proposed and calculated a clinical APES (Antibody Prevalence in Epilepsy before Surgery) score for each subject, which was modified based on Dubey's previously published APE2 score. RESULTS`: A total of 335 patients were screened and 86 subjects were included in final analysis. The mean age at the time of recruitment was 44.84±14.86years, with age at seizure onset 30.89±19.88years. There were no significant differences among baseline clinical features between retrospective and prospective sub-cohorts. The prevalence of at least one positive Ab was 33.72%, and central nervous system (CNS)-specific Abs was 8.14%. APES score ≥4 showed slightly better overall prediction (area under the curve [AUC]: 0.84 vs 0.74) and higher sensitivity (100% vs 71.4%), with slightly lower but similar specificity (44.3% vs 49.4%), when compared to APE2 score ≥4. For subjects who had available positron emission tomography (PET) results and all components of APES score (n=60), the sensitivity of APES score ≥4 yielded a similar prediction potential with an AUC of 0.80.SIGNIFICANCE: Our findings provide persuasive evidence that a subset of patients with focal DRE have potentially immune-mediated causes. We propose an APES score to help identify patients who may benefit from a workup for immune etiologies during the pre-surgical evaluation for focal refractory epilepsy with unknown cause.

    View details for DOI 10.1111/epi.16820

    View details for PubMedID 33464599

  • Improving Cognitive Assessment of Adult Epilepsy Monitoring Unit Patients Chen, W., Liu, V., Meador, K., Le, S. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • 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
  • Superselective methohexital challenge prior to intracranial endovascular embolization JOURNAL OF CLINICAL NEUROSCIENCE Bican, O., Cho, C., Suarez-Roman, A., Viet Nguyen, Lee, L., Le, S., Heit, J., Dodd, R., Lopez, J. 2019; 63: 68–71
  • EMG, MEP, and SSEP in the Intraoperative Neurophysiologic Monitoring of Lumbar Surgeries Viet Nguyen, Atikilt, N., Cho, S., Lee, L., Le, S., Lopez, J. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Comparative Neuropsychological Effects of Carbamazepine and Eslicarbazepine Acetate Meador, K., Seliger, J., Razavi, B., Falco-Walter, J., Le, S., Loring, D. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Driving Ability Correlated with Severity of Polyneuropathy Lopez, J., Cho, A., Nguyen, V., Lee, L., Le, S., Cho, S. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • 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

  • Superselective methohexital challenge prior to intracranial endovascular embolization. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Bican, O., Cho, C., Suarez-Roman, A., Nguyen, V., Lee, L., Le, S., Heit, J., Dodd, R., Lopez, J. 2019

    Abstract

    Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients. BAEPs were performed in anesthetized patients if indicated. Methohexital was administered as an injection at a dose of 5 mg or 10 mg and repeat testing was performed if needed.Sixty-three endovascular procedures that met criteria were performed in 32 patients. 54 procedures in 28 patients were performed under general anesthesia, 9 procedures in 4 patients were performed in wakefulness. PT was negative in 61 procedures and subsequently completed embolizations without neurological sequelae. In two cases, the testing was positive and the procedure was terminated without embolization in one patient. The other patient underwent embolization at an alternative site without repeat PT. There were no new postoperative neurologic deficits after any of these procedures. Specificity of PT was 100% as none of the patients with a negative provocative test developed a new postoperative neurologic deficit after embolization. To our knowledge, this is the first review of PT with the use of neurophysiologic IONM techniques under general anesthesia. These data suggest a high specificity comparable to awake testing.

    View details for PubMedID 30772199

  • Tripolar concentric EEG electrodes reduce noise. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Aghaei-Lasboo, A. n., Inoyama, K. n., Fogarty, A. S., Kuo, J. n., Meador, K. J., Walter, J. J., Le, S. T., Graber, K. D., Razavi, B. n., Fisher, R. S. 2019; 131 (1): 193–98

    Abstract

    To assay EEG signal quality recorded with tripolar concentric ring electrodes (TCREs) compared to regular EEG electrodes.EEG segments were recorded simultaneously by TCREs and regular electrodes, low-pass filtered at 35 Hz (REG35) and 70 Hz (REG70). Clips were rated blindly by nine electroencephalographers for presence or absence of key EEG features, relative to the "gold-standard" of the clinical report.TCRE showed less EMG artifact (F = 15.4, p < 0.0001). Overall quality rankings were not significantly different. Focal slowing was better detected by TCRE and spikes were better detected by regular electrodes. Seizures (n = 85) were detected by TCRE in 64 cases (75.3%), by REG70 in 75 (88.2%) and REG35 in 69 (81.2%) electrodes. TCRE detected 9 (10.6%) seizures not detected by one of the other 2 methods. In contrast, 14 seizures (16.5%) were not detected by TCRE, but were by REG35 electrodes. Each electrode detected interictal spikes when the other did not.TCRE produced similar overall quality and confidence ratings versus regular electrodes, but less muscle artifact. TCRE recordings detected seizures in 7% of instances where regular electrodes did not.The combination of the two types increased detection of epileptiform events compared to either alone.

    View details for DOI 10.1016/j.clinph.2019.10.022

    View details for PubMedID 31809982

  • Laser interstitial thermal therapy (LITT): Seizure outcomes for refractory mesial temporal lobe epilepsy. Epilepsy & behavior : E&B Le, S., Ho, A. L., Fisher, R. S., Miller, K. J., Henderson, J. M., Grant, G. A., Meador, K. J., Halpern, C. H. 2018; 89: 37–41

    Abstract

    BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive alternative with less cognitive risks compared with traditional surgery for focal drug-resistant epilepsy.OBJECTIVE: We describe seizure outcomes and complications after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE).MATERIAL AND METHODS: We prospectively tracked Stanford's MTLE cases treated with LITT from October 2014 to October 2017. Primary endpoints were seizure outcomes by (1) Engel classification and (2) reduction in baseline seizure frequency. Secondary outcomes were postablation complications.RESULTS: A total of 30 patients underwent selective amygdalohippocampotomy via LITT. Mesial temporal sclerosis (MTS) was present in 23/30 (77%) patients. Median follow-up was 18 ± 12 months (range: 6-44 months). Almost all 28/29 (97%) patients had >50% reduction, and 22/29 (76%) patients had >90% reduction in seizure frequency. Engel Class I outcome was achieved in 18/29 (62%) patients; with complete seizure freedom in 9/29 (31%) patients (Engel Class IA). Three (10%) patients have had only focal aware seizures (Engel Class 1B). Seizures only occurred with medication withdrawal in 6/29 (21%) patients (Engel Class ID). Class II was achieved by 6/29 (21%) and Class III by 5/29 (17%) patients. Complications included perioperative seizures in 10/29 (34%) and nonseizure complaints in 6/29 (21%) patients. Three (10%) patients had neurological deficits including one permanent superior quadrantanopsia, one transient trochlear, and one transient oculomotor nerve palsy.CONCLUSIONS: Overall, Engel Class I outcome was achieved in 62% of patients with MTLE, and 97% of patients achieved >50% seizure frequency reduction. Complications were largely temporary, though there was one persistent visual field deficit. Laser ablation is well-tolerated and offers marked seizure reduction for the majority of patients.

    View details for DOI 10.1016/j.yebeh.2018.09.040

    View details for PubMedID 30384097

  • Optimal recording duration of ambulatory EEG (aEEG). Epilepsy research Kuo, J., Lee-Messer, C., Le, S. 2018; 149: 9–12

    View details for DOI 10.1016/j.eplepsyres.2018.07.025

    View details for PubMedID 30399521

  • Seizure Risk From Intraoperative Motor Evoked Potential Stimulation Viet Nguyen, Sandoval, B., Ahuja, B., Lee, L., Cho, S., Le, S., Lopez, J. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy JOURNAL OF NEUROSURGERY Ho, A. L., Sussman, E. S., Pendharkar, A. V., Le, S., Mantovani, A., Keebaugh, A. C., Drover, D. R., Grant, G. A., Wintermark, M., Halpern, C. H. 2018; 128 (4): 1165–72

    Abstract

    OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive method for thermal destruction of benign or malignant tissue that has been used for selective amygdalohippocampal ablation for the treatment of temporal lobe epilepsy. The authors report their initial experience adopting a real-time MRI-guided stereotactic platform that allows for completion of the entire procedure in the MRI suite. METHODS Between October 2014 and May 2016, 17 patients with mesial temporal sclerosis were selected by a multidisciplinary epilepsy board to undergo a selective amygdalohippocampal ablation for temporal lobe epilepsy using MRgLITT. The first 9 patients underwent standard laser ablation in 2 phases (operating room [OR] and MRI suite), whereas the next 8 patients underwent laser ablation entirely in the MRI suite with the ClearPoint platform. A checklist specific to the real-time MRI-guided laser amydalohippocampal ablation was developed and used for each case. For both cohorts, clinical and operative information, including average case times and accuracy data, was collected and analyzed. RESULTS There was a learning curve associated with using this real-time MRI-guided system. However, operative times decreased in a linear fashion, as did total anesthesia time. In fact, the total mean patient procedure time was less in the MRI cohort (362.8 ± 86.6 minutes) than in the OR cohort (456.9 ± 80.7 minutes). The mean anesthesia time was significantly shorter in the MRI cohort (327.2 ± 79.9 minutes) than in the OR cohort (435.8 ± 78.4 minutes, p = 0.02). CONCLUSIONS The real-time MRI platform for MRgLITT can be adopted in an expedient manner. Completion of MRgLITT entirely in the MRI suite may lead to significant advantages in procedural times.

    View details for PubMedID 28665249

  • Positive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization. Clinical imaging Bican, O., Cho, C., Lee, L., Nguyen, V., Le, S., Heit, J., Lopez, J. 2018; 51: 155–59

    Abstract

    A middle-aged patient underwent staged endovascular embolization of a Spetzler-Martin grade V right parietal arteriovenous malformation(AVM).In the fifth endovascular embolization, after methohexital 10 mg injection into a right posterior choroidal artery feeding the AVM nidus, there was an immediate change in the electroencephalogram (EEG) with simultaneous loss of motor evoked potentials (MEPs) in the bilateral upper and lower extremities and a delayed change in somatosensory evoked potential responses (SSEPs). No embolization was made and procedure was terminated. This case demonstrates the utility of intraoperative neurophysiologic monitoring (IONM) with pharmacologic provocative testing in predicting and mitigating the risks prior to the proposed embolization.

    View details for PubMedID 29501883

  • Retrospective Waveform Analysis of Transcranial Motor Evoked Potentials (MEP) to Identify Early Predictors of Impending Motor Deficits in Spinal Surgeries. Neurodiagn J Le, S. 2017; 57 (1:53-68)
  • Retrospective Waveform Analysis of Transcranial Motor Evoked Potentials (MEP) to Identify Early Predictors of Impending Motor Deficits in Spinal Surgeries. The Neurodiagnostic journal Le, S., Nguyen, V., Ekwueme, A. C., Cho, S. C., Lee, L., López, J. 2017; 57 (1): 53-68

    Abstract

    Although there are guidelines analyzing transcranial motor evoked potentials (MEP) waveform criteria, they vary widely and are not applied universally during intraoperative neurophysiologic monitoring (IONM). The objective is to generate hypotheses to identify early and reliable MEP waveform characteristics prior to complete loss of MEP to predict impending motor spinal cord injuries during spinal surgeries. The ultimate goal is to enhance real-time feedback to prevent injury or detect reversible spinal cord damage.Fifteen true positive cases of persistent intraoperative MEP loss and new postoperative motor deficits were retrospectively identified from 2011 to 2013. Waveform characteristics of latency, amplitude, duration, phases, and area-under-the-curve (AUC) were measured, and an intraoperative spinal cord index (ISCI) was calculated for 5 traces prior to complete MEP loss. ISCI = [amplitude x duration x (phases+1) x AUC]/latency.Out of 22 muscles in 15 cases, latency increased in 2, duration decreased in 12, amplitude decreased in 13, AUC decreased in 13, and ISCI decreased in 14. In 11 out of 15 cases (73%), ISCI dropped > 40% in at least one muscle before MEP were completely lost. Thirteen cases had concurrent somatosensory evoked potentials (SSEP) changes, 9 out of 13 had > 50% decrease in SSEP: 2 out of 9 changed before MEP, 5 out of 9 simultaneously, and 2 out of 9 after.In these cases of motor injury, smaller and simpler MEP waveforms preceded complete loss of signal. An ISCI 40% drop could be tested as a warning threshold for impending motor compromise in future prospective studies and lead to eventual standardization to predict irreversible postoperative deficits.

    View details for DOI 10.1080/21646821.2017.1257330

    View details for PubMedID 28436812

  • Tracking generalized tonic-clonic seizures with a wrist accelerometer linked to an online database SEIZURE-EUROPEAN JOURNAL OF EPILEPSY Velez, M., Fisher, R. S., Bartlett, V., Le, S. 2016; 39: 13-18

    Abstract

    Clinical management of epilepsy and current epilepsy therapy trials rely on paper or electronic diaries often with inaccurate self-reported seizure frequency as the primary outcome. This is the first study addressing the feasibility of detecting and recording generalized tonic-clonic seizures (GTCS) through a biosensor linked to an online seizure database.A prospective trial was conducted with video-EEG (vEEG) in an epilepsy monitoring unit. Patients wore a wristwatch accelerometer that detected shaking and transmitted events via Bluetooth® to a bedside electronic tablet and then via Wi-Fi to an online portal. The watch recorded the date, time, audio, duration, frequency and amplitude of events. Events logged by the watch and recorded in a bedside paper diary were measured against vEEG, the "gold standard."Thirty patients were enrolled and 62 seizures were recorded on vEEG: 31 convulsive and 31 non-convulsive. Twelve patients had a total of 31 convulsive seizures, and of those, 10 patients had 13 GTCS. The watch captured 12/13 (92.3%) GTCS. Watch audio recordings were consistent with seizures in 11/12 (91.6%). Data were successfully transferred to the bedside tablet in 11/12 (91.6%), and to the online database in 10/12 (83.3%) GTCS. The watch recorded 81 false positives, of which 42/81 (51%) were cancelled by the patients. Patients and caregivers verbally reported 15/62 seizures (24.2% sensitivity) but no seizures were recorded on paper logs.Automatic detection and recording of GTCS to an online database is feasible and may be more informative than seizure logging in a paper diary.

    View details for DOI 10.1016/j.seizure.2016.04.009

    View details for PubMedID 27205871

  • Persistent Intraoperative Neurophysiologic Monitoring Changes in Scoliosis Surgery Correlate with Postoperative Deficits Viet Nguyen, Shen, H., Cho, C., Le, S., Lee, L., Lopez, J. LIPPINCOTT WILLIAMS & WILKINS. 2016
  • Auricular polychondritis presenting as non-infectious, non-paraneoplastic limbic encephalitis Ho, J., Rumma, R. T., Le, S. Current Neurobiology. 2016
  • A New Association Between Castleman Disease and Immune-Mediated Cerebellitis JAMA NEUROLOGY Lee, S., Le, S. 2015; 72 (6): 722-723

    View details for PubMedID 26053442

  • Detection of inferolateral trunk syndrome by neuromonitoring during catheter angiography with provocative testing. Journal of neurointerventional surgery Le, S., Dodd, R., López, J., Nguyen, V., Cho, S. C., Lee, L. 2013; 5 (2)

    Abstract

    It is not uncommon that endovascular balloon test occlusion (BTO) is performed to assess collateral blood flow and risk of injury of permanent occlusion of the internal carotid artery (ICA). This case is the first reported of detection and reversal of the inferolateral trunk (ILT) syndrome in an awake patient during provocative BTO; prompt recognition of the syndrome effectively prevented permanent neurologic deficits.The case of a 42-year-old woman is reported who had a left sphenoid wing meningioma with extension into the cavernous sinus and who underwent awake catheter angiography with provocative BTO of the ICA. Serial examinations by intraoperative monitoring neurologists and neurointerventionalists detected acute progressive left retro-orbital pressure followed by sudden inability to adduct the left eye, or a left medial rectus palsy, indicative of the ILT syndrome which led to immediate balloon deflation and resolution of the deficits. The hypothesis was that hypoperfusion of the ILT, an arterial branch of the ICA which provides blood supply to several cranial nerves (CN) III, CN V1 and CN V2, caused her acute symptoms.Although cerebral ischemia is a well known complication of endovascular procedures, CN ischemia is a rare potential risk. Knowledge of cerebrovascular anatomy and serial examinations prevented neurologic deficits; this case underscores the added utility of examinations by intraoperative monitoring neurologists and interdisciplinary collaboration.

    View details for DOI 10.1136/neurintsurg-2011-010236

    View details for PubMedID 22345146

  • Waveform Analysis of Transcranial Motor Evoked Potentials (TcMEPs) To Predict Impending Motor Deficits in Spinal Surgeries Le, S., Ekwueme, A., Cho, S., Lee, L., Viet Nguyen, Lopez, J. LIPPINCOTT WILLIAMS & WILKINS. 2013
  • Case Report: Rasmussen’s Encephalitis Treated Successfully with Rituximab Lockman, J., Le, S., Fisher, R. S., Laxer, K. Cureus.com. 2013
  • An online diary for tracking epilepsy EPILEPSY & BEHAVIOR Le, S., Shafer, P. O., Bartfeld, E., Fisher, R. S. 2011; 22 (4): 705-709

    Abstract

    My Epilepsy Diary is a free Web-based application on the public website epilepsy.com, available for patients to track epilepsy and to aid clinicians with data-based, individualized management. The first aim of this descriptive study was to outline electronic diary functions. Second, the study retrospectively profiled a large cohort of 2010 calendar year diary users including demographics, seizure types, temporal distribution of seizures, triggers, and use and side effects of antiepileptic drugs (AEDs). A total of 1944 users provided demographic information and 1877 recorded seizure data. Most (64%) users were women. Average age was 29.9±16.0 years. A total of 70,990 seizure entries and 15,630 AED entries were logged. Events were apportioned as 79% seizures and 21% seizure clusters. Specific AEDs were detailed in 7331 entries: monotherapy was used in 18% and polytherapy in 82%. Mood-related side effects were most commonly reported in 19% of 1027 users.

    View details for DOI 10.1016/j.yebeh.2011.08.035

    View details for PubMedID 21975298

  • Gelastic epilepsy and hypothalamic hamartomas: neuroanatomical analysis of brain lesions in 100 patients BRAIN Parvizi, J., Le, S., Foster, B. L., Bourgeois, B., Riviello, J. J., Prenger, E., Saper, C., Kerrigan, J. F. 2011; 134: 2960-2968

    Abstract

    Hypothalamic hamartomas present with isolated fits of ictal laughter (gelastic epilepsy) or a combination of gelastic and other types of seizures. Many of these patients also suffer from cognitive decline, neuropsychiatric comorbidities and precocious puberty. Although there is a large body of anecdotal evidence about hypothalamic hamartomas and gelastic seizures, many questions still remain to be answered. For instance, which specific hypothalamic regions are most affected by the location of hamartomas causing laughing versus other types of seizures? Does the neuroanatomical localization of the lesions differ in cases with only gelastic seizures or a combination of gelastic and other types of seizures? Does the location of the lesions correlate with the presence of precocious puberty, and does the type of lesion influence the severity or the type of seizures? In a retrospective review of clinical and structural neuroimaging data from 100 cases of gelastic epilepsy and hypothalamic hamartoma, we aimed to address these questions by analysing the clinical presentation and the neuroanatomical features of the hypothalamic lesions in these patients. Our findings suggest that in all 100 cases, lesions were centred at the level of the mammillary bodies in the posterior hypothalamus. Compared with the patients with pure gelastic seizures (n = 32), those with gelastic and other types of seizures (n = 68) had significantly longer duration of epilepsy (P < 0.001), whereas age of seizure onset, the volume of lesions and the proximity to the mammillary bodies were not different between the two groups. In contrast, patients with cognitive or developmental impairment and those with precocious puberty had significantly larger lesions involving the anterior and posterior hypothalamus.

    View details for DOI 10.1093/brain/awr235

    View details for Web of Science ID 000295681400015

    View details for PubMedID 21975589

  • Clinical Presentation and Long-Term Outcome of Cerebral Venous Thrombosis NEUROCRITICAL CARE English, J. D., Fields, J. D., Le, S., Singh, V. 2009; 11 (3): 330-337

    Abstract

    Despite recent advances, the clinical features of cerebral venous thrombosis (CVT) remain incompletely characterized. To our knowledge, no case series have been reported from North American centers with detailed long-term outcome data, and few studies have evaluated recanalization rates.All cases of CVT at a single tertiary care hospital between 1995 and 2004 were retrospectively reviewed. Follow-up information was obtained from direct patient interviews.Follow-up data were available for 58 of 61 CVT patients (median 50 months). Average age was 40, and 66% were women. Headache and focal neurological deficits were noted in 82% and 72%, respectively. Intracranial hemorrhage was seen in 44%. Hypercoagulable risk factors were identified in 84%. Anticoagulation was initiated acutely in 84%, including in all patients with intraparenchymal hemorrhage (IPH). The percentage of patients with a modified Rankin Score (mRS) of 0 to 2 at admission, hospital discharge and last follow-up were 41%, 67%, 90%, respectively; the rate of favorable long-term outcome did not differ significantly between patients with and without IPH. In the subset of 21 patients with follow-up imaging available for direct review, 90% had partial or complete recanalization.The demographics, clinical presentation, imaging findings, and risk factors in this large North American cohort of CVT patients strongly support the observations of previous European case series. In addition, the favorable long-term outcome and recanalization rates observed lend further support to the safety and efficacy of acute heparin therapy for the treatment of symptomatic CVT (irrespective of the presence of ICH).

    View details for DOI 10.1007/s12028-009-9234-8

    View details for Web of Science ID 000271943800006

    View details for PubMedID 19777388

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