Dr. Walter received her MD from Georgetown University in Washington, DC. She stayed at Georgetown for her internship in Internal Medicine and then moved to New York City to complete her residency in Neurology at the Icahn School of Medicine at Mount Sinai. She went on to pursue a Clinical Neurophysiology Fellowship at Rush University in Chicago, IL, training in both EEG and EMG. Due to her particular interest in Epilepsy she went on to become the first Epilepsy Fellow at Rush University. Dr. Walter provides clinical care to general neurology patients as well as patients with epilepsy and enjoys teaching residents and medical students. She also has a particular interest in dietary treatments for epilepsy and clinical research.
- Dietary Treatments of Epilepsy (ketogenic, modified atkins)
Clinical Assistant Professor, Neurology & Neurological Sciences
Honors & Awards
Fellows Program, American Epilepsy Society (AES) (2015-2016)
Epilepsy Program, J. Kiffin Penry (2012)
Intramural Training Award Recipient (IRTA), National Institutes of Health (NIH) (2005-2006)
Boards, Advisory Committees, Professional Organizations
Member, American Epilepsy Society (2015 - Present)
Member, American Clinical Neurophysiological Society (2015 - Present)
Member, American Academy of Neurology (2011 - Present)
Board Certification: American Board of Psychiatry and Neurology, Neurology (2014)
Medical Education: Georgetown University School of Medicine Registrar (2010) DC
Fellowship: Rush University Epilepsy Fellowship (2016) IL
Fellowship: Rush University Clinical Neurophysiology Fellowship (2015) IL
Internship: Georgetown University Internal Medicine Residency (2011) DC
Board Certification: American Board of Psychiatry and Neurology, Epilepsy (2017)
Board Certifications, American Board of Psychiatry and Neurology (ABPN), Neurology, Clinical Neurophysiology
Board Certification: American Board of Psychiatry and Neurology, Clinical Neurophysiology (2015)
Fellowship, Rush University Medical Center (Chicago, IL), Neurophysiology (2015), Epilepsy (2016)
Residency, Mount Sinai Medical Center/Icahn School of Medicine (New York, NY), Neurology (2014)
Residency: Icahn School of Medicine at Mount Sinai Neurology Residency (2014) NY
Internship, Georgetown University Hospital Center/Medstar (Washington, DC), Internal Medicine (2011)
MD, Georgetown University School of Medicine (Washington, DC) (2010)
Undergrad, Yale University (New Haven, CT), Cognitive Science (2005)
Inpatient, Dose-Ranging Study of Staccato Alprazolam in Epilepsy With Predictable Seizure Pattern
This is a multi-center, double-blind, randomized, parallel group, dose-ranging study to investigate the efficacy and clinical usability of STAP-001 in adult (18 years of age and older) subjects with epilepsy with a predictable seizure pattern. These subjects have an established diagnosis of focal or generalized epilepsy with a documented history of predictable seizure episodes. This is an in-patient study. The subjects will be admitted to a Clinical Research Unit (CRU) or Epilepsy Monitoring Unit (EMU) for study participation. The duration of the stay in the in-patient unit will be 2-8 days. One seizure event per subject will be treated with study medication. The duration and timing of the seizure event and occurrence of subsequent seizures will be assessed by the Staff Caregiver(s)1 through clinical observation and confirmed with video electroencephalogram (EEG).
Status epilepticus and other EEG findings in patients with COVID-19: A case series.
2020; 81: 198–200
PURPOSE: Neurological manifestations of COVID-19 infection include impaired consciousness, strokes, and seizures. Limited reports describing EEG abnormalities in patients with COVID-19 have been published. These articles reported nonspecific encephalopathic patterns, epileptiform discharges, and rarely seizures. Our primary aim was to assess EEG abnormalities in patients with COVID-19 and evaluate for epileptiform activity or seizures.METHODS: We identified five critically ill adult patients with COVID-19 who underwent EEG monitoring. All patients had Ceribell rapid response EEG initially and two continued with conventional long-term video EEG.RESULTS: All 5 patients had encephalopathy and 3 also had seizure-like movements, thus prompting EEG monitoring. EEGs all showed nonspecific markers of encephalopathy including diffuse slowing and generalized rhythmic delta activity. Two also had epileptiform discharges reaching 2-3 Hz at times, with one patient in nonconvulsive status epilepticus and the other developing clinical status epilepticus with myoclonic movements. EEG and clinical symptoms improved with anti-seizure medications.CONCLUSION: Status epilepticus was present in 2 out of our cohort of 5 critically ill patients who underwent EEG monitoring. These findings highlight the importance of EEG monitoring in high-risk patients with COVID-19 and encephalopathy. EEG recordings in such patients can identify pathological patterns that will benefit from treatment with anti-seizure medications.
View details for DOI 10.1016/j.seizure.2020.08.022
View details for PubMedID 32861152
Epileptic seizure induced by tilt-table testing: a case report
LIPPINCOTT WILLIAMS & WILKINS. 2020
View details for Web of Science ID 000536058009071
- Comparative neuropsychological effects of carbamazepine and eslicarbazepine acetate EPILEPSY & BEHAVIOR 2019; 94: 151–57
- Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life EPILEPSY & BEHAVIOR 2019; 93: 113–18
Do certain subpopulations of adults with drug-resistant epilepsy respond better to modified ketogenic diet treatments? Evaluation based on prior resective surgery, type of epilepsy, imaging abnormalities, and vagal nerve stimulation.
Epilepsy & behavior : E&B
OBJECTIVE: Adults with drug-resistant epilepsy (DRE) are among the most challenging to treat. This study assessed whether specific subpopulations of adult patients with refractory epilepsy responded differently to modified ketogenic diet (MKD) therapy.METHODS: Changes in seizure frequency, severity, and quality of life (QOL) were retrospectively analyzed based on pre-MKD surgical history, type of epilepsy, imaging findings, and vagal nerve stimulation (VNS) history among adults, ≥17 years of age, with DRE, receiving MKD therapy for three months. Additionally, particular attention was made to medication and VNS adjustments.RESULTS: Responder rates in seizure frequency, severity, and QOL reported among those with prior surgery were 56%, 75%, and 94%, respectively. Among those with focal epilepsy: 57%, 76%, and 76% had improvements in seizure frequency, seizure severity, and QOL, respectively whereas 83% improvement was seen for all three measures in those with generalized epilepsy. Among those with abnormal imaging: just over 50% reported improvements on all measures. For those with VNS, 53%, 63%, and 95% had improvements in seizure frequency, seizure severity, and QOL, respectively. No statistical differences in seizure frequency, severity, or QOL were noted between groups based on prediet surgical history, seizure type, imaging abnormalities, or VNS history. Compared with expected improvement from medication adjustment alone, significant improvement was seen for all groups; notably, the Z-test for proportions for the surgery group, when compared with placebo responder rates at 20%, was 3.6, p < 0.001.CONCLUSIONS: Modified ketogenic diet therapies are effective in improving seizure frequency, severity, and QOL and may offer the best chance for improvement among those whose seizures have persisted despite surgical intervention and VNS therapy. All types of epilepsy respond to MKDs, and possibly those with generalized epilepsy may respond better.
View details for DOI 10.1016/j.yebeh.2019.01.010
View details for PubMedID 30738724
Tripolar concentric EEG electrodes reduce noise.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
2019; 131 (1): 193–98
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
The new definition and classification of seizures and epilepsy.
2018; 139: 73–79
This review discusses the updated classifications of seizures and the epilepsies, which were recently published by the International League Against Epilepsy (ILAE). While it is always a challenge to learn a new classification system, particularly one that has remained essentially unchanged for over three decades, these new classifications allow for the inclusion of some previously unclassifiable seizure types and utilize more intuitive terminology. In this review, we specifically discuss the use of these new classifications for patients, clinicians, and researchers.
View details for PubMedID 29197668
Magnetoencephalography and New Imaging Modalities in Epilepsy
2017; 14 (1): 4-10
The success of epilepsy surgery is highly dependent on correctly identifying the entire epileptogenic region. Current state-of-the-art for localizing the extent of surgically amenable areas involves combining high resolution three-dimensional magnetic resonance imaging (MRI) with electroencephalography (EEG) and magnetoencephalography (MEG) source modeling of interictal epileptiform activity. Coupling these techniques with newer quantitative structural MRI techniques, such as cortical thickness measurements, however, may improve the extent to which the abnormal epileptogenic region can be visualized. In this review we assess the utility of EEG, MEG and quantitative structural MRI methods for the evaluation of patients with epilepsy and introduce a novel method for the co-localization of a structural MRI measurement to MEG and EEG source modeling. When combined, these techniques may better identify the extent of abnormal structural and functional areas in patients with medically intractable epilepsy.
View details for DOI 10.1007/s13311-016-0506-7
View details for PubMedID 28054328
'Tickling' seizures originating in the left frontoparietal region.
Epilepsy & behavior case reports
2016; 6: 49-51
We report a 10-year-old boy with mild developmental delay and epilepsy with new events of right back tickling and emotional upset. These initially appeared behavioral, causing postulation of habit behaviors or psychogenic nonepileptic seizures. Several ictal and interictal EEGs were unrevealing. Continuous EEG revealed only poorly localized frontal ictal activity. Given that his clinical symptoms suggested a parietal localization, double-density EEG electrodes were placed to better localize the epileptogenic and symptomatogenic zones. These revealed evolution of left greater than right frontoparietal discharges consistent with seizures at the time of the attacks. Medical management has significantly reduced the patient's seizures.
View details for DOI 10.1016/j.ebcr.2016.07.002
View details for PubMedID 27579251
Treatment of Established Status Epilepticus.
Journal of clinical medicine
2016; 5 (5)
Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.
View details for DOI 10.3390/jcm5050049
View details for PubMedID 27120626