Julie Christina Uchitel

All Publications

• Utility of repeat stereotactic EEG in pediatric patients with tuberous sclerosis. Epilepsia open Uchitel, J., Fariyike, O., Steeman, S., Rockwood, S., Kim, L. H., Choi, J., Hengartner, A. C., Fel, A. H., Teeyagura, P., Grant, G., Buch, V., Mahaney, K. B., Prolo, L. M., Hyslop Segeren, A., Phillips, H. W. 2026

  Abstract

  Tuberous sclerosis complex (TSC) is a rare genetic disorder associated with early-onset drug-resistant epilepsy (DRE) secondary to intracranial tubers. Many patients undergo stereo-EEG (sEEG) for seizure onset localization, sometimes requiring multiple sEEGs and subsequent epilepsy surgeries. Our objective was to evaluate the effects of single versus multiple sEEGs on seizure outcomes in pediatric patients with TSC-associated DRE.Retrospective review of 45 pediatric TSC patients who underwent epilepsy surgery at our institution (2/2013-4/2026). Collected data included demographics, seizure history, number of sEEGs, surgical interventions, and outcomes. Primary outcomes were Engel scores after definitive epilepsy surgery.Among 34 identified TSC patients who underwent sEEG prior to surgery, 19 had one sEEG, 15 had two or more (mean ± SE: 2.4 ± 0.2, range: 2-5). 68% of single sEEG patients had one presumed seizure focus on phase I vEEG versus only 27% of multiple sEEG patients (p = 0.03). Phase I vEEG and MEG data were concordant in 67% of single sEEG patients and 91% of multiple sEEG patients. Single ictal focus epilepsy on vEEG was significantly associated with use of only single sEEG on logistic regression (p = 0.01). Patients with a single sEEG more often underwent laser ablation (53% vs. 27%), while those with multiple sEEGs more commonly underwent resective surgery (73% vs. 47%, p = 0.171). Four patients (20%) in the single sEEG group had additional treatment surgeries without repeat sEEG. At one-year and most recent (2.3 ± 0.4 vs. 2.8 ± 0.4 years) follow-up in patients who had at least 1 year of follow up after their most recent surgery (n = 24, 82%), favorable seizure outcomes (Engel I/II) were observed in 86% and 93% in single sEEG patients, and 64% and 79% in multiple sEEG patients (p > 0.99).TSC-associated DRE is often multifocal and challenging to treat, requiring sEEG for localization. Presurgical multifocal vEEG or MEG findings may predict need for repeat sEEG. While multifocal networks may necessitate additional sEEG evaluations and subsequent surgeries, favorable seizure outcomes can be achieved.Tuberous sclerosis complex (TSC) is a rare genetic condition that often causes difficult-to-control epilepsy in children. Some patients need a procedure called stereo-EEG (sEEG) to locate where seizures begin in the brain before surgery. We reviewed 34 children with TSC who underwent sEEG before epilepsy surgery. Children with a single seizure focus were more likely to need only one sEEG, while those with multiple seizure areas often required repeat sEEGs and additional surgeries. Despite more complex epilepsy, many patients still achieved good seizure control after treatment. These findings suggest that repeat sEEGs may help guide effective treatment in children with multifocal epilepsy.

  View details for DOI 10.1002/epi4.70293

  View details for PubMedID 42400368

• Safety, feasibility, and technique of stereo-electroencephalography in children younger than 3 years. Journal of neurosurgery. Pediatrics Uchitel, J., Fariyike, O. A., Rockwood, S. J., Steeman, S., Kim, L. H., Choi, J., Berg, A., Ren, A., Teeyagura, P., Grant, G., Buch, V., Mahaney, K. B., Prolo, L. M., Porter, B. E., Hyslop, A., Phillips, H. W. 2026: 1-10

  Abstract

  Stereo-electroencephalography (sEEG) is a minimally invasive technique for intracranial monitoring that was traditionally reserved for adults but is increasingly used in very young pediatric patients with drug-resistant epilepsy. The aim of this study was to evaluate its safety, feasibility, and technical considerations in pediatric patients younger than 3 years.The authors reviewed the records of 21 children younger than 3 years who underwent sEEG monitoring at Lucile Packard Children's Hospital between February 2013 and March 2025. Data were collected from patients' clinical records and operative reports. Skull thickness was measured at the thinnest point under electrodes. Primary outcome variables were 1) sEEG-related complications, and 2) electrode placement entry point error (EPE) and target point error (TPE).Twenty-one patients (67% male) had a mean ± SE age at seizure onset of 0.5 ± 0.5 years (range birth-1.6 years). Patients underwent 23 sEEG surgeries at a mean age of 2.2 ± 0.1 years (range 0.9-2.7 years). The Mayfield headframe with the Infinity Support System was used in 65% of cases. Overall, a mean of 19 ± 1 (range 9-27) depth electrodes were placed per patient. In total, 443 electrodes were placed, most often in the frontal (189 electrodes, 43%) and temporal (121 electrodes, 27%) regions. A total of 440 bolts were used, and the most common sizes were 20 mm (68%) and 13 mm (18%); 3 electrodes were placed without bolts. The mean skull thickness at the thinnest point of electrode placement was 2.0 ± 0.1 mm (range 1.5-3.2 mm). For 417 electrodes available for analysis, the mean EPE was 1.9 ± 0.1 mm, and the mean TPE was 2.8 ± 0.1 mm. Aside from a CSF leak from a bolt in 1 patient, there were no complications. The most common procedures included open resection (61% of sEEG cases) and laser ablation (30%). Procedures were performed at a mean of 43 ± 11 days (range 0-150 days) after sEEG removal, with a mean patient age of 2.3 ± 0.1 years (range 1.2-2.9 years).This study supports the safety and feasibility of sEEG in children younger than 3 years, even in those with a skull thickness < 2 mm. Moreover, the authors report the youngest patient in the literature to have undergone sEEG at 11 months, without complications. The minimum skull thickness in which an electrode was successfully secured with a bolt was 1.5 mm. With appropriate technical adaptations, sEEG can be accurately performed in children younger than 3 years.

  View details for DOI 10.3171/2025.9.PEDS25194

  View details for PubMedID 41650398

• Wearable technologies for assisted mobility in the real world. Nature communications Gao, S., Chen, J., Xia, Y., Li, X., Ma, W., Yang, H., Li, J., Zhou, X., Jia, T., Xu, Y., Uchitel, J., Ta, D., Qi, P., Ge, J., Guo, Y., Qin, Y., Kang, I., Xu, W., Li, H., Chang, J., Zuo, S., Wang, S., Luo, S., Gionfrida, L., Hu, C., Dong, S., Guo, Y., Yuan, Y., Zhang, H., Chen, H., Pan, Y., Dai, C., Ren, Q., Loureiro, R., Carlson, T., Chen, W., Zhang, Y., Kyriacou, P., Heidari, H., Nazarpour, K., Prodromakis, T., Casson, A., Makin, T. R., Cauwenberghs, G., Farina, D., Zhao, H. 2025

  Abstract

  Mobility impairments from aging, injury, or medical conditions limit independence and social participation. Conventional assistive devices lack adaptability in complex environments. Recent wearable technologies integrating neural sensing, electronics, and co-design offer personalized, responsive mobility support. This perspective focuses on advances in wearable sensing and multimodal fusion for intent recognition, environmental interaction, and adaptive control in exoskeletons, prosthetics, smart wheelchairs, and navigation systems. Emphasizing human-in-the-loop and cognitive-sensorimotor integration, it outlines emerging trends and challenges, promoting intelligent, user-centered solutions to restore function and enhance autonomy, accessibility, and inclusion for individuals with mobility impairments.

  View details for DOI 10.1038/s41467-025-67126-4

  View details for PubMedID 41361181

• Supraorbital craniotomy for focal frontal epilepsy via eyebrow incision and guided by in situ stereo-EEG electrodes: illustrative case. Journal of neurosurgery. Case lessons Ravi, K., Huang, Y., Fariyike, O. A., Uchitel, J., Wu, A. Y., Hyslop, A., Gallentine, W. B., Phillips, H. W. 2025; 10 (18)

  Abstract

  Focal cortical dysplasia (FCD) is a common cause of focal, pediatric, drug-resistant epilepsy. For FCDs in the frontal lobe, resection may be hampered by both difficult access and proximal eloquent cortex. Stereo-EEG (sEEG) can help define the boundaries of the suspected seizure onset zone (SOZ); however, subsequent epilepsy resections often rely on lateral approaches, requiring electrode removal before resection. Nevertheless, for some lesions, especially those in the frontopolar region, skull base approaches provide an in-line, minimally invasive trajectory that allows electrodes to remain in situ during resection as both anatomical landmarks and a source of intraoperative, continuous electrocorticography (ECoG).A 17-year-old, otherwise healthy male presented with 2 years of epilepsy secondary to a left frontopolar FCD. Left frontal and temporal sEEG confirmed a lesion-confined SOZ. The patient underwent a left supraorbital keyhole craniotomy via eyebrow incision for resection of the identified epileptogenic focus. All sEEG electrodes remained implanted during resection, serving as anatomical and electrophysiological surgical adjuncts.The authors present a case of frontopolar FCD-associated epilepsy resected using a supraorbital craniotomy via eyebrow approach. We highlight the utility of leveraging previously placed sEEG electrodes for intraoperative ECoG, resulting in gross-total resection and seizure freedom a year postoperatively. https://thejns.org/doi/10.3171/CASE25428.

  View details for DOI 10.3171/CASE25428

  View details for PubMedID 41183319

  View details for PubMedCentralID PMC12584153

• Intracranial neuromodulation for pediatric drug-resistant epilepsy: early institutional experience. Frontiers in surgery Uchitel, J., Lui, A., Knowles, J., Parker, J. J., Phillips, H. W., Halpern, C. H., Grant, G. A., Buch, V. P., Hyslop, A., Kumar, K. K. 2025; 12: 1569360

  Abstract

  Pediatric drug-resistant epilepsy (DRE) is defined as epilepsy that is not controlled by two or more appropriately chosen and dosed anti-seizure medications (ASMs). When alternative therapies or surgical intervention is not viable or efficacious, advanced options like deep brain stimulation (DBS) or responsive neurostimulation (RNS) may be considered.Describe the Stanford early institutional experience with DBS and RNS in pediatric DRE patients.Retrospective chart review of seizure characteristics, prior therapies, neurosurgical operative reports, and postoperative outcome data in pediatric DRE patients who underwent DBS or RNS placement.Nine patients had DBS at 16.0 ± 0.9 years and 8 had RNS at 15.3 ± 1.7 years (mean ± SE). DBS targets included the centromedian nucleus of the thalamus (78% of DBS patients), anterior nucleus of the thalamus (11%), and pulvinar (11%). RNS placement was guided by stereo-EEG and/or intracranial monitoring in all RNS patients (100%). RNS targets included specific seizure onset zones (63% of RNS patients), bilateral hippocampi (25%) and bilateral temporal lobes (12%). Only DBS patients had prior trials of ketogenic diet (56%) and VNS therapy (67%). Four DBS patients (44%) had prior neurosurgical interventions, including callosotomy (22%) and focal resection (11%). One RNS patient (13%) and one DBS patient (11%) required revision surgery. Two DBS patients (22%) developed postoperative complications. Three RNS patients (38%) underwent additional resections; one RNS patient had electrocorticography recordings for seizure mapping before surgery. For patients with a follow-up of at ≥1 year (n = 7 for DBS and n = 5 for RNS), all patients had reduced seizure burden. Clinical seizure freedom was achieved in 80% of RNS patients and 20% had a >90% reduction in seizure burden. The majority (71%) of DBS patients had a ≥50% reduction in seizures. No patients experienced no change or worsening of seizure frequency.In the early Stanford experience, DBS was used as a palliatively for generalized or mixed DRE refractory to other resective or modulatory approaches. RNS was used for multifocal DRE with a clear seizure focus on stereo-EEG and no prior surgical interventions. Both modalities reduced seizure burden across all patients. RNS offers the additional benefit of providing data to guide future surgical planning.

  View details for DOI 10.3389/fsurg.2025.1569360

  View details for PubMedID 40264742

  View details for PubMedCentralID PMC12011735

• Temporal Dynamics and Physical Priori Multimodal Network for Rehabilitation Physical Training Evaluation IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS Gao, S., Chen, J., Chen, X., Uchitel, J., Tang, C., Li, C., Pan, Y., Zhao, H. 2024; 28 (9): 5613-5623

  Abstract

  Sensor-based rehabilitation physical training assessment methods have attracted significant attention in refined evaluation scenarios. A refined rehabilitation evaluation method combines the expertise of clinicians with advanced sensor-based technology to capture and analyze subtle movement variations often unobserved by traditional subjective methods. Current approaches center on either body postures or muscle strength, which lack more sophisticated analysis features of muscle activation and coordination, thereby hindering analysis efficacy in deep rehabilitation feature exploration. To address this issue, we present a multimodal network algorithm that integrates surface electromyography (sEMG) and stress distribution signals. The algorithm considers the physical knowledge a priori to interpret the current rehabilitation stage and efficiently handles temporal dynamics arising from diverse user profiles in an online setting. Besides, we verified the performance of this model using a learned-nonuse phenomenon assessment task in 24 subjects, achieving an accuracy of 94.7%. Our results surpass those of conventional feature-based, distance-based, and ensemble baseline models, highlighting the advantages of incorporating multimodal information rather than relying solely on unimodal data. Moreover, the proposed model presents a network design solution for rehabilitation physical training that requires deep bioinformatic features and can potentially assist real-time and home-based physical training work.

  View details for DOI 10.1109/JBHI.2024.3414291

  View details for Web of Science ID 001309075700030

  View details for PubMedID 38869994

• Characteristics of non-sleep related apneas in children with alternating hemiplegia of childhood. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society Thamby, J., Prange, L., Boggs, A., Subei, M. O., Myers, C., Uchitel, J., ElMallah, M., Bartlett-Lee, B., Riviello, J. J., Mikati, M. A. 2023; 48: 101-108

  Abstract

  BACKGROUND: Non-sleep related apnea (NSA) has been observed in alternating hemiplegia of childhood (AHC) but has yet to be characterized.GOALS: Investigate the following hypotheses: 1) AHC patients manifest NSA that is often severe. 2) NSA is usually triggered by precipitating events. 3) NSA is more likely in patients with ATP1A3 mutations.METHODS: Retrospective review of 51 consecutive AHC patients (ages 2-45 years) enrolled in our AHC registry. NSAs were classified as mild (not needing intervention), moderate (needing intervention but not perceived as life threatening), or severe (needing intervention and perceived as life threatening).RESULTS: 19/51 patients (37%) had 52 NSA events (6 mild, 11 moderate, 35 severe). Mean age of onset of NSA (± Standard Error of the Mean (SEM)): 3.8±1.5 (range 0-24) years, frequency during follow up was higher at younger ages as compared to adulthood (year 1: 2.2/year, adulthood: 0.060/year). NSAs were associated with triggering factors, bradycardia and with younger age (p<0.008 in all) but not with mutation status (p=0.360). Triggers, observed in 17 patients, most commonly included epileptic seizures in 9 (47%), anesthesia, AHC spells and intercurrent, stressful, conditions. Management included use of pulse oximeter at home in nine patients, home oxygen in seven, intubation/ventilatory support in seven, and basic CPR in six. An additional patient required tracheostomy. There were no deaths or permanent sequalae.CONCLUSIONS: AHC patients experience NSAs that are often severe. These events are usually triggered by seizures or other stressful events and can be successfully managed with interventions tailored to the severity of the NSA.

  View details for DOI 10.1016/j.ejpn.2023.12.002

  View details for PubMedID 38096596

• Ensuring Optimal Early Childhood Development Globally: Optimism about the Increasing Role of Pediatricians. Journal of developmental and behavioral pediatrics : JDBP Mikati, M. A., Uchitel, J. 2023; 44 (1): e70

  View details for DOI 10.1097/DBP.0000000000001145

  View details for PubMedID 36563348