Julie Christina Uchitel

All Publications

• 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