Eleonora Tamilia

• PhD
• Instructor at Harvard Medical School

In this work a novel unobtrusive technologyaided system is presented and tested for the assessment of newborns’ oral-motor behavior and coordination during bottle feeding. A low-cost monitoring device was designed and developed in order to record Suction (S) and Expression (E) pressures from a typical feeding bottle. A software system was developed...

Objective In patients with medically refractory epilepsy (MRE), interictal ripples (80‐250 Hz) are seen in large brain areas whose resection may be unnecessary for seizure‐freedom. This limits their utility as epilepsy biomarkers for surgery. We assessed the spatiotemporal propagation of interictal ripples on intracranial electroencephalography (iE...

Objective: To evaluate the accuracy and clinical utility of conventional 21-channel EEG (conv-EEG), 72-channel high-density EEG (HD-EEG) and 306-channel MEG in localizing interictal epileptiform discharges (IEDs). Methods: Twenty-four children who underwent epilepsy surgery were studied. IEDs on conv-EEG, HD-EEG, MEG and intracranial EEG (iEEG)...

Objective Intracranial EEG (icEEG) studies show that interictal ripples propagate across the brain of children with medically refractory epilepsy (MRE) and the onset of this propagation (ripple‐onset‐zone, ROZ) estimates the epileptogenic zone. It is still unknown whether we can map this propagation non‐invasively. The goal of this study is to map...

About 30% of children with drug-resistant epilepsy (DRE) continue to have seizures after epilepsy surgery. Since epilepsy is increasingly conceptualized as a network disorder, understanding how brain regions interact may be critical for planning re-operation in these patients. We aimed to estimate functional brain connectivity using scalp EEG and i...

Surgical success for patients with focal drug resistant epilepsy (DRE) relies on accurate localization of the epileptogenic zone (EZ). Currently, no exam delineates this zone unambiguously. Instead, the EZ is approximated by the area where seizures begin, which is identified manually through a tedious process that is prone to errors and biases. Mor...

Spikes are the most established interictal epilepsy biomarkers. Yet, they suffer from low specificity since they are partially concordant with the epileptogenic zone and often found in non-epileptogenic areas. High frequency oscillations, classified as ripples and fast ripples, are considered more specific biomarkers compared to spikes. Ripples occ...

Objective We aimed to test whether T‐wave alternans (TWA), which is a marker of susceptibility to ventricular fibrillation, is abnormal in children with Angelman syndrome (AS) compared with typically developing children (TDC), and whether it can be used as a biomarker of AS. Materials and Methods Using surface electrocardiogram (ECG), we calculate...

Objective Interictal biomarkers are critical for identifying the epileptogenic focus. However, spikes and ripples lack specificity while fast ripples lack sensitivity. These biomarkers propagate from more epileptogenic onset to areas of spread. The pathophysiological mechanism of these propagations is elusive. Here, we examine zones where spikes an...

Epileptogenic zone identification to aid in surgery planning for drug-resistant focal epilepsy. SEEG signal anaylisis on MATLAB and Brainstorm, MRI and CT visualization, resection area outlining and statistical data analysis to identify new predictors of seizure-freedom. Proposal of new interictal iEEG measures of “interconnected-excitability” to t...

Magnetoencephalography (MEG) is an imaging technique that enables the assessment of cortical activity via direct measures of neurophysiology. It is a non-invasive and passive technique that is completely painless. MEG has gained increasing prominence in the field of pediatric neuroimaging. This dedicated review article for the pediatric population...

Objective To deconstruct the epileptogenic networks of patients with drug‐resistant epilepsy (DRE) using source functional connectivity (FC) analysis; unveil the FC biomarkers of the epileptogenic zone (EZ); and develop machine learning (ML) models to estimate the EZ using brief interictal electroencephalography (EEG) data. Methods We analyzed sca...

In drug-resistant epilepsy, a visual inspection of intracranial electroencephalography (iEEG) signals is often needed to localize the epileptogenic zone (EZ) and guide neurosurgery. The visual assessment of iEEG time-frequency (TF) images is an alternative to signal inspection, but subtle variations may escape the human eye. Here, we propose a deep...

Introduction: Literature lacks studies investigating the cortical generation of sleep spindles in drug-resistant epilepsy (DRE) and how they evolve after resection of the epileptogenic zone (EZ). Here, we examined sleep EEGs of children with focal DRE who became seizure-free after focal epilepsy surgery, and aimed to investigate the changes in the...

Objective: To evaluate the diagnostic accuracy of electromagnetic source imaging (EMSI) in localizing spikes and predict surgical outcome in children with drug resistant epilepsy (DRE) due to focal cortical dysplasia (FCD). Methods: We retrospectively analyzed magnetoencephalography (MEG) and high-density (HD-EEG) data from 23 children with FCD-...

Normal brain functioning emerges from a complex interplay among regions forming networks. In epilepsy, these networks are disrupted causing seizures. Highly connected nodes in these networks are epilepsy surgery targets. Here, we assess whether functional connectivity (FC) using intracranial electroencephalography can quantify brain regions epilept...

Objective: To evaluate whether ictal phase-amplitude coupling (PAC) between high-frequency activity and low-frequency activity could be used as a preoperative biomarker of Focal Cortical Dysplasia (FCD) subtypes. We hypothesize that FCD seizures present unique PAC characteristics that may be linked to their specific histopathological features. Meth...

Normal brain functioning emerges from a complex interplay among regions forming networks. In epilepsy, these networks are disrupted causing seizures. Nodes of these networks are the target of epilepsy surgery. Here, we assess whether functional connectivity (FC) using intracranial electroencephalography (iEEG) can quantify epileptogenicity and pred...

Multimodal brain magnetic resonance imaging (MRI) can provide biomarkers of early influences on neurodevelopment such as nutrition, environmental and genetic factors. As the exposure to early influences can be separated from neurodevelopmental outcomes by many months or years, MRI markers can serve as an important intermediate outcome in multivaria...

Delineation of resected brain cavities on magnetic resonance images (MRIs) of epilepsy surgery patients is essential for neuroimaging/neurophysiology studies investigating biomarkers of the epileptogenic zone. The gold standard to delineate the resection on MRI remains manual slice-by-slice tracing by experts. Here, we proposed and validated a semi...

Objective Delineation of the seizure onset zone (SOZ) is required in children with drug resistant epilepsy (DRE) undergoing neurosurgery. Intracranial EEG (icEEG) serves as gold standard but has limitations. Here, we examine the utility of virtual implantation with electrical source imaging (ESI) on ictal scalp EEG for mapping the SOZ and predict s...

Interictal epileptiform discharges (IEDs) serve as sensitive but not specific biomarkers of epilepsy that can delineate the epileptogenic zone (EZ) in patients with drug resistant epilepsy (DRE) undergoing surgery. Intracranial EEG (icEEG) studies have shown that IEDs propagate in time across large ar- eas of the brain. The onset of this propagatio...

Studies on intracranial electroencephalography (icEEG) recordings of patients with drug resistant epilepsy (DRE) show that epilepsy biomarkers propagate in time across brain areas. Here, we propose a novel method that estimates critical features of these propagations for different epilepsy biomarkers (spikes, ripples, and fast ripples), and assess...

Children with medically refractory epilepsy (MRE) require resective neurosurgery to achieve seizure freedom, whose success depends on accurate delineation of the epileptogenic zone (EZ). Functional connectivity (FC) can assess the extent of epileptic brain networks since intracranial EEG (icEEG) studies have shown its link to the EZ and predictive...

Introduction Generalized tonic-clonic seizures (GTCS) are associated with elevated electrodermal activity (EDA) and postictal generalized electroencephalographic suppression (PGES), markers that may indicate sudden unexpected death in epilepsy (SUDEP) risk. This study investigated the association of GTCS semiology, EDA, and PGES in children with ep...

Objective To assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery. Methods We examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure...

Objective To assess the utility of interictal magnetic and electric source imaging (MSI and ESI) using dipole clustering in magnetic resonance imaging (MRI)-negative patients with drug resistant epilepsy (DRE). Methods We localized spikes in low-density (LD-EEG) and high-density (HD-EEG) electroencephalography as well as magnetoencephalography (ME...

A term neonate is born with the ability to suck; this neuronal network is already formed and functional by 28 weeks gestational age and continues to evolve into adulthood. Because of the necessity of acquiring nutrition, the complexity of the neuronal network needed to suck, and neuroplasticity in infancy, the skill of sucking has the unique abilit...

Objectives Photoplethysmography (PPG) reflects variations of blood perfusion in tissues, which may signify seizure‐related autonomic changes. The aim of this study is to assess the variability of PPG signals and their value in detecting peri‐ictal changes in patients with focal impaired awareness seizures (FIASs). Methods PPG data were recorded us...

Objective Photoplethysmography (PPG) is an optical technique measuring variations of blood perfusion in peripheral tissues. We evaluated alterations in PPG signals in relationship to the occurrence of generalized tonic‐clonic seizures (GTCSs) in patients with epilepsy to evaluate the feasibility of seizure detection. Methods During electroencephal...

Objective: To assess the ability of high-density Electroencephalography (HD-EEG) and magnetoencephalography (MEG) to localize interictal ripples, distinguish between ripples co-occurring with spikes (ripples-on-spike) and independent from spikes (ripples-alone), and evaluate their localizing value as biomarkers of epileptogenicity in children with...

Objective To localize the seizure onset zone (SOZ) and irritative zone (IZ) using electric source imaging (ESI) on intracranial EEG (iEEG) and assess their clinical value in predicting epilepsy surgery outcome in children with focal cortical dysplasia (FCD). Methods We analyzed iEEG data from 25 children with FCD-associated medically refractory ep...

Rationale High frequency oscillations (HFOs) are emerging biomarkers of epileptogenicity that are typically investigated with intracranial EEG (iEEG). A major limitation of iEEG, linked to its invasiveness, is that it can only sample a portion of the entire cerebral cortex. Full-head non-invasive tests are often necessary to optimize iEEG placement...

Objective: To determine the relationship between nutritive sucking and microstructural integrity of sensorimotor tracts in newborns with brain injury. Study design: Diffusion imaging was performed in ten newborns with brain injury. Nutritive sucking was assessed using Nfant®. The motor, sensory, and corpus callosum tracts were reconstructed via...

Introduction: Patients with medically refractory epilepsy (MRE) need surgical resection of the epileptogenic zone (EZ) to gain seizure-freedom. High-frequency oscillations (HFOs, > 80 Hz) are promising biomarkers of the EZ that are typically localized using intracranial electroencephalography (icEEG). The goal of this study was to localize the cor...

Despite extensive literature showing damages in the sensorimotor projection fibers of children with hemiplegic cerebral palsy (HCP), little is known about how these damages affect the global brain network. In this study, we assess the relationship between the structural integrity of sensorimotor projection fibers and the integrity of intergyral ass...

Rationale For patients with medically refractory epilepsy (MRE), the success of epilepsy surgery depends on the availability of a precise biomarker of epileptogenicity. High-frequency oscillations (HFOs) have emerged as reliable epilepsy biomarkers. Ripple HFOs (>80 Hz) can be seen using magnetoencephalography (MEG) or scalp electroencephalography...

Introduction Epilepsy surgery is a potentially curative treatment for medically refractory epilepsy (MRE). The goal of epilepsy surgery is the resection of the epileptogenic zone. Before surgery, MEG and scalp EEG are used to estimate the epileptogenic zone noninvasively by localizing the irritative zone (IZ), which is the area where interictal epi...

Introduction Approximately 20–30% of children with epilepsy develop medically refractory epilepsy (MRE), and require surgical resection of the epileptogenic zone for seizure-freedom. High-frequency oscillations (HFOs), recorded with intracranial electroencephalography (iEEG) and separated into ripples (>80 Hz) and fast-ripples (>250 Hz) are new pro...

Introduction: This study evaluates magnetoencephalographic (MEG) spike population as compared with intracranial electroencephalographic (IEEG) spikes using a quantitative method based on distributed source analysis. Methods: We retrospectively studied eight patients with medically intractable epilepsy who had an MEG and subsequent IEEG monitorin...

Neonatal feeding has been traditionally understudied so guidelines and evidence-based support for common feeding practices are limited. A major contributing factor to the paucity of evidence-based practice in this area has been the lack of simple-to-use, low-cost tools for monitoring sucking performance. We describe new methods for quantifying neon...

Problem: Current methods of identifying infants with Neonatal Brain Injury (NBI) may not be sensitive enough to detect in the neonatal period and others are too costly to be used routinely. Study Design: Longitudinal cohort. Expected Outcomes: Demonstrate clear evidence of the association between early abnormalities in feeding performance and und...

Up to one-third of patients with epilepsy are medically intractable and need resective surgery. To be successful, epilepsy surgery requires a comprehensive preoperative evaluation to define the epileptogenic zone (EZ), the brain area that should be resected to achieve seizure freedom. Due to lack of tools and methods that measure the EZ directly, t...

Neonatal feeding has been traditionally understudied so guidelines and evidence-based support for common feeding practices are limited. A major contributing factor to the paucity of evidence-based practice in this area has been the lack of simple-to-use, low-cost tools for monitoring sucking performance. We describe new methods for quantifying neon...

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency Oscillations (HFOs) have emerged as potential presurgical biomarkers for the identification of the EZ in addition to Interictal Epileptiform Discharges (IEDs) and ictal activity. Although they are promisin...

Objective: current clinical practice lacks of quantitative tools for the assessment of nutritive sucking and its coordination with breathing. This work aimed to fill this gap by integrating a module for neonatal breathing monitoring with a system for the measurement of sucking during bottle feeding. Methods: an in-house flow meter, based on two com...

The quantitative monitoring of breathing, sucking, and swallowing is required to predict newborns’ neurodevelopmental outcomes. In particular, the coordination of breathing timing with respect to sucking cycle is crucial. In this work, we present the characterization of a low-cost flowmeter designed for noninvasive recording of breathing pattern du...

The assessment of Oral-Motor Behavior (OMB) represents one the earliest noninvasive ways to evaluate the newborns' well-being and neuromotor behavior. This work aimed at developing a new low-cost, easy-to-use and noninvasive system for a technology-aided assessment of newborns' OMB during bottle feeding. A SUcking MOnitoring Device (SUMOD) was desi...

In this paper, we propose a novel, low cost flowmeter suitable for application in disposable breathing circuits. The sensor consists of two nominally identical transistors employed as hot sensing elements, placed into a pipe where the fluid flows. The working principle is based on the convective heat transfer between the transistors, heated by Joul...

In newborns, a poor coordination between sucking, swallowing and breathing may undermine the effectiveness of oral feeding and signal immaturity of Central Nervous System. The aim of this work is to develop and validate a non-invasive device for recording respiratory events of newborns during bottle feeding. The proposed device working principle is...

A bidirectional, low cost flowmeter for neonatal artificial ventilation, suitable for application in mono-patient breathing circuits, is described here. The sensing element consists of two nominally identical bipolar junction transistors employed as hot bodies. The sensor working principle is based on the convective heat transfer between the transi...

In this work we propose a new method to study the development of motor planning abilities in children and, in particular, in children at high risk for ASD. Although several modified motor signs have been found in children with ASD, no specific markers enabling the early assessment of risk have been found yet. In this work, we discuss the problem po...

Nutritive Sucking (NS) is a highly organized process that can reflect infants' maturation during the early post-natal period. The assessment of NS may provide a sensitive means of evaluating early motor skills and their development. Thus, a reliable tool for assessing sucking behavior may benefit diagnostics and treatment of newborns since the firs...

Fiber Bragg Grating (FBG) technology is very attractive to develop sensors for the measurement of thermal and mechanical parameters in biological applications, particularly in presence of electromagnetic interferences. This work presents the design, working principle and experimental characterization of a force sensor based on two FBGs, with the fe...

Action selection is extremely important, particularly when the accomplishment of competitive tasks may require access to limited motor resources. The spontaneous exploration of the world plays a fundamental role in the development of this capacity, providing subjects with an increasingly diverse set of opportunities to acquire, practice and refine...

Recent advances in wearable sensor technologies for motion capture have produced devices, mainly based on magneto and inertial measurement units (M-IMU), that are now suitable for out-of-the-lab use with children. In fact, the reduced size, weight and the wireless connectivity meet the requirement of minimum obtrusivity and give scientists the poss...

Nutritive Sucking (NS) is a highly organized process that is essential for infants’ feeding during the first six months of their life. It requires the complex coordination of sucking, swallowing and breathing. The infant’s inability to perform a safe and successful oral feeding can be an early detector of immaturity of the Central Nervous System (C...

Motion capture based on magneto-inertial sensors is a technology enabling data collection in unstructured environments, allowing "out of the lab" motion analysis. This technology is a good candidate for motion analysis of children thanks to the reduced weight and size as well as the use of wireless communication that has improved its wearability an...

The Sucking Efficiency (SEF) is one of the main parameters used to monitor and assess the sucking pattern development in infants. Since Nutritive Sucking (NS) is one of the earliest motor activity performed by infants, its objective monitoring may allow to assess neurological and motor development of newborns. This work proposes a new ecological an...

Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology Assessing the localization accuracy and clinical utility of electric and magnetic source imaging in children with epilepsy