Background High definition transcranial direct current stimulation (HD-tDCS) has been administered over single brain regions for small numbers of sessions. Safety, feasibility and tolerability of HD-tDCS over multiple brain regions, multiple daily stimulations and long periods are not established. Objective We studied safety, feasibility and tolerability of daily HD-tDCS over 2–4 brain regions for 20 sessions in healthy adults. Methods Five healthy adults underwent physical and neurological examination, electrocardiogram (EKG), electroencephalogram (EEG) and cognitive screening (ImpACT) before, during and after HD-tDCS. Four networks (left/right temporoparietal and frontal) were stimulated in sequence (20 min each) using HD-tDCS in 20 daily sessions. Sessions 1–10 included sequential stimulation of both temporoparietal networks, sessions 11–15 stimulations of 4 networks and sessions 16–20 two daily stimulation cycles of 4 networks/cycle (1.5 mA/network). Side effects, ImpACT scores and EEG power spectrum were compared before and after HD-tDCS. Results All subjects completed the trial. Adverse events were tingling, transient redness at the stimulation site, perception of continuing stimulation after end of session and one self-resolving headache. EEG power spectrum showed decreased delta power in frontal areas several days after HD-tDCS. While at the group level ImpACT scores did not differ before and after stimulations, we found a trend for correlation between decreased EEG delta power and individual improvements in ImpACT scores after HD-tDCS. Conclusion Prolonged, repeat daily stimulation of multiple brain regions using HD-tDCS is feasible and safe in healthy adults. Preliminary EEG results suggest that HD-tDCS may induce long lasting changes in excitability in the brain.

Purpose In order to develop a theoretical framework for person-centered care models for children with epilepsy and their parents, we conducted a qualitative study to explore and understand parents’ needs, values, and preferences to ultimately reduce barriers that may be impeding parents from accessing and obtaining help for the child’s co-occurring problems. Methods A qualitative grounded theory study design was utilized to understand parents’ perspectives. The participants were 22 parents of children with epilepsy who ranged in age from 31-53 years. Interviews were conducted using open ended semi-structured questions to facilitate conversation. Transcripts were analyzed using grounded theory guidelines. Results In order to understand the different perspectives parents had about their child, we devised a theory composed of three zones (Zones 1, 2, 3) that can be used to conceptualize parents’ viewpoints. Zone location was based on parents’ perspectives of their child’s comorbidities in the context of epilepsy. These zones were developed to help identify distinctions between parents’ perspectives and to provide a framework within which to understand parents’ readiness to access and implement interventions to address the child’s struggles. These zones of understanding describe parents’ perspectives of their child’s struggles at a particular point in time. This is the perspective from which parents address their child’s needs. This theoretical perspective provides a structure in which to discuss parents’ perspectives on conceptualizing or comprehending the child’s struggles in the context of epilepsy. The zones are based on how the parents a) describe their concerns about the child’s struggles, b) their understanding of the struggles, and c) the parent’s view of the child’s future. Conclusions Clinicians working with individuals and families with epilepsy are aware that epilepsy is a complex and unpredictable disorder. The zones help clinicians conceptualize and build a framework within which to understand how parents view their child’s struggles, which influences the parents’ ability to understand and act on clinician feedback and recommendations. Zones allow for increased understanding of the parent at a particular time and provide a structure within which a clinician can provide guidance and feedback to meet parents’ needs, values and preferences. This theory allows clinicians to meet the parents where they are and address their needs in a way that benefits the parents, family and child.

Summary Objective Birth weight is an important indicator of prenatal environment and subtle variations of birth weight within the normal range have been associated with differential risk for cognitive and behavioral problems. Therefore, we aimed to determine if there are differences in birth weight between full term children with uncomplicated new/recent-onset epilepsies and typically-developing healthy controls. We further examined the relationships between birth weight and childhood/adolescent cognition, behavior, and academic achievement. Methods 108 children with new/recent-onset epilepsy and 70 healthy controls underwent neuropsychological assessment. All participants were born full-term (>37 weeks) without birth complications. Parents were interviewed regarding their child's gestation, birth and neurodevelopmental history. Results Birth weight of children with epilepsy was significantly lower than healthy controls (p=0.023). Whereas birth weight (covaried with age, sex, handedness, and mother's education) was significantly associated with cognition in controls in multiple domains (intelligence, language, aspects of academic achievement), this relationship was absent in children with epilepsy. Birth weight was not associated with clinical epilepsy variables (age of onset, epilepsy syndrome) and was not predictive of a variety of other academic or psychiatric comorbidities of epilepsy. Significance Although the origin of lower birth weight in children with epilepsy is unknown, these findings raise the possibility that abnormal prenatal environment may impact childhood-onset epilepsy. Furthermore, the positive relationship between birth weight and cognition evident in healthy controls was disrupted in children with epilepsy. However, birth weight was not related to academic and psychiatric comorbidities of childhood epilepsy.

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