Mechanisms and Prognostic Value of Ictal Onset Patterns for Epilepsy Neurostimulation

/ABSTRACT Dr. Andrew Michalak is an Assistant Professor of Neurology at New York University Grossman School of Medicine (NYUGSoM) with clinical expertise in epilepsy. His long-term goal is to be a physician scientist using multiscale electrophysiology to bridge the gap between the basic mechanisms of epilepsy and therapeutic options for patients. Outcomes after responsive neurostimulation (RNS) implantation for drug-resistant epilepsy vary widely, and there are currently no known biomarkers to guide lead placement or patient selection. Ictal onset patterns (IOPs) are used widely for predicting response to surgical resection, but we do not know if they are effective for guiding RNS placement. Furthermore, classifying IOPs is subjective and time-consuming. This proposal explores the basic mechanisms that give rise to ictal onset patterns using hybrid micro-/macroelectrode recordings, determines their use in predicting RNS outcomes, and uses machine learning to classify ictal patterns rapidly across the full ictal period. The specific aims are (1) identify interictal neural mechanisms that generate IOPs via multiscale recordings, (2) quantify the predictive value of IOPs for seizure reduction after RNS, and (3) determine the accuracy of neural networks to classify the full ictal period. This proposal builds on Dr. Michalak’s prior research on epilepsy surgery outcomes and microscale electrophysiology. With a mentor team of experts in the field from NYUGSoM, Dr. Michalak will gain expertise in multiscale electrophysiology methods and analysis, signal processing, and machine learning. Dr. Michalak’s mentors (Drs. Friedman, Flinker, Liu, and Devinsky) have strong track records of mentorship and will provide specific expertise in these areas. He will take advantage of the high volume of surgical epilepsy at NYUGSoM and a large retrospective dataset, as well as an existing multicenter collaboration with University of Pennsylvania and University of California – San Francisco. The data and training derived from this career development award and his strong mentorship will position Dr. Michalak as an independent clinician scientist and leader in the field of epilepsy biomarker research and therapeutic strategies. Project Number: 1K23NS146693-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Neurological Disorders and Stroke (NINDS) | Principal Investigator: Andrew Michalak | Institution: NEW YORK UNIVERSITY SCHOOL OF MEDICINE, NEW YORK, NY | Award Amount: $247,994 | Activity Code: K23 | Study Section: Special Emphasis Panel[ZRG1 CN-F (91)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11283042