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Wu YE, Zheng YY, Li QY, Yao BF, Cao J, Liu HX, Hao GX, van den Anker J, Zheng Y, Zhao W. Model-informed drug development in pediatric, pregnancy and geriatric drug development: States of the art and future. Adv Drug Deliv Rev 2024; 211:115364. [PMID: 38936664 DOI: 10.1016/j.addr.2024.115364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 06/09/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
The challenges of drug development in pediatric, pregnant and geriatric populations are a worldwide concern shared by regulatory authorities, pharmaceutical companies, and healthcare professionals. Model-informed drug development (MIDD) can integrate and quantify real-world data of physiology, pharmacology, and disease processes by using modeling and simulation techniques to facilitate decision-making in drug development. In this article, we reviewed current MIDD policy updates, reflected on the integrity of physiological data used for MIDD and the effects of physiological changes on the drug PK, as well as summarized current MIDD strategies and applications, so as to present the state of the art of MIDD in pediatric, pregnant and geriatric populations. Some considerations are put forth for the future improvements of MIDD including refining regulatory considerations, improving the integrity of physiological data, applying the emerging technologies, and exploring the application of MIDD in new therapies like gene therapies for special populations.
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Affiliation(s)
- Yue-E Wu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan-Yuan Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiu-Yue Li
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bu-Fan Yao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Cao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui-Xin Liu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guo-Xiang Hao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA; Departments of Pediatrics, Pharmacology & Physiology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA; Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - Yi Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Meador KJ, Cohen MJ, Loring DW, Matthews AG, Brown CA, Robalino C, Carmack A, Sumners S, Birnbaum AK, Kalayjian LA, Gedzelman E, Voinescu PE, Gerard EE, Hanna J, Cavitt J, Sam M, Hwang ST, Pack AM, Tsai JJ, Pennell PB. Association of Prenatal Exposure to Antiseizure Medications With Creative and Executive Function at Age 4.5 Years. Neurology 2024; 102:e209448. [PMID: 38810172 PMCID: PMC11226309 DOI: 10.1212/wnl.0000000000209448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neurodevelopmental effects of fetal antiseizure medication (ASM) exposure on creativity and executive functions are poorly understood. We previously found fetal valproate exposure to adversely affect measures of creativity and executive functions. In this study, we examine fetal exposure of newer ASMs on these functions in children of women with epilepsy (WWE) compared with children of healthy women (HW). METHODS The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a multicenter NIH-funded prospective observational cohort study of WWE and HW enrolled in pregnancy and their offsprings. This report examines blindly assessed creativity and executive functions in 4.5-year-old children of WWE vs HW. In addition, exposure-dependent ASM effects during the third trimester were examined in children of WWE, using a ratio of maximum observed ASM concentrations and ratio of defined daily dose (ratio DDD). For polytherapy, ratios were summed across ASMs. Linear regression models adjusted for multiple potential confounding factors were conducted for all analyses. The primary outcome for 4.5-year-old children was the Torrance Test of Creative Thinking-Figural Creativity Index. Secondary outcomes included the Global Executive Composite Score from the Behavior Rating Inventory of Executive Function-Preschool Version and subscales and other indexes of both measures. RESULTS The primary analysis included 251 children of WWE and 73 of HW. No differences in creativity or executive function were found between children of WWE vs HW. No ASM exposure-dependent effects were found for the creativity measures, but exposure-dependent effects for executive function were present for ratio ASM concentration and ratio DDD. DISCUSSION Our findings at 4.5 years show no differences in creative thinking between children of WWE vs HW (-3.2 [-9.0 to 2.7], p = 0.286) or associations with fetal exposure to ASMs (-2.6 [-11.0 to 5.7], p = 0.530). Secondary analyses revealed fetal exposure-dependent effects for executive function in children of WWE (7.0 [2.9-11.2], p = 0.001), which are most marked for levetiracetam (12.9 [4.2-21.6], p = 0.004). Our findings suggest that even for relatively safe ASMs, dosing needs to be adjusted to concentrations that prevent seizures, but balance risks to the fetus that high concentrations may pose. TRIAL REGISTRATION INFORMATION The study is registered at ClinicalTrials.gov as NCT01730170.
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Affiliation(s)
- Kimford J Meador
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Morris J Cohen
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - David W Loring
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Abigail G Matthews
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Carrie A Brown
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Chelsea Robalino
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Andrea Carmack
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Sarah Sumners
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Angela K Birnbaum
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Laura A Kalayjian
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Evan Gedzelman
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Paula E Voinescu
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Elizabeth E Gerard
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Julie Hanna
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Jennifer Cavitt
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Maria Sam
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Sean T Hwang
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Alison M Pack
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Jeffrey J Tsai
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
| | - Page B Pennell
- From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA
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