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Children with epilepsy are at increased risk for language and reading difficulties. Phonological processing and language underlie reading success, yet their association with reading achievement in children with epilepsy is unknown. We assessed phonological processing, oral language, and reading in children (ages 6 to 12) with epilepsy (EP; n = 6), language problems (LP; n = 14), and typical development (TD; n = 15). The EP and LP group had lower scores on all measures compared with the TD group, with the EP group scoring the lowest on reading comprehension. Phonological processing followed by epilepsy diagnosis predicted reading decoding. Language followed by epilepsy diagnosis predicted reading comprehension. Thus, reading problems in children with epilepsy are not fully explained by their phonological processing or language deficits. Further research that considers other cognitive processes important for reading (e.g., executive function) in this population may help inform our understanding of their reading success.

We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children's families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure.

CDKL5 deficiency disorder (CDD) results in early-onset epilepsy and lifelong cognitive and motor impairments. With no validated measure for communication in CDD, this study evaluated the psychometric properties of the Communication and Symbolic Behavior Scales-Developmental Profile Infant Toddler Checklist (CSBS-DP ITC). Caregivers (n = 150; affected individuals aged 1-29 years) completed the CSBS-DP ITC. Distribution of scores indicated a floor effect. There was poor divergent validity for the three-factor model but goodness of fit and convergent validity data were satisfactory for the one-factor model. Individuals with poorer overall functional abilities scored lower on the CSBS-DP ITC. Test-retest reliability was excellent. The floor effect could explain the very high reliability, suggesting problems as a sensitive outcome measure in clinical trials for CDD.

Background: We now have sufficient evidence demonstrating inequalities in specific avoidable causes of death for adults with intellectual disability compared to their peers without intellectual disability. Apart from COVID-19, the largest differentials that disadvantage people with intellectual disability are in relation to pneumonia, aspiration pneumonia, epilepsy, cerebrovascular disease, ischaemic heart disease, deep vein thrombosis, diabetes and sepsis. The aim of this systematic review is to report on strategies at the individual, population or policy levels aimed at preventing these conditions that are applicable to adults with intellectual disability and that have been based on or recommended by research. Methods: Systematic review of PUBMED, EMBASE, CINAHL, PsychInfo, Social Care Online, International Bibliography of the Social Sciences (IBSS), Web of Science, Scopus, Overton, the Cochrane Library and Google Scholar databases was carried out. Searches were completed on 30 June 2023. Quantitative, qualitative and mixed-methods research; systematic, scoping or evidence-based reviews; and audit and reports of mortality reviews were included. Publications included in the review were about preventing the eight potentially avoidable causes of death. Findings: Ninety-four papers were included in the review (9 in relation to pneumonia; 11 for aspiration pneumonia; 18 for sudden unexpected death in epilepsy; 7 for cerebrovascular disease; 8 for ischaemic heart disease; 4 for deep vein thrombosis; 31 for diabetes; 6 for sepsis). The eight most frequently occurring potentially avoidable causes of death in people with intellectual disability are very different medical conditions, but they shared striking similarities in how they could be prevented. The literature overwhelmingly implicated the need to make lifestyle changes to address obesity, lack of exercise and poor nutrition, and to have regular medical reviews. In addition, 'whole-population' approaches are required that look beyond the individual to the social determinants of health. Conclusions: We found little peer-reviewed evidence specifically about preventing these conditions in people with intellectual disability. However, most of the literature about preventative strategies pertaining to the general population was applicable to people with intellectual disability, albeit that some 'reasonable adjustments' would be required.

This study aimed to describe the behavioral profile of individuals with SYNGAP1-ID. Parents/carers of 30 individuals aged 3-18 years old with a diagnosis of SYNGAP1-ID and 21 typically developing individuals completed the Vineland-3 Adaptive Behavior Scale and the Child Behavior Checklist. We found that those with SYNGAP1-ID showed fewer adaptive behaviors and higher levels of internalizing and externalizing behaviors across almost all domains compared to typically developing controls. There was some evidence that these differences were greatest in older children, and more apparent in those with co-occurring epilepsy. This characterization of the phenotype of SYNGAP1-ID significantly aids our understanding of the behavioral profile of this population and is a step towards the development of tailored interventions.

This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.

This systematic review aimed to identify factors significantly associated with the occurrence of epilepsy in autistic individuals and to consider the impact of study quality on findings. Electronic databases were systematically searched on October 2nd, 2020 and records retrieved were limited to those published from 2000 onwards. Study quality was categorised as 'good', 'moderate' or 'weak'. Fifty-three studies were included and in studies where the prevalence of epilepsy was reported (n = 257,892), 18,254 (7%) had co-occurring epilepsy. Intellectual disability/cognitive impairment was the most commonly reported risk factor associated with occurrence of epilepsy in autistic individuals. The evidence supporting other, potentially relevant factors was weak and inconsistent and requires further evaluation. Only 9/53 studies were considered 'good' quality.

Background: Previous research indicated a high prevalence of disordered sleep among adults with learning disabilities, however issues with design impacted findings. The current systematic review aims to: (1) present how disordered sleep and sleep disorders amongst adults with learning disabilities are described in the literature, and (2) report on the prevalence of disordered sleep and sleep disorders among adults with learning disabilities. Methods: Five databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO and PubMed) were searched for articles published from 1900 to October 2021 that examined the prevalence of disordered sleep and/or sleep disorders in adults aged 18 or older with learning disabilities. The Joanna Briggs Institute critical appraisal checklist for prevalence studies was used to assess study quality and prevalence is described and reported as ranges. The study was registered on PROSPERO (ID: CRD42019134550). Findings: A total of 27 studies were selected. Twenty studies (n = 8043 participants) examined the prevalence of disordered sleep and identified prevalence ranging from 6.1% to 74.2% across a range of sleep parameters. Twelve studies examined sleep-related breathing disorders (n = 2558 participants) and identified prevalence which ranged from 0.5% to 100%. There was notable heterogeneity between studies in terms of quality, definition of disordered sleep, measurement of sleep, and study design. Conclusion: There was a variable prevalence of disordered sleep among people living with learning disabilities. There were problems in meaningfully synthesising results due to heterogeneity in measurement, diagnosis, study design and study quality. Based on these limitations, we suggest that future studies should seek to utilise objective, replicable and consistent measures of sleep in this population and control for physical health factors which could influence prevalence such as epilepsy and iatrogenic effects.

To assess the role of clinical features in diagnosing seizures in children with autism spectrum disorder who present with staring spells. A 10-year retrospective chart analysis of autism spectrum disorder patients aged 3-14 years was performed at a tertiary care children's hospital. Patient demographics, clinical presentation, and epileptic seizure versus non-epileptic spell diagnosis were assessed. Target episodes of staring spells were captured during a long-term electroencephalogram monitoring record. Multilevel likelihood ratios and a receiver operating characteristic curve were determined using 8 of the 11 clinical variables. Among the cohort of 140 patients with autism spectrum disorder, 16% were diagnosed with epileptic seizures with the most common seizure being atypical absence seizures (64%). Clinical semiology differed between those diagnosed with epileptic seizures versus those diagnosed with non-epileptic spells in the average duration of episodes (42 s vs 87 s), frequency of spells per week (6 vs 11.5 spells), increase in frequency of staring spells over time (100% vs 40%), and response to verbal stimulation (0% vs 100%), respectively. Multilevel likelihood ratios based on the receiver operating characteristic curves and clinical semiology features may be helpful in differentiating epileptic seizures from non-epileptic spells in children with autism spectrum disorder.

This is a retrospective case series of pediatric patients referred to the psychogenic nonepileptic events clinic (PNEE) who had comorbid diagnoses of autism spectrum disorder (ASD) or intellectual disability (ID). We describe 15 patients, nine with ASD and six with ID who had a telephone visit follow-up at 12 months. There were higher rates of male gender (40%) and comorbid epilepsy (53%) compared to the larger PNEE cohort. Eleven patients were available for follow-up and ten patients had improvement in events or were event-free. We report that patients with ASD or ID can develop PNEE and experience improvement from events.

Echolalia is a typical feature of children with epilepsy and autism, but whether it is pathological is still controversial. This article aims to explore the contentious issue of echolalia based on data from three selected Chinese children with epilepsy and autism. Through discourse analysis, we explored two types of echolalia: immediate echolalia and delayed echolalia. It was found that the two types of echolalia were used to achieve interactional function, interpersonal function, and experiential function. Our research also found that the echolalia phenomenon reflected the participants' pragmatic awareness when dealing with new information. This article will contribute to understanding echolalia in children with epilepsy and autism and provide intervention methods for children with language impairment.

Background: While epilepsy can decrease quality of life and self-determination in individuals without intellectual disabilities, the impact of epilepsy on experienced self-determination in people with intellectual disabilities remains unclear. Method: We conducted semi-structured interviews with six adults (four men, two women) aged 30-61 with mild intellectual disabilities and drug-resistant epilepsy to investigate their experiences of self-determination. The data were analysed using Interpretative Phenomenological Analysis. Results: Three main themes were identified: (A) I am a competent person with epilepsy; (B) My social needs: being accepted as I am and stability in relationships; and (C) Being in control. Conclusions: In this study, the impact of epilepsy on experienced self-determination of people with mild intellectual disabilities outweighs the influence of intellectual disabilities. Identity formation, friendships with peers, and autonomy support in risk management are identified as important topics in supporting this group.

Sex education rarely covers disability. This paper uses autoethnography to reflect on how being epileptic impacted the author's understanding of sex and sexuality. The paper grapples with disability narratives and internalised ableism surrounding sex. The paper seeks to engage with conceptions of "who" sex education is for, and how disabled people are treated when it comes to sexuality.

Background: People with epilepsy and intellectual disability should be considered at high risk of developing metabolic bone disease. Risk is increased with number of comorbidities and polypharmacy, particularly anti-seizure medications. One way of improving bone health is to ensure that every one has adequate levels of vitamin D through supplementation. Methods: This audit phase of a wider quality improvement (QI) project monitors the implementation of a Bone Health Project (BHP) for people with epilepsy and intellectual disability. Key Clinical Standard 1 of the BHP aims to ensure that where appropriate everyone prescribed anti-seizure medication is offered vitamin D supplementation. This audit standard is based upon the Scientific Advisory Committee on Nutrition Guidance. The complete audit cycle was undertaken for the entire patient cohort under the care of a specialist epilepsy service and followed QI methodology. Findings: From the initial audit, the total number of patients prescribed vitamin D supplementation increased significantly from 95 (29%) to 182 (79%) by the end of the cycle. For those prescribed enzyme-inducing anti-seizure medications, the number of patients prescribed vitamin D supplementation increased significantly from 52 (49%) to 89 (90%). Conclusions: Working collaboratively with people with intellectual disability and epilepsy can enhance engagement. Vitamin D supplementation at 800IU has been established as safe and largely efficient in ensuring most people have adequate levels of serum vitamin D. There will be people who require vitamin D replacement therapy, and this requires further intervention including monitoring of bone profiles and referral to other specialists.

The COVID-19 pandemic has led to a radical lifestyle change, which may unintendedly change physical activity levels. We aimed to perform a systematic review to investigate the physical activity changes in people with neurological diseases, and to examine the relationship between physical activity and disease symptoms, and psychosocial factors. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of the literature across five databases (PubMed, CINAHL, Web of Science, SCOPUS, and Cochrane Library) was carried out using the keywords relating to COVID-19, physical activity, sedentary behaviour, exercise, and the name of the neurological diseases. The systematic search was updated on 4 February 2021 with the same keywords. Fourteen studies (n = 7662 persons with neurological diseases, n = 1663 healthy controls) were eligible for this review. The study populations were Parkinson disease (n = 7), dementia (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 1), hereditary spastic paraplegia (n = 1), neuromuscular diseases (n = 1), Charcot-Marie-Tooth neuropathy (n = 1), and epilepsy (n = 1). Thirteen studies reported a decreased physical activity level, one study reported a high interruption rate of physiotherapy/rehabilitation. Furthermore, the physical activity reduction was associated with worse disease symptoms, depression, perceived health, and mental and physical components of quality of life. The COVID-19 pandemic has a negative impact on the physical activity levels of people with neurological diseases, and this change was related to the worsening of disease symptoms and psychosocial factors. "Registration number" A protocol of the review was registered with the PROSPERO database (CRD42020207676).

Individuals diagnosed with autism spectrum disorder (ASD) have a higher probability of developing co-occurring mental or physical health conditions. However, little is known about how these health conditions develop and impact the lives of the adult ASD population. This paper reviewed existing studies concerning factors affecting the health status of adults with ASD and described their outcomes and prevalence. A systematic search of electronic databases yielded 21 studies eligible to be included. The most common physical problems affecting health were epilepsy and immune, gastrointestinal, and sleep disorders. Mental health disorders, most prominently mood and anxiety disorders and OCD, were also strong factors for determining health in adults. Future research should focus on measuring the overall health status of the adult ASD population.

Persons with rare, epilepsy-related disorders often have intellectual disability and need long-term care. Informal and formal caregivers need information in order to care for the persons in a safe way. Aims: The aims of this review were: (1) to obtain an overview of caregiver-reported information needs; and (2) to investigate if there are information needs that are unique for caregivers of persons with rare epilepsies. Method: We followed the scoping review framework outlined by Arksey and O'Malley and the preferred reporting items outlined by PRISMA. Results: Among the 17 articles that met the inclusion criteria, 5 included caregivers of persons with rare epilepsies. Categories of information needs: (1) Medical information; (2) Information on how to cope with emotional distress; (3) Experiential information from peers; and (4) Interdisciplinary information exchange. The need for disorder-specific information seemed particularly important for caregivers of persons with rare epilepsies. Conclusion: There is a need for further studies, particularly on formal caregivers' information needs.

The clinical similarity among different neuropsychiatric disorders (NPDs) suggested a shared genetic basis. We catalogued 23,109 coding de novo mutations (DNMs) from 6511 patients with autism spectrum disorder (ASD), 4,293 undiagnosed developmental disorder (UDD), 933 epileptic encephalopathy (EE), 1022 intellectual disability (ID), 1094 schizophrenia (SCZ), and 3391 controls. We evaluated that putative functional DNMs contribute to 38.11%, 34.40%, 33.31%, 10.98% and 6.91% of patients with ID, EE, UDD, ASD and SCZ, respectively. Consistent with phenotype similarity and heterogeneity in different NPDs, they show different degree of genetic association. Cross-disorder analysis of DNMs prioritized 321 candidate genes (FDR < 0.05) and showed that genes shared in more disorders were more likely to exhibited specific expression pattern, functional pathway, genetic convergence, and genetic intolerance.

Video self-modeling instruction offers advantages compared to in-vivo instruction but has not been used with individuals with Dravet syndrome. Therefore, the purpose of this study was to investigate the effects of video self-modeling (VSM) on three different behaviors of a 12-year-old boy with Dravet syndrome. We taught the participant's mother to use video-modeling instruction via role-playing and feedback and evaluated effects of VSM using a multiple-baseline design across behaviors: ordering numbers in descending sequence, positioning features on a face, and reading words. The VSM increased performance accuracy for all three skills, suggesting that VSM interventions via telehealth may provide an effective and sustainable option for skill development.

Angelman syndrome (AS) is a neurogenetic disorder characterized by delays including a severe expressive language delay, motor concerns, ataxia, epilepsy, sleep disturbances, gastrointestinal problems, and characteristic behaviors, including a happy demeanor, hyperactivity, and excitability. The syndrome is one of the first neurodevelopmental disorders with a clear trajectory towards meaningful treatment with approximately 20 companies actively developing targeted therapeutics for AS. Herein, we highlight the historical context of the road to therapeutics and some of the challenges in the field with the potential to impact the success of clinical trials for Angelman syndrome and also have relevance of other neurogenetic developmental disabilities.

Fyodor Dostoyevsky wrote masterpieces describing the exploitation and victimisation of the socially disadvantaged who were affected by industrialisation in the 19th century. In "The Brothers Karamazov," Pavel Fyodorovich Smerdyakov (hereafter, Smerdyakov) plays a critical role in various spheres of the story. His birth was the result of the rape of Lizaveta Smerdyastchaya by Fyodor Pavlovich Karamazov (hereafter, Fyodor). Tragically, Lizaveta died immediately after the delivery. Grigory and Marfa, Fyodor's serfs, adopted Smerdyakov, who then also grew up as a serf. Eventually, Smerdyakov murders Fyodor, and accordingly, this destined act turned Smerdyakov into a hybrid of goodness and evilness, being described by the narrator as 'a contemplative', which makes the story quite complicated and tragic. Despite his complexities, Smerdyakov remains one of the least-discussed characters in the studies hitherto. Hence, this paper has two aims, the first of which is the discussion of the meaning of the early life of Smerdyakov by revealing a tragic tension within him. It will also discuss education for a contemplative like Smerdyakov from the perspectives of polyphony as advocated by Bakhtin -- as it is important to view the contemplative as an indispensable protagonist and understand them through listening.

Biomimicry is a useful method to develop students' skills, such as design and systems thinking, particularly when complemented with inquiry-based learning. The research seeks to uncover how students engage in the biomimicry process and what types of designs they produce to reveal insights that could assist educators in teaching biomimicry. A study was conducted with 70 undergraduate students who were placed into 12 groups. Using an inquiry-based learning method, students selected their own health challenge and proposed a biomimetic design. Students submitted reports which were analysed via thematic analysis revealing numerous findings, including two common forms of biomimicry carried out by students, further insights into the strategy of 'cross breed mimicry', the types of organisms students imitated, and the successes and difficulties students faced in applying biomimicry. It contributes to the understanding of how students engage in biomimicry. This research is among one of the first studies to apply an existing six stage biomimicry process and to test this in the field of biomedical engineering.

The literature from inception to 2020 on the prevalence of epilepsy in autistic individuals was systematically reviewed and further explored by subgroup analyses and meta-regression models. This systematic review is registered with PROSPERO (CRD42020179725). A total of 66 studies from 53 articles were included. The updated pooled prevalence of epilepsy in autistic individuals was 10% (95% CI: 6-14). The respective prevalence estimate of epilepsy was 19% (95% CI: 6-35) in the clinical sample-based cross-sectional study, 7% (95% CI: 3-11) in the cohort study, and 9% (95% CI: 5-15) in the population-based cross-sectional study. The pooled prevalence of epilepsy was 7% (95% CI: 4-11) in autistic children and 19% (95% CI: 14-24) in autistic adults. Compared to the school-aged group, the adolescence group (OR: 1.15, 95% CI: 1.06-1.25) and the pre-school group (OR: 1.06, 95% CI: 0.94-1.19) were positively associated with the prevalence of epilepsy. The moderators of age, human development index of the country, gender, and intellectual function accounted for most of the heterogeneity. The prevalence estimates were associated with age, female gender, intellectual disability rate, and the human development index of countries. About 1/10 autistic individuals co-occurred with epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability, and less common in the country with high human development index.

Duplication of chromosome 15q11.2-q13.1 (dup15q syndrome) results in hypotonia, intellectual disability (ID), and autism symptomatology. Clinical electroencephalography has shown abnormal sleep physiology, but no studies have characterized sleep behaviors. The present study used the Children's Sleep Habits Questionnaire (CSHQ) in 42 people with dup15q syndrome to examine the clinical utility of this questionnaire and quantify behavioral sleep patterns in dup15q syndrome. Individuals with fully completed forms (56%) had higher cognitive abilities than those with partially completed forms. Overall, caregivers indicated a high rate of sleep disturbance, though ratings differed by epilepsy status. Results suggest that clinicians should use caution when using standardized questionnaires and consider epilepsy status when screening for sleep problems in dup15q syndrome.

Acute intoxication with cholinesterase inhibiting organophosphates (OP) can produce life-threatening cholinergic crisis and status epilepticus (SE). Survivors often develop long-term neurological consequences, including spontaneous recurrent seizures (SRS) and impaired cognition. Numerous studies implicate OP-induced neuroinflammation as a pathogenic mechanism contributing to these chronic sequelae; however, little is known about the inflammatory phenotype of innate immune cells in the brain following acute OP intoxication. Thus, the aim of this study was to characterize the natural history of microglial and astrocytic inflammatory phenotypes following acute intoxication with the OP, diisopropylfluorophosphate (DFP). Adult male and female Sprague-Dawley rats were administered a single dose of DFP (4 mg/kg, sc) followed by standard medical countermeasures. Within minutes, animals developed benzodiazepine-resistant SE as determined by monitoring seizures using a modified Racine scale. At 1, 3, 7, 14, and 28 d post-exposure (DPE), neuroinflammation was assessed using translocator protein (TSPO) positron emission tomography (PET) and magnetic resonance imaging (MRI). In both sexes, we observed consistently elevated radiotracer uptake across all examined brain regions and time points. A separate group of animals was euthanized at these same time points to collect tissues for immunohistochemical analyses. Colocalization of IBA-1, a marker for microglia, with iNOS or Arg1 was used to identify pro- and anti-inflammatory microglia, respectively; colocalization of GFAP, a marker for astrocytes, with C3 or S100A10, pro- and anti-inflammatory astrocytes, respectively. We observed shifts in the inflammatory profiles of microglia and astrocyte populations during the first month post-intoxication, largely in hyperintense inflammatory lesions in the piriform cortex and amygdala regions. In these areas, iNOS+ proinflammatory microglial cell density peaked at 3 and 7 DPE, while anti-inflammatory Arg1+ microglia cell density peaked at 14 DPE. Pro- and anti-inflammatory astrocytes emerged within 7 DPE, and roughly equal ratios of C3+ pro-inflammatory and S100A10+ anti-inflammatory astrocytes persisted at 28 DPE. In summary, microglia and astrocytes adopted mixed inflammatory phenotypes post-OP intoxication, which evolved over one month post exposure. These activated cell populations were most prominent in the piriform and amygdala areas and were more abundant in males compared to females. The temporal relationship between microglial and astrocytic responses suggests that initial microglial activity may influence delayed, persistent astrocytic responses. Further, our findings identify putative windows for inhibition of OP-induced neuroinflammatory responses in both sexes to evaluate the therapeutic benefit of anti-inflammation in this context.

Despite promising advancements, closed-loop neurostimulation for drug-resistant epilepsy (DRE) still relies on manual tuning and produces variable outcomes, while automated predictable algorithms remain an aspiration. As a fundamental step towards addressing this gap, here we study predictive dynamical models of human intracranial EEG (iEEG) response under parametrically rich neurostimulation. Using data from n = 13 DRE patients, we find that stimulation-triggered switched-linear models with ~300 ms of causal historical dependence best explain evoked iEEG dynamics. These models are highly consistent across different stimulation amplitudes and frequencies, allowing for learning a generalizable model from abundant STIM OFF and limited STIM ON data. Further, evoked iEEG in nearly all subjects exhibited a distance-dependent pattern, whereby stimulation directly impacts the actuation site and nearby regions (≲ 20 mm), affects medium-distance regions (20 ~ 100 mm) through network interactions, and hardly reaches more distal areas (≳ 100 mm). Peak network interaction occurs at 60 ~ 80 mm from the stimulation site. Due to their predictive accuracy and mechanistic interpretability, these models hold significant potential for model-based seizure forecasting and closed-loop neurostimulation design.