Intra- and inter-hemispheric network dynamics supporting object recognition and speech production.

We built normative brain atlases that animate millisecond-scale intra- and inter-hemispheric white matter-level connectivity dynamics supporting object recognition and speech production. We quantified electrocorticographic modulations during three naming tasks using event-related high-gamma activity from 1,114 nonepileptogenic intracranial electrodes (i.e., non-lesional areas unaffected by epileptiform discharges). Using this electrocorticography data, we visualized functional connectivity modulations defined as significant naming-related high-gamma modulations occurring simultaneously at two sites connected by direct white matter streamlines on diffusion-weighted imaging tractography. Immediately after stimulus onset, intra- and inter-hemispheric functional connectivity enhancements were confined mainly across modality-specific perceptual regions. During response preparation, left intra-hemispheric connectivity enhancements propagated in a posterior-to-anterior direction, involving the left precentral and prefrontal areas. After overt response onset, inter- and intra-hemispheric connectivity enhancements mainly encompassed precentral, postcentral, and superior-temporal (STG) gyri. We found task-specific connectivity enhancements during response preparation as follows. Picture naming enhanced activity along the left arcuate fasciculus between the inferior-temporal and precentral/posterior inferior-frontal (pIFG) gyri. Nonspeech environmental sound naming augmented functional connectivity via the left inferior longitudinal and fronto-occipital fasciculi between the medial-occipital and STG/pIFG. Auditory descriptive naming task enhanced usage of the left frontal U-fibers, involving the middle-frontal gyrus. Taken together, the commonly observed network enhancements include inter-hemispheric connectivity optimizing perceptual processing exerted in each hemisphere, left intra-hemispheric connectivity supporting semantic and lexical processing, and inter-hemispheric connectivity for symmetric oral movements during overt speech. Our atlases improve the currently available models of object recognition and speech production by adding neural dynamics via direct intra- and inter-hemispheric white matter tracts.

Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan.

OBJECTIVE: This study aimed to investigate the factors affecting the unwillingness of physicians involved in epilepsy care to continue telemedicine during the coronavirus disease 2019 (COVID-19) pandemic in Japan. METHOD: This was a national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan) which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES). We asked physicians who conducted telemedicine in patients with epilepsy (PWE) during the COVID-19 pandemic at four clinics and 21 hospitals specializing in epilepsy care in Japan from March 1 to April 30, 2021. The following data were collected: (1) participant profile, (2) characteristics of PWE treated by telemedicine, and (3) contents and environmental factors of telemedicine. Statistically significant variables (p < 0.05) in the univariate analysis were analyzed in a multivariate binary logistic regression model to detect the independently associated factors with the unwillingness to continue telemedicine. RESULT: Among the 115 respondents (response rate: 64%), 89 were included in the final analysis. Of them, 60 (67.4%) were willing to continue telemedicine, and 29 (32.6%) were unwilling. In the univariate binary logistic regression analysis, age (Odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.10-3.09, p = 0.02), psychiatrist (OR = 5.88, 95% CI 2.15-16.08, p = 0.001), hospital (OR = 0.10, 95% CI 0.01-0.94, p = 0.04), the number of COVID-19 risk factors in the participant (OR = 2.88, 95% CI 1.46-5.69, p = 0.002), the number of COVID-19 risk factors in the cohabitants (OR = 2.52, 95% CI 1.05-6.01, p = 0.04), COVID-19 epidemic area (OR = 4.37, 95% CI 1.18-16.20, p = 0.03), consultation time during telemedicine (OR = 2.51, 95% CI 1.32-4.76, p = 0.005), workload due to telemedicine (OR = 4.17, 95% CI 2.11-8.24, p < 0.001) were statistically significant. In the multivariate binary logistic regression analysis, workload due to telemedicine (OR = 4.93, 95% CI 1.96-12.35) was independently associated with the unwillingness to continue telemedicine. CONCLUSION: This national-level cross-sectional survey found that workload due to telemedicine among physicians involved in epilepsy care was independently associated with the unwillingness to continue telemedicine.

Risk factors for psychological distress in electroencephalography technicians during the COVID-19 pandemic: A national-level cross-sectional survey in Japan.

OBJECTIVE: To identify the risk factors for psychological distress in electroencephalography (EEG) technicians during the coronavirus disease 2019 (COVID-19) pandemic. METHOD: In this national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan), which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES), a questionnaire was administered to 173 technicians engaged in EEG at four clinics specializing in epilepsy care and 20 hospitals accredited as (quasi-) epilepsy centers or epilepsy training facilities in Japan from March 1 to April 30, 2021. We collected data on participants' profiles, information about work, and psychological distress outcome measurements, such as the K-6 and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Linear regression analysis was used to identify the risk factors for psychological distress. Factors that were significantly associated with psychological distress in the univariate analysis were subjected to multivariate analysis. RESULTS: Among the 142 respondents (response rate: 82%), 128 were included in the final analysis. As many as 35.2% of EEG technicians have been under psychological distress. In multivariate linear regression analysis for K-6, female sex, examination for patients (suspected) with COVID-19, and change in salary or bonus were independent associated factors for psychological distress. Contrastingly, in multivariate linear regression analysis for TMDP, female sex, presence of cohabitants who had to be separated from the respondent due to this pandemic, and change in salary or bonus were independent associated factors for psychological distress. CONCLUSION: We successfully identified the risk factors associated with psychological distress in EEG technicians during the COVID-19 pandemic. Our results may help in understanding the psychological stress in EEG technicians during the COVID-19 pandemic and improving the work environment, which is necessary to maintain the mental health of EEG technicians.

Long-read sequencing identifies the pathogenic nucleotide repeat expansion in RFC1 in a Japanese case of CANVAS.

Recently, a recessively inherited intronic repeat expansion in replication factor C1 (RFC1) was identified in cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS). Here, we describe a Japanese case of genetically confirmed CANVAS with autonomic failure and auditory hallucination. The case showed impaired uptake of iodine-123-metaiodobenzylguanidine and 123I-ioflupane in the cardiac sympathetic nerve and dopaminergic neurons, respectively, by single-photon emission computed tomography. Long-read sequencing identified biallelic pathogenic (AAGGG)n nucleotide repeat expansion in RFC1 and heterozygous benign (TAAAA)n and (TAGAA)n expansions in brain expressed, associated with NEDD4 (BEAN1). Enrichment of the repeat regions in RFC1 and BEAN1 using a Cas9-mediated system clearly distinguished between pathogenic and benign repeat expansions. The haplotype around RFC1 indicated that the (AAGGG)n expansion in our case was on the same ancestral allele as that of European cases. Thus, long-read sequencing facilitates precise genetic diagnosis of diseases with complex repeat structures and various expansions.

Diagnostic yield of seizure recordings and neuroimaging in patients with focal epilepsy without interictal epileptiform discharges.

OBJECTIVE: Repeated routine electroencephalography (EEG) or even long-term video-EEG monitoring (VEM) does not always record interictal epileptiform discharges (IEDs) in some patients with epilepsy. The present study investigated whether focal seizures detected by VEM and focal abnormalities on neuroimaging are useful for the diagnosis of patients with focal epilepsy without IEDs. METHODS: We retrospectively reviewed 409 consecutive patients with focal epilepsy (207 men, aged 9 to 76 years) who underwent 4- or 5-day VEM, magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis to identify patients without IEDs. The occurrence of focal seizures during VEM and the presence of focal abnormalities on neuroimaging were investigated in those patients. The occurrence rate of seizures during VEM was investigated in patients with daily, weekly, monthly, and yearly seizure frequency based on history-taking. RESULTS: Ninety-five (23.2%) of 409 patients with focal epilepsy did not have IEDs. Fifty-five (57.9%) of the 95 patients had focal seizures during VEM. Fifty-four patients (56.8%) showed focal abnormalities compatible with seizure semiology on neuroimaging investigations. Neither seizure recordings nor neuroimaging abnormalities were seen in 16 (16.8%) of the 95 patients. The occurrence rate of seizures during VEM depended on the seizure frequency at history-taking. However, 28 (45.9%) of 61 patients with monthly and yearly seizure frequency had focal seizures during 4- or 5-day VEM with seizure induction. CONCLUSIONS: Video-EEG monitoring can detect focal seizures in patients with focal epilepsy but no IEDs. Comprehensive assessment including VEM and neuroimaging study is important for the diagnosis.

Stacking Control by Molecular Symmetry of Sterically Protected Phthalocyanines.

The synthesis and characterization of two phthalocyanine (Pc) structural isomers, 1 and 2, in which four 2,6-di(hexyloxy)phenyl units were attached directly to the 1,8,15,22- or 1,4,15,18-positions of the Pc rings, are described. Both Pcs 1 and 2 exhibited low melting points, i.e., 120 and 130 °C respectively, due to the reduction in intermolecular π-π interaction among the Pc rings caused by the steric hindrance of 2,6-dihexyloxybenzene units. The thermal behaviors were investigated with temperature-controlled polarizing optical microscopy, differential scanning calorimetry, powder X-ray diffraction, and absorption spectral analyses. Pc 1, having C4h molecular symmetry, organized into a lamellar structure containing lateral assemblies of Pc rings. In contrast, the other Pc 2 revealed the formation of metastable crystalline phases, including disordered stacks of Pcs due to rapid cooling from a melted liquid.

Recent Progress in the Synthesis of the Monocarba-closo-dodecaborate(-) Anions.

This Concept article focuses on the rapid growth in studies of the chemistry of the monocarba-closo-dodecaborate(-) anion (C1 carborane anion). As one of the most stable anions known, the C1 carborane anion has been useful for exploring the chemistry of highly reactive cations. On the other hand, development of novel functional molecules utilizing the unique properties of C1 carborane anion (e.g., σ-aromaticity, rigid spherical skeleton) has progressed more slowly. The main reason for this is the relatively undeveloped state of synthetic chemistry in this area. Recent advances in the synthetic chemistry of C1 carborane anion are highlighted in this Concept article, focusing on cross-coupling reactions at the carbon vertex, direct conversion of B-H bonds, and the synthesis of multivalent weakly coordinating anions. These progressions move this species beyond its well-established role of highly stable "counter" monocharged anion.

"Dumbbell"- and "Clackers"-Shaped Dimeric Derivatives of Monocarba-closo-dodecaborate.

We designed, synthesized, and characterized two types of dimeric forms of monocarba-closo-dodecaborate, namely, a "dumbbell"-shaped dianion having a C-C bond and a "clackers"-shaped monoanion having an iodonium linker. The unique architectures of these anionic molecules were established by X-ray analysis. Spectroscopic analysis, DFT calculations, and reactivity experiments revealed high anionic and chemical stability of both anions, which are crucial properties for weakly coordinating anions.

"Naked" Lithium Cation: Strongly Activated Metal Cations Facilitated by Carborane Anions.

Experimental and spectroscopic studies revealed unprecedented reactivity of a "naked" lithium cation with very weakly coordinating anions, including carborane anions. The superactivated lithium cation has greatly enhanced Lewis acidic character and mediates various organic reactions such as carbonyl-ene reaction, NBS-bromination of unactivated aromatics, and Friedel-Crafts alkylation, which are not promoted by conventional lithium salts. Chemical robustness of the counteranion also plays an important role in the chemistry of the strongly activated lithium cation.

NMR Relaxometry for the Thermal Stability and Phase Transition Mechanism of Flower-like Micelles from Linear and Cyclic Amphiphilic Block Copolymers.

Linear and cyclic amphiphilic block copolymers consisting of poly(ethylene oxide) (PEO) as the hydrophilic segment and poly(methyl acrylate) or poly(ethyl acrylate) as the hydrophobic segments were synthesized and self-assembled to form flower-like micelles. The micelles from linear (methyl acrylate)12(ethylene oxide)73(methyl acrylate)12 (Mn = 1000-3200-1000, l-MOM) showed a cloud point (Tc) at 46 °C by the transmittance of the micellar solution, whereas that of cyclic (methyl acrylate)30(ethylene oxide)79 (Mn = 2600-3500, c-MO) increased to 72 °C, as previously reported. DLS showed comparable diameters (l-MOM, 14 nm; c-MO, 12 nm) and Tc values (l-MOM, 48 °C; c-MO, 75 °C). For the investigation of the difference in Tc and the phase transition mechanism based on the polymer topology, NMR relaxometry was performed to determine the spin-lattice (T1) and spin-spin (T2) relaxation times. A decrease in T2 of the PEO segment in both l-MOM and c-MO was observed above Tc, suggesting that slow large-scale motions, such as the detachment of a chain end from the core, bridging, and interpenetration of the micelles, were inhibited. T1 of the PEO segment in l-MOM continuously increased in the experimental temperature range, indicating that the segment is hydrated even above its Tc. On the other hand, that of c-MO reached a ceiling above its Tc, likely due to the prevention of the rotation of the PEO main chain bonds caused by dehydration. Similar results were obtained for linear (ethyl acrylate)8(ethylene oxide)79(ethyl acrylate)8 (Mn = 800-3500-800, l-EOE) and its cyclic (ethyl acrylate)15(ethylene oxide)78 (Mn = 1500-3400, c-EO).

Cortical and white matter substrates supporting visuospatial working memory.

OBJECTIVE: In tasks involving new visuospatial information, we rely on working memory, supported by a distributed brain network. We investigated the dynamic interplay between brain regions, including cortical and white matter structures, to understand how neural interactions change with different memory loads and trials, and their subsequent impact on working memory performance. METHODS: Patients undertook a task of immediate spatial recall during intracranial EEG monitoring. We charted the dynamics of cortical high-gamma activity and associated functional connectivity modulations in white matter tracts. RESULTS: Elevated memory loads were linked to enhanced functional connectivity via occipital longitudinal tracts, yet decreased through arcuate, uncinate, and superior-longitudinal fasciculi. As task familiarity grew, there was increased high-gamma activity in the posterior inferior-frontal gyrus (pIFG) and diminished functional connectivity across a network encompassing frontal, parietal, and temporal lobes. Early pIFG high-gamma activity was predictive of successful recall. Including this metric in a logistic regression model yielded an accuracy of 0.76. CONCLUSIONS: Optimizing visuospatial working memory through practice is tied to early pIFG activation and decreased dependence on irrelevant neural pathways. SIGNIFICANCE: This study expands our knowledge of human adaptation for visuospatial working memory, showing the spatiotemporal dynamics of cortical network modulations through white matter tracts.

Nanofiltration Performance of Poly(p-xylylene) Nanofilms with Imidazole Side Chains.

Herein, we report the nanofiltration performance of poly(p-xylylene) thin films with imidazole side chains that were deposited onto commercial polyethersulfone ultrafiltration membranes using a chemical vapor deposition process. The resulting thin films with a few tens of nanometers exhibited water permeation under a pressure difference of 0.5 MPa and selectively rejected water-soluble organic dyes based on their molecular sizes. Additionally, thin flaky ZIF-L crystals (Zn(mim)2·(Hmim)1/2·(H2O)3/2) (Hmim = 2-methylimidazole) formed on the surface of imidazole-containing poly(p-xylylene) films, and the composite films demonstrated the ability to adsorb methylene blue molecules within the cavities of ZIF-L.

Dynamic cortical and tractography atlases of proactive and reactive alpha and high-gamma activities.

Alpha waves-posterior dominant rhythms at 8-12 Hz reactive to eye opening and closure-are among the most fundamental EEG findings in clinical practice and research since Hans Berger first documented them in the early 20th century. Yet, the exact network dynamics of alpha waves in regard to eye movements remains unknown. High-gamma activity at 70-110 Hz is also reactive to eye movements and a summary measure of local cortical activation supporting sensorimotor or cognitive function. We aimed to build the first-ever brain atlases directly visualizing the network dynamics of eye movement-related alpha and high-gamma modulations, at cortical and white matter levels. We studied 28 patients (age: 5-20 years) who underwent intracranial EEG and electro-oculography recordings. We measured alpha and high-gamma modulations at 2167 electrode sites outside the seizure onset zone, interictal spike-generating areas and MRI-visible structural lesions. Dynamic tractography animated white matter streamlines modulated significantly and simultaneously beyond chance, on a millisecond scale. Before eye-closure onset, significant alpha augmentation occurred at the occipital and frontal cortices. After eye-closure onset, alpha-based functional connectivity was strengthened, while high gamma-based connectivity was weakened extensively in both intra-hemispheric and inter-hemispheric pathways involving the central visual areas. The inferior fronto-occipital fasciculus supported the strengthened alpha co-augmentation-based functional connectivity between occipital and frontal lobe regions, whereas the posterior corpus callosum supported the inter-hemispheric functional connectivity between the occipital lobes. After eye-opening offset, significant high-gamma augmentation and alpha attenuation occurred at occipital, fusiform and inferior parietal cortices. High gamma co-augmentation-based functional connectivity was strengthened, whereas alpha-based connectivity was weakened in the posterior inter-hemispheric and intra-hemispheric white matter pathways involving central and peripheral visual areas. Our results do not support the notion that eye closure-related alpha augmentation uniformly reflects feedforward or feedback rhythms propagating from lower to higher order visual cortex, or vice versa. Rather, proactive and reactive alpha waves involve extensive, distinct white matter networks that include the frontal lobe cortices, along with low- and high-order visual areas. High-gamma co-attenuation coupled to alpha co-augmentation in shared brain circuitry after eye closure supports the notion of an idling role for alpha waves during eye closure. These normative dynamic tractography atlases may improve understanding of the significance of EEG alpha waves in assessing the functional integrity of brain networks in clinical practice; they also may help elucidate the effects of eye movements on task-related brain network measures observed in cognitive neuroscience research.

Abnormal heart rate variability during non-REM sleep and postictal generalized EEG suppression in focal epilepsy.

OBJECTIVE: To identify any relationship between abnormal interictal heart rate variability (HRV) during sleep and the occurrence of postictal generalized EEG suppression (PGES), a potential biomarker of sudden unexpected death in epilepsy (SUDEP), in patients with focal epilepsy. METHODS: We retrospectively reviewed 34 consecutive patients with focal epilepsy, who presented with focal to bilateral tonic-clonic seizures (FBTCSs), 19 with PGES (PGES+) and 15 without PGES (PGES-), and 14 patients without epilepsy as controls. HRV spectrum analysis was performed for periods of 10 minutes during wakefulness, non-REM sleep, and REM sleep. HRV spectra consisted of high frequency (HF) and low frequency (LF) regions. Normalized HF representing parasympathetic activities and normalized LF were compared between the PGES+, PGES-, and control groups for each sleep stage. RESULTS: The PGES+ group showed significantly decreased normalized HF and increased normalized LF during non-REM sleep compared to the PGES- (P < 0.05) and control (P < 0.01) groups, but not during wakefulness or REM sleep. CONCLUSIONS: Abnormal interictal HRV during non-REM sleep, indicating abnormally decreased parasympathetic activities, was associated with PGES in patients with FBTCS. SIGNIFICANCE: This study proposes to further investigate the relation between decreased parasympathetic activities and PGES.

Phosphorescence emission from spatial stacks of phenanthrene units in oligo(9,10-phenanthrene)s.

The covalent linkage of phenanthrene units at 9 and 10 positions resulted in a broadening of the absorption band and a red-shift of the fluorescence band in ethanol compared with its monomer. Spatial stacking of phenanthrene units also altered the spectral shape of phosphorescence emission, and the oligomer film emitted phosphorescence at room temperature.

Impact of COVID-19 pandemic on epilepsy care in Japan: A national-level multicenter retrospective cohort study.

OBJECTIVE: The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study. METHODS: This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes. RESULTS: In 2020, the frequency of outpatient EEG studies (-10.7%, p<0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10-3 % per case, p<0.001) and EEG monitoring (-3.81*10-3 % per case, p = 0.004). Further, the state of emergency was an independent factor associated with outpatient with epilepsy (-11.9%, p<0.001), outpatient EEG (-32.3%, p<0.001), telemedicine for epilepsy (+12,915%, p<0.001), epilepsy admissions (-35.3%; p<0.001), EEG monitoring (-24.7%: p<0.001), and epilepsy surgery (-50.3%, p<0.001). SIGNIFICANCE: We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.

Versatile Covalent Postsynthetic Modification of Metal Organic Frameworks via Thermal Condensation for Fluoride Sensing in Waters.

Having access to safe drinking water is one of the 17 sustainable development goals defined by the United Nations (UN). However, many settlements around the globe have limited access to drinkable water due to non-anthropogenic pollution of the water sources. One of those pollutants is fluoride, which can induce major health problems. In this manuscript, we report on a post synthetic functionalization of metal organic frameworks for the sensing of fluoride in water. The proposed thermal condensation methodology allows for a high yield of functionalization using few steps, reducing reagent costs and generating minimal by-products. We identified a Rhodamine B functionalized Al-BDC-NH2 metal organic framework as one particularly suitable for fluoride detection in water.

Initial delta and delayed theta/alpha pattern in the temporal region on ictal EEG suggests purely hippocampal epileptogenicity in patients with mesial temporal lobe epilepsy.

OBJECTIVE: To determine whether the ictal scalp EEG findings suggest purely hippocampal epileptogenicity in patients with mesial temporal lobe epilepsy (mTLE) associated with hippocampal sclerosis (HS). METHODS: Twenty-three patients with mTLE with pathologically confirmed HS were divided into 12 with epileptogenicity only in the hippocampus (HS only group) and 11 with epileptogenicity in both the hippocampus and temporal neocortex or other locations (HS plus group), based on the combination of surgical procedures, postoperative outcome, and pathological findings. Sixteen underwent selective amygdalohippocampectomy (SelAH) and 7 received anterior temporal lobectomy. Ictal scalp EEG findings of 79 focal impaired awareness seizures were compared between the HS only and HS plus groups. We focused on the 1-4 Hz rhythmic delta activity at ictal onset followed by 5-9 Hz rhythmic theta/alpha activity 10-30 s after the onset in the temporal region. RESULTS: The initial delta and delayed theta/alpha (ID-DT) pattern was observed in 8 of 12 patients in the HS only group, but in none of 11 patients in the HS plus group (p < 0.01). CONCLUSIONS: ID-DT pattern on ictal EEG suggests purely hippocampal epileptogenicity in mTLE with HS. SIGNIFICANCE: Patients with the ID-DT pattern are likely to become seizure-free after SelAH.

Teleconference-based education of epileptic seizure semiology.

BACKGROUND: To evaluate whether a teleconference-based lecture provides similar understanding of seizure semiology to a face-to-face lecture for physicians. METHODS: Subjects were 66 physicians consisting of adult and pediatric neurologists, neurosurgeons, psychiatrists, and general practitioners. All attended the 30-minute lecture to introduce various types of seizure semiology using video-clips by one of the authors (Yo.K.) and then joined the comprehensive case conference which discussed three cases in 1.5 h. Group A received the lecture and conference using a teleconference system (N = 43) and Group B attended in person (N = 23) for geographical reasons. After the conference, 32 subjects (23 in Group A and nine in Group B) scored their own post-lecture understanding of seizure semiology using the four-point Likert scale from 1 (not at all) to 4 (very well) as well as the estimated pre-lecture score. Data was analyzed to assess whether their understanding was improved after the lecture. RESULTS: No significant difference was found in improvement of understanding after the lecture between Group A (43%) and Group B (22%; p = 0.42). Pre-lecture score of subjects with improved understanding was significantly lower (2.3 +/- 0.2) than those without improvement (3.7 +/- 0.1) (p < 0.05). SIGNIFICANCE: Teleconference-based lectures can be a useful tool to educate seizure semiology for physicians, especially at the inexperienced level, by overcoming geographical limitations.