Frontlines with Frontera is a NeurologyLive podcast hosted by Jennifer Frontera, MD, professor of neurology at NYU Langone Health. Built for clinicians, the series delivers practical, evidence-driven conversations on high-stakes decision-making in neurocritical care and acute neurology, featuring expert insights from leaders across the field.

In part 2 of this 2-part episode of Frontlines with Frontera, host Jennifer Frontera, MD, professor of neurology at NYU Langone Health, continues her conversation with Brian Edlow, MD, vice chair of research in neurology at Mass General Brigham and associate professor at Harvard Medical School, focusing on the clinical implications of diagnosing covert consciousness. The discussion explores how this diagnosis may influence treatment decisions, including the use of neurostimulants, rehabilitation strategies, and emerging neurotechnologies such as brain-computer interfaces and deep brain stimulation. Edlow also examines the challenges of patient selection, ethical considerations surrounding invasive interventions, and the limitations of current therapeutic approaches. The episode concludes with a forward-looking perspective on advances in diagnostics, personalized brain mapping, and novel neuromodulation strategies that may reshape care for patients with disorders of consciousness.

Episode Breakdown:

• 0:00–3:40 – Clinical impact of diagnosis on care decisions
• 3:40–7:20 – Rehabilitation challenges and cognitive-motor dissociation
• 7:20–11:30 – Brain-computer interfaces: noninvasive vs invasive approaches
• 11:30–15:45 – Ethical considerations and patient selection for intervention
• 15:45–19:30 – Neurostimulation strategies: DBS, TMS, and emerging data
• 19:30–23:10 – Patient experience, quality of life, and uncertainty
• 23:10–26:30 – Future directions: diagnostics, mapping, and therapeutics

Frontlines with Frontera is a NeurologyLive podcast hosted by Jennifer Frontera, MD, professor of neurology at NYU Langone Health. Built for clinicians, the series delivers practical, evidence-driven conversations on high-stakes decision-making in neurocritical care and acute neurology, featuring expert insights from leaders across the field.

In part 1 of this 2-part episode of Frontlines with Frontera, host Jennifer Frontera, MD—professor of neurology at NYU Langone Health and neurocritical care specialist—speaks with Brian Edlow, MD, vice chair of research in neurology at Mass General Brigham and associate professor at Harvard Medical School, about the evolving science of consciousness in brain-injured patients. The discussion highlights how clinicians assess wakefulness and awareness, the emergence of covert consciousness detected through advanced EEG and fMRI, and its presence across acute and chronic settings. Edlow also reviews the prognostic implications of these findings in the ICU, the uncertainty surrounding neurologic recovery, and the influence of clinician communication on goals-of-care decisions, while introducing the potential role of multimodal testing and AI-driven models in improving prognostication. (Part 2 will further explore implementation challenges and future directions.)

Episode Breakdown:

• 0:00–3:20 – Defining consciousness: wakefulness vs awareness
• 3:20–7:50 – Covert consciousness: history and prevalence
• 7:50–12:05 – Prognostic implications and ICU decision-making
• 12:05–17:10 – Multimodal testing and AI-driven prognostication
• 17:10–19:30 – Practical EEG/fMRI implementation strategies
• 19:30–24:20 – Limitations: false negatives and interpretation
• 24:20–28:15 – Translating positive findings to clinical outcomes

• 1:30 – Why evidence gaps and practice variation persist in neurocritical seizure management
• 4:50 – How AI and real-world data can address limitations of traditional clinical trials
• 8:10 – Using EEG-based AI models to quantify seizure burden and predict outcomes
• 10:40 – Applying NLP and large language models to extract meaningful data from EHRs
• 21:20 – Challenges of model validation, portability, and multicenter collaboration
• 26:20 – Future applications of AI for seizure prophylaxis, multimodal monitoring, and trial design