Dr. Fiona Baumer is an Assistant Professor of Neurology and Neurological Sciences at Stanford University School of Medicine. She hails from Sunnyside Avenue in Pleasantville, NY, where her first foray into neuroscience was looking at opioid pharmacodynamics under the patient and generous guidance of Dr. Richard Bodnar. Dr. Baumer started on her path toward a career in clinical research after a close friend was diagnosed with bipolar disorder. As an undergraduate in the Stanford Pediatric Bipolar Disorders Clinic, she found that children with a family history of bipolar disorder have a high risk of developing mania when exposed to certain antidepressants. This experience cemented for her a desire to study pediatric disorders, leading her to a post-college job in pediatric neuroradiology at University of California, San Francisco, where she assisted Dr. Orit Glenn in assessing fetal diffusion tensor imaging (DTI) as a biomarker of neurologic outcomes in children with prenatally diagnosed ventriculomegaly. As a medical student and then a resident in Dr. Mustafa Sahin’s lab at Harvard, Dr. Baumer worked closely with Dr. Jurriaan Peters to study imaging biomarkers of developmental outcomes in children with Tuberous Sclerosis Complex (TSC), describing that poor white matter integrity was associated with autism and intellectual disability. The TSC population piqued her interest in the relationship between epilepsy and cognition, and it sparked her desire to subspecialize in pediatric epilepsy as she hoped to understand this interplay and develop interventions that improve cognitive outcomes.
During epilepsy fellowship at Stanford, Dr. Baumer joined the lab of Dr. Amit Etkin, a psychiatrist who urged her to consider that cognitive disturbances in epilepsy may be caused by disruption, not of a single brain region but rather of broader neural circuits. She gained expertise in transcranial magnetic stimulation (TMS) paired with EEG. TMS is a unique tool as it is one of the only non-invasive ways to test the causal influence of one brain region on others. TMS also has exciting therapeutic potential because, when applied in repetitive trains (rTMS), it leads to long-lasting neuromodulation. With a mentorship team including Dr. Robert Fisher, a leader in invasive neuromodulation, and Dr. Alex Rotenberg, an expert in pediatric TMS, Dr. Baumer conducted the first TMS-EEG study in children with epilepsy, focusing on a common syndrome called self-limited epilepsy with centrotemporal spikes (SeLECTS). In SeLECTS, pathological electrical activity called spikes arise from the motor cortex, yet children develop language difficulties. Dr. Baumer discovered that TMS-EEG measurements of plasticity from the motor cortex strongly predict language learning, leading her to posit that epilepsy disrupts language by altering connectivity between motor and language regions.
Dr. Baumer’s lab has pursued this hypothesis using a two-pronged approach. The first arm of her research focuses on determining how brain connectivity is altered in SeLECTS and whether connectivity is associated with language function. In a paper that won the American Epilepsy Society Young Investigator Award, Dr. Baumer found pathological hyperconnectivity between the left inferior frontal region (critical for expressive language) and the epileptic motor regions. In follow-up work funded by her K23 career development award, she has been pairing careful language phenotyping with connectivity measured as children perform language tasks to better understand the impact of this connectivity on language performance. She has found that children with higher connectivity between motor and language cortices perform worse on language tasks, suggesting hyperconnectivity has negative functional consequences. The second arm of Dr. Baumer’s research aims to modulate spikes and connectivity using rTMS. Her lab has recently found in a sham-controlled trial that a single dose of rTMS transiently reduces connectivity in SeLECTS, potentially by reducing spike frequency. Dr. Baumer’s lab is now working to better understand the way that connectivity changes over time while also building toward clinical application of rTMS. Currently, rTMS has FDA-cleared applications for several neuropsychiatric disorders but not yet for epilepsy. Her long-term goal is to utilize rTMS therapies for optimized/personalized treatment of intractable epilepsy and cognitive dysfunction. She has a specific interest in developing such therapies for children with Developmental/Epileptic Encephalopathy with Spike Wave Activation in Slow Wave Sleep (D/EE-SWAS), a condition that has fascinated and frustrated her since she learned about it as a neurology sub-intern during a lunchtime lecture from Dr. David Urion.
Due to her interest in the role of spike waves on cognitive impairment, Dr. Baumer has also worked closely with the Pediatric Epilepsy Research Consortium (PERC) D/EE-SWAS, Infantile Spasms, and Sunflower Syndrome Interest Groups (SIGs) and published several papers on these disorders. Treatment of D/EE-SWAS is controversial, and the SIG collected data about treatment regimens and clinical course of children seen across the country. Dr. Baumer led a comparative effectiveness analysis showing that while antiseizure medications are the most common first-line therapy, they are less likely to result in clinical or electrographic improvement than steroids or benzodiazepines. Her work on disparities in treatment for infantile spasms was widely publicized for the shocking inequities in the use of first-line therapies in Black, non-Hispanic patients and those with public insurance. At Stanford, Dr. Baumer is also the medical director of the pediatric TMS lab. She is an expert in the use of TMS to identify eloquent cortex in patients with intractable epilepsy and a co-PI for a National Consortium of Pediatric TMS Centers funded by the Pediatric Epilepsy Research Foundation.
Dr. Baumer is committed to her patients and their families and strives to improve all aspects of their quality of life. She is a generous and passionate colleague, helping her coworkers focus on the best outcomes for their patients, providing an excellent moral compass for compassionate care, and pushing us to do rigorous and innovative research. She takes her role as a mentor seriously and delights in the accomplishments of her postdoctoral, medical, and undergraduate students, as well as her research coordinators, all of whom she tries to recruit into child neurology.
Dr. Baumer has also learned that it takes a village to run a trial and would like to acknowledge her incredible work family, particularly those who mentor and sponsor her, including Drs. Brenda Porter, Heidi Feldman, Christopher Lee-Messer, and Paul Fisher; the Stanford research team, especially Ms. Sweta Patnaik; and the neurologists, neuropsychologists, nurses, case managers, and EEG technologists who continuously contribute to these clinical research efforts. She is very grateful to all the children and their families who have participated in this work and inspired her with their questions and insights. Finally, and most importantly, Dr. Baumer loves and supports her own family as a daughter, sister, aunt, wife, and mother. Her work would not be possible without the emotional and technical support of her husband Keh-Li, who has ssh-ed into many a coding pipeline, and her children, Faye, Ronan, and Mairead, who pilot EEG tasks, keep her current on topics ranging from Bluey to T. Swift and teach her daily about the joys and challenges of cognitive development.