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The article presents the results of comparison of prevalence, incidence and disability from nervous diseases and epilepsy among children of the Kharkiv region of Ukraine and Ukraine as a whole and the results are compared with global figures. In 2015 in Ukraine 407 618 cases of diseases of nervous system were registered in children from 0 to 17 years of age, that is 53.53 per 1000 children, the average value for 5 years is 459 300 children (58.354 ‰), in the Kharkiv region 36 494 children (86.28 ‰) were diagnosed with diseases of nervous system, 5-year average is 39 883 children (94.476 ‰). The prevalence of epilepsy in Ukraine amounts to 25 695 children (3.21 ‰), higher than the prevalence of cerebral palsy or neuroinfections, the average value for 5 years is 24 667 children (3.144 ‰). In the Kharkiv region the number is 1 451 children (3.43 ‰), 5-year average is 1 340 children (3.21 ‰). The incidence of diseases of the nervous system in children in Ukraine amounts to 140 494 children (18.45 ‰), an average over 5 years is 159 215 children (20.29 ‰), in the Kharkiv region the number is 11 871 children (28.07 ‰), an average is 13 795 children (33.068 ‰). The incidence of epilepsy in children in Ukraine is 3 306 children (0.43 ‰), the average value for 5 years is 3 569 children (0.454 ‰). In Kharkiv region the incidence is 252 persons (0.53 ‰), an average is 201.2 children (0.468 ‰). In Ukraine, over the past 5 years there has been a tendency to reduce the prevalence and incidence of diseases of the nervous system in children, while in the Kharkiv region in 2014–15 there is an increase of these indicators, which is connected, apparently, with the migration of the population. In the structure of disability of children under the age of 18 in Ukraine diseases of the nervous system come second, amounting to 29 684 children (37.1 per 10 000 children), the proportion is 17.6 %, in the Kharkiv region this number is 1 770 (41.8 per 10 000 children). Thus, the presented results of the work allowed to analyze a group of children under 18 years of age with diseases of the nervous system, to determine a number of epidemiological indicators for the Kharkiv region, to assess first of all, the place and importance of epilepsy, to compare data obtained with all-Ukrainian data for optimization of medical care for children.

PURPOSE To evaluate the retention rate, efficacy, and safety of ketogenic diet therapy for drug-resistant epilepsy in children and compare the results with those of a previous cohort at our institution. METHODS A total of 634 children with drug-resistant epilepsy were included in this retrospective study. Patients were categorized into two groups. The previous cohort was included as a control group and included 317 children assessed between 2004 and 2011, whereas the current group included 317 children assessed between 2015 and 2019. The control group was provided care as usual, and the current group additionally adopted the goal and long-term management strategy. Outcomes were measured with respect to retention rate, seizure reduction, and adverse reaction. RESULTS Patient demographics were consistent between both cohorts. Compared to the past ten years, the retention rate significantly increased over time (3 months: 62.8% vs. 82.0%, p

Objective: to evaluate the efficacy and safety of low-dose hormonal therapy of epilepsy in children. Material and methods: a study was conducted of 32 children aged 3 months to 11 years (21 boys, 11 girls) who received hormone therapy in the lowest clinically effective doses due to the resistance of epileptic seizures to the ongoing therapy with antiepileptic drugs, cognitive, behavioral disorders and regression development. Hormonal preparations were used: tetracosactide (synacthen depot) at a maximum single dose of 0.25-0.5 mg intramuscularly and dexamethasone at a dose of 0.15 mg/kg/day per os. All patients underwent: electroencephalography (EEG) and EEG-video monitoring with the inclusion of sleep, magnetic resonance imaging of the brain, according to indications - tandem mass spectrometry, DNA analysis by clinical sequencing (panel "Inherited epilepsy"), studies aimed at identifying possible side effects of corticosteroid therapy. The duration of follow-up after completion of hormone therapy was 1-4 years. Research results: a positive result of the therapy was: 1) reduction of epileptiform activity on the EEG, 2) relief of epileptic seizures, 3) restoration (improvement) of impaired higher cortical functions. Long-term positive results were obtained in 62,5% (20/32). The best results were observed in patients with epileptic encephalopathy with continuous spike and wave during sleep, atypical childhood epilepsy with centrotemporal spikes, LandauKleffner syndrome in 100% (8/8). In patients with structural focal epilepsy and continuous spike and wave during sleep, a positive result was achieved in 60% (3/5); in patients with West syndrome, in 57,1% (8/14). A short-term positive result (or lack thereof) was noted mainly in patients with a structure of brain pathology and late initiation of hormone therapy. Side effects were absent or were transient.

To further define the epilepsy phenotype in a cohort of children with 15q13.3 microdeletion syndrome.We retrospectively reviewed the phenotypic spectrum of all children aged18 years with epilepsy and 15q13.3 microdeletion syndrome.Thirteen children were included, 69% were female. The median age of children in the cohort was 12 years (age range: 3 years-15 years). Median age at seizure onset was 4 years. Eleven children (85%) had intellectual disability. Nine of 13 children (69%) had a history of typical absence seizures with median age of onset at 5 years (2 had absence status epilepticus). Thirty-one percent (4/13) had focal with impaired awareness non-motor onset seizures. ILAE recognized absence epilepsy syndromes were diagnosed in 6/13 (46%). The remainder were classified as having genetic generalized epilepsies with overlap clinical features, combined or focal epilepsies. Electroencephalogram in the cohort showed generalized (85%) and focal epileptiform discharges (62%) and posterior dominant rhythm slowing (33%). One child had electrical status epilepticus of sleep. Neuroimaging was performed in 5 children (38%) and revealed abnormal findings in 3. Seizures were drug resistant in a third of the cohort. Valproate resulted in seizure freedom in 5 (42%). Oxcarbazepine caused clinical worsening in one child with combined seizure types. Two children tried cannabidiol and one tried the ketogenic diet; neither was effective.The epilepsy phenotype in children with 15q13.3 microdeletion syndrome is defined by childhood onset absence seizures, and may have atypical features such as, early onset absences, persistence into adolescence, status epilepticus, intellectual disability and treatment resistance. Focal seizures and focal EEG findings may be observed and should be treated cautiously, given the possibility of combined seizure types. Valproate appeared effective, although other treatments must be explored further.

With a growing number of forcibly displaced people (FDP) globally, the focus on their medical needs has necessarily increased. Studies about the prevalence and incidence of epilepsy and psychogenic non-epileptic seizures (PNES) in this population are, though, sparse. This Review highlights the importance of exploring and managing both conditions in these vulnerable people to promote global health. We performed an exhaustive review of 10 databases, as well as a manual search of relevant websites related to global health and refugee-related organizations. We analyzed data related to the prevalence and incidence of epilepsy and PNES; health visits; costs of medical care and challenges faced by healthcare workers in relation to FDP with these conditions. Fifty six papers met our inclusion criteria. Of these, 53 reported directly or indirectly on the prevalence of epilepsy and its costs in FDP. Two articles reported on the prevalence of PNES in forcibly displaced people. The reported prevalence of epilepsy in FDP varied from 0.2% to 39.13%, being highest in people with pre-existing neurological or psychiatric comorbidities. Only one study reported on the incidence of epilepsy in internally displaced children. Data from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have identified a tendency to higher incidence of epilepsy in children following wars. While within displaced women without a history of sexual violence the rate of PNES was 16.7%, in FDP women with such a history the rate of PNES was 43.7% (p=0.02). The healthcare costs for epilepsy can be high, with recurrent health visits related to seizures being the most common cause of health encounters in refugee camps. Increasing awareness and further studies of multicultural aspects to improve shared understanding of seizure phenomenon in vulnerable displaced populations would seem crucial.

Background and Purpose: The risk of epilepsy after stroke has not been thoroughly explored in pediatric ischemic stroke. We examined the risk of epilepsy in children with ischemic stroke as well as in their first-degree relatives. Methods: In Swedish National Registers, we identified 1220 children Results: Through this nationwide population-based study, 219 (18.0%) children with ischemic stroke and 91 (0.7%) comparators were diagnosed with epilepsy during follow-up corresponding to a 27.8-fold increased risk of future epilepsy (95% CI, 21.5–36.0). The risk of epilepsy was still elevated after 20 years (hazard ratio [HR], 7.9 [95% CI, 3.3–19.0]), although the highest HR was seen in the first 6 months (HR, 119.4 [95% CI, 48.0–297.4]). The overall incidence rate of epilepsy was 27.0 per 100 000 person-years (95% CI, 21.1–32.8) after ischemic stroke diagnosed ≤day 28 after birth (perinatal) and 11.6 per 100 000 person-years (95% CI, 9.6–13.5) after ischemic stroke diagnosed ≥day 29 after birth (childhood). Siblings and parents, but not offspring, to children with ischemic stroke were at increased risk of epilepsy (siblings: HR, 1.64 [95% CI, 1.08–2.48] and parents: HR, 1.41 [95% CI, 1.01–1.98]). Conclusions: The risk of epilepsy after ischemic stroke in children is increased, especially after perinatal ischemic stroke. The risk of epilepsy was highest during the first 6 months but remained elevated even 20 years after stroke which should be taken into account in future planning for children affected by stroke.

AIM To compare the prevalence of epilepsy in children with cerebral palsy (CP) to peer controls and their differences in healthcare utilization. METHOD The Quebec CP registry was linked to the provincial administrative health database. Two CP cohorts were identified from the registry (n=302, 168 males, 1y 2mo-14y) and administrative data (n=370, 221 males, 2y 2mo-14y). A control cohort (n=6040, 3340 males, 10-14y) was matched by age, sex, and region to the CP registry cohort. Administrative data algorithms were used to define epilepsy cases. Data on hospitalizations and emergency department presentations were obtained. RESULTS Using the most sensitive epilepsy definition, prevalence was 42.05% in the CP registry, 43.24% in the CP administrative data, and 1.39% in controls. Prevalence rose with increasing Gross Motor Function Classification System level. Children with CP and epilepsy had increased number and length of hospitalizations and emergency department presentations compared to children with CP or epilepsy alone. Epilepsy accounted for approximately 5% of emergency department presentations and 10% of hospitalizations in children with epilepsy, with and without CP. INTERPRETATION Children with CP have an increased risk of epilepsy compared to their peers. Children with CP and coexisting epilepsy represent a unique subset with complex developmental disability and increased healthcare service utilization.

Aim. To identify the most important risk factors affecting the development of epilepsy in children with cerebral palsy. Methods. The study included 160 cerebral palsy patients with and without epilepsy who received treatment at the Baku Children's Neurological Hospital. The patients were divided into 2 groups. The first group consisted of 110 (68.7%) patients with cerebral palsy and epilepsy, and the second group consisted of 50 (31.3%) patients with cerebral palsy. The age of children ranged from 1 to 14 years. Statistical data processing was performed by using the SPSS software version 16.0. The Chi-square test was used to compare categorical measurements. T-test for independent groups was used for comparison between groups of continuous measurements. Binary logistic regression was used for determining the risk factors. In all tests, the level of statistical significance was set at p 0.05. Results. There was no significant difference in age and gender distribution between groups (p=0.492 and p=0.818, respectively). 10 (9.1%) children in the main group had a positive family history of epilepsy (odds ratio 8.08, p=0.028). Neonatal seizures were observed in 25 (22.7%) children in the main group and 3 (6%) children in the control group (odds ratio 4.4, p=0.010). The presence of infection during pregnancy in the mother was found in both the main (39.1%) and control (20%) groups (odds ratio 2.6, p=0.018). Level IV of the Gross Motor Function Classification System (GMFCS) was the most frequent among patients with epilepsy (odds ratio 12.8; p=0.035). The incidence rate of epilepsy among cerebral palsy patients was 68.7%. The mean age of onset of seizures was 19.226.6 months. The most frequent epileptic seizures (55.5%) occurred in spastic quadriplegic cerebral palsy. Conclusion. The presence of a positive family history of epilepsy, neonatal seizures, maternal infection during pregnancy and severe GMFCS level were identified as factors for the development of epilepsy in patients with cerebral palsy; premature birth, presence of hypoxic-ischemic injury, low birth weight, consanguineous marriage, multiple pregnancies, or gender were not identified as risk factors for the development of epilepsy in children.

The report is dedicated to the landmark work by V.A. Karlov “Epilepsy in children and adult women and men”, 2nd edition, released in 2019. Here, there are discussed crucial aspects underlying a theory and application for epilepsy treatment reflected in the monograph that underline a great importance for complete all-encompassing analysis of experience and advances in domestic and foreign epileptology described in the book.

The article is devoted to the topical problem of neonatology and pediatric neurology — the diagnosis and treatment of seizures in newborns and young children. The work presents an algorithm for the diagnosis and treatment of epileptic seizures in children. It is indicated that the therapeutic effect of most antiepileptic drugs consists of modulation of voltage-gated and ligand-gated channels of membranes of neurons of the cerebral cortex, enhancement of inhibitory synaptic transmission or inhibition of activating synaptic transmission. The issues of the pharmacokinetics and pharmacodynamics of antiepileptic drugs are considered, taking into account the age characteristics of the child's body, in particular, newborns and early age children. The problems of drug interaction were discussed. The properties of individual antiepileptic drugs, which are used in newborns and young children, are considered. Emphasized are «polar» differences in the work of phenobarbital, which depend on the stage of epileptogenesis, namely: suppression of epileptiform activity at the early stage of epileptogenesis and its enhancement in the already formed epileptic focus (epileptic system). The literature data on the differentiated treatment of certain epileptic syndromes are presented. The issues on the prospects for the treatment of genetically determined diseases, which are accompanied by seizures associated with metabolic disorders, are considered. The modern high-tech methods of treatment of these diseases are noted. The role of diet therapy, co-factor therapy in the treatment of hereditary metabolic disorders, in particular, the ketogenic diet as a method of alternative treatment for drug-resistant epilepsy in children, is shown. No conflict of interest was declared by the authors. Key words: newborn, epilepsy, epileptic encephalopathy, treatment, antiepileptic drugs, review.

Introduction: Sodium valproate is proposed for addition to the Model List of Essential Medicines, for use in the management of epilepsy in children. This is effective in treating many seizure types, like a generalized tonic-clonic seizure, myoclonic seizure, absence seizure, in other epilepsy syndromes like an infantile spasm, Landau-Kleffner syndrome (LKS), etc. Aim of the study: This study aimed to observe the side effects caused by sodium valproate in children below 2 years of age. Methodology: An observational study was conducted in the Department of Paediatric M Abdur Rahim Medical College (MARMC), Dinajpur, Bangladesh, during the period of January 2019 to December 2019. Sixty (60) children Results: Male were dominated the gender distribution and were 54% and female were 46%. A maximum of 46% of patients was diagnosed with epilepsy between 6-12 months, Out of the total studied patients, the maximum 44% started sodium valproate ages between 7-12 months. Among the total studied patients 40% took 26-30mg/kg/day sodium valproate as their treatment regime. A total of 16% had anemia among the studied patients, whereas for the rest 84% of patients no other symptoms were found during their general examination. Among the total studied patients, the most dominating side effect of the patients was vomiting which resulted in 1/5th (20%) of all side effects. The side effects of both hair loss and loss of appetite show the same result of 10% for each whereas, only 4% and 2% had abdominal pain and weight gain respectively. Conclusion: In this study vomiting was found as the most significant side effect which similar to other different studies also. These findings may be helpful for future researchers in further research. It was a single centered study with a small-sized sample.

Introduction: There is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilised, especially in developing countries. Methods: We describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery. Results: Twenty-one Corpus callosotomies and 6 resective surgeries were performed. The mean seizure frequency decreased from 465 per month before surgery to 37.2 per month thereafter (P

Objective To assess the quality of life among caregivers of children with epilepsy in a tertiary care center of eastern Nepal. Methods A cross‐sectional study was conducted among primary caregivers of children with epilepsy, who accompanied their child in child neurology clinic. Consecutive sampling was done, and 106 respondents were interviewed. Data were collected using World Health Organization Quality of Life‐BREF (WHOQOL‐BREF) scale and analyzed using Statistical Package for the Social Sciences. Descriptive and Inferential statistics were applied. Results Mean WHOQOL‐BREF score was 82.25 {standard deviation (SD) ±12. 11}. Transformed scores (0‐100) for each domain were 57.98 ± 14.55 in physical, 55.87 ± 13.16 in psychological, 53.12 ± 13.42 in social, and 52.52 ± 13.04 in environmental domain. Mean score for overall perception of quality of life (QOL) was 2.71 ± 0.79 and was 3.12 ± 0.75 for overall perception of health. Living below poverty line (P = .03) and poor seizure control status of children (P = .46) were significantly associated with lower total QOL score. Living below poverty line was significantly associated with low social relationship (P = .003) and environment domain (

Introduction. Cerebral palsy is often combined with epilepsy and epileptiform electroencephalographic (EEG) activity. Currently, the question of how rehabilitation with cerebral palsy is dangerous in relation to the provocation of epileptic seizures is relevant. Objective: to study the effect of cerebral palsy rehabilitation on epilepsy in a standard rehabilitation center. Material and methods. We examined 80 children with various forms of cerebral palsy and epileptiform EEG activity. The patients were divided into two groups: children of Group 1 never had epileptic seizures, children of Group 2 had a history of epileptic seizures of more than 6 months ago. The follow-up was 12 months during which children underwent EEG before and after rehabilitation courses. Depending on the risks associated with provoking epileptic seizures, patients were prescribed rehabilitation procedures of various intensities: Vojta kinesiotherapy, massage, physiotherapeutic treatment in the form of transcranial micropolarization and paraffin therapy. Results. During the study, epileptic seizures developed in 5 patients (12.5%) from Group 1 and in 7 children (17.5%) from Group 2. In all cases, rare focal seizures were recorded (1–2 times a year). All patients with seizures during our study had a history of seizures under the age of 1 year. The onset of seizures was quickly stopped by the basic antiepileptic drugs in monotherapy. Epileptic seizures developed in children with moderate to severe cerebral palsy on GMFCS (Gross Motor Function Classification System) and a history of neonatal seizures. We attributed both of these to risk factors. In children with cerebral palsy and epilepsy in remission of 6 months or more, massage and Vojta therapy did not provoke epileptic seizures. The effect of epileptiform activity on the severity of motor status and on cognitive functions in cerebral palsy has not been established in our study. Conclusion. According to our data, rehabilitation measures do not have a significant impact on the risk of developing epilepsy.

Introduction: Ketogenic diet was first approached diet in treatment of epilepsy in children, later on, many studies showed its positive effect on adults who have chronic diseases and obesity. The main aim of the diet is to allow the body to reach the state of ketosis by generating energy from fat rather than glucose, and this happen by lowering the carbohydrates, adding moderate protein and high fat, thus letting the body burn fat for fuel. Since more than 50 years studies linked consumption of saturated fat with cardio-metabolic disease risk and obesity, and nowadays many studies have shown a positive impact of consumption of saturated fat. Therefore, this is a study to determine the prevalence of Saudi adult with chronic disease who follow a ketogenic diet. Methods: This was an observational cross-sectional study based on web-survey questionnaires developed by developed originally by author with high confidence level. The sample size was 479 estimated using the Qualtrics calculator with a confidence level of 95% and a margin of error of 5%. The questionnaire is divided into four categories. We started the questioner with demographic factors including age, nationality, dental degree date and in which country, work setting and cariology course attendance. 2nd it was about 3 clinical scenarios. Data were collected using Google forms and prepared for analysis using Microsoft Excel. Statistical analysis was performed using the SPSS software. Results: The total number of the current study participants was 464, the highest percentage (33.90%) were in the age group of 40-50 years old, 44.80% were in the weight range of 61-80 kg, while 11.90% have a weight of >100 kg, and half (50%) of the participants have a height range of 151-160 cm. Most (71%) of the participants have a college educational level, and 44.30% were employees. The prevalence of hypercholesterolemia and diabetes among the respondents was 23.70%, and 2.50%, respectively. The overall prevalence of metabolic syndrome was 2.30%. Almost half (50.10%) of the participants reported having obesity, and 19.10% were hypertensive. Conclusion: Ketogenic diet in this review showed a positive results within the utilization in chronic illnesses and obesity. In any case, The long-term hazard related with adverse impacts is unknown; therefore, advance studies may be valuable. Future randomized clinical trials are required to affirm the viability of the ketogenic diet in different sorts of adults’ chronic illness and to supply advance data on a few uncertain commonsense issues, i.e., how long the ketogenic diet ought to be proceeded.

Objectives The aim of this study was to compare the adherence, healthcare resource and cost implications of using Episenta® minitablets or Epilim® monolithic tablet in the treatment of epilepsy in children in England. Design This is a retrospective analysis of healthcare administrative databases. Setting The study analysed data collected from Primary Care (Clinical Practice Research Datalink (CPRD)) and Secondary Care (Hospital Episode Statistics (HES)) in England, UK. Participants Patients (stratified by age 0–12; 0–17 and 18+ years) with a diagnosis of epilepsy in receipt of a new prescription for Episenta® minitablets or Epilim® monolithic tablet from January 2012 to October 2017. Limited to those with a minimum of 12 months follow-up. Main outcome measures Determining the impact of sodium valproate formulation on measures of treatment adherence and healthcare resource usage. Results There were 793 patients in the dataset: 84 on Episenta® minitablets and 709 on Epilim® tablets. Measures of medication adherence were not significantly different between the minitablet formulation and the monolithic matrix tablet. However there was a greater annualised incidence rate of epilepsy related primary healthcare contacts in a paediatric population from the tablet formulation compared to those treated with minitablets (95% CI [−1.561,0.0152]) for those aged 0–12 and (95% CI [−1.3234,−0.0058]) for those aged 0–17. This is found despite a lower dose being used in the minitablet cohort (595 mg vs 945 mg for the tablet) for those aged 0–17 which indicates effective therapy at a lower dose using the minitablet compared to the monolithic tablet formulation. Conclusions Minitablet formulations of sodium valproate (presented as granules in capsules or sachets) can provide better therapeutic outcomes and reduced associated healthcare resource costs compared to monolithic tablets in children and young people with epilepsy. The interpretation of this data is limited by the large difference in sample size between the two groups which needs additional investigation to generate matched data for future comparisons. Further work is required to understand why the Episenta® minitablets formulation generated better outcomes in paediatric populations.

The centromedian (CM) and anterior nucleus of the thalamus (ANT) are deep brain stimulation (DBS) targets for management of generalized, and focal drug resistant epilepsy (DRE), respectively. We report on a single center retrospective case series of 16 children and adults with DRE who underwent CM with simultaneous ANT (69 %) or CM without simultaneous ANT DBS (31 %). Seizure frequency, epilepsy severity, life satisfaction, and quality of sleep before and after DBS were compared. Baseline median seizure frequency was 323 seizures per month (IQR, 71-563 sz/mo). Median follow up time was 80 months (IQR 37-97 mo). Median seizure frequency reduction was 58 % (IQR 13-87 %, p = 0.002). Ten patients (63 %) reported ≥50 % seizure frequency reduction. Median seizure frequency reduction and responder rate were not significantly different for CM + ANT versus CM only. Seizure severity and life satisfaction were significantly improved. Three patients (19 %) developed device-related side effects, 2 of them (12.5 %) required surgical intervention. In a heterogenous population of children and adults with generalized, multifocal, posterior onset, and poorly localized DRE, CM with or without ANT DBS is feasible, relatively safe and is associated with reduced seizure frequency and severity, as well as improved life satisfaction.

Epilepsy is one of childhood's most common neurological disorders. 5 to 10 per 1000 people worldwide. This study aims to determine the efficacy on Education inferences regarding care on Epilepsy in Children among Anganwadi workers and to find out the association between the knowledge on the care of epilepsy in children among Anganwadi workers with population variables. Interventional pretest and post-test method of A quantitative approach to analysis were used. The study participants were 100 Anganwadi workers at Anganwadi center, Kancheepuram district between the age 25-40 years. Convenient sampling method was used to collect the data and assigned to the control group and the experimental group. The tool consists of two sections which include Section A: Demographic variables of the samples include age, religion, type of family, education qualification, marital status. Income and socioeconomic status, area of residence and availability of health support system. Section B: It consists of 30 inquiry form regarding the care of epilepsy in children, meaning and influence, treatment and avoidance of epilepsy. The study found that the majority of Anganwadi staff 25 (25%) had insufficient knowledge of child care epilepsy. So, in Educational service program on the care of epilepsy in children can be organized in Anganwadi centers to improve the knowledge of Anganwadi workers.

Background Epilepsy is one of the most widely recognized neurological disorders; unfortunately, twenty to thirty percent of patients do not get cured from epilepsy, despite many trials of antiepileptic drug (AED) therapy. Immunotherapy may be a viable treatment strategy in a subset of epileptic patients. The association between Toll-like receptor polymorphisms and epilepsy clarifies the role of the immune system in epilepsy and its response to the drug. Thus, this study will focus on the relation between TLR4 rs1927914, rs11536858, rs1927911SNPs, and epilepsy in an Egyptian case-control study to assess their link to antiepileptic drug response. Results According to TLR4 rs1927914, there is a significant association between the SNP and the development of epilepsy, as CC genotype is 15.3 times more at risk for developing epilepsy than TT genotype, and CT is 11.1 times more at risk for developing epilepsy than TT. Also, patients with CC genotypes are 6.3 times more at risk for developing primary epilepsy than TT genotype. According to rs11536858, there is a significant association between cases and control groups, as AA genotypes are found to be more at risk for developing epilepsy than GG genotypes. Also, there is a statistically significant association between clonazepam resistance and rs11536858, as p value < 0.001* with the highest frequency of TT genotypes at 4.3%. According to rs1927911, there are no significant results between the cases and the control groups or between drug-responsive and drug resistance. Conclusion Possible involvement of the Toll-like receptor clarifies the importance of innate immunity in initiating seizures and making neuronal hyperexcitability. In this work, multiple significant associations between TLR SNPs and epilepsy, epileptic phenotype, and drug-resistant epilepsy have been found. More studies with bigger sample sizes and different techniques with different SNPs are recommended to find the proper immunotherapy for epilepsy instead of the treatment by antiepileptic drugs.

Background: Epilepsy is one of the most common neurological disorders. The prevalence of active epilepsy was estimated to be 6.38 per 1000 persons. Serum malondialdehyde (MDA) is used as a marker to investigate the oxidative damage of lipids in many degenerative human diseases. Vitamin C is important for the proper functioning of the central nervous system. Objective: To evaluate the association of serum MDA and vitamin C with epilepsy in children. Methods: This case-control study was carried out in the Pediatric Department at Zagazig University Hospitals during the period from December 2019 to July 2020. This study included 46 children who were divided into 2 groups: Cases group: which included 23 epileptic children. Control group: which included 23 healthy children with age and sex-matched to cases. All the participants were subjected to measuring serum malondialdehyde MDA and Vitamin C. Results: This study showed that there was a statistically significant increase in serum malondialdehyde (MDA) among the case group than the control group. Also, there was a statistically significant decrease in serum Vitamin C among the case group than the control group. Conclusion: This study has correlated the increase of lipid peroxidation and defective antioxidant defense and the pathogenesis of epilepsy and we found a significantly elevated level of MDA and a depleted level of vitamin C in epileptic patients than in the healthy control subjects

Objective The economic burden of childhood epilepsy to the health care system remains poorly understood. This study aimed to determine phase-specific and cumulative long-term health care costs in children with epilepsy (CWE) from the health care payer perspective. Methods This cohort study utilized linked health administrative databases in Ontario, Canada. Incident childhood epilepsy cases were identified from January 1, 2003 to June 30, 2017. CWE were matched to children without epilepsy (CWOE) on age, sex, rurality, socioeconomic status, and comorbidities, and assigned prediagnosis, initial, ongoing, and final care phase based on clinical trajectory. Phase-specific, 1-year and 5-year cumulative health care costs, attributable costs of epilepsy, and distribution of costs across different ages were evaluated. Results A total of 24 411 CWE were matched to CWOE. The costs were higher for prediagnosis and initial care than ongoing care in CWE. Hospitalization was the main cost component. The costs of prediagnosis, initial, and ongoing care were higher in CWE than CWOE, with the attributable costs at $490 (95% confidence interval [CI] = $352-$616), $1322 (95% CI = $1247-$1402), and $305 (95% CI = $276-$333) per 30 patient-days, respectively. Final care costs were lower in CWE than CWOE, with attributable costs at -$2515 (95% CI = -$6288 to $961) per 30 patient-days. One-year and 5-year cumulative costs were higher in CWE ($14 776 [95% CI = $13 994-$15 546] and $39 261 [95% CI = $37 132-$41 293], respectively) than CWOE ($6152 [95% CI = $5587-$6768] and $15 598 [95% CI = $14 291-$17 006], respectively). The total health care costs were highest in the first year of life in CWE for prediagnosis, initial, and ongoing care. Significance Health care costs varied along the continuum of epilepsy care, and were mainly driven by hospitalization costs. The findings identified avenues for remediation, such as enhancing care around the time of epilepsy diagnosis and better care coordination for epilepsy and comorbidities, to reduce hospitalization costs and the economic burden of epilepsy care.

There is increasing recognition that epilepsy can be associated with a broad spectrum of comorbidities. While epileptic seizures are an essential element of epilepsy in children, there is a spectrum of neurological, mental health and cognitive disorders that add to the disease burden of childhood epilepsy resulting in a decreased quality of life. The most common comorbid conditions in childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disorders, attention deficits, cognitive impairment, and migraine. While epilepsy can result in comorbidities, many of the comorbidities of childhood have a bi-directional association, with the comorbid condition increasing risk for epilepsy and epilepsy increasing the risk for the comorbid condition. The bidirectional feature of epilepsy and the comorbidities suggest a common underlying pathological basis for both the seizures and comorbid condition. While recognition of the comorbid conditions of pediatric epilepsies is increasing, there has been a lag in the development of effective therapies partly out of concern that drugs used to treat the comorbid conditions could increase seizure susceptibility. There is now some evidence that most drugs used for comorbid conditions are safe and do not lower seizure threshold. Unfortunately, the evidence showing drugs are effective in treating many of the childhood comorbidities of epilepsy is quite limited. There is a great need for randomized, placebo-controlled drug trials for efficacy and safety in the treatment of comorbidities of childhood epilepsy.

Objective. To analyze the long-term results after surgical treatment of multifocal cortical epilepsy in children and determine prognostic factors. The use of multilobar resections in the surgical treatment of pediatric multi-focal epilepsy remains an pressing problem of current neurology and neurosurgery. Materials and methods . A retrospective analysis of the multifocal resections data in 47 children with drug-resistant single-hemispheric multifocal epilepsy was performed by monitoring patients between age of 8 months up to 17 years old, who were operated from 1994 to 2014, additionally examined for prognostic factors affecting short- and long-term treatment outcomes after surgery. Results. According to the MRI data, structural changes in the brain were found in 63.8% subjects, whereas in 36.2% cases no pathology was detected. The following types of surgical interventions were performed: fronto-temporal resection - 44.68% cases; temporal resection combined with subpial removal of the frontal and parietal cortex in 21.28% patients; resection of the temporal lobe and cortical foci of the parietal lobe - 19.15%; removal of the temporal, parietal and occipital lobes - 2 cases; resection of the temporal and occipital - 2 cases; resection of the temporal lobe in combination with multifocal resection of the cortical epileptic foci of the frontal, parietal and occipital lobes - 1 cases; fronto-central-parietal combined with multiple subpial transection of the cortex - 1 case, fronto-parieto-occipital - 1 case. Immediately in postoperative period and up to 12 months post-surgery, seizures disappeared in 42.9% cases, whereas in long-term period results remained stable with Engel I outcome in 41.7% after 3 years, 41.2% - after 5 years and 40.6% - after 10 years post-surgery. Conclusion: Multilobar resections performed in multifocal epilepsy allow to provide a favorable result in the short-term and long-term period with fully abrogated seizures in 48% and 41% cases, respectively. Positive prognostic factors were found to be duration of epilepsy less than 7 years, onset of the disease at school age, lack of generalized seizures and epileptic status in history, as well as the vastness of surgery.

Context: Epilepsy is said to be intractable when two or more trials of anticonvulsants fail to control the seizures. Literature suggests that intractable epilepsy carries a higher morbidity than controlled epilepsy in children and their caregivers. Aims: The aim of this study is to assess the quality of life (QOL) in children with intractable epilepsy (IE) in KASCH, a tertiary care hospital in Riyadh, Saudi Arabia. Settings and Design: This is a cross-sectional study utilizing a self-administered questionnaire filled by caregivers of epileptic patients visiting the outpatient neurology clinics. Methods and Materials: The quality of life in childhood epilepsy (QOLCE-55) scale examined four domains of life: cognitive, emotional, social, and physical. The sample consisted of 59 parents whose children aged 4-14 of either sex. Statistical Analysis Used: The collected data were analyzed by Statistical Package for the Social Sciences (SPSS) version 22. Results: The mean age of children was 8.9 (SD = 2.9). The mean QOL was 52.8 (SD = 12.9), which reflected a poor QOL. Age was not related to the QOL. Gender was significantly associated with the total and social scores, (P = 0.04) (P = 0.001), respectively. Out of all comorbidities, global developmental delay (GDD) and encephalopathy were significantly associated with the QOL (P < 0.05). Conclusions: Intractable epilepsy impacted all functioning domains of life rendering a poor QOL. Males have reported better QOL and social functioning compared to females. Children with GDD and encephalopathy showed lower well-being.

Objectives This cross‐sectional study was designed to test the applicability of the 1989, 2010, and 2017 International League Against Epilepsy (ILAE) classification of epilepsy in children from a resource‐limited setting in India. Methods Classification of seizure types and syndromes was done through parental interviews and review of medical records in children with epilepsy aged one month to 18 years. Available investigations including EEG, MRI, and metabolic/genetic tests were used in classifying patients as per the 1989, 2010, and 2017 ILAE (level II‐epilepsy type) classification. We compared the proportion of children remaining unclassified by each scheme. Results Seven hundred and twenty‐six children (436 males, mean age 6.4 ± 4.6 years) were enrolled. Using the 1989 ILAE classification, we were able to classify 95.7%, and 82.6% children by the 2010 scheme. The 2017 ILAE classification could classify all 726 children at level I (seizure type), 664 (91.0%) children at level II (epilepsy type), and an electroclinical syndrome could be identified in 409 (56.1%) of the children. An etiology could be identified in 75%, perinatal brain injury being the most frequent. West syndrome was the most common electroclinical syndrome, identified in 22.7% patients. The 1989 ILAE classification system was superior to the 2010 system (P = .01) in epilepsy classification. There was no difference between the 1989 and 2017 schemes (P = .31) or the 2010 and 2017 schemes (P = .10). Significance The 2017 ILAE classification, being multidimensional, allowed classification of children who could not undergo extensive evaluation due to economic constraints and also provided room for overlapping etiologies.

Background: Epilepsy is a common chronic neurological condition in developing years that can negatively impact one's physical, social and emotional function. Aim of Study: The aim of this study was to assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt, comparing the relationship between different types of seizures and the HRQOL and increasing the awareness of the importance of assessing physical, psychosocial, and behavioral well-being of children with epilepsy in Egypt. Patients and Methods: To assess the health-related quality of life (HRQOL) and its predictors in children with epilepsy in Egypt during the period from August 2019 and December 2019. This cross-sectional study was conducted at Ain Shams Neurology Department and included 75 children with epilepsy of 11-18 years. The tools used to assess children's QOL were pediatric QOL questionnaires. Parents' QOL was assessed using SF36 inventory. Results: Children with epilepsy have an affected quality of life according to the PedQOL assessment tool with a mean PedQOL total score 64.4±6.9 and ranged from 56.1 to 83.6. Among the different domains of the PedQOL inventory, the results of our study showed that children with epilepsy have got higher scores in the physical and the school domains than in the emotional and social domains. Our sample was drawn from Ain Shams University Hospital. Patients attending this health facility are usually from low to intermediate socio-economic status which may explain this result. Conclusion: Epilepsy in children has a great impact on the quality of life of those children particularly on the emotional and social domains. Some antiepileptic drugs like valproic acid have a better effect on the quality of life than others. The higher the children's quality of life the higher is the parents' quality of life. The highly impacted domains of the parents quality of life according to the SF36 questionnaire were role limitation (physical or social), social functioning and mental health domain.

Background: Ketogenic diets (KD) consist of high fat, moderate protein and low carbohydrates.Aim: This review explores the effect of ketogenic diet and its mechanism of actions in disease management.Methods: Recent information on ketogenic diets and disease management were retrieved from academic journals using scientific search engines and popular library databases such as PubMed, Scopus, Web of Science, JSTOR amongst others.Commentary: Ketogenic diet means a high fat, low-carbohydrate diet, with enough protein content, which makes the body utilize fat, rather than carbohydrate, as a preferred energy source. There are four different types of ketogenic diet, the traditional classic ketogenic diet, medium chain triglyceride (MCT) ketogenic diet, the modified Atkins diet (MAD), and the low glycemic index treatment (LGIT). The classic ketogenic diet, also known as long-chain fats consist of 16-20 carbon atoms. Its peculiarity is the low carbohydrate content, which could be difficult to maintain. The MCT was developed as an alternative to classic ketogenic diet. It has a fat composition of 60% octanoic acid (eight-carbon fatty acid) and 40% decanoic acid (10-carbon fatty acid). The MCT provides about 45% of energy when compared with the classic ketogenic diet. The MAD though strongly encourages the intake of high fat, it allows for 10-20 g of carbohydrate per day. The LGIT permits only low glycemic index foods. Ketogenic diets have been a therapeutic strategy for several diseases such as obesity, dyslipidemia, cancer and a broad range of neurological disorders.Conclusion: The ketogenic diet, an effective and age-long treatment for epilepsy in children, is gradually gaining acceptance as a therapeutic modality for many other diseases.

Advances in autoimmune encephalitis studies in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to the disorder. The disorder or syndrome has been linked to a wide variety of pathologic processes associated with the neuron-specific autoantibodies targeting intracellular and plasma membrane antigens. However, current criteria for autoimmune encephalitis are quite dependent on antibody testing and responses to immunotherapy, which might delay the diagnosis. This form of encephalitis can involve the multifaceted presentation of seizures and unexpected behavioral changes. The spectrum of neuropsychiatric symptoms in children is less definitive than that in adults, and the incorporation of clinical, immunological, electrophysiological, and neuroradiological results is critical to the diagnostic approach. In this review, we document the clinical and immunologic characteristics of autoimmune encephalitis known to date, with the goal of helping clinicians in differential diagnosis and to provide prompt and effective treatment.

Objective Seizure recurrence following surgery for temporal lobe (TL) epilepsy may be related to extratemporal epileptogenic foci, so-called temporal-plus (TL+) epilepsy. Here, we sought to leverage whole brain connectomic profiling in magnetoencephalography (MEG) to identify neural networks indicative of TL+ epilepsy in children. Methods Clinical and MEG data were analyzed for 121 children with TL and TL+ epilepsy spanning 20 years at the Hospital for Sick Children. Resting-state connectomes were derived using the weighted phase lag index from neuromagnetic oscillations. Multidimensional associations between patient connectomes, TL versus TL+ epilepsy, seizure freedom, and clinical covariates were performed using a partial least squares (PLS) analysis. Bootstrap resampling statistics were performed to assess statistical significance. Results A single significant latent variable representing 66% of the variance in the data was identified with significant contributions from extent of epilepsy (TL vs TL+), duration of illness, and underlying etiology. This component was associated with significant bitemporal and frontotemporal connectivity in the theta, alpha, and beta bands. By extracting a brain score, representative of the observed connectivity profile, patients with TL epilepsy were dissociated from those with TL+, independent of their postoperative seizure outcome. Significance By analyzing 121 connectomes derived from MEG data using a PLS approach, we find that connectomic profiling could dissociate TL from TL+ epilepsy. These findings may inform patient selection for resective procedures and guide decisions surrounding invasive monitoring.

Background and purpose Epilepsy is an important neurologic feature of patients with tuberous sclerosis complex (TSC). Most common seizure types are focal seizure and epileptic spasm. Seizure control often requires multiple antiepileptic drugs. This study has been done to evaluate the seizure types, electro-encephalography (EEG), neuroimaging features, and drug treatment of epilepsy in TSC. Methods This prospective observational study has been conducted on epilepsy patients with TSC at Bangabandhu Sheikh Mujib Medical University from 2011 to 2019. Results Seventy patients with a mean±standard deviation age of 5.64±3.96 years were identified and 57.1% were female. Most common type of seizure was focal seizure (46%). Epileptic spasm occurred in 17% of patients and all of them had seizure onset before 1 year. In 47% of patients EEG showed focal epileptic discharge; hypsarrhythmia was found in most of the patients with epileptic spasm. Majority of the patients needed more than one drug to control seizure. Only 34% of patients were seizure free for at least 12 months and 22.8% had drug resistant epilepsy. Conclusions This study highlights the pattern of seizure, treatment pattern, response to drug, and short-time outcome of children with TSC with epilepsy in a developing country like Bangladesh.

Background and purpose Epilepsy is a chronic unpredictable debilitating condition. Epilepsy has great impacts not only on patients with epilepsies but also the persons around them. Burden among caregivers is understudied area. In view of the dearth of literature or studies focused on caregivers of children with epilepsy in Nepalese context, this study is expected to assess burden and its predictors among caregivers of children with epilepsy. Methods A total of 106 caregivers were interviewed using purposive sampling technique. The Zarit Burden Interview Scale short version was used to assess burden and Hospital Anxiety Depression Scale was used to assess anxiety and depression. Data were analysed using SPSS ver. 16.0. Chi-square test, multinomial logistic regression and linear regression analysis were done for analysis of inferential statistics to find out the predictors of burden. Results Majority of the caregivers (71.7%) were females and 64.2% of caregivers were mothers of children. Majority of responders (77.4%) were Hindus. Mild to moderate burden was found in 27.4% and high burden was found in 14.2% of the caregivers. Borderline anxiety, borderline depression, anxiety and depression were present in 7.5%, 8.5%, 6.6%, and 6.6% caregivers respectively. Burden was significantly higher in caregivers of epileptic children with poorly controlled seizure (p=0.003) and with co-morbidities (p=0.009). Similarly, burden score had significant positive correlation (p=0.001) with depression and significant negative correlation (p=0.005) with age of onset of epilepsy in children. Conclusions Burden, anxiety and depression are common problems in caregivers of children with epilepsy. Poorly controlled seizure, presence of associated comorbidities, younger age of onset of seizure in children and presence of depression in caregivers are the important factors that predict burden among caregivers of children with epilepsy.

Background. Comparative study of antiepileptic drugs allows to make the optimal choice in therapy.The aim of the study: a comparative analysis of the administration of two similar by chemical structure antiepileptic drugs (zonisamide and topiramate) in the outpatient practice in epilepsy in children, taking into account the efficacy and tolerability.Materials and methods. A retrospective analysis of outpatient charts of equal in number (n = 18) groups of patients with different forms of epilepsy treated with zonisamide and topiramate in monotherapy and in combined therapy was carried out.Results. In general, no statistically significant difference in the efficacy of zonisamide and topiramate was obtained (p = 0.692). Efficacy in structural focal epilepsy was also comparable (absence of seizures 54.6 % and 45.5 %, respectively). With comparable efficacy, zonisamide was administered to patients much later in the antiepileptic drugs (Me = 5) than topiramate (Me = 3). Side effects on zonisamide were registered in 27.8 %, side effects on topiramate – in 38.9 % (p = 0.480). The difference in the effect of these drugs on cognitive functions was noted.Conclusions. Zonisamide shows its effectiveness in different forms of epilepsy in children, despite the later appointment in practice. The drug is well tolerated and probably has less negative effect on children’s cognitive functions than topiramate.

Purpose To understand the experiences with and perspectives of neurologists about the use of medical cannabis in the treatment of pediatric drug-resistant epilepsy. Methods In this qualitative study, we interviewed neurologists who provide care to children with drug-resistant epilepsy in Canada. Through semi-structured telephone interviews, we sought participants’ views about and experiences with medical cannabis for the treatment of drug-resistant epilepsy in children. Here we present a thematic summary of the interviews. Results The 12 interviewed neurologists generally perceived medical cannabis as a viable treatment option for children with drug-resistant epilepsy; however, participants identified important gaps in the evidence and implications for their practices. Six themes were generated from the content of the interviews: learning about medical cannabis; perceptions about medical cannabis; discussing medical cannabis with parents; experiences with medical cannabis authorization; barriers to authorizing medical cannabis; and the impact of medical cannabis on clinical care. Of note, while some neurologists took on all aspects of the children’s care, including medical cannabis, others referred interested families to non-neurology health care professionals. Conclusion Our findings highlight the diverse opinions and experiences of neurologists in Canada with medical cannabis for the treatment of drug-resistant epilepsy in children, including with the authorization process and caring for children using medical cannabis. Additional education about medical cannabis may be warranted, in order to better prepare neurologists to have informed and open conversations with parents about this treatment option and to provide care for children using medical cannabis.

Epileptic encephalopathies of infancy are difficult-to-treat destructive cases of epilepsy in infants and young children, which include the two clinical observations of Coppola Dulac syndrome (malignant migrating partial attacks of infancy) given in this article. Epileptic encephalopathies are a genetically heterogeneous group of disorders that are characterized by the presence of a convulsive syndrome and are accompanied by cognitive and behavioral disorders. As a result of intensive development of methods of molecular genetic research, ideas about the causes of epilepsy in children began to change, this fact led to the fact that the international League against epilepsy replaced the term idiopathic epilepsy with genetic epilepsy. To date, about 60 phenotypic variants of early epileptic encephalopathies have been registered in children, including those associated with mutations of genes that regulate the functions of voltage-dependent calcium and sodium channels. In our work, we consider clinical observations of genetic epileptic encephalopathies caused by mutations in the CACNA1A and SCN8A genes, respectively, which are channelopathy. Malignant migrating partial attacks of infancy (infant epilepsy with migrating focal attacks, Coppola Dulac syndrome) are manifested at an early age, from the first days to 6 months of life, and are characterized by typical multifocal attacks with a tendency to change hemispheres and involve opposite limbs. G. Coppola based on the analysis of their own observations, described in 1995 a new age dependent epileptic syndrome, introducing a definition for it migrating partial attacks of infancy. Currently, it is recommended to use the term infant epilepsy with migrating focal seizures. We present our own clinical and neurophysiological observations of this rare syndrome.