The effect of educational interventions on drug adherence in children with epilepsy and parents: Systematic review and meta-analysis.

Nailfold videocapillaroscopy reveals early microvascular changes in pediatric epilepsy.

Evaluation of executive functions and cognitive disengagement syndrome in children and adolescents with epilepsy.

Arterial spin labeling in pediatric epilepsy in the emergency setting: clinical predictors of diagnostic yield and optimal acquisition time.

Prospective Assessment of Cognitive Outcomes in Pediatric Self-Limited Epilepsy With Centrotemporal Spikes.

Visually Enhanced Mental Simulation (VEMS) in teacher candidates' emergency response to epileptic seizures and attitudes toward epilepsy.

Seizure onset the transition from interictal to ictal network states-remains poorly understood despite decades of research. To date, most analyses of seizure onset rely on descriptors of passively recorded network variables such as spectral features or functional connectivity. However, direct causal analysis of brain network dynamics across the ictal transition have yet to be systematically studied. We therefore sought to characterize the ictal transition using active network probing via corticocortical evoked potentials (CCEPs) generated by direct cortical stimulation. We analyzed a unique dataset of pediatric and adult epilepsy patients in whom electroclinical seizures were triggered by low-frequency (<2 Hz) direct cortical stimulation. CCEP amplitudes were quantified preceding, during, and following seizure onset, comparing responses within versus outside the spontaneous seizure onset zone (SOZ) across anatomic locations and seizure onset patterns. Seizure onset was characterized by a rapid, dramatic reduction of CCEP amplitudes within the SOZ. CCEPs were relatively preserved at sites outside the SOZ, indicating preferential loss of incoming, rather than outgoing, responses to the SOZ, a phenomenon we term "effective disconnection." This effect was independent of SOZ anatomic location but was preferentially associated with a low-voltage fast activity seizure onset pattern on exploratory analysis. In a subset of patients, CCEPs returned during seizure evolution after the fast activity phase, at times with reversal of response polarity. These findings provide a novel characterization of the ictal transition based on the sensitivity of the seizure-generating network to external perturbation and provide a framework for causal network interrogation during seizure onset and early evolution. The described pattern of effective disconnection indicates preferential loss of incoming connectivity to the SOZ at seizure onset. We propose an integrative, hypothesis-generating model linking local inhibitory dynamics and network connectivity at seizure onset and demonstrate the utility of peri-ictal cortical stimulation as a tool for interrogating epilepsy networks.

To develop a working definition of successful transition from paediatric to adult epilepsy services, assess transition success, identify predictors and determine whether success is associated with improved seizure outcomes in early adulthood. Retrospective cohort study. Paediatric and adult epilepsy services in London, UK. Patients aged 20-24 with epilepsy in the paediatric service database (2009-2023) who transitioned to adult care. Date of birth, sex, ethnicity. Age at first documented paediatric epilepsy clinical appointment (this is not age of epilepsy onset) and number of epilepsy-related comorbidities at age 17. Success was defined by four criteria: developmentally appropriate initiation, comprehensive preparation using National Institute for Health and Care Excellence guidance, attendance at joint paediatric/adult transition clinic and adult follow-up within 6 months of transition clinic. Change in seizure frequency between ages 17 and 20. Of 59 eligible patients, 72.9% (43/59) achieved successful transition. Criteria were well-met: initiation (91.5%), preparation (91.5%), joint clinic (79.7%) and follow-up (88.1%). Successful transition increased the odds of seizure improvement/remaining seizure-free (adjusted OR 4.28, 95% CI 1.07 to 17.19) after adjusting for: age at first paediatric epilepsy clinical appointment, sex, ethnicity and comorbidities. Males had higher odds of seizure improvement/remaining seizure free than females (adjusted OR 4.29, 95% CI 1.26 to 14.67).No significant association was seen with ethnicity or age at first appointment. A novel transition success tool was developed. Larger, multicentre studies are needed to validate this tool and confirm associations with long-term outcomes.

BackgroundEpilepsy is a common pediatric diagnosis, and recent national and international efforts aim to improve care for neurologic conditions. This study examined initial clinical differences between English- and Spanish-speaking pediatric epilepsy patients.MethodsWe used single-center retrospective analysis of pediatric English- and Spanish-speaking patients with epilepsy. Demographic information was recorded. Initial encounters and subsequent care for the first 6 months were reviewed. Wilcoxon rank sum tests, Fisher exact tests, and multivariable logistic regression were used.ResultsA total of 118 English-speaking and 112 Spanish-speaking patients met the inclusion criteria. Epilepsy classification, presenting seizure type, initial encounter location, medications prescribed, and subjective seizure improvement rates did not differ between language cohorts. Differences between language cohorts were seen in communication rates and medication trials. Some differences were found depending on race within Spanish-speaking populations.ConclusionDespite many similarities in care, institutional processes-specifically our triage differences for English- and Spanish-speaking patients-may explain differences in contact rates and medications trials with similar rates of seizure improvement. The intersection of race within Spanish-speaking patients with epilepsy should be explored further.

Age-dependent effects of cannabidiol on cortical hyperexcitability in an experimental model of malformation of cortical development.

Epilepsy is one of the most prevalent neurological conditions in pediatric populations, and its management extends beyond seizure control to encompass comorbidities, psychosocial well-being, and long-term care. In the West Bank, Palestine, limited availability of pediatric neurologists means that general pediatricians often serve as the primary point of contact for children with epilepsy. Despite this critical role, no study has comprehensively assessed epilepsy knowledge among pediatricians in this setting. This study aimed to evaluate the knowledge and awareness of epilepsy management, etiologies, and comorbidities among pediatricians practicing in the West Bank. A descriptive, cross-sectional study was conducted among 246 pediatric residents, general pediatricians, and pediatric subspecialists from November 2025 to March 2026. A validated questionnaire covering five knowledge domains (etiology, long-term management, comorbidities, quality of life, and first-aid management) was administered. Responses were classified as correct or incorrect, and composite scores were calculated for each domain. Group comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests, with post-hoc pairwise comparisons where applicable. The overall aggregate correct response rate was 71.3%, with a median total score of 18 out of 25. Respondents performed best in first-aid management (81.6%) and long-term management (76.5%), while the lowest scores were observed in quality of life (55.2%) and comorbidities (67.7%). Notable gaps included low recognition of social difficulties (33.7%), increased aggression (34.1%), and comorbid hyperactivity (46.3%) in children with epilepsy, as well as incomplete awareness of sudden unexpected death in epilepsy, recognized by only 62.6% of respondents. Kruskal-Wallis tests revealed significant differences by professional role for etiology (p < 0.001), long-term management (p = 0.019), and total score (p = 0.021). Age and medical school location showed no significant associations with knowledge scores, while gender was associated with a significant difference only in the quality of life domain (p = 0.020). Palestinian pediatricians demonstrate moderate overall epilepsy knowledge but exhibit clinically meaningful gaps in recognizing psychosocial consequences and comorbidities. These findings highlight the need for targeted continuing medical education programs and curricular reforms in pediatric residency training, with emphasis on the psychosocial dimensions and comorbidity burden of childhood epilepsy.

Efficacy, tolerability, and EEG lateralization-based predictors of neuropsychiatric adverse events in pediatric SeLECTS treated with perampanel monotherapy.

Health-Related Quality of Life and Family Impact Among Children with Epilepsy: The Role of Seizure Control.

A causal inference framework to bridge association and mechanism in the gut-brain axis.

Epilepsy can profoundly influence children's psychological functioning, yet the contextual factors shaping this experience remain insufficiently understood. Using data from 104 children with epilepsy, their parents, homeroom teachers, and 1829 classmates, this study examined factors affecting children's psychological functioning. A range of diagnostic, psychological, and social variables were assessed, and structural equation modeling was used to analyze relationships. The results showed that both epilepsy-related factors (presence of comorbidities, non-verbal intelligence, seizure freedom, and number of antiepileptic medications) and social influences significantly contributed to psychological functioning. Key social influences linked to the school environment included teacher support and attitudes, classmates' awareness of the child's epilepsy, stigma among classmates, and the child's sociometric position. On the parental side, a significant role was played by parental depression and discrepancies between parent and child quality-of-life assessments. Notably, social influences were as impactful as medical factors, underscoring the need for holistic, multi-level interventions.

Approximately one-third of patients with epilepsy develop drug-resistant epilepsy (DRE). Extratemporal lobe epilepsy (ETLE) represents 30%-40% of focal epilepsy cases. ETLE poses significant challenges in localization and treatment because these patients often have diffuse and complex epileptogenic networks. Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative for localizable DRE, yet data for its use in the pediatric ETLE population remain limited. This study aimed to evaluate the safety and efficacy of LITT in pediatric ETLE and identify predictive factors for favorable seizure outcomes. This retrospective study reviewed pediatric patients who underwent LITT for ETLE at a single National Association of Epilepsy Centers level 4 epilepsy center from 2015 to 2023. Patients with prior LITT for temporal lobe epilepsy, hypothalamic hamartomas, or corpus callosotomies were excluded. Preoperative evaluations included noninvasive testing (e.g., video-EEG, MRI, PET, magnetoencephalography) and invasive monitoring with stereo-EEG. The primary study endpoints were 1) International League Against Epilepsy (ILAE) classification at 12 months after the index LITT or additional surgical intervention for the treatment of seizures, and 2) procedure-related complications. Secondary analyses examined imaging concordance with the final ablation location, total ablation volume, and perioperative metrics. Twenty-nine patients underwent an index LITT procedure for ETLE. At 12 months, 14 patients (48.3%) achieved a good outcome (ILAE class 1-3), and 12 (41.4%) were seizure free (ILAE class 1). There were 6 patients (20.7%) who required additional surgery within 12 months. Concordant PET with the final LITT ablation volume independently predicted seizure outcome (p = 0.04). The total ablation volume ranged from 0.66 to 8.45 cm3, and was not statistically different between groups. In the perioperative period, 3 patients developed transient steroid-responsive LITT-related edema, while no permanent neurological deficits, hematomas, surgical site infections, or deaths occurred. This study demonstrated that LITT is a safe and effective treatment option for pediatric ETLE and may achieve acceptable rates of seizure freedom with a minimally invasive approach. Concordance between noninvasive imaging (particularly PET) with LITT targets was associated with favorable outcomes, underscoring the importance of thorough preoperative evaluations to determine appropriate ablation candidates. Future multicenter prospective studies are warranted to further refine patient selection criteria and optimize treatment paradigms.

Diagnostic and treatment delays in infantile epileptic spasms syndrome (IESS) increase the risk of poor neurodevelopmental outcomes. Early clinical recognition of IESS is essential, especially in regions lacking expedited access to electroencephalograms (EEG). This study aimed to determine clinicians' accuracy at recognizing infantile epileptic spasms (ES) based on smartphone videos, and the impact of brief IESS education on accuracy, diagnostic confidence, and willingness to treat without EEG. This multicenter prospective cohort study took place over seven sessions globally from 2022 to 2023. Smartphone videos of children from the US and South Africa with EEG-confirmed diagnoses of IESS (6 videos) and non-epileptic ES-mimickers (3 videos) were obtained. Staff physicians and trainee participants from multiple subspecialties worldwide viewed videos three times: (1) baseline viewing, (2) after brief IESS training, and (3) with clinical history. Surveys on diagnosis and management were completed after each viewing. Of 187 participants who attended a session and initiated a survey, 180 (80 trainees [44%]) met the inclusion criteria. Initial diagnostic accuracy averaged 64% (95% confidence interval [CI]: 62-66%) and improved to 72% (69-74%) after IESS training and clinical history (V + T + CHx). Area under the curve for diagnostic performance of smartphone videos was 0.80 (0.78-0.82), and sensitivity was 0.85 (0.83-0.88) after V + T + CHx. The odds of making a correct diagnosis increased by 86% (OR 1.86, CI 1.59-2.18, p < 0.001) after V + T + CHx. Diagnostic confidence and clinician comfort level treating ES without EEG also improved significantly after V + T + CHx (by 0.36 points and 0.45 points, respectively, on 5-point Likert scales, p < 0.001). Diagnostic accuracy correlated strongly with increased diagnostic confidence and increased clinician comfort level managing patients without an EEG (p < 0.001). Staff physicians had a 24% higher likelihood of making a correct diagnosis than trainees. Smartphone videos, especially when enhanced by brief IESS training, can facilitate triage and early identification of infantile ES, reducing diagnostic delays in this time-sensitive condition. Infantile epileptic spasms syndrome is associated with severe developmental impacts, which can be worsened by delayed treatment. Rapid diagnosis is critical, especially in resource-limited settings lacking specialists and timely access to diagnostic tests. Our study found that clinician participants identified epileptic spasms, the hallmark seizure type of this condition, based on video alone with moderately high accuracy, and accuracy improved after education and clinical information. Thus, smartphone videos, particularly when enhanced by brief training, may be an effective tool to triage movements concerning for epileptic spasms, potentially improving resource allocation and reducing diagnostic delays in this urgent childhood epilepsy condition.

Drug-resistant epilepsy is defined as failure of 2 appropriately chosen and tolerated antiseizure medications (ASMs), after which referral for surgical evaluation is recommended. However, many children undergo additional ASM trials before referral. We aimed to identify preoperative factors associated with a higher number of ASM trials before referral in a nationwide, population-based pediatric epilepsy surgery cohort. We conducted a retrospective study of all children (younger than19 years) undergoing resective epilepsy surgery at the national pediatric epilepsy surgery center in Finland between 2002 and 2022. Patients were identified from a prospective surgical registry. Preoperative clinical characteristics, including etiology, seizure frequency, and resection location, were analyzed. Patients were categorized according to ≤3 vs >3 ASM trials before referral. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of referral after >3 ASM trials. Seizure outcomes 2 years after the final surgery were classified using the Engel classification. Among 239 children, the median number of ASM trials before referral was 4.0 (IQR, 3.0); 68% were referred after >3 ASMs. Younger age at epilepsy onset, daily seizures, and extratemporal, multilobar, or hemispheric resections were independently associated with referral after >3 ASM trials. Compared with patients referred after ≤3 ASMs, those referred after >3 ASMs had longer onset-to-referral intervals and were less likely to achieve Engel class 1 (odds ratio 2.0, 95% CI 1.0-3.9, P = .047) and more likely to require reoperation (20.9% vs 5.3%, P = .002). The number of prereferral ASM trials decreased over time. In this population-based cohort, most children underwent more ASM trials than recommended before referral for epilepsy surgery. Greater ASM exposure was associated with more severe epilepsy phenotypes. These findings reinforce the importance of timely recognition of drug-resistant epilepsy and consideration of surgical evaluation alongside escalation of ASM trials.

Invasive presurgical evaluation plays a key role in pediatric epilepsy surgery, particularly in magnetic resonance imaging (MRI)-negative cases, by guiding resective, disconnective, or ablative procedures. This International League Against Epilepsy (ILAE) Pediatric Epilepsy Surgery Taskforce study provides an updated global overview of current invasive evaluation practices. Group-level data were collected from 61 epilepsy surgery programs (49 pediatric-only) in 29 countries across six continents. Included were children and adolescents who underwent presurgical evaluation and epilepsy surgery in 2023. The study was designed to enable comparison with the similar ILAE survey conducted in 2004. A total of 2427 patients were included. Invasive evaluations were performed in 21.1% of cases, most frequently in North America (33.7%, higher than Europe: 18.0%, p = .003). Among invasive cases, 32.3% had no detectable MRI abnormalities. The main indication for invasive evaluation was seizure onset localization (88.1%), followed by motor or sensory mapping (17.2%) and language mapping (14.2%). Stereoelectroencephalography (SEEG) was the predominant technique (19.8% overall, 93.6% of invasive cases), more common in North America (30.0%, p = .021) and less common in South America (7.4%, p < .001). Subdural electrodes were used in only 3.2% of invasive cases, and combined depth and subdural approaches in 3.2%. SEEG-guided radiofrequency thermocoagulation (RF-TC) was performed in 40.9% of SEEG cases, most commonly in Asia (63.8%). In 16.2% of invasive evaluations, patients did not proceed to resection, disconnection, or ablation, with the highest rate in Europe (28.5%). This global survey provides the first broad overview of invasive evaluation practices in pediatric epilepsy surgery across participating centers worldwide. It highlights the widespread adoption of SEEG, declining use of subdural electrodes, and increasing application of SEEG-guided RF-TC. The high proportion of MRI-negative cases and the considerable proportion of patients not proceeding to resection, disconnection, or ablation underscore the complexity of contemporary surgical candidates and the need for further refinement of selection strategies.

We hypothesized that [18F]FDG PET/MRI would improve presurgical lesion detection compared with MRI alone in pediatric patients with focal epilepsy. We analyzed surgical outcomes and the presurgical evaluation pipeline. Methods: We included pediatric patients undergoing [18F]FDG PET/MRI between January 2017 and October 2021. Eligible patients were 18 y or younger, had a diagnosis of focal epilepsy under surgical evaluation, and had a negative or inconclusive MRI result. Data analysis phases included evaluation of prior MRI data (phase 0), masked review of PET/MRI-acquired MR sequences (phase 1), joint (nuclear medicine/neuroradiology) PET/MRI assessment (phase 2), and verification of PET/MRI findings against the hypothesized epileptogenic zone (EZ) (through electroencephalography in all cases; through stereoelectroencephalography outcomes and histology when relevant) (phase 3). Results: Seventy-nine patients were included in the study (49 male; mean age, 9.5 y). Patients' mean duration of epilepsy was 4.4 y, and 65 (83%) had drug-resistant seizures. Initial MRI results were inconclusive in 26 (33%) patients and negative in 53 (67%) patients. Blinded 3-T MRI identified suspect lesions in 36 (46%) patients, identifying additional lesions in 10 patients. Joint PET/MRI reading revealed that 46 (58%) patients had concordant PET-positive/MRI-positive results, 24 (30%) had PET-positive/MRI-negative results, and 8(10%) had PET-negative/MRI-negative results. Concordant PET-positive/MRI-positive findings demonstrated high accuracy in identifying epileptogenic lesions, particularly focal cortical dysplasia. PET/MRI showed metabolic alterations in 70 (89%) patients: 67 of 70 (96%) with hypometabolism and 6 of 70 (9%) with mixed areas of hypometabolism and hypermetabolism. The results were concordant with the electroclinical hypothesis in 45 (98%) of 46 patients with PET-positive/MRI-positive results and in 15 (63%) of 24 patients with PET-positive/MRI-negative results. Twenty-four patients underwent resection or disconnection, and 5 underwent thermocoagulation. Of these, 22 (76%) achieved Engel Class IA outcomes (average follow-up, 2.1 y). Conclusion: [18F]FDG PET/MRI offered significant diagnostic and prognostic value, especially in MRI-negative or inconclusive cases, enhancing presurgical evaluation precision and guiding clinical decision-making in pediatric epilepsy surgery.