Objective: This study aimed to evaluate the effect of training teachers using the video simulation method on their knowledge of epileptic seizure management and on their first-aid intervention skills. Methods: A survey was distributed to 250 participating teachers working in both private and public schools. The survey included basic demographic information, teachers' awareness of epilepsy, and their knowledge of first aid measures. Subsequently, the teachers received a training session on general information about epilepsy, first response to epileptic seizures, and emergency procedures using the video simulation training method. Awareness and attitudes were reassessed using the same survey. Results: The study involved 250 participants with an average age of 39.76 years, 62.8% female, and 78.4% working in the public sector. Participants with connections to individuals with epilepsy had significantly higher pre-training correct response scores (p=0.026, p=0.001). 72.8% had received first-aid training, and 26.6% had performed first aid, but only 6.1% considered their knowledge sufficient. Before training, 94.4% recognized epilepsy as a neurological disorder. The awareness of epilepsy being treatable increased from 70.7% to 90.4% (p<0.001). Knowledge of proper seizure interventions significantly improved, with correct responses to questions about safe positioning and jaw clenching rising from 52.4% to 78.4% and 52.4% to 90.8%, respectively (p<0.001). The total number of correct answers significantly increased after training, from 9.38 +/- 4.18 to 11.59 +/- 3.64 (p<0.001). Conclusion: These findings indicate that video simulation training is an effective method for improving teachers' knowledge and first-aid skills in managing epileptic seizures, supporting the integration of structured simulation-based interventions into school-based emergency preparedness programs.

BACKGROUND:Malnutrition is a common but frequently underrecognized comorbidity in children with neurological disorders. Accurate nutritional assessment is often challenging in pediatric neurology practice due to motor impairment, skeletal deformities, and unreliable height and weight measurements. Mid-upper arm circumference Z-score (MUAC-Z) has emerged as a practical anthropometric alternative; however, its age-dependent diagnostic performance in neurologically affected children remains insufficiently defined. OBJECTIVE:To evaluate the age-specific diagnostic accuracy of MUAC-Z for detecting malnutrition in a large pediatric neurology outpatient cohort and in a predefined subgroup of children with cerebral palsy (CP). METHODS:This multicenter, analytical cross-sectional study included 3668 children aged 6 months to 19 years attending pediatric neurology outpatient clinics, including 242 children with CP. Participants were stratified into two age groups (6-60 months and 5-19 years). Malnutrition was defined as weight-for-age Z-score (WAZ) < -2 in children under 5 years and body mass index-for-age Z-score (BMI-Z) < -2 in older children. Anthropometric measurements, laboratory parameters, and enteral feeding status were recorded. Diagnostic performance of MUAC-Z was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS:MUAC-Z demonstrated moderate diagnostic accuracy in children aged 6-60 months (AUC 0.772), with marked variability across early childhood subgroups. In contrast, MUAC-Z showed excellent diagnostic performance in children aged 5-19 years (AUC 0.907). In the CP subgroup, malnutrition prevalence was substantially higher across all indices. MUAC-Z showed limited accuracy in CP children under 5 years (AUC 0.668) but good diagnostic performance in those aged 5-19 years (AUC 0.774). Older malnourished children, particularly those with CP, exhibited more frequent laboratory abnormalities consistent with chronic nutritional impairment. CONCLUSIONS:The diagnostic utility of MUAC-Z in pediatric neurology is strongly age-dependent. MUAC-Z represents a reliable and practical screening tool in school-aged children and adolescents, including those with cerebral palsy, while its use in early childhood should be complementary to conventional anthropometric indices.

This study aimed to investigate the effect of upper respiratory tract infections on serum antiseizure medication levels in children with idiopathic epilepsy and the relationship between that condition and inflammation. Forty-nine patients aged 2–18 years presenting to our paediatric neurology clinic who were under follow-up with a diagnosis of idiopathic epilepsy and who were receiving valproate or carbamazepine therapy were included in this study. All patients were using either valproic acid (n = 31) or carbamazepine (n = 18). Patients were evaluated at the time of presentation with symptoms of upper respiratory tract infection and during the control period one month later. Serum antiseizure medication, interleukin-17 A and interleukin-23 levels, complete blood count, alanine transaminase levels, creatinine levels, albumin levels, erythrocyte sedimentation rates, and C-reactive protein levels were measured during infection and during the control period one month later. Simultaneous electroencephalography examinations were also performed. No provoked seizures occurred in any patient during the infection period. Serum valproic acid levels were higher in patients during the infection period than in those same patients during the control period after one month, although this difference was not statistically significant (p = 0.073). There was also no significant difference in carbamazepine levels (p = 0.484). While no difference was observed in the interleukin-23 values between the two periods in patients receiving valproic acid, these values were greater in the patients who received carbamazepine during the infection period (p = 0.039). The findings of this study suggest that mild upper respiratory tract infections do not cause clinically significant alterations in serum valproate or carbamazepine levels.

Spinal muscular atrophy (SMA) Type 1 in infants with two SMN2 copies is characterised by rapid motor neuron loss and a historically fatal course if untreated; however, nationwide real-world comparative data evaluating screening efficacy remain scarce. This nationwide retrospective, multicentre study evaluated the real-world impact of Turkey's national newborn screening (NBS) program on clinical outcomes in a high-risk population-of infants with genetically confirmed SMA and two SMN2 copies-treated with nusinersen. Patients were classified into a historical symptomatic cohort diagnosed before NBS implementation (pre-NBS, n = 162) and an NBS cohort identified through screening (n = 96); all received nusinersen. Outcomes included survival, respiratory and nutritional independence, and acquisition of WHO-defined motor milestones. Motor function was evaluated using the Children's Hospital of Philadelphia-Infant Test of Neuromuscular Disorders (CHOP-INTEND) scale. The NBS program markedly reduced the mean age at diagnosis and treatment initiation. Mortality was 6.3% in the NBS cohort compared with 30.9% in the pre-NBS group (p < 0.001). CHOP-INTEND scores at baseline were higher in the NBS cohort. Sustained motor gains were confirmed in both cohorts, though the NBS cohort maintained superior function throughout follow-up; 48.3% of NBS-identified infants achieved independent walking, compared with only 8.6% in the pre-NBS group. Preservation of bulbar and respiratory function was superior in the NBS cohort, whereas the pre-NBS group demonstrated progressive decline. NBS program fundamentally altered the clinical trajectory of SMA Type 1 in infants with two SMN2 copies in the present cohort. Pre-symptomatic treatment in the NBS cohort supports sustained motor development and preserves bulbar and respiratory functions, underscoring the importance of minimising delays between birth, diagnosis, and treatment initiation.

L-2-hydroxyglutaric aciduria (L-2-HGA) is a rare metabolic disorder associated with an increased risk of brain tumor development. Early diagnosis can be challenging due to non-specific neurological and magnetic resonance imaging (MRI) findings in the initial stages. A literature search of PubMed/MEDLINE and Google Scholar was conducted using predefined keywords related to L-2-hydroxyglutaric aciduria and central nervous system tumors. After screening and applying eligibility criteria, 19 publications reporting 32 intracranial tumor cases were identified. Together with the current illustrative case, 33 cases were included finally. We present a case of a brain tumor that was detected in a patient with L-2-HGA after a six-year seizure-free period following the onset of focal seizures, and we performed a comparative analysis with the 33 cases reported in the literature. Serial MRI examinations revealed progression of T2 hyperintensities and nodular contrast enhancement, which is consistent with high-grade tumor transformation. Clinical observations suggest that the emergence of new neurological symptoms and rapid progression may be early indicators of tumor developmen. MRI findings that may initially be mistaken for metabolic changes or demyelinating lesions can complicate the early diagnosis of the tumor. Therefore, careful clinical follow-up involving serial contrast-enhanced MRIs is crucial for patients with L-2-HGA. A literature review and case presentation emphasize that rapid neurological changes, or the recurrence and worsening of existing neurological symptoms, may be early warning signs. Long-term and dynamic follow-up is critical for the early detection of tumor progression and appropriate treatment planning.

PURPOSE:We aimed to investigate structural changes in the hippocampus using automated segmentation techniques to evaluate the anatomy and function of the hippocampus in patients with West syndrome (WS). METHODS:The study included 48 participants (24 with WS and 24 healthy controls) aged 0-4 years. Automated segmentation methods were used to measure hippocampal volume and evaluate diffusion tensor imaging (DTI) parameters such as fractional anisotropy (FA) and mean diffusivity (MD). Bonferroni correction was applied for multiple comparisons, setting the adjusted significance threshold at p < 0.0033. RESULTS:Children with WS exhibited significantly reduced total hippocampal volume and diminished volumes in the CA2-CA3, CA4-dentate gyrus (CA4-DG), and SR-SL-SM regions compared to healthy controls (padj <0.0033). After correction, no significant differences were found in the CA1 and subiculum regions (padj >0.0033). Although initial comparisons between ongoing WS and seizure-controlled WS suggested increased volumes in several hippocampal regions in the seizure-controlled group, these differences did not remain significant after adjustment and must be interpreted with caution. Notably, patients with seizure-controlled WS displayed larger hippocampal volumes, higher FA, and lower MD values, indicating a possible link between seizure activity and structural alterations. Additionally, DTI analysis of the cingulum revealed lower FA and higher MD values in WS patients, suggesting compromised microstructural integrity. CONCLUSIONS:These findings emphasize the potential role of hippocampal alterations in the pathophysiology of WS and suggest that DTI parameters may serve as useful measures for monitoring disease progression and treatment response.

Purpose This study aimed to investigate the relationship between ghrelin levels and severity of inflammation in children with epilepsy by evaluating the differences in total ghrelin, High Mobility Group Box 1 (HMGB1), Interleukin-1 Receptor Type 1 (IL1R1), and Interleukin-1 Beta (IL1-β) levels in patients with drug-resistant and non-drug-resistant epilepsy and comparing these parameters with those of healthy controls. Methods We measured total ghrelin, HMGB1, IL1R1, and IL1-β levels—known to play roles in epileptogenesis—in patients with severe (n: 28), mild (n:29) epilepsy, and 31 healthy controls. The severe epilepsy group included patients with treatment-resistant epilepsy, while the mild epilepsy group consisted of patients whose seizures could be controlled with monotherapy. Results Total ghrelin levels, along with HMGB1, IL1R1, and IL1-β, were significantly elevated in children with epilepsy compared to healthy controls. This increase was more pronounced in the drug-resistant epilepsy group, suggesting a potential role for ghrelin in drug-resistant epilepsy. While no direct correlation was found between ghrelin and the inflammatory markers, we observed that ghrelin levels rose significantly when levels of IL1R1, IL1-β, and HMGB1 surpassed their respective cut-off values in epilepsy patients. The biomarkers IL1R1 and IL1-β had the strongest discriminative potential in distinguishing patients with severe epilepsy from healthy controls. Although ghrelin was not as powerful a diagnostic marker as IL1R1 or IL1-β, it still showed moderate diagnostic value. Conclusion Ghrelin could serve as a biomarker reflecting both inflammation and drug resistance in epilepsy. It may be associated with inflammatory responses in epilepsy and could play a potential role in the pathophysiology of the disease.

Objective: This study aimed to evaluate the relationship between normal brain magnetic resonance imaging (MRI) findings and prognosis in children with focal epileptic disorder on electroencephalography (EEG) without an epileptic syndrome. Material and Methods: Data from patients aged 0-18 years, who were followed up with a diagnosis of epilepsy at the pediatric neurology clinics over the last 5 years, were retrospectively reviewed. Patients with focal epileptic disorder on EEG were selected. Those with an epileptic syndrome were excluded from the study. The patients’ demographic characteristics, seizure types, etiologies, brain MRI findings, seizure focus, treatment methods, and seizure control were analyzed. Patients were divided into two groups based on their brain MRI findings (normal and abnormal) and compared in terms of treatment resistance, number of medications, and seizure control. Results: The mean age of the 100 patients included in the study was 8±4.32 years, with an equal gender distribution (50% female, 50% male). Generalized seizures were observed in 72% of patients, while 28% had focal seizures. Seizure freedom was achieved in 60% of cases, and treatment resistance was noted in 23%. Cranial MRI revealed structural abnormalities in 67% of patients, with the majority (84%) showing sequelae-related changes, including hypoxic-ischemic sequelae (16%), encephalomalacia (12%), and structural malformations (10%). Although treatment resistance (28.8% vs. 12.1%) was higher and seizure freedom (56.7% vs. 66.7%) was lower in patients with abnormal MRI findings compared to those with normal MRI, these differences were not statistically significant (p =0.150 and p=0.310 respectively) . However, perinatal (p=0.013) and postnatal complications (p=0.042) were significantly more frequent in patients with abnormal MRI findings. Conclusion: In children with focal epileptic disorder on EEG, normal brain MRI findings do not predict a better prognosis in terms of seizure control and treatment resistance. Other factors affecting treatment resistance in this population need to be investigated in more detail.

To investigate the histologic effects of topiramate (TPM), lamotrigine (LTG), levetiracetam (LEV), lacosamide (LCM), clobazam (CLB), and zonisamide (ZNS) on rat bone. Seventy male Wistar-Albino rats (aged 21-24 days) were divided into 7 experimental groups with 10 rats each:(i) Control group, (ii) TPM group (40 mg/kg/day), (iii) LTG group (10 mg/kg/day), (iv) LEV group (200 mg/kg/day), (v) LCM group (30 mg/kg/day), (vi) CLB group (50 mg/kg/day), and (vii) ZNS group (100 mg/kg/day). All the drugs were administered by gavage for 90 days.The specimens were analyzed using apoptosis (TUNEL) and immunohistochemical staining. The number of osteoblasts and the thickness of femoral compact bone decreased significantly in TPM, LTG, LEV, LCM, CLB, and ZNS groups. The number of TUNEL-positive cells was higher in all experimental groups compared to the control group, and this difference was statistically significant in CLB and ZNS groups (p < 0.001 for both). The HSCORE increased significantly for caspase-3, caspase-9, and Bcl-2-associated X protein (BAX) immunohistochemical staining (p < 0.001) and increased significantly in TPM, LTG, LEV, LCM, CLB, and ZNS groups (p < 0.001). In summary, the use of antiseizure medications adversely affected the expression of proteins critical to bone physiology in young non-epileptic rats, with varying degrees of impact.

Objective: This study aimed to evaluate the relationship between mid-upper arm circumference (MUAC) and quality of life in children with cerebral palsy (CP). Material and Methods: A total of 99 children aged 2–18 years with a diagnosis of CP were included in the study. Nutritional status and quality of life were assessed using anthropometric measurements and the Pediatric Quality of Life Inventory (PedsQL 3.0 CP Module). Results: This study revealed that mid-upper arm circumference (MUAC) is a reliable indicator not only of nutritional status but also of quality of life in children with cerebral palsy. Anthropometric parameters such as height, weight, MUAC, thigh circumference, and arm length were significantly lower in children with feeding difficulties (p<0.001). MUAC was strongly and positively correlated with total PedsQL scores (r=0.988, p<0.001), indicating a robust association between nutritional status and perceived quality of life. Additionally, as GMFCS level increased, indicating more severe motor impairment, both growth metrics and quality of life scores declined. Conclusion: MUAC measurement reflects both malnutrition and quality of life in children with CP. Routine clinical use of this parameter in follow-up is recommended.

Introduction: Thisstudyaimsto investigatethe clinical and electroencephalographic characteristics of children diagnosed with SeLECTS (Self-limited epilepsy with centrotemporal spikes), comparing the effectiveness of antiseizure medications (ASMs) based on the presence or absence of Attention Deficit Hyperactivity Disorder (ADHD), and evaluating the prognostic value of the spike-wave index (SWI). Materials and Methods: A retrospective review was conducted on 914 children diagnosed with SeLECTS between 2005-2023. A total of 542 patients who met the inclusion criteria were followed for a minimum of three years with at least three EEG recordings. SWI values were analyzed according to the type of ASM valproic acid (VPA), carbamazepine (CBZ), and levetiracetam (LEV), ADHD status, and age. The predictive power of SWI for EEG improvement and seizure control was assessed using ROC curve analysis. Results: The mean age was 8.18 +/- 3.35 years; the male-to-female ratio was 1.47:1. Onset before age five was associated with more frequent seizures (p=0.003). VPA was more effective for EEG improvement, while LEV provided better seizure control. SWI was significantly higher in children with ADHD. SWI values decreased over time. ADHD prevalence was 19.9%. Conclusion: SWI is a valuable tool for assessing treatment response. Epilepsy burden is higher in patients with ADHD. VPA is superior in EEG normalization, whereas LEV offers more effective seizure control.

OBJECTIVES:Hyponatremia is a frequent electrolyte disturbance that increases seizure susceptibility and may aggravate neuronal injury. Brain-derived neurotrophic factor (BDNF) is a neurotrophin critical for hippocampal function, yet the relationship between hyponatremia, seizures, and hippocampal BDNF expression remains unclear. This study aimed to investigate the effects of acute and chronic hyponatremia, with and without seizures, on hippocampal integrity in rats using immunohistochemistry and electron microscopy. METHODS:Forty-two male Wistar Albino rats were randomly assigned to six groups (n = 7/group): acute hyponatremia, acute hyponatremia + seizures, chronic hyponatremia, chronic hyponatremia + seizures, normonatremic controls, and normonatremic controls + seizures. Hyponatremia was induced by vasopressin and glucose water administration, and seizures were triggered with kainic acid. Plasma sodium levels, seizure onset/duration, BDNF expression, and ultrastructural damage were evaluated. RESULTS:Plasma sodium concentrations were significantly reduced in hyponatremic groups compared with controls (acute: 126.1 ± 3.8; chronic: 121.8 ± 4.3; normonatremic: 135.5 ± 2.3 mEq/L; p < 0.001). Seizures were longer and more severe in chronic hyponatremia + seizure rats compared with acute hyponatremia + seizure rats (p < 0.001). BDNF expression was significantly decreased in both acute and chronic hyponatremia groups relative to controls, with the lowest values in chronic hyponatremia + seizure rats (p < 0.05). Electron microscopy revealed marked ultrastructural injury, including myelin detachment, mitochondrial swelling, and vacuolization, most pronounced in chronic hyponatremia + seizure animals. CONCLUSIONS:Hyponatremia, particularly in its chronic form, exacerbates seizure-induced hippocampal injury, reflected by reduced BDNF expression and severe ultrastructural damage. These findings provide novel preclinical evidence linking sodium imbalance to hippocampal vulnerability and highlight the need for further mechanistic and translational studies.

Background: There is no certain validated electroencephalographic (EEG) parameters for outcome prediction in children with self-limited epilepsy with centrotemporal spikes. To assess the effectiveness of antiseizure medication (ASM) for seizure outcome with respect to the spike-wave index (SWI) on serial EEG recordings. Methods: In this multicenter study, the study cohort consisted of 604 children with self-limited epilepsy with centrotemporal spikes. A data set of epilepsy centers follow-up between 2010 and 2022. The cohort was divided into 4 groups as those receiving 3 different monotherapy (carbamazepine [CBZ]/valproic acid [VPA]/levetiracetam [LEV]) and dual therapy. SWI analysis was performed with the percent of spikes in the 2-minute epoch in the 5th 6th minutes of the nonrapid eye movement sleep EEG record. The study group were also categorized according to seizure burden with seizure frequency (I) >2 seizures and (II) >5 seizures. Seizure outcome was evaluated based on the reduction in seizure frequency over 6-month periods: (1) 50% reduction and (2) seizure-free (complete response). Results: ASM monotherapy was achieved in 74.5% children with VPA, CBZ, and LEV with similar rates of 85.8%, 85.7%, and 77.9%. Dual therapy was need in the 25.5% of children with SeLECT. More dual therapy was administered in children aged below 5 years with a rate of 46.2%. Earlier seizure-free achievement time was seen in children with LEV monotherapy with more complete-response rate (86.7%) compared the VPA and CBZ. Conclusions: We also determined that the children on dual therapy had more SWI clearance in the subsequent EEG recordings. The ROC curve analyses were performed to predict initial drug selection with using the SWI% might be used for the prediction of ASM type and drug selection in children. (c) 2023 Elsevier Inc. All rights reserved.

Background Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with numerous etiologies, mostly characterized by magnetic resonance imaging (MRI) abnormalities in the posterior cerebral white and gray matter and acute neurological symptoms. Aim To examine the predisposing factors, clinical results, and radiological features of PRES in children diagnosed with malignancy. Materials and Methods The study included 20 patients (7 F/13 M) aged 4-16 years at the time of diagnosis who were diagnosed with malignancy and developed PRES during chemotherapy. Results All the patients were diagnosed as having PRES both clinically and radiographically during chemotherapy. The time from the initiation of the chemotherapy to the onset of PRES ranged from 7-675 days. Hypertension was detected in nine patients, seizure was the most common presenting symptom - had involvement in the occipital and parietal lobes on MRI (n=14)/followed by headache (n=8)/altered consciousness (n=5)/visual impairment (n=4). Hydrocephalus and tentorial herniation were observed in one patient. Most of the lesions on MRI resolved within 10-33 days and the EEG findings within 9 months. Clinical symptoms of PRES also disappeared completely the 5-year Press frequency was found to be 2.48%. Conclusion PRES may complicate the oncological treatment in children. Hypertension is a leading risk factor for PRES, while it should be kept in mind that the blood pressure may be normal in chemotherapy-induced PRES cases. PRES should be included in the differential diagnosis of all patients receiving chemotherapy and presenting with acute neurological symptoms.

Objective: Moyamoya disease is a rare progressive cerebrovascular disorder. It is characterized by progressive stenosis in the terminal branches of the internal carotid arteries, leading to the formation of an abnormal vascular network. The aim of this study was to present the clinical findings and outcomes of pediatric patients diagnosed with Moyamoya disease by analyzing our cohort to identify the common clinical presentations, diagnostic challenges, and treatment outcomes associated with this rare cerebrovascular disorder. Material and Methods: Nine pediatric cases of Moyamoya disease admitted over a 10-year period were retrospectively reviewed. Clinical presentations, associated diseases, radiological findings, treatments, and outcomes were analyzed. Results: The median age at diagnosis was 48 months (3-87). Presenting symptoms included hemiparesis in five patients, seizures in six patients, headache in one patient, and choreathetosis with headache in one patient. Three patients experienced symptoms triggered by fever, and one patient by exposure to hot water. Seven patients presented with ischemic symptoms, while two presented with non-ischemic symptoms. Neurofibromatosis type-1 (NF-1) was associated with the disease in four patients. Recurrent attacks occurred in two patients. Interictal electroencephalograms (EEGs) showed hemispheric/focal slowing in five cases. Cranial magnetic resonance imaging (MRI) revealed infarctions in seven patients, and MR angiography showed bilateral findings in six patients. Two patients experienced no long-term sequelae. Conclusion: Moyamoya disease manifests with both ischemic and non-ischemic symptoms. Recognition of non-ischemic presentations requires a high index of suspicion for accurate diagnosis.

Coronavirus pandemic has become one of the most important illness affecting all over the world and causing the death of millions of people. Because it started at the end of 2019 it named as coronavirus disease-2019 (COVID-19). Multisystem inflammatory syndrome in children (MIS-C), which is a new disease definition, that has emerged as a result of the COVID-19 pandemic. Although it is known that MIS-C causes many different symptoms, our knowledge will increase exponentially as more articles and case reports continue to published to the literature. Although MIS-C affects many systems, various neurological involvement has also been reported. But, according to literature, no case with hemiparesis in MIS-C has been reported so far. To the best of our knowledge this is the case presenting with hemiparesis without intracranial pathology in the diagnosis of MIS-C.