Background: While significant progress has been made in characterizing the psycholinguistic structure of akshara-based orthographies, the neurocognitive processes underlying fluent reading in these systems remain under-examined. Objective: To delineate the child-level cognitive-motor competencies and orthographic constraints governing processing efficiency in Sinhala using a neuropsychological approach grounded in process analysis and Complex Dynamic Systems theory. Method: A sample of children and adolescents (N=96, ages 7–17) completed naming latency tasks across five conditions (e.g., inherent-vowel consonants, isolated diacritics, and perceptual manipulations) alongside a battery assessing verbal memory, phonemic fluency, category fluency, executive planning, and manipulative dexterity. Results: Findings reveal a ‘speed-accuracy paradox: while accuracy for complex glyphs is established early, naming efficiency continues to refine through adolescence. Akshara-level analysis identified a massive ‘analytical cost’ for segmentation; naming isolated diacritics was nearly four times slower than naming integrated units. Notably, manipulative dexterity remained a significant predictor for both holistic naming and segmentation. Furthermore, executive planning, correlated with fluid intelligence, uniquely predicted segmentation efficiency, suggesting that higher-order inductive reasoning facilitates the mastery of isolated diacritic sounds. Conclusion: These results suggest the akshara is a primary psychological unit, with analytical segmentation acting as a 'stress test' for executive functions. Viewed through an ‘enactive mind’ lens, Sinhala literacy is an embodied process where sensory-motor precision and executive strategy remain integral to the reading circuit long after foundational accuracy is achieved.

OBJECTIVE:Young children and infants, especially newborns, are highly susceptible to seizures, which, if undetected and untreated, can lead to severe long-term neurological consequences. Early detection typically requires continuous electroencephalography (cEEG) monitoring in hospital settings, involving costly equipment and highly trained specialists. This study presents a low-cost, active dry-contact electrode-based, adjustable electroencephalography (EEG) headset, combined with an explainable deep learning model for seizure detection from reduced-montage EEG, and a multimodal artifact removal algorithm to enhance signal quality. METHODS:EEG signals were acquired via active electrodes and processed through a custom-designed analog front end for filtering and digitization. The adjustable headset was fabricated using three-dimensional printing and laser cutting to accommodate varying head sizes. The deep learning model was trained to detect neonatal seizures in real time, and a dedicated multimodal algorithm was implemented for artifact removal while preserving seizure-relevant information. System performance was evaluated in a representative clinical setting on a pediatric patient with absence seizures, with simultaneous recordings obtained from the proposed device and a commercial wet-electrode cEEG system for comparison. RESULTS:Signals from the proposed system exhibited a correlation coefficient exceeding 0.8 with those from the commercial device. Signal-to-noise ratio analysis indicated noise mitigation performance comparable to the commercial system. The deep learning model achieved accuracy and recall improvements of 2.76% and 16.33%, respectively, over state-of-the-art approaches. The artifact removal algorithm effectively identified and eliminated noise while preserving seizure-related EEG features.

Introduction: Febrile seizures (FS) are the most common childhood seizures, categorized into simple and complex types. Simple febrile seizures (SFS), which are benign and self-limiting, account for over 70% of cases and often prompt emergency visits, sometimes leading to unnecessary investigations. Data on adherence to FS management guidelines in Sri Lanka are scarce.Objectives: To evaluate adherence to standard FS management guidelines at the Primary Care Unit (PCU), Lady Ridgeway Hospital (LRH), Colombo.Methods: A prospective clinical audit was conducted at LRH PCU from August 1-30, 2023, including 25 FS cases via convenience sampling. Data were collected by direct observation using a checklist. Parental counselling was assessed using an expert-validated eight-point guide.Results: The mean age was 2.63 years, and 56% were male. They presented due to SFS in 68% and complex FS in 32%. There were two children with febrile status epilepticus. URTIs were the most common cause of fever (56%). First-time seizures accounted for 66% of admissions. Over-investigation was observed in 65% of SFS; 9.5% of eligible patients were under-admitted. Buccal midazolam (IV preparation, off-label) was the most frequently used first line.Parental counselling was inconsistent and inadequate. It was as verbal instructions in 32% and in written form in 16%. Key educational points were incompletely addressed; epilepsy risk was never discussed. However, inappropriate prescription of intermittent prophylaxis (clobazam) was minimal.Conclusion: The audit revealed over-investigation, under-admission, and inadequate parental counselling, highlighting the need for standardized protocols and structured caregiver education.

BACKGROUND:The economic crisis in Sri Lanka in 2022-23, has had a significant impact on its healthcare system, particularly with epilepsy, a condition demanding continuous care, facing heightened vulnerability amidst this turmoil. OBJECTIVES:To assess the health impact of the economic crisis on people with epilepsy (PWE), their caregivers and healthcare providers and on the delivery of epilepsy-related healthcare services METHOD: A hospital-based cross-sectional study was conducted from June to August 2022 in the most populated province in Sri Lanka. The sample included 405 patients and their caregivers. A separate cross-sectional survey among all neurologists practicing in the national healthcare system was concurrently performed. Health outcomes were assessed by recall for before and after the economic crisis. Epilepsy control scales, mental well-being scales and questionnaires were used to measure health outcomes. Impact on healthcare services was evaluated through 1). a country-wide survey on availability of anti-seizure medication (ASM) and 2). neurologists' views on effects on healthcare services during the crisis. RESULTS:Significant shifts in health outcomes such as increase in frequency of average number of seizures experienced (p < 0.001), number of emergency admissions(p < 0.01) and greater number of breakthrough seizures(p < 0.001) was reported. Psychological distress was reported by all three categories (PWEs, caregivers and care providers). Healthcare services were affected due to shortage of ASMs and other first-line medications. Healthcare providers reported management challenges, including medication shortages and increased patient burdens. SIGNIFICANCE:The adverse impacts of the economic crisis in Sri Lanka extend to both health and epilepsy-related healthcare services. This study underscores the imperative for immediate collaborative efforts to address these challenges. FUNDING:Self-funded by the authors.

Background: Seizures are commoner in the neonatal period than any other time. Incidence of clinical seizures in term infants is around 3 per 1000 live births, whereas in preterm infants, it is as high as 57 to 130 per 1000 live births. Currently, there is no local data on this disease burden.Objectives: To determine the incidence of neonatal seizures in term and preterm babies in a birth cohort of neonates born in the premier maternity hospitals in the Colombo district.Method: A prospective follow-up was done of a birth cohort in Colombo city over a period of 3 months. All newborns born in the 2 premier maternity hospitals in the city from 1st June to 31st July 2017 were recruited. They were followed up over 28 days (neonatal period) for development of clinical seizures. All deliveries before completion of 37 weeks of gestation were considered as preterm.Results: Total number of births during this period was 2906. Number of intrauterine or neonatal deaths was eight. Number of neonatal intensive care admissions was 73. There were 2410 children followed up during the first 28 days for development of seizures (2198 term deliveries and 212 preterm deliveries). Number lost for follow up was 496. Total number of babies who developed neonatal seizures was 11 (nine term and two preterm babies). The onset of seizures was within 24 hours in 5, 1-7 days in 2 and after 7 days in 4. There were two deaths at one year follow up. The incidence of neonatal seizures in this birth cohort of children born in the two main maternity hospitals in the Colombo city was 4.5 per 1000 live births: 3.6 per 1000 for term babies and 14.1 per 1000 for pre-term babies.Conclusions: The incidence of neonatal seizures in this birth cohort was 4.5 per 1,000 live births; higher rates were observed among preterm infants. These findings indicate a higher disease burden.

Objective The objective of this study is to estimate the prevalence of cerebral palsy (CP) in the 2- to 5-year age group in a rural setting in Sri Lanka and describe the type, topography, severity, functional status of CP, and associated comorbidities.Design and Patients A population-based, cross-sectional study was conducted in the district of Ampara, which represents a typical rural setting in Sri Lanka. A house-to-house survey was performed in 60 geographically defined areas to screen 2- to 5-year-old children for motor disability or any developmental delay. Those who were positive underwent face-to-face interviews for confirmation of the diagnosis of CP. This was followed by an evaluation of the features of the CP.Results A total of 1,090 children aged 2 to 5 years were screened for CP. Among them, there were four children with confirmed CP, resulting in an overall prevalence of 3.7 per 1,000 children aged 2 to 5 years (95% confidence interval [CI]: 1.0, 9.4%). Male dominance was noted (75%). The most common single type of CP was spastic (75%). The other was of the mixed type (25%). A severe level of disability (level V) based on gross motor function and manual ability and communication function was seen in 75% of cases. The two most common comorbidities were cerebral visual impairment (75%) and epilepsy (50%). Gastrointestinal-related problems (75%) and contractures (75%) were the most common complications.Conclusion The burden of CP is relatively high among children in rural settings in Sri Lanka in comparison to reported rates in developed countries. However, these rates are comparable to reported rates from similar rural settings in other regional countries. The majority suffered from a severe degree of impairment.

J.H.C. has acted as an investigator for studies with GW Pharma/Jazz Pharmaceuticals, Zogenix/UCB Pharma, Vitaflo, Stoke Therapeutics, and Ultragenyx. She has been a speaker and on advisory boards for Jazz Pharmaceuticals, UCB, Biocodex, and Nutricia; all remuneration has been paid to her department. She holds an endowed chair at UCL Great Ormond Street Institute of Child Health; she holds grants from National Institute of Health Research (NIHR), EPSRC, GOSH Charity, ERUK, the Waterloo Foundation, and the NIHR Biomedical Research Centre at Great Ormond Street Hospital. J.W. (Jo Wilmshurst) is an associate editor for Epilepsia, chief editor of the Pediatric Neurology subsection of Frontiers in Neurology, and on the South African national advisory board for Sanofi, Novartis, and Roche. The remaining authors have no conflicts of interest. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. All important data related to the article are given within the article. Table S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Background and ObjectivesSpinal muscular atrophy (SMA) is a neurodegenerative disorder manifesting with progressive muscle weakness and atrophy. SMA type 1 used to be fatal within the first 2 years of life, but is now treatable with therapies targeting splicing modification and gene replacement. Nusinersen, risdiplam, and onasemnogene abeparvovec-xioi improve survival, motor strength, endurance, and ability to thrive, allowing many patients to potentially attain a normal life; all have been recently approved by major regulatory agencies. Although these therapies have revolutionized the world of SMA, they are associated with a high economic burden, and access to these therapies is limited in some countries. The primary objective of this study was to compare the availability and implementation of treatment of SMA from different regions of the world.MethodsIn this qualitative study, we surveyed health care providers from 21 countries regarding their experiences caring for patients with SMA. The main outcome measures were provider survey responses on newborn screening, drug availability/access, barriers to treatment, and related questions.ResultsTwenty-four providers from 21 countries with decades of experience (mean 26 years) in treating patients with SMA responded to the survey. Nusinersen was the most available therapy for SMA. Our survey showed that while genetic testing is usually available, newborn screening is still unavailable in many countries. The provider-reported treatment cost also varied between countries, and economic burden was a major barrier in treating patients with SMA.DiscussionOverall, this survey highlights the global inequality in managing patients with SMA. The spread of newborn screening is essential in ensuring improved access to care for patients with SMA. With the advancement of neurotherapeutics, more genetic diseases will soon be treatable, and addressing the global inequality in clinical care will require novel approaches to mitigate such inequality in the future.

Neonatal seizures are the most common neurological emergency in newborns; often signalling significant neurological dysfunction. Their pathophysiology is complex and relates to the imbalance between excitatory and inhibitory neurotransmitters in the immature brain. During the neonatal period, excitatory circuits mediated via neuro-transmitters like glutamate predominate while inhibitory circuits mediated via gamma-aminobutyric acid (GABA) signalling are underdeveloped. Additionally, immature ion channels, such as sodium, chloride, potassium, and calcium, increase neuronal excitability. The most common aetiology of seizures is attributed to neonatal hypoxic cerebral injury. However, metabolic vulnerabilities, such as hypoglycaemia and electrolyte imbalances, can also precipitate seizures. Identifying the underlying cause, which in a large majority is acute symptomatic, is critical for prompt treatment. Early intervention is essential to prevent long-term neurodevelopmental consequences.Diagnosing neonatal seizures is challenging due to their subtle presentations. Distinguishing them from non-seizure events is crucial. Accurate diagnosis is essential for appropriate treatment and management. Continuous electroencephalography (cEEG) is the gold standard for diagnosis, but an amplitude-integrated EEG (aEEG) is a useful alternative tool in neonatal intensive care units (NICUs), for high-risk infants. This facilitates diagnosis of electroclinical as well as electrical seizures; commonly encountered in the very sick newborns and those born prematurely. Neuroimaging, like magnetic resonance imaging (MRI) and computed tomography (CT) is required to identify structural causes, while laboratory and genetic tests check for infectious, metabolic and genetic aetiologies. The new classification proposed by the International League Against Epilepsy (ILAE), underscores the importance of recognition of electrical seizures and highlights the value of recognising the seizure semiology for the diagnosis of the underlying aetiology.

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Background and Objectives:Spinal muscular atrophy (SMA) is a neurodegenerative disorder manifesting with progressive muscle weakness and atrophy. SMA type 1 used to be fatal within the first 2 years of life, but is now treatable with therapies targeting splicing modification and gene replacement. Nusinersen, risdiplam, and onasemnogene abeparvovec-xioi improve survival, motor strength, endurance, and ability to thrive, allowing many patients to potentially attain a normal life; all have been recently approved by major regulatory agencies. Although these therapies have revolutionized the world of SMA, they are associated with a high economic burden, and access to these therapies is limited in some countries. The primary objective of this study was to compare the availability and implementation of treatment of SMA from different regions of the world.Methods:In this qualitative study, we surveyed health care providers from 21 countries regarding their experiences caring for patients with SMA. The main outcome measures were provider survey responses on newborn screening, drug availability/access, barriers to treatment, and related questions.Results:Twenty-four providers from 21 countries with decades of experience (mean 26 years) in treating patients with SMA responded to the survey. Nusinersen was the most available therapy for SMA. Our survey showed that while genetic testing is usually available, newborn screening is still unavailable in many countries. The provider-reported treatment cost also varied between countries, and economic burden was a major barrier in treating patients with SMA.Discussion:Overall, this survey highlights the global inequality in managing patients with SMA. The spread of newborn screening is essential in ensuring improved access to care for patients with SMA. With the advancement of neurotherapeutics, more genetic diseases will soon be treatable, and addressing the global inequality in clinical care will require novel approaches to mitigate such inequality in the future.

AbstractObjectivesInfantile epileptic spasm syndrome (IESS) is an epileptic encephalopathy with often devastating developmental consequences. Most children with IESS have a known etiology, although differing in proportion by geographical settings. Therefore, registries are useful to understand the characteristics of IESS in different countries. The Sri Lanka Infantile Spasms Registry (SLISR) was established to study the demographics and etiology of infants with IESS and their response to therapy in a resource‐limited country.MethodsFive pediatric neurologists (out of nine) in different parts of the country prospectively recruited children with IESS. The etiology was evaluated using the services available in each setting. Response to treatment for standard (adrenal corticotropic hormone, prednisolone, or vigabatrin) versus nonstandard medications was evaluated at two and six weeks.ResultsIncluded in the current analysis were 270 children who were registered since 2017. Median age at presentation was 5.36 months (SD 3.6). The mean interval between seizure onset and treatment onset was 1.7 months (SD 1.3). A sizable proportion of the children (61.2%) did not complete the evaluation of etiology. Structural brain abnormality was the most frequently identified etiology in those who were evaluated (38.8%); hypoxic‐ischemic injury was the most common antecedent. The majority of the patients (86%) received a recommended standard therapy as the first treatment, with prednisolone being the most frequent choice. By treatment day 14, the first treatment had achieved spasm control in 63.8% and an electro‐clinical response in 43.6%. While both standard therapies led to positive outcomes, oral prednisolone produced the best therapeutic response.ConclusionWe describe the etiologies, treatment choices, and response to first‐line medications in a large group of children with IESS from a South Asian country. Although most patients received a recommended first‐line therapy (most often prednisolone), a sizable number initially received nonstandard therapy. Our data illustrate the challenges in the management of IESS in a resource‐limited environment.

BACKGROUND: The National Epilepsy Center (NEC) in Sri Lanka was established in 2017. Seizure outcome, effects on quality of life (QOL) and surgical complications among nonpediatric patients who underwent epilepsy surgery from October 2017 to February 2023 are described. METHODS: Nineteen patients (>= 14 years) underwent epilepsy surgery at the NEC. We used Engel classification and Quality of Life in Epilepsy 31 (QOLIE-31) questionnaire to assess seizure outcome and QOL respectively. Surgical complications were categorized into neurological and complications related to surgery. RESULTS: Nine female and 10 male patients underwent surgery (mean age 27.5 years (range 14-44 years). The mean follow-up duration was 10.5 months (range 6-55 months). Twelve patients underwent temporal lobe resections. At 6-months follow-up, 83.3% (10/12) had favorable seizure outcomes with Engel class I/II. At 1-year follow-up 6/8 patients (75.0%) and at 2-year follow-up, 5/7 patients (71.4%) had a favorable outcome. Seven patients had extra-temporal lobe surgeries and one defaulted. Seizure freedom was observed in 6/6 at 6 months, 3/3 at 1-year, and 2/2 at 2-year follow-up. Five patients (26.3%) experienced minor post-operative surgical site infection. Two (11.1%) had persistent quadrantanopia. Meaningful improvement in QOL (change in QOLIE-31 score >= 11.8) was observed irrespective of seizure outcome or type of surgery (P < 0.001). CONCLUSIONS: Epilepsy surgery is effective in developing countries. Seizure outcomes in our patients are comparable to those worldwide. Clinically important QOL improvement was observed in our series. This is the first published data on epilepsy surgery outcomes in nonpediatric patients from Sri Lanka.

The primary objective of this study was to compare the availability and implementation of disease-modifying treatment for spinal muscular atrophy (SMA) from different regions of the world.