Suvasini Sharma

Aim: To develop the Pediatric Autoimmune encephalitis Severity Scale (PASS) using expert consensus and the Delphi process, and validate it in children with autoimmune encephalitis. Method: This prospective observational study enrolled children who underwent serial rating with PASS, the Clinical Assessment Scale in Autoimmune Encephalitis (CASE), and the modified Rankin Scale, at eight time points until 6 months of presentation. Clinical outcomes included the Pediatric Quality of Life Inventory (PedsQL) score (parent‐rated) and developmental and intellectual outcome at 6 months. Interrater agreement, internal consistency, and correlations of PASS and CASE with clinical outcomes were compared. Results: There were 361 assessments in 27 children (11 females, 16 males) with autoimmune encephalitis (15 with antibody‐negative autoimmune encephalitis, 11 with N ‐methyl‐ D ‐aspartate receptor antibody encephalitis, and one with steroid‐responsive encephalopathy associated with autoimmune thyroiditis) with a median age at onset of 4 years (interquartile range = 3 years to 6 years 5 months). There was excellent interrater agreement for PASS and CASE with comparable intraclass correlation coefficients (0.984 vs 0.983). The worst PASS score was inversely correlated with the final PedsQL score ( r = −0.42, p = 0.047). Factor analysis revealed distinct ‘cognitive and behavioural’ and ‘disinhibition and excitability’ dimensions in the PASS items. Interpretation: PASS is a severity assessment tool for autoimmune encephalitis in children and offers an alternative to adult scales, which may be difficult to use in children.

West Syndrome (WS) (alternate terms: Epileptic spasms; infantile spasms (IS), West’s Syndrome, juvenile spasms, generalized flexion epilepsy, infantile epileptic encephalopathy, infantile myoclonic...

Rationale: The ketogenic diet (KD) is a well-established therapeutic option for children with non-surgical drug-resistant epilepsy (DRE). The purpose of this study was to determine whether specific anti-seizure medications (ASM) are associated with positive seizure outcomes when used concurrently with KD. Methods: This was a retrospective chart review of children with DRE treated with KD at the Hospital for Sick Children from Jan 2011 to Feb 2022. Data included demographics, epilepsy etiology, seizure type, and ASM used. Children with seizure data available for at least 3 months without dose modification were enrolled. Children with ≥50% reduction in seizures from baseline were classified as responders. The effect of ASM on the efficacy of the KD was analyzed using logistic regression with two models: ASM with clinical parameters such as age, etiology, seizure types, and diet type; and the second model with ASM alone. Results: A total of 127 children (55 boys) were enrolled. In both models, 5 ASMs were found to have a statistically significant positive association with the efficacy of the ketogenic diet – lacosamide (OR 10.261 [95% CI: 1.533–68.671]), vigabatrin (5.582 [1.141–27.312]), lamotrigine (5.004 [1.423–17.601]), topiramate (3.194 [1.064–9.589]), and levetiracetam (2.895 [1.085–7.722]). No ASMs were negatively associated with seizure responder rate in either model. Conclusion: Several ASMs were positively associated with KD efficacy for seizure reduction. Given the observational design and potential confounding, these findings should be interpreted cautiously and support selecting concomitant ASM based on electro-clinical phenotype and tolerability rather than anticipated effects on KD efficacy.

Rationale: Ketogenic Diet Therapy (KDT) is an effective but complex treatment for paediatric drug‐resistant epilepsy. Access to trained dietitians limits the global use of KDT. The increasing use of artificial intelligence (AI) chatbots for health and dietary advice presents both opportunities and risks. This exploratory study evaluates the accuracy and feasibility of AI‐generated KDT plans for paediatric epilepsy. Methods: We conducted a comparative analysis of three major AI chatbots: ChatGPT, Microsoft Copilot, and Gemini. Three clinical vignettes, one for each KDT type, were created to represent common KDT diet plans: the Classic Ketogenic Diet (Classic KD), the Medium‐Chain Triglyceride (MCT) diet, and the Modified Atkins Diet (MAD). Two KDT dietitians evaluated the AI‐generated diet plans for accuracy of macronutrient calculations, appropriateness of food choices, and overall safety and feasibility. Results: All three chatbots failed to produce accurate KD plans. In the Classic KD, none of the chatbots generated menus that matched their calculated macronutrient targets, resulting in widely varying and inaccurate ketogenic ratios. For the MCT diet, the generated menus provided significantly less MCT than prescribed and failed to meet the caloric and macronutrient goals. For the MAD, the chatbots exceeded the specified net carbohydrate limits and provided inappropriate food suggestions. Conclusion: AI chatbots, in their current state, are not reliable or safe for generating KDT plans for children with epilepsy. The inaccuracies in macronutrient calculations and inappropriate food suggestions pose significant risks. This study underscores the critical need for human oversight by qualified professionals in the clinical application of AI for specialised dietary therapies.

Discussing sudden unexpected death in epilepsy (SUDEP) is difficult and sensitive for health care providers (HCPs), people with epilepsy (PwE), and caregivers. This scoping review examines the literature on SUDEP communication, focusing on need, timing, content, methods, facilitators, barriers, and outcomes. We performed a thematic analysis to identify themes that summarized the perceptions of the epilepsy community regarding key elements of SUDEP communication. We identified 66 articles that met inclusion criteria. These studies included more than 5300 HCPs and 40 000 PwE and caregivers. Caregivers and PwE felt that all PwE should receive SUDEP information. However, the majority of HCPs did not discuss SUDEP. The preferred source of information was an epilepsy specialist, but PwE also valued other HCPs with whom they have a trusted relationship. There was general agreement SUDEP should be discussed at diagnosis, but limited HCP time and training were barriers. Caregivers and PwE overwhelmingly wanted information about SUDEP. Greater education and training about SUDEP for HCP may facilitate communication. Fear of causing distress was the primary barrier to SUDEP communication. However, these concerns, although valid, were often exaggerated. Even in studies that found negative emotional responses to learning about SUDEP, participants regularly reported that the benefits of knowing outweighed the short‐term consequences.