Pub Date : 2026-02-01Epub Date: 2024-09-19DOI: 10.1016/j.seizure.2024.09.012
Mary Nyakato, Shubaya Kasule Naggayi, Pamela Rosemary Akun, Sam Ononge, Alfred Odong, Erias Adams Baguma, Hellen Nansiiro, Dennis Kalibbala, Simple Ouma, Innocent Besigye, Richard Idro
Introduction: Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.
Objectives: The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.
Methods: A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.
Results: Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.
Conclusion: Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.
简介点头综合征（NS）是一种在儿童中发病的严重神经系统疾病，人们对其了解甚少。在乌干达，一些 NS 病例已成长为有生育能力的成年人。患有 NS 的母亲所生的婴儿可能容易出现神经发育障碍。患有 NS 的母亲在认知方面的缺陷可能会进一步影响对其子女的照顾，从而影响神经认知发育、身体发育和行为：本研究旨在确定母亲患有点头综合征的儿童在神经发育、行为、营养和身体发育方面的结果：2021 年 5 月至 2022 年 4 月在乌干达北部进行了一项横断面比较研究。母亲患有点头综合征的 0-5 岁儿童与母亲未患有点头综合征的 0-5 岁儿童进行了比较，两者的年龄、性别和居住地相匹配。采用标准化方法对神经发育、行为、营养和身体发育情况进行评估，并采用 t 检验对结果进行分组比较：共有 106 名儿童参加了研究。53名儿童的母亲患有NS，53名儿童的母亲未患有NS；他们的平均年龄分别为26.9（2.22）个月和27.5（2.12）个月。母亲患有 NS 的儿童在精细运动（37.5(12.1) vs 44.2(14.3)，P = 0.011）、接受性语言（37.8（10.8） vs 43.9（12.9），p = 0.010）、整体认知发展（74.36（17.8） vs 83.34（19.6），p = 0.015）和注意力（0.64（0.20） vs 0.76（0.15），p = 0.001）。行为评分方面没有差异。母亲患有 NS 的儿童的年龄体重 z 分数（WAZ）（p = 0.003）和年龄身长/身高 z 分数（LAZ/HAZ）（p = 0.001）也明显较低；其中有 19 人（35.9%）发育不良：结论：母亲患有 NS 的儿童在神经发育、营养和体格生长方面都较差。结论：母亲患有 NS 的儿童在神经发育、营养和身体发育方面都较差，因此有必要采取干预措施来改善这些儿童的发育状况。
{"title":"Poor neurodevelopment, nutritional and physical growth outcomes among children born to mothers with nodding syndrome.","authors":"Mary Nyakato, Shubaya Kasule Naggayi, Pamela Rosemary Akun, Sam Ononge, Alfred Odong, Erias Adams Baguma, Hellen Nansiiro, Dennis Kalibbala, Simple Ouma, Innocent Besigye, Richard Idro","doi":"10.1016/j.seizure.2024.09.012","DOIUrl":"10.1016/j.seizure.2024.09.012","url":null,"abstract":"<p><strong>Introduction: </strong>Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.</p><p><strong>Objectives: </strong>The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.</p><p><strong>Methods: </strong>A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.</p><p><strong>Results: </strong>Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.</p><p><strong>Conclusion: </strong>Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":"129-133"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.seizure.2026.01.003
Alastair Snell , Jiaxin Du , Viktor Vegh , David Reutens
Background
MRI is the cornerstone for detecting and characterising focal cortical dysplasia (FCD), a leading cause of drug-resistant epilepsy. Accurate identification of FCD is critical, as MRI-positive patients have markedly better surgical and clinical outcomes. However, lesion detection can be challenging, particularly in subtle or MRI-negative cases, and a range of MRI techniques has been developed to improve diagnostic performance.
Methods
PubMed, Embase, Scopus, and Web of Science were searched up to April 2025. Diagnostic accuracy studies comparing MRI findings with histopathology or multidisciplinary consensus were retained. 68 studies satisfied eligibility; data extraction was performed, and risk of bias was assessed with QUADAS-2. Marked methodological and outcome heterogeneity precluded meta-analysis, so results were synthesised narratively.
Results
Conventional 1.5T/3T protocols incorporating 3D-T1 and FLAIR were reported to identify most type II lesions, with sensitivities of 50–91 %. At 7T, additional lesions, due partially to the characteristic “black-line” sign, were detected. Quantitative or specialised sequences and post-processing approaches enhanced detection in MRI-negative or type I/III cohorts. Across all patients, machine-learning classifiers yielded sensitivities of 74–93 % but exhibited wide-ranging specificities (34–100 %).
Conclusions
Based on these findings, a tiered diagnostic pathway is recommended: initial evaluation with standard MRI followed, when clinical suspicion persists, by high-field imaging and advanced quantitative or computational methods. Standard MRI detects most type II lesions, but advanced imaging and computational methods improve detection in MRI-negative or subtle cases; real-world implementation requires access, expertise, and standardised validation. Key limitations of the review were study heterogeneity, single-reviewer processes, and lack of consecutively case-sampled studies. The field would benefit from a multi-centre benchmark dataset of operated, histologically confirmed, seizure-free FCD patients, enabling fair head-to-head evaluation of detection methods.
背景：MRI是检测和表征局灶性皮质发育不良（FCD）的基础，FCD是耐药性癫痫的主要原因。准确识别FCD是至关重要的，因为mri阳性患者有明显更好的手术和临床结果。然而，病变检测可能具有挑战性，特别是在细微或MRI阴性的情况下，并且已经开发了一系列MRI技术来提高诊断性能。方法：检索截至2025年4月的PubMed、Embase、Scopus和Web of Science。保留了比较MRI结果与组织病理学或多学科共识的诊断准确性研究。68项研究符合资格；进行数据提取，并使用QUADAS-2评估偏倚风险。显著的方法学和结果异质性妨碍了meta分析，因此结果是叙述性综合的。结果：据报道，结合3D-T1和FLAIR的传统1.5T/3T方案可识别大多数II型病变，敏感性为50- 91%。在7T时，由于特征性的“黑线”征象，检测到额外的病变。定量或专门序列和后处理方法增强了mri阴性或I/III型队列的检测。在所有患者中，机器学习分类器的敏感性为74- 93%，但表现出广泛的特异性（34- 100%）。结论：基于这些发现，建议采用分层诊断途径：采用标准MRI进行初步评估，当临床怀疑仍然存在时，采用高场成像和先进的定量或计算方法。标准MRI可检测大多数II型病变，但先进的成像和计算方法可改善MRI阴性或细微病例的检测；现实世界的实现需要访问权限、专业知识和标准化验证。该综述的主要局限性是研究异质性、单一评价过程和缺乏连续的病例抽样研究。该领域将受益于手术、组织学证实、无癫痫发作的FCD患者的多中心基准数据集，从而能够对检测方法进行公平的正面评估。
{"title":"MRI techniques for detecting focal cortical dysplasia: A systematic review","authors":"Alastair Snell , Jiaxin Du , Viktor Vegh , David Reutens","doi":"10.1016/j.seizure.2026.01.003","DOIUrl":"10.1016/j.seizure.2026.01.003","url":null,"abstract":"<div><h3>Background</h3><div>MRI is the cornerstone for detecting and characterising focal cortical dysplasia (FCD), a leading cause of drug-resistant epilepsy. Accurate identification of FCD is critical, as MRI-positive patients have markedly better surgical and clinical outcomes. However, lesion detection can be challenging, particularly in subtle or MRI-negative cases, and a range of MRI techniques has been developed to improve diagnostic performance.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Scopus, and Web of Science were searched up to April 2025. Diagnostic accuracy studies comparing MRI findings with histopathology or multidisciplinary consensus were retained. 68 studies satisfied eligibility; data extraction was performed, and risk of bias was assessed with QUADAS-2. Marked methodological and outcome heterogeneity precluded meta-analysis, so results were synthesised narratively.</div></div><div><h3>Results</h3><div>Conventional 1.5T/3T protocols incorporating 3D-T1 and FLAIR were reported to identify most type II lesions, with sensitivities of 50–91 %. At 7T, additional lesions, due partially to the characteristic “black-line” sign, were detected. Quantitative or specialised sequences and post-processing approaches enhanced detection in MRI-negative or type I/III cohorts. Across all patients, machine-learning classifiers yielded sensitivities of 74–93 % but exhibited wide-ranging specificities (34–100 %).</div></div><div><h3>Conclusions</h3><div>Based on these findings, a tiered diagnostic pathway is recommended: initial evaluation with standard MRI followed, when clinical suspicion persists, by high-field imaging and advanced quantitative or computational methods. Standard MRI detects most type II lesions, but advanced imaging and computational methods improve detection in MRI-negative or subtle cases; real-world implementation requires access, expertise, and standardised validation. Key limitations of the review were study heterogeneity, single-reviewer processes, and lack of consecutively case-sampled studies. The field would benefit from a multi-centre benchmark dataset of operated, histologically confirmed, seizure-free FCD patients, enabling fair head-to-head evaluation of detection methods.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 56-72"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.seizure.2026.01.013
Zakariya Vansoh , Rachael Fothergill , Fiona Bell , Ria Osborne , Andy Rosser , Caitlin Wilson , Jacqueline Stephen , Richard F. Chin , National Ambulance Research Steering Group
Purpose
Childhood convulsive status epilepticus (CSE) is a time-critical emergency (incidence 17-23/100,000/yr) requiring prompt treatment to reduce morbidity and mortality. Prehospital midazolam is as safe as diazepam, but more effective. However, legal and logistical barriers limit its use by paramedics. We performed a UK-wide survey of current practice, perceived barriers, and views on intramuscular midazolam (IMMDZ) to inform service development, gauge interest in a potential ambulance-based trial of emergency treatment of childhood CSE and identify opinions to consider in trial study design.
Methods
We conducted a cross-sectional JISC Knowledge-Attitude-Practice survey of personnel across all 13 UK NHS Ambulance Services (21 May–30 June 2025). The survey captured demographics, first-line antiseizure medication (ASM) choices, operational challenges, knowledge of IMMDZ usage, and support for research.
Results
153 respondents across all 13 ambulance services (4–26/service) participated; 146 (95%) were paramedics (100 were generalist). Diazepam (by the rectal or intravenous route) was first-line ASM in nine services; buccal midazolam in three, and IMMDZ in one. 89% reported that alternative ASMs should be available to generalist paramedics. 97% supported research on IMMDZ for emergency treatment of childhood CSE. If approved, 85% thought their Trust would likely support its clinical use. Potential barriers to use included dosing uncertainty (53%), risk of respiratory depression (46%), inappropriate use (37%), and reticence of administering intramuscular medication (24%).
Conclusion
There is a need to standardize paramedic treatment of seizures in children in the UK. NHS Ambulance clinicians are supportive of investigating IMMDZ as prehospital treatment for childhood CSE.
{"title":"Prehospital management of convulsive status epilepticus in children: a knowledge, attitude and practice survey of UK ambulance service clinicians","authors":"Zakariya Vansoh , Rachael Fothergill , Fiona Bell , Ria Osborne , Andy Rosser , Caitlin Wilson , Jacqueline Stephen , Richard F. Chin , National Ambulance Research Steering Group","doi":"10.1016/j.seizure.2026.01.013","DOIUrl":"10.1016/j.seizure.2026.01.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Childhood convulsive status epilepticus (CSE) is a time-critical emergency (incidence 17-23/100,000/yr) requiring prompt treatment to reduce morbidity and mortality. Prehospital midazolam is as safe as diazepam, but more effective. However, legal and logistical barriers limit its use by paramedics. We performed a UK-wide survey of current practice, perceived barriers, and views on intramuscular midazolam (IMMDZ) to inform service development, gauge interest in a potential ambulance-based trial of emergency treatment of childhood CSE and identify opinions to consider in trial study design.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional JISC Knowledge-Attitude-Practice survey of personnel across all 13 UK NHS Ambulance Services (21 May–30 June 2025). The survey captured demographics, first-line antiseizure medication (ASM) choices, operational challenges, knowledge of IMMDZ usage, and support for research.</div></div><div><h3>Results</h3><div>153 respondents across all 13 ambulance services (4–26/service) participated; 146 (95%) were paramedics (100 were generalist). Diazepam (by the rectal or intravenous route) was first-line ASM in nine services; buccal midazolam in three, and IMMDZ in one. 89% reported that alternative ASMs should be available to generalist paramedics. 97% supported research on IMMDZ for emergency treatment of childhood CSE. If approved, 85% thought their Trust would likely support its clinical use. Potential barriers to use included dosing uncertainty (53%), risk of respiratory depression (46%), inappropriate use (37%), and reticence of administering intramuscular medication (24%).</div></div><div><h3>Conclusion</h3><div>There is a need to standardize paramedic treatment of seizures in children in the UK. NHS Ambulance clinicians are supportive of investigating IMMDZ as prehospital treatment for childhood CSE.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 73-76"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.seizure.2026.01.014
Mohammad A. Sharaf , Marwa Hosni Abdelhamed , Marwa Salah , Shaimaa Gad Ragheb Abdulbaki , Heba G.A. Ali
Objectives
Epilepsy is a common neurological disorder that can severely affect children's cognitive development and quality of life. While anti-seizure medications (ASM) are the first-line treatment, approximately 20–30% of pediatric patients experience drug-resistant epilepsy (DRE), necessitating alternative therapies. The classical ketogenic diet (CKD) and the modified Atkins diet (MAD) are two non-pharmacological interventions that have shown efficacy in reducing seizure frequency in children with DRE.
Methods
A meta-analysis included experimental and observational studies retrieved from relevant databases. It evaluated the efficacy of CKD and MAD in children with DRE. Data were extracted and analyzed using RevMan. A 3-month follow-up was used to measure all outcomes, whenever available; otherwise, the nearest reported time point was used.
Results
Eight studies were included in this meta-analysis. Both MAD and CKD were effective in treating drug-resistant epilepsy. CKD demonstrated a statistically significant advantage over MAD for achieving >50% seizure reduction (OR = 0.55, 95% CI: 0.35–0.87; P = 0.01). However, no statistically significant differences were observed between CKD and MAD for complete seizure freedom (100% reduction; OR = 0.72, 95% CI: 0.43–1.19) or >90% seizure reduction (OR = 0.87, 95% CI: 0.51–1.47). No statistically significant differences were found in lipid-related adverse effects or gastrointestinal symptoms, although MAD showed non-significant trends toward fewer cases of vomiting and constipation.
Conclusion
The CKD provides significant advantages in the management of drug-resistant epilepsy over the MAD, and CKD is more effective in reducing seizures at different levels.
{"title":"Comparative efficacy of the classical ketogenic diet and modified Atkins diet in children with drug-resistant epilepsy: A systematic review and meta-analysis","authors":"Mohammad A. Sharaf , Marwa Hosni Abdelhamed , Marwa Salah , Shaimaa Gad Ragheb Abdulbaki , Heba G.A. Ali","doi":"10.1016/j.seizure.2026.01.014","DOIUrl":"10.1016/j.seizure.2026.01.014","url":null,"abstract":"<div><h3>Objectives</h3><div>Epilepsy is a common neurological disorder that can severely affect children's cognitive development and quality of life. While anti-seizure medications (ASM) are the first-line treatment, approximately 20–30% of pediatric patients experience drug-resistant epilepsy (DRE), necessitating alternative therapies. The classical ketogenic diet (CKD) and the modified Atkins diet (MAD) are two non-pharmacological interventions that have shown efficacy in reducing seizure frequency in children with DRE.</div></div><div><h3>Methods</h3><div>A meta-analysis included experimental and observational studies retrieved from relevant databases. It evaluated the efficacy of CKD and MAD in children with DRE. Data were extracted and analyzed using RevMan. A 3-month follow-up was used to measure all outcomes, whenever available; otherwise, the nearest reported time point was used.</div></div><div><h3>Results</h3><div>Eight studies were included in this meta-analysis. Both MAD and CKD were effective in treating drug-resistant epilepsy. CKD demonstrated a statistically significant advantage over MAD for achieving >50% seizure reduction (OR = 0.55, 95% CI: 0.35–0.87; P = 0.01). However, no statistically significant differences were observed between CKD and MAD for complete seizure freedom (100% reduction; OR = 0.72, 95% CI: 0.43–1.19) or >90% seizure reduction (OR = 0.87, 95% CI: 0.51–1.47). No statistically significant differences were found in lipid-related adverse effects or gastrointestinal symptoms, although MAD showed non-significant trends toward fewer cases of vomiting and constipation.</div></div><div><h3>Conclusion</h3><div>The CKD provides significant advantages in the management of drug-resistant epilepsy over the MAD, and CKD is more effective in reducing seizures at different levels.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 77-87"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.seizure.2026.01.012
Natasha S. Carmichael , Lana YH Lai , Md Shadab Mashuk , Yang Lu , Daniela Di Basilio , Emily J Pegg , Rajiv Mohanraj
Background
Ethnic disparities in healthcare access are well-documented, but their impact on epilepsy outcomes in the UK remains unclear. We examined ethnic representation and seizure outcomes in a tertiary epilepsy clinic.
Methods
Retrospective analysis of 1,609 adults attending Manchester Centre for Clinical Neurosciences (2020–2024). Ethnic distribution was compared with census data. Logistic regression assessed associations between ethnicity and seizure freedom, adjusting for age, sex, and deprivation.
Results
Asian (6.4 %), Black (1.4 %), and Mixed (1.7 %) patients were underrepresented compared to Greater Manchester demographics (13.6 %, 4.0 %, 3.0 % respectively; all p
Conclusions
Ethnic minorities are underrepresented in this tertiary epilepsy clinic yet achieve comparable outcomes once engaged in care, indicating disparities in access rather than treatment quality. Culturally competent care delivery, community outreach, and systematic review of referral pathways are needed to ensure equitable access to specialist services.
{"title":"Ethnic Representation, Deprivation and Seizure Outcomes in a UK Tertiary Epilepsy Clinic","authors":"Natasha S. Carmichael , Lana YH Lai , Md Shadab Mashuk , Yang Lu , Daniela Di Basilio , Emily J Pegg , Rajiv Mohanraj","doi":"10.1016/j.seizure.2026.01.012","DOIUrl":"10.1016/j.seizure.2026.01.012","url":null,"abstract":"<div><h3>Background</h3><div>Ethnic disparities in healthcare access are well-documented, but their impact on epilepsy outcomes in the UK remains unclear. We examined ethnic representation and seizure outcomes in a tertiary epilepsy clinic.</div></div><div><h3>Methods</h3><div>Retrospective analysis of 1,609 adults attending Manchester Centre for Clinical Neurosciences (2020–2024). Ethnic distribution was compared with census data. Logistic regression assessed associations between ethnicity and seizure freedom, adjusting for age, sex, and deprivation.</div></div><div><h3>Results</h3><div>Asian (6.4 %), Black (1.4 %), and Mixed (1.7 %) patients were underrepresented compared to Greater Manchester demographics (13.6 %, 4.0 %, 3.0 % respectively; all p</div></div><div><h3>Conclusions</h3><div>Ethnic minorities are underrepresented in this tertiary epilepsy clinic yet achieve comparable outcomes once engaged in care, indicating disparities in access rather than treatment quality. Culturally competent care delivery, community outreach, and systematic review of referral pathways are needed to ensure equitable access to specialist services.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"Pages 88-95"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2024-05-06DOI: 10.1016/j.seizure.2024.05.001
Olivia Kamoen, Stephen Raimon Jada, Jacopo Mattia Rovarini, Gasim Abd-Elfarag, Luís-Jorge Amaral, Yak Bol, Joseph Nelson Siewe Fodjo, Robert Colebunders
Purpose: The epilepsy prevalence in Maridi County, South Sudan, in 2018 was 43.8 (95% CI: 40.9-47.0) per 1000 persons; 85.2% of the identified persons with epilepsy (PWE) met the criteria of onchocerciasis-associated epilepsy. To address this health problem, an epilepsy clinic was established at Maridi County Hospital in 2020. In August 2023, the impact of the clinic on the lives of PWE and their families was evaluated.
Methods: At the Maridi epilepsy clinic, data routinely collected by primary healthcare workers as part of patient care was reviewed. We also analyzed findings from two household surveys conducted in 2018 and 2022, which assessed the impact of the clinic on epilepsy care. Moreover, four households, each with four PWE, were visited in a high epilepsy prevalence area. PWE were examined by a neurologist, and in-depth interviews were conducted with family members.
Results: The proportion of PWE on anti-seizure medication increased by 39.7% (95%CI: 35.3-44.2) between 2018 and 2022. The proportion of PWE reporting daily seizures decreased from 27.3% in 2018 to 5.3% in 2022. Of the 754 PWE seen in the clinic in July 2023, only 17 (2.3%) reported side effects. During household visits in July 2023, 13/173 (7.5%) of the visited PWE were found without remaining anti-seizure medication. A high level of epilepsy-related stigma was observed in all visited households.
Conclusion: The Maridi epilepsy clinic positively impacted the lives of PWE in Maridi. Similar initiatives should be accessible for all PWE living in onchocerciasis-endemic areas. Evidence-based information about OAE is needed to decrease misconceptions and epilepsy-related stigma.
{"title":"Evaluating epilepsy management in an onchocerciasis-endemic area: Case of Maridi, South Sudan.","authors":"Olivia Kamoen, Stephen Raimon Jada, Jacopo Mattia Rovarini, Gasim Abd-Elfarag, Luís-Jorge Amaral, Yak Bol, Joseph Nelson Siewe Fodjo, Robert Colebunders","doi":"10.1016/j.seizure.2024.05.001","DOIUrl":"10.1016/j.seizure.2024.05.001","url":null,"abstract":"<p><strong>Purpose: </strong>The epilepsy prevalence in Maridi County, South Sudan, in 2018 was 43.8 (95% CI: 40.9-47.0) per 1000 persons; 85.2% of the identified persons with epilepsy (PWE) met the criteria of onchocerciasis-associated epilepsy. To address this health problem, an epilepsy clinic was established at Maridi County Hospital in 2020. In August 2023, the impact of the clinic on the lives of PWE and their families was evaluated.</p><p><strong>Methods: </strong>At the Maridi epilepsy clinic, data routinely collected by primary healthcare workers as part of patient care was reviewed. We also analyzed findings from two household surveys conducted in 2018 and 2022, which assessed the impact of the clinic on epilepsy care. Moreover, four households, each with four PWE, were visited in a high epilepsy prevalence area. PWE were examined by a neurologist, and in-depth interviews were conducted with family members.</p><p><strong>Results: </strong>The proportion of PWE on anti-seizure medication increased by 39.7% (95%CI: 35.3-44.2) between 2018 and 2022. The proportion of PWE reporting daily seizures decreased from 27.3% in 2018 to 5.3% in 2022. Of the 754 PWE seen in the clinic in July 2023, only 17 (2.3%) reported side effects. During household visits in July 2023, 13/173 (7.5%) of the visited PWE were found without remaining anti-seizure medication. A high level of epilepsy-related stigma was observed in all visited households.</p><p><strong>Conclusion: </strong>The Maridi epilepsy clinic positively impacted the lives of PWE in Maridi. Similar initiatives should be accessible for all PWE living in onchocerciasis-endemic areas. Evidence-based information about OAE is needed to decrease misconceptions and epilepsy-related stigma.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":"115-122"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-29DOI: 10.1016/j.seizure.2026.01.019
M Claudia Burbano, R Grace Couper, Poul H Espino, Jorge G Burneo
Objective: The potential teratogenic effects of valproic acid (VPA) have been widely discussed; however, outcomes after VPAwithdrawal in female patients are less well known. This review summarizes the evidence on switching or withdrawing VPA in people with epilepsy of childbearing potential or during pregnancy.
Methods: We searched Embase, MEDLINE, and Scopus databases in June 2025 for studies measuring outcomes including seizure frequency, side effects, or maternal/fetal complications, in females withdrawn from VPA before or during pregnancy. Reference lists were screened. Risk of bias assessments included the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and Quality Assessment Tool for Case Series Studies. Studies with comparison groups and common outcomes were included in meta-analyses.
Results: The systematic review included nine studies, and meta-analysis included three studies. Overall, 277 females who were pregnant or planning pregnancy withdrew or switched from VPA, while 2206 remained on VPA.We calculated odds ratios of tonic-clonic seizures (TCS) recurrence in females with VPA changes compared with females maintained on VPA using random-effect models. Females planning pregnancy and pregnant females withdrawn from VPA had an increased odds ratio of TCS recurrence during pregnancy (OR 1.73, 95% CI 1.06-2.84). Between 7.9% and 72.2% females withdrawn from VPA before or during pregnancy later restarted VPA.
Conclusion: Withdrawal of VPA during pregnancy had significantly higher odds ratio of TCS recurrence compared with maintenance of VPA. Evidence on fetal outcomes or maternal complications remain limited; studies with longer-term outcomes beyond pregnancy are needed.
目的：丙戊酸（VPA）的潜在致畸作用已被广泛讨论；然而，女性患者停药后的结果尚不清楚。本文综述了在育龄期或妊娠期癫痫患者中切换或停用VPA的证据。方法：我们于2025年6月检索了Embase、MEDLINE和Scopus数据库，以测量在怀孕前或怀孕期间停用VPA的女性的结局，包括癫痫发作频率、副作用或母胎并发症。筛选了参考书目。偏倚风险评估包括美国国立卫生研究院（NIH）观察性队列和横断面研究质量评估工具和病例系列研究质量评估工具。具有对照组和共同结果的研究被纳入meta分析。结果：系统评价纳入9项研究，荟萃分析纳入3项研究。总的来说，277名怀孕或计划怀孕的女性退出或切换了VPA，而2206名仍在使用VPA。我们使用随机效应模型计算了VPA改变的女性与维持VPA的女性的强直-阵挛性发作（TCS）复发的比值比。计划怀孕的女性和退出VPA的孕妇在怀孕期间TCS复发的优势比增加（OR 1.73, 95% CI 1.06-2.84）。7.9%至72.2%的女性在怀孕前或怀孕后重新开始VPA。结论：妊娠期停用VPA与维持VPA相比，TCS复发的优势比明显增高。关于胎儿结局或母体并发症的证据仍然有限；需要对怀孕后的长期结果进行研究。
{"title":"Outcomes of valproic acid withdrawal in females before or during pregnancy: A systematic review and meta-analysis.","authors":"M Claudia Burbano, R Grace Couper, Poul H Espino, Jorge G Burneo","doi":"10.1016/j.seizure.2026.01.019","DOIUrl":"10.1016/j.seizure.2026.01.019","url":null,"abstract":"<p><strong>Objective: </strong>The potential teratogenic effects of valproic acid (VPA) have been widely discussed; however, outcomes after VPAwithdrawal in female patients are less well known. This review summarizes the evidence on switching or withdrawing VPA in people with epilepsy of childbearing potential or during pregnancy.</p><p><strong>Methods: </strong>We searched Embase, MEDLINE, and Scopus databases in June 2025 for studies measuring outcomes including seizure frequency, side effects, or maternal/fetal complications, in females withdrawn from VPA before or during pregnancy. Reference lists were screened. Risk of bias assessments included the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and Quality Assessment Tool for Case Series Studies. Studies with comparison groups and common outcomes were included in meta-analyses.</p><p><strong>Results: </strong>The systematic review included nine studies, and meta-analysis included three studies. Overall, 277 females who were pregnant or planning pregnancy withdrew or switched from VPA, while 2206 remained on VPA.We calculated odds ratios of tonic-clonic seizures (TCS) recurrence in females with VPA changes compared with females maintained on VPA using random-effect models. Females planning pregnancy and pregnant females withdrawn from VPA had an increased odds ratio of TCS recurrence during pregnancy (OR 1.73, 95% CI 1.06-2.84). Between 7.9% and 72.2% females withdrawn from VPA before or during pregnancy later restarted VPA.</p><p><strong>Conclusion: </strong>Withdrawal of VPA during pregnancy had significantly higher odds ratio of TCS recurrence compared with maintenance of VPA. Evidence on fetal outcomes or maternal complications remain limited; studies with longer-term outcomes beyond pregnancy are needed.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"135 ","pages":"96-104"},"PeriodicalIF":2.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To describe the clinical profile, management, and outcomes of children with new-onset super-refractory status epilepticus (NOSRSE), and to identify predictors of survival.
METHOD
This was a retrospective observational study conducted in the Pediatric Intensive Care Unit at PGIMER, Chandigarh, India, from January 2019 to August 2024. Thirty-six children diagnosed with NORSE who progressed to super-refractory status epilepticus were included. Clinical characteristics, neurodiagnostic findings, treatment details, and outcomes were analyzed. Univariate logistic regression was used to identify predictors of survival.
RESULTS
Median age was 8 years; 63.9 % were male. No etiology was identified in 28 (77.7 %) children, autoimmune encephalitis in 5 (13.9 %) and viral encephalitis in 3 (8.3 %) children. MRI abnormalities were seen in 72.7 %, and non-convulsive seizures on EEG in 55.6 %. Seizure control was achieved in 80.6 %, and 72.2 % survived to hospital discharge. Median PCPC score improved from 5 at discharge to 3 at 6-month follow-up. Early immunotherapy (OR 0.83; 95 % CI (0.69, 0.99); p 0.04) was associated with better survival.
CONCLUSION
Despite the severity of illness, favorable outcomes were achievable. Early immunotherapy was associated with improved survival. These findings underscore the need for time-sensitive, protocolized care in pediatric NOSRSE, especially in resource-limited settings.
目的：描述新发超难治性癫痫持续状态（NOSRSE）儿童的临床概况、治疗和结局，并确定生存的预测因素。方法：这是一项回顾性观察性研究，于2019年1月至2024年8月在印度昌迪加尔的PGIMER儿科重症监护室进行。36名诊断为NORSE的儿童进展为超难治性癫痫持续状态。分析临床特征、神经诊断结果、治疗细节和结果。单变量逻辑回归用于确定生存预测因子。结果：中位年龄8岁；63.9%为男性。28例（77.7%）患儿病因不明，5例（13.9%）患儿为自身免疫性脑炎，3例（8.3%）患儿为病毒性脑炎。MRI异常占72.7%，脑电图非惊厥发作占55.6%。80.6%的患者癫痫发作得到控制，72.2%的患者存活至出院。中位PCPC评分从出院时的5分提高到随访6个月时的3分。早期免疫治疗(OR 0.83; 95% CI (0.69, 0.99)；P 0.04)与较好的生存率相关。结论：尽管病情严重，但良好的结果是可以实现的。早期免疫治疗与生存率提高有关。这些发现强调了在儿童NOSRSE中，特别是在资源有限的情况下，需要时间敏感的、协议化的护理。
{"title":"Pediatric new-onset super refractory status epilepticus: Potential of timely immunotherapy in a resource-limited PICU","authors":"Aakash Chandran Chidambaram , Jerin C Sekhar , Suresh Kumar Angurana , Karthi Nallasamy , Muralidharan Jayashree , Naveen Sankhyan , Jitendra Kumar Sahu , Renu Suthar , Arushi Gahlot Saini , Arun Bansal","doi":"10.1016/j.seizure.2026.01.021","DOIUrl":"10.1016/j.seizure.2026.01.021","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To describe the clinical profile, management, and outcomes of children with new-onset super-refractory status epilepticus (NOSRSE), and to identify predictors of survival.</div></div><div><h3>METHOD</h3><div>This was a retrospective observational study conducted in the Pediatric Intensive Care Unit at PGIMER, Chandigarh, India, from January 2019 to August 2024. Thirty-six children diagnosed with NORSE who progressed to super-refractory status epilepticus were included. Clinical characteristics, neurodiagnostic findings, treatment details, and outcomes were analyzed. Univariate logistic regression was used to identify predictors of survival.</div></div><div><h3>RESULTS</h3><div>Median age was 8 years; 63.9 % were male. No etiology was identified in 28 (77.7 %) children, autoimmune encephalitis in 5 (13.9 %) and viral encephalitis in 3 (8.3 %) children. MRI abnormalities were seen in 72.7 %, and non-convulsive seizures on EEG in 55.6 %. Seizure control was achieved in 80.6 %, and 72.2 % survived to hospital discharge. Median PCPC score improved from 5 at discharge to 3 at 6-month follow-up. Early immunotherapy (OR 0.83; 95 % CI (0.69, 0.99); p 0.04) was associated with better survival.</div></div><div><h3>CONCLUSION</h3><div>Despite the severity of illness, favorable outcomes were achievable. Early immunotherapy was associated with improved survival. These findings underscore the need for time-sensitive, protocolized care in pediatric NOSRSE, especially in resource-limited settings.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 40-45"},"PeriodicalIF":2.8,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.seizure.2026.01.020
Alex S. Aguirre , Ellen C. Broekhuizen , Daan A. Pijs , Iván Sánchez Fernández
Objective
To describe how disparities in the use of epilepsy surgery have evolved between 2004 and 2024 among children with drug-resistant epilepsy.
Methods
Retrospective descriptive study using the Pediatric Health Information System database. Outcomes were use of epilepsy surgery and time from first diagnosis of drug-resistant epilepsy to epilepsy surgery, main predictors were type of insurance, race, and ethnicity.
Results
We studied 50,953 patients with drug-resistant epilepsy (median (p25-p75) age: 8.0 (3.5–13.4) years, 54% males), of whom 7220 (14.2%) patients had at least one epilepsy surgery. The number of epilepsy surgeries per 100 person-years increased from 4.0 in 2004–2006 to 15.8 in 2022–2024. On multivariable analysis, the odds ratio (OR) of receiving epilepsy surgery for patients with private versus public insurance increased from OR: 1.50 (1.25–1.80) in 2004–2006 to OR: 1.75 (1.50–2.04) in 2022–2024; increased for White patients versus Black patients from OR: 1.35 (1.03–1.76) in 2004–2006 to OR: 2.39 (1.86–3.08) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from OR: 1.08 (0.85–1.38) in 2007–2009 (first years with the “Not Hispanic/Latino” category) to OR: 1.23 (1.01–1.51) in 2022–2024. On multivariable Cox regression analysis, the hazard ratio (HR) of receiving epilepsy surgery for patients with private insurance versus public insurance increased from HR: 1.55 (1.32–1.82) in 2004–2006 to HR: 1.92 (1.65–2.24) in 2022–2024; increased for White patients versus Black patients from HR: 1.46 (1.14–1.86) in 2004–2006 to HR: 2.67 (2.05–3.48) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from HR: 1.20 (0.96–1.51) in 2007–2009 to HR: 1.30 (1.06–1.60) in 2022–2024.
Conclusion
Despite increasing use of epilepsy surgery in pediatric patients with drug-resistant epilepsy between 2004 and 2024, disparities by type of insurance, race, and ethnicity are widening.
{"title":"Evolution of disparities in pediatric epilepsy surgery use over two decades","authors":"Alex S. Aguirre , Ellen C. Broekhuizen , Daan A. Pijs , Iván Sánchez Fernández","doi":"10.1016/j.seizure.2026.01.020","DOIUrl":"10.1016/j.seizure.2026.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>To describe how disparities in the use of epilepsy surgery have evolved between 2004 and 2024 among children with drug-resistant epilepsy.</div></div><div><h3>Methods</h3><div>Retrospective descriptive study using the Pediatric Health Information System database. Outcomes were use of epilepsy surgery and time from first diagnosis of drug-resistant epilepsy to epilepsy surgery, main predictors were type of insurance, race, and ethnicity.</div></div><div><h3>Results</h3><div>We studied 50,953 patients with drug-resistant epilepsy (median (p<sub>25</sub>-p<sub>75</sub>) age: 8.0 (3.5–13.4) years, 54% males), of whom 7220 (14.2%) patients had at least one epilepsy surgery. The number of epilepsy surgeries per 100 person-years increased from 4.0 in 2004–2006 to 15.8 in 2022–2024. On multivariable analysis, the odds ratio (OR) of receiving epilepsy surgery for patients with private versus public insurance increased from OR: 1.50 (1.25–1.80) in 2004–2006 to OR: 1.75 (1.50–2.04) in 2022–2024; increased for White patients versus Black patients from OR: 1.35 (1.03–1.76) in 2004–2006 to OR: 2.39 (1.86–3.08) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from OR: 1.08 (0.85–1.38) in 2007–2009 (first years with the “Not Hispanic/Latino” category) to OR: 1.23 (1.01–1.51) in 2022–2024. On multivariable Cox regression analysis, the hazard ratio (HR) of receiving epilepsy surgery for patients with private insurance versus public insurance increased from HR: 1.55 (1.32–1.82) in 2004–2006 to HR: 1.92 (1.65–2.24) in 2022–2024; increased for White patients versus Black patients from HR: 1.46 (1.14–1.86) in 2004–2006 to HR: 2.67 (2.05–3.48) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from HR: 1.20 (0.96–1.51) in 2007–2009 to HR: 1.30 (1.06–1.60) in 2022–2024.</div></div><div><h3>Conclusion</h3><div>Despite increasing use of epilepsy surgery in pediatric patients with drug-resistant epilepsy between 2004 and 2024, disparities by type of insurance, race, and ethnicity are widening.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 4-11"},"PeriodicalIF":2.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.seizure.2026.01.015
Oi-Wa Chan , Chun-Nun Chao , Shao-Hsuan Hsia , En-Pei Lee , Kuang-Lin Lin , Jainn-Jim Lin
{"title":"Secondary hemophagocytic lymphohistiocytosis concurrent with febrile infection-related epilepsy syndrome in a child","authors":"Oi-Wa Chan , Chun-Nun Chao , Shao-Hsuan Hsia , En-Pei Lee , Kuang-Lin Lin , Jainn-Jim Lin","doi":"10.1016/j.seizure.2026.01.015","DOIUrl":"10.1016/j.seizure.2026.01.015","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"136 ","pages":"Pages 1-3"},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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