Background: Seizures in childhood absence epilepsy (CAE) are typically easily controlled with anti-seizure medications (ASMs). Factors predictive of treatment resistance remain unclear. Our objectives were to assess prevalence of neuropsychiatric problems and factors influencing treatment resistance in a cohort of CAE at a single centre. Methods: We retrospectively reviewed patients with CAE diagnosed between January 1999 and December 2016 with at least 1-year follow-up. Treatment resistance was defined as failure to respond to two appropriate ASMs. Exclusion criteria included eyelid myoclonia with absence, myoclonic absence, and generalized tonic-clonic (GTC) seizures prior to absence seizures. Results: The study population comprised 164 patients (65 males) with mean age at seizures onset of 6.1years. 21% had treatment-resistant seizures. The first ASM was Ethosuximide (63.4%), Valproic acid (23.2%), and Lamotrigine (6.7%). 32.9% of children had learning disabilities, 28.7% ADHD, and 12.8 % anxiety.

A stepwise binary logistic regression analysis identified GTC seizures, learning disability (LD) and ongoing general spike and wave on EEG as predictors of treatment resistance. At last follow-up (average of 5.4 years), 43.3% of children were seizure-free off ASMs. Conclusions: 21% of children with CAE had treatment-resistant seizures. LD, GTC and failure of normalization of the EEG were associated with treatment resistance.

Background: Greater variability of neuronal signalling, measured as the standard deviation of the blood oxygen dependent signal (BOLDSD), relates to information processing capacity. Resting-state functional magnetic resonance imaging was used to determine differences in BOLDSD between children with and without epilepsy. Methods: We studied 24 controls (mean age 8.52 ± 1.35 years) and 18 patients (mean age 11.5 ± 3.4 years) with medically refractory epilepsy that underwent imaging for preoperative planning.Standard preprocessing steps (FSL v6.0, FMRIB) were followed and AAL atlas was used. Whole-brain two sample t-tests were used for group comparisons and significance was set at p <0.05 FDR-corrected. Results: Children with epilepsy showed significantly lower BOLDSD in left inferior and middle temporal gyri (p < 0.001), right caudate nucleus (p < 0.01), cuneus (p < 0.001), and fusiform gyrus (p < 0.001), and significantly increased BOLDSD bilaterally in inferior occipital gyri (p < 0.0001). There were no significant differences when comparing whole-brain BOLDSD values. Conclusions: Neuroplastic changes in epilepsy may depend on an optimal amount of internal neural variability driven by the identified key regions. Certain temporal and occipital regions may underlie neural processing differences in children with epilepsy. Further studies may correlate these findings with behavioral testing.

Background: Effort mobilization is important in older adults to stay healthy, notably for decision-making. The process of decreasing subjective value of a reward as required effort increases is called effort discounting. By identifying underlying neural correlates related to effort discounting, we can better understand factors affecting normal cognitive aging. Methods: We acquired resting-state functional magnetic resonance images from 19 cognitively normal older adults (10 males; 66±6 years). Participants completed a computerized cognitive task—called Effort Expenditure for Rewards Task—capturing the willingness to expend effort for rewards through binary choices between high-reward-high-effort or low-reward-low-effort option to obtain varying monetary rewards. We modelled subjective value to assess the k parameter, effort discounting. A functional connectivity analysis examined the involvement of regions associated to the salience network. Results: The seed-to-voxel analysis revealed increased connectivity within the precuneus cortex and to clusters in the right temporal and posterior cingulate gyri, with increased k-value or decreased willingness to expend effort. There was also decreased connectivity between the anterior cingulate and right lateral occipital cortex, and between the left anterior insula to the cerebellum and precuneus cortex. Conclusions: The process of effort discounting is correlated to functional connectivity changes involving the precuneus, anterior cingulate, and left anterior insula in healthy older adults.

We hypothesized that children receiving medium-chain triglyceride ketogenic diet (MCTKD) experience similar seizure reduction despite lower ketosis compared with classic ketogenic diet (CKD). Children initiating CKD or MCTKD were enrolled in a prospective observational study. Forty-five children completed 6 months of KD (n = 17 MCTKD, n = 28 CKD). The proportion achieving ≥50% seizure reduction was 71% CKD group and 59% MCTKD group; ≥90% reduction was 32% and 36% in CKD and MCTKD groups, respectively. CKD had higher urine ketones (≥8 mmol/L: 79% vs. 36%, p = 0.005). Children receiving MCTKD experience similar seizure control to CKD despite lower urine ketone measures.