Epilepsy is one of the major neurological disorders affecting millions of people worldwide, with significant variations in incidence and prevalence across different regions. This study focuses on the epidemiological trends of idiopathic epilepsy in Central Asia, a region characterized by a long process of healthcare system transformation and socioeconomic conditions after the collapse of the Soviet Union. Understanding these trends is crucial for developing effective public health strategies tailored to the unique needs of the population. GBD 2021 data were analyzed for 9 Central Asian countries (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, Mongolia), identifying trends in incidence, prevalence, mortality, and disability-adjusted life years associated with idiopathic epilepsy from 1990-2021. The average annual percentage change (AAPC) was determined to compare regional and global trends. The data were disaggregated by country, year, age, and sex to identify demographic patterns. In 2021, the highest prevalence of idiopathic epilepsy was in Uzbekistan (473 per 100,000; 95 % UI: 140.1-761.1), while Armenia had the lowest (291.3; 95 % UI: 94.8-486.1). Incidence decreased across most countries, with Tajikistan showing a significant decline (AAPC:0.89 %; 95 % CI:0.98 to -0.8). Mortality was highest in Tajikistan (4.6; 95 % UI: 3.4-6.1) and lowest in Armenia (0.9; 95 % UI: 0.7-1.1). DALYs were highest in Tajikistan (422.7; 95 % UI: 284.1-591.7) and lowest in Armenia (118.8; 95 % UI: 57.4-204.9). Most trends were declining, except for Turkmenistan, which showed increases in prevalence and DALYs. The sex-specific estimates are consistently greater in the male population across all the metrics. Central Asia has demonstrated promising downward trends in the burden of epilepsy; however, challenges persist in some countries. This study underscores the urgent need for local data generation, robust registries, and tailored policies to improve care for people with epilepsy in the region.

Background and Objectives: Evidence on epilepsy surgery from Central Asia is limited, reflecting the real-world challenges of developing this service in low- and middle-income settings. We evaluated one-year seizure outcomes after resective surgery for drug-resistant focal epilepsy at a single center in Kazakhstan, and we assessed whether the use of advanced presurgical imaging was associated with seizure freedom. Materials and Methods: A retrospective cohort study was conducted, including consecutive adults who underwent curative-intent resective epilepsy surgery from 2017 to 2023. Outcomes at 12 months or more post-surgery were classified using the Engel criteria. Logistic regression was used to examine associations between the advanced presurgical diagnostic tool and achieving an Engel class I outcome. Crude and adjusted risk ratios (RRs) for not achieving Engel I were estimated using modified Poisson regression with robust SEs. Results: Among 112 patients (median age 31 years; median epilepsy duration 19 years), 76% underwent temporal lobe procedures and 71% had lobectomies. At one year, 74 patients were seizure-free (Engel II: 15.2%, III: 11.6%, IV: 7.1%). Year-to-year Engel I rates varied without a significant linear trend from 2018 to 2023. In bivariable analyses, MRI-defined atrophy (RR, 3.14) and mixed lesions (RR, 2.62) were associated with a higher risk of not achieving Engel I, whereas longer epilepsy duration was linked to a lower risk (RR, 0.97 per year). In adjusted models, predictors of not achieving Engel I included generalized tonic–clonic seizures (aRR, 1.96), atrophy (aRR, 2.98), mixed lesions (aRR, 2.45), and undergoing any advanced diagnostic test (aRR, 3.38). Longer epilepsy durations remained protective (aRR 0.95 per year). In modality-specific logistic models, fMRI use was associated with higher odds of Engel I (aOR 3.39), and MR spectroscopy was associated with lower odds (aOR 0.33). Conclusions: In this Central Asian single-center cohort, about two-thirds of adults achieved complete seizure freedom one year after resective surgery—comparable to international benchmarks. Advanced imaging modalities showed divergent associations with outcomes, likely reflecting confounding by indication. These findings support the feasibility of effective epilepsy surgery in a low-resource context and the value of targeted use of advanced imaging.

Background Epilepsy is a chronic neurological disorder affecting millions worldwide, with a particularly high burden in low- and middle-income countries (LMICs). In Kazakhstan, a middle-income country, the epidemiological situation regarding pediatric epilepsy remains underexplored, especially in terms of treatment availability and healthcare resources. Objective This study aimed to assess the regional distribution of epilepsy prevalence and the availability of healthcare resources for pediatric epilepsy patients across Kazakhstan. Methods Using secondary data collected from regional healthcare reports 2023, we analyzed the prevalence of epilepsy, the distribution of epilepsy forms, the availability of pediatric neurologists, and the provision of antiepileptic drugs (AEDs) across 16 regions. Results We found significant regional disparities in epilepsy prevalence, ranging from 54.20 to 4,263.86 per 100,000 population, with the highest prevalence in the Zhambyl and Almaty regions. The availability of pediatric neurologists varied widely, from as few as 2 specialists in some regions to 156 in Almaty. Carbamazepine and valproic acid were the most widely available AEDs, but there were gaps in the provision of other drugs, such as Diazepam and Oxcarbazepine. Conclusion Our findings highlight critical gaps in healthcare infrastructure and access to treatment, particularly in rural regions, which may contribute to the high treatment gap for epilepsy in Kazakhstan. The study underscores the need for targeted healthcare interventions, increased resources for pediatric epilepsy care, and policy initiatives to address regional disparities in treatment and diagnostic services.

Background/Objectives: Epilepsy is a major neurological disorder associated with significant comorbidity and treatment challenges. In low- and middle-income countries, access to newer antiseizure medications (ASMs) remains limited, and prescription patterns often rely on older agents. This study aimed to characterize national prescribing patterns of ASMs among patients with epilepsy in Kazakhstan from 2021 to 2023. Methods: We conducted a retrospective observational study using de-identified electronic health record data from the Unified National Electronic Health System of Kazakhstan. All patients with an ICD-10 diagnosis of epilepsy (G40) and at least one ASM prescription during 2021–2023 were included. Prescription frequencies, therapy type, and chronic polytherapy levels were analyzed. Associations between therapy type, age, and comorbidity status were determined. Results: A total of 54,274 patients were identified (median age 42 years; interquartile range (IQR) 31–57). Monotherapy predominated: 61.7% remained on monotherapy, 18.5% remained on polytherapy, and 19.8% had mixed exposure. Carbamazepine and valproic acid were most frequently prescribed (64.3% and 45.6% of patients, respectively). Among those with chronic medication data (n = 15,752), nervous-system drugs were common (70.1%), led by psycholeptics (49.7%); frequently dispensed agents included chlorpromazine (n = 5991), clozapine (n = 1875), and risperidone (n = 1642). Cardiovascular agents were recorded in 37.2% (acetylsalicylic acid n = 4056; atorvastatin n = 2235), and diabetes drugs in 12.1% (metformin n = 1430). Conclusions: Epilepsy treatment in Kazakhstan remains dominated by older broad-spectrum ASMs, while the use of lamotrigine and levetiracetam is steadily increasing. The frequent co-prescription of psychotropic and cardiometabolic drugs underscores the need for coordinated, multidisciplinary care and continued monitoring of prescribing patterns to enhance treatment safety and effectiveness.

Background/Objectives: Epilepsy is a major neurological disorder associated with significant comorbidity and treatment challenges. In low- and middle-income countries, access to newer antiseizure medications remains limited, and prescription patterns often rely on older agents. This study aimed to characterize national prescribing patterns of antiepileptic drugs (AEDs), assess monotherapy versus polytherapy use, and examine comorbid medication profiles among patients with epilepsy in Kazakhstan from 2021 to 2023. Methods: We conducted a retrospective observational study using de-identified electronic health record data from the Unified National Electronic Health System of Kazakhstan. All patients with an ICD-10 diagnosis of epilepsy (G40) and at least one AED prescription during 2021–2023 were included. Prescription frequencies, therapy type, and chronic polytherapy levels were analyzed. Non-AED medications were categorized using the WHO ATC classification, and the most common comorbid drugs were identified. Associations between therapy type, age, and comorbidity status were determined. Results: A total of 54,274 patients were identified (median age 42 years; IQR 31–57). Monotherapy predominated: 61.7% remained on monotherapy, 18.5% remained on polytherapy, and 19.8% had mixed exposure. Overall, 12.3% escalated from monotherapy to polytherapy and 11.3% de-escalated from polytherapy to monotherapy. Carbamazepine and valproic acid were most frequently prescribed (64.3% and 45.6% of patients, respectively). Lamotrigine (20.4%) and levetiracetam (15.2%) showed year-on-year increases, topiramate was stable (8.8%), and oxcarbazepine remained infrequent but rose from a low baseline (2.4%). Among those with chronic medication data (n=15,752), nervous-system drugs were common (70.1%), led by psycholeptics (49.7%); frequently dispensed agents included chlorpromazine (n=5,991), clozapine (n=1,875), and risperidone (n=1,642). Cardiovascular agents were recorded in 37.2% (acetylsalicylic acid n=4,056; atorvastatin n=2,235), and diabetes drugs in 12.1% (metformin n=1,430). Conclusions: AED prescribing in Kazakhstan is dominated by older broad-spectrum agents, with increasing uptake of lamotrigine and levetiracetam. High monotherapy rates align with guideline-concordant care, whereas escalation and de-escalation patterns reflect the dynamic management of refractory disease. The frequent use of psychotropic and cardiometabolic medicines highlights the need for integrated, multidisciplinary care and ongoing surveillance of prescribing to optimize safety and effectiveness.

This exploratory study aims to explore whether a calm and safe environment, minimal external stimuli, and neutral behavior of bystanders and medical personnel may contribute to shorter functional seizure (FS) duration. This exploratory study included adults with documented-FS first diagnosed between December 2024 and August 2025. During seizures, only observation or minimal intervention to prevent harm was performed; no external stimuli (e.g., physical contact, manipulations, or forced head or body turning) were applied. Demographic and seizure-related data, healthcare utilization in the three months before diagnosis, and prospective 3-month follow-up data on seizure occurrence, duration, Emergency Medical Services (EMS) calls, and hospitalizations were collected. Twenty-one patients with documented-FS were included. Hypermotor seizures were the most frequent subtype, observed in 12 patients (57%). Headache, often migraine, was reported as a common trigger for seizures by 67%. The most frequently reported actions prior EMU were turning the patient onto their side (to presumably protect the airway), which was done in 18 patients (85.7%), and massaging or shaking the limbs/body to "stimulate" the patient, reported in 17 patients (81%), splash water (11 patients, 52.4%), restraining the patient's movements occurred in 10 patients (47.6%).The median reported duration of a typical seizure was 20 min (IQR 11.5-40 min) decreased to approximately 7 min (IQR 4-10 min), and to 8 min (IQR 5-10 min) post-Epilepsy Monitoring Unit (EMU) period. Patients frequently contacted EMS in response to their seizures, with a median of 11 calls (IQR 8-24), EMS calls by relatives (familiar with the diagnosis) dropped to 0 (IQR 0-1). In this exploratory study, FS recorded under calm, non-intervening conditions in the EMU were consistently shorter than patients' habitual seizures, and diagnosis combined with structured counseling was associated with marked reductions in emergency service use and hospitalizations.