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/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.

The epidemiology of psychogenic non-epileptic seizures (PNES) is still unclear. Although approximately 14 million people need neurosurgical care annually, there is a dearth of thorough analysis on PNES occurrence following surgery. This study seeks to estimate the proportion of newly diagnosed PNES. We conducted a literature search of the PubMed, Ovid, CINAHL, and Cochrane Library databases up to December 2023. We identified studies using an observational design on the occurrence of PNES in patients who underwent intracranial surgery, and confirmed diagnosis using video-EEG. Estimates are reported as proportions using random effects models. We reported both 95 % CIs and prediction intervals (PI). We assessed the risk of bias and identified the pooled odds ratio (OR) for mutually exclusive groups. The heterogeneity was investigated using the I² statistic and significance determined using Cochran's Q-test. Post-hoc Egger's regression test, and several sensitivity analyses were performed. This study was registered in PROSPERO (CRD42023488611). Of the 1766 unique studies identified, 86 were selected for full-text review. Eight studies (n = 3,699) were eligible for inclusion. Studies, spanning from 1995 to 2017, primarily focused on epilepsy surgeries. The pooled proportion was 3 % (95 % CI 2 %-5 %; 95 % PI 0 %-11 %). Temporal resections indicated twofold increase of PNES comparing to either resections (OR 2.05, 95 %CI 0.81-5.19). The risk of bias assessment indicated satisfactory quality for included studies, and heterogeneity in estimates was mainly explained by publication year of studies and their rounded sample size. Given the estimations, there is expected impact of intracranial procedures on functional seizures epidemiology. Further efforts need to understand the contribution of brain resections to PNES incidence.

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.

Despite numerous achievements in the treatment of epilepsy, some patients continue to remain unresponsive to drug therapy. In such cases, neurosurgical treatment can become an effective way to reduce the frequency of attacks and improve the quality of life of patients. The purpose of the study: to estimate the influence of the age of the onset of the disease and the time elapsed from the onset to the operation on the effectiveness of neurosurgical intervention in patients with temporal epilepsy. Methods. 93 patients with focal temporal epilepsy took part in this retrospective study. The age of onset was studied for two groups: the group with presurgical diagnosis and the group without presurgical diagnosis. In the main group, the average age at the onset of epilepsy was 8.99 years ±9.06 years, with a minimum value of 0.083 years and a maximum value of 34 years. In the control group, the average age at the onset of epilepsy was 15.97 years ± 12.84 years, with a minimum value of 0.33 years and a maximum value of 44.5 years. Results. Differences in the distribution of causes of epilepsy can be seen by looking at the percentage distribution in each time group. For example, there were no cases of febrile convulsions in the group with a time from the debut to the operation of less than 10 years, while there were 5 cases (25.0%) in the group with a time of 30 years or more. When analyzing the time from debut to surgery (categorized) in each age group, the result of statistical analysis (p<0.001) shows that there are statistically significant differences in the distribution of time from debut to surgery between different age groups. Conclusions. Predictors of effective presurgical diagnosis in patients with temporal epilepsy, such as the age of onset of the disease, duration of epilepsy, type of seizures affect the outcome of neurosurgical intervention and their consideration will allow to determine the most effective personalized treatment strategy for each patient.

Background: Drug-resistant epilepsy can significantly impair cognitive functioning in individuals with epilepsy, adversely affecting their social, academic, occupational, and everyday functioning. Objective: To assess the relationship between executive functioning measured by Epitrack and sociodemographic and clinical factors in patients with drug-resistant epilepsy in Kazakhstan. Materials and methods: This retrospective cross-sectional study included 20 adult patients with drug-resistant epilepsy who underwent Epitrack assessment as part of presurgical evaluation at the Epilepsy Center between January and December 2025. Collected data included demographic, clinical, and sociodemographic variables. Quantitative variables with non-normal distribution were analyzed using the non-parametric Mann–Whitney U test for independent groups, with results reported as median (Q1; Q3). Statistical significance was defined as p<0.05. Results: Analysis of executive functioning based on Epitrack scores showed that a statistically significant association was found only for employment status in the significantly impaired group (p=0.043). Higher education predominated in the average group (6; 85.7%), whereas secondary education was more common in the mildly (60%) and significantly impaired groups (75%), although not statistically significant (p=0.056) but higher educational attainment was associated with better executive outcomes. Men predominated in the average executive functioning group (5; 71.4%), whereas women were more common in the mildly (3; 60%) and significantly impaired groups (5; 62.5%), with no significant differences. Unmarried patients predominated across all groups (71.4%, 60%, and 75%), without statistical significance. Conclusions: Findings indicate that executive performance, measured via Epitrack, is a key determinant of employment outcomes in Kazakhstani DRE patients. Higher scores were linked to better work status, highlighting the intersection of cognitive health, education, and quality of life. Consequently, routine neuropsychological assessment is recommended as a core component of comprehensive epilepsy care in the region. Введение: Фармакорезистентная эпилепсия может значительно ухудшать когнитивные функции у пациентов, отрицательно влияя на их социальную, учебную, профессиональную и повседневную активность. Цель: Оценить взаимосвязь исполнительных функций, измеренных с помощью Epitrack, с социодемографическими и клиническими факторами у пациентов с лекарственно-резистентной эпилепсией в Казахстане. Материалы и методы: В ретроспективное поперечное исследование включены 20 взрослых пациентов с фармакорезистентной эпилепсией, прошедших оценку по шкале Epitrack в рамках предоперационного обследования в Центре эпилепсии в период с января по декабрь 2025 года. Собраны демографические, клинические и социодемографические данные. Количественные переменные с ненормальным распределением анализировались с использованием непараметрического критерия Манна–Уитни для независимых групп, результаты представлены в виде медианы (Q1; Q3). Уровень статистической значимости принят равным p<0,05. Результаты: Анализ исполнительных функций по шкале Epitrack показал, что статистически значимая ассоциация выявлена только для статуса занятости в группе с выраженными нарушениями (p=0,043). Высшее образование преобладало в группе со средним уровнем (6; 85,7%), тогда как в группах с умеренными (60%) и выраженными нарушениями (75%) чаще встречалось среднее образование (p=0,056), при этом более высокий уровень образования был связан с лучшими исполнительными функциями. В группе со средним уровнем преобладали мужчины (5; 71,4%), тогда как в группах с умеренными (3; 60%) и выраженными нарушениями (5; 62,5%) чаще встречались женщины; различия не достигли статистической значимости. Незамужние/неженатые пациенты преобладали во всех группах (71,4%, 60% и 75%) без статистически значимых различий. Заключение: Полученные данные свидетельствуют о том, что исполнительные функции, оцененные с помощью Epitrack, являются важным фактором, связанным с трудовой занятостью у пациентов с лекарственно-резистентной эпилепсией в Казахстане. Более высокие показатели ассоциированы с лучшим трудовым статусом, что подчеркивает взаимосвязь когнитивного...