Background and Objectives: Infantile spasms (ISs), or West syndrome (WS), represent an early-onset epileptic encephalopathy in which diverse structural, genetic, metabolic, infectious, and neurocutaneous conditions converge on a shared pattern of hypsarrhythmia, clustered spasms, and later developmental impairment. Growing use of genomic diagnostics has revealed that variants in STXBP1, KCNQ2, GRIN2A, GRIN2B, and TSC-related genes are more common than previously recognized and can be linked to partially actionable pathways. This review aimed to synthesize current evidence on the multifactorial etiology, network-based pathogenesis, and evolving targeted therapies for ISs, with particular attention to TSC-related forms. Materials and Methods: A structured narrative review was undertaken of publications from 1990 to 2025 in PubMed, Scopus, Web of Science, and Embase using terms related to ISs, WS, genetics, mTOR, ACTH, vigabatrin, ketogenic diet, and precision therapies. Authoritative guidance from ILAE and AAN was incorporated. Clinical, molecular, and therapeutic data were grouped under etiological, pathogenetic, and management domains. Results: Structural causes remained the largest group, but combined genetic, genetic–structural, and metabolic etiologies accounted for about one third of contemporary cohorts. Early network disruption involving cortex, thalamus, basal ganglia, and brainstem, together with imbalances in NGF, BDNF, and IGF-1, explained why distinct primary insults produce a uniform electroclinical phenotype. Early treatment with ACTH or high dose prednisolone, with or without vigabatrin, was consistently associated with higher electroclinical remission and better developmental outcome. Everolimus and related mTOR inhibitors showed benefit in TSC-associated ISs, while agents directed at NMDA receptors or KCNQ channels are emerging for genotype defined subgroups. Conclusions: ISs should be approached as a heterogeneous but mechanistically convergent disorder in which rapid diagnosis, parallel genetic testing, and early disease modifying therapy improve prognosis. Integration of molecular profiling with standardized outcome monitoring is likely to move management from symptomatic seizure control to pathway-specific intervention.

The objective was to demonstrate the possibility of performing awake craniotomy in a child.Materials and methods. The 9-year-old child with a dysembrioplastic neuroepithelial tumor in the left temporal lobe was planned and performed awake craniotomy. During awakening, the child performed a naming test, object designation tests, word repetition and spontaneous speech, and Luria’s test.Results. During psychological tests and intraoperative neuromonitoring, it was possible to successfully identify the speech zone and motor areas of the face, which helped to safely remove brain formation without complications. This clinical case was also interesting because the child’s native language was Kazakh, so an interpreter was presented during the intraoperative awakening.Conclusions. The case demonstrates the possibility of performing awake craniotomy in a child, which depends not only on the somatic and psychological state, but also on the professionalism of the operating team, including surgeons, anesthesiologists, neurophysiologist, neuropsychologist and a large number of nursing staff who are able to clearly interact with each other.

Introduction. Selective dorsal rhizotomy is an evidence-based surgical method for the management of spasticity in cerebral palsy, now widely adopted in international clinical practice. In Kazakhstan, the medical technology "Selective Dorsal Rhizotomy for Spastic Syndrome" was officially approved by the Ministry of Health in 2017; however, the use of this method remains limited. Aim of the study — to analyse the clinical and demographic characteristics, as well as the features of early postoperative rehabilitation, in patients with cerebral palsy who had undergone selective dorsal rhizotomy. Objective. To analyse the clinical and demographic characteristics of patients with cerebral palsy who underwent selective dorsal rhizotomy and to evaluate the features of early postoperative rehabilitation. Methods. A retrospective single-centre observational study was conducted using archival medical records of patients with cerebral palsy who underwent selective dorsal rhizotomy between 2020 and 2025. Demographic characteristics, clinical variables, perioperative data, and early rehabilitation strategies were analysed. Statistical analysis was performed using Python 3.10. Descriptive statistics, the Mann–Whitney U test, Fisher's exact test, and Spearman's rank correlation coefficient were applied. Results. Most patients were classified as Gross Motor Function Classification System levels III–IV and underwent surgery during primary or middle school age. The postoperative course was favourable, with a low incidence of surgical complications and only transient neurological deficits related to the surgical intervention. Early rehabilitation was implemented in all patients and consisted predominantly of physiotherapy procedures combined with therapeutic massage. However, rehabilitation programmes demonstrated limited individualisation according to functional status and showed minimal variation between Gross Motor Function Classification System subgroups. Conclusion. The accumulated national experience demonstrates that SDR can be performed safely and effectively in Kazakhstan. The relatively low number of procedures is likely associated with limited awareness of the technique among healthcare professionals and families, as well as insufficient continuity of care between outpatient and inpatient services. Optimisation of patient referral pathways, multidisciplinary collaboration, and alignment of early rehabilitation protocols with contemporary international recommendations may improve access to SDR and postoperative functional outcomes. Keywords: rhizotomy, cerebral palsy, muscle spasticity, rehabilitation, neurosurgery.

BACKGROUND AND IMPORTANCE: Microsurgical DREZotomy (MDT) involves lesioning the dorsal root entry zone at the cervical spinal level, carrying a potential risk of iatrogenic spinal cord injury. Misidentifying the C4 root can lead to impaired diaphragmatic contractions and respiratory compromise. This report is the first MDT procedure in our Central Asian region and introduces the simultaneous analysis of 3 ventilator waveforms—capnography, pressure time, and flow time—as a novel, rapid-response intraoperative neurophysiological monitoring for definitive C4 root identification. CLINICAL PRESENTATION: Traumatic brachial plexus avulsion is an upper limb injury resulting in severe complications such as paralysis and neuropathic pain. Patients with refractory, pharmaco-resistant pain may be candidates for cervical MDT. Intraoperative neurophysiological monitoring during MDT is beneficial because it allows for anatomical mapping from C4 to Th1 nerve roots. The C4 root should not be targeted during MDT because it is cardinal for diaphragmatic muscular activity. Three ventilation curves simultaneously displayed synchronous changes during C4 ventral root stimulation, indicative of phrenic excitation and the diaphragm's reaction against the anesthesia machine. The expected C4 ventral root responses completely aligned with the stimulation patterns observed across all 3 monitored parameters. CONCLUSION: The simplicity of this method and its high practical applicability make it valuable for identifying phrenic nerve fibers during various surgical procedures where nerve roots responsible for diaphragmatic muscle contraction may be at risk.