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.

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.

Diagnosis in epilepsy depends on several distinct objectives—including interictal epileptiform discharge (IED) detection, source localisation of epileptiform activity, and seizure classification—each shaped by the underlying sensing technology. This review examines the opportunities that quantum magnetic sensing offers within this diagnostic framework, with particular emphasis on translational readiness and clinical potential. Seizure classification is included to situate the broader clinical context of epilepsy diagnostics, whereas the review of quantum sensing evidence is focused on IED detection and presurgical source localisation, the objectives for which such evidence currently exists. Magnetoencephalography (MEG) provides non-invasive source localisation that complements electroencephalography (EEG), and its clinical adoption is increasingly determined by advances in magnetic sensor technology. Optically pumped magnetometer (OPM)-based MEG represents the most clinically developed quantum sensing application, progressing from proof-of-concept in 2020 toward small-cohort clinical feasibility studies from 2022 onwards. By enabling on-scalp recordings at reduced sensor-to-brain distance, OPM-MEG improves signal amplitude and permits flexible sensor placement, with early evidence of benefit in paediatric populations and mesial temporal lobe epilepsy. However, current evidence derives from small, heterogeneous cohorts, and no prospective data yet link OPM-MEG to surgical outcomes. ⁴He-OPMs represent an early feasibility stage with IED detection comparable to superconducting quantum interference device (SQUID)-MEG in small case series; nitrogen-vacancy centres in diamond and silicon carbide divacancy magnetometry remain preclinical, constrained by a fundamental standoff-sensitivity trade-off. We conclude that OPM-MEG is best positioned as a complementary modality within established presurgical workflows, with prospective multicentre outcome studies representing the critical next step toward clinical translation.