Epilepsy, as a common neurological disorder in childhood, requires early diagnosis and intervention that are crucial for improving disease prognosis. Although traditional techniques such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have made progress in pediatric epilepsy diagnosis and treatment, significant limitations remain in imaging-negative cases and in identifying deep lesions. Magnetoencephalography (MEG), a non-invasive neurophysiological technique with both high temporal and spatial resolution, has recently demonstrated unique advantages in localizing epileptogenic zones, analyzing functional connectivity, and identifying brain functional areas in children with epilepsy. In particular, the next-generation MEG systems based on optically pumped magnetometers (OPMs) have significantly broadened its applicability in pediatric populations. Nonetheless, practical use of OPM-MEG remains hindered by challenges such as non-standardized signal processing workflows, lack of agreement on dependable electrophysiological biomarkers, and the relatively high cost of devices. In the future, with continuous advances in multimodal integration, wearable device incorporation, and AI-assisted analysis, MEG is expected to achieve broader application in pediatric epilepsy diagnosis and treatment.
VNS can achieve a stable reduction in seizure frequency across different DRE populations, with a well-documented time-dependent cumulative therapeutic effect, while complete seizure freedom is rarely achieved in patients. Compared with low-intensity stimulation, high-intensity stimulation significantly increased the probability of achieving ≥50% seizure reduction (RR=1.73). For pediatric DRE, systematic reviews and meta-analyses revealed that approximately 55% of patients achieved significant seizure reduction (≥50%), and the overall response rate reached around 68% in DRE cases with genetic etiologies. Real-world studies indicated that the cumulative rate of ≥12-month complete seizure freedom was approximately 11%, whereas the cumulative rate of ≥12-month freedom from tonic-clonic seizures reached up to 54.9%; moreover, seizure-free status was closely correlated with improved quality of life. In terms of safety profile, common stimulation-related adverse events included voice alteration/hoarseness, cough, and dyspnea, most of which were tolerable. Summaries of long-term clinical experience showed that the incidence of surgery-related complications was approximately 8.6%, and that of hardware-related complications was around 3.7%. Infection, hematoma, vocal cord paralysis, and lead malfunction were the key events requiring priority prevention and control.VNS is an important neuromodulatory treatment option for DRE, especially for patients who are ineligible for resective surgery or have persistent seizures after surgery, with a favorable overall tolerability profile. However, its ability to achieve long-term complete seizure freedom remains limited. Standardized long-term follow-up and individualized programming (including closed-loop strategies and parameter optimization) are expected to further enhance clinical benefits. Future research should focus on stratification by etiology/network phenotype, standardization of core outcome measures, external validation of translatable predictive biomarkers, as well as prospective controlled studies on key programming strategies and combined treatment pathways.
ObjectiveTo investigate the current situation of ketogenic diet treatment centers in China, including the target, quantity, indication diseases, staffing and regional distribution of ketogenic diet therapy centers.MethodsMembers from the China Association Against Epilepsy (CAAE) received an investigation on the development situation of ketogenic diet therapy in their own epilepsy centers through an online survey. ResultsAt present, there are 91 centers for ketogenic diet therapy in China, and among them, there are 74 centers (81.32%) only treat pediatric patients. 59 centers of them (64.83%) were established between 2010 and 2020; patients of 63 centers (69.23%) have been treated with ketogenic therapy for status epilepticus (SE), among which only 9 centers (14.29%) have 5 or more epileptic patients on averge per month. 35 centers (38.46%) are offering ketogenic diet treatment for indications other than epilepsy. The main diseases are autism spectrum disorder, encephalitis, febrile infection related epilepsy syndrome (FIRES), rare diseases and glycolipid metabolic diseases. All ketogenic diet treatment centers are equipped with high-quality professionals, mainly neurologists and pediatric physicians; There are significant differences in regional distribution, with centers in the eastern region accounting for more than half (53.85%). ConclusionsThe development of ketogenic diet therapy in China has achieved initial results, but there are still some problems such as small number of patients treated and uneven geographical distribution.