Developmental Medicine & Child Neurology

• Human milk and breastfeeding can be incorporated safely into ketogenic diet therapy.
• With expert guidance, human milk and breastfeeding do not reduce diet effectiveness.
• We show two strategies for clinical practice to include human milk.
• Mothers can be encouraged to continue breastfeeding.

Clinical practice guideline on human milk and breastfeeding during ketogenic diet therapy.

This original article is commented by Roth on pages 1118–1119 of this issue.

• Severe motor and non-motor impairments in cerebral palsy (CP) increase epilepsy risk.
• Epilepsy more likely resolves in bilateral spastic and milder CP impairments.
• Epilepsy in CP often manifests at an early age with multiple seizure types and high drug resistance.
• Children with a known genetic cause and CP epilepsy surgery group represent distinct clinical subgroups.

This original article is commented on by Ruggieri on pages 689–690 of this issue.

• The focal cortical dysplasia detection algorithm collocated with the seizure-onset zone (SOZ) in 4 out of 19 patients.
• The algorithm changed the resection boundaries in 1 of 19 patients undergoing stereoelectroencephalography for drug-resistant epilepsy.
• The patient with an altered resection due to the algorithm was seizure-free 1 year after resective surgery.
• Overall, the algorithm did not increase the proportion of patients in whom SOZ was identified.

This original article is commented on by Dan and Seeuws on pages 144–145 of this issue.

The experience with neurostimulation for childhood epilepsy is far less extensive than for adults. Nevertheless, the implementation of these techniques could be of great value, especially considering the detrimental effects of ongoing seizures on the developing brain. In this review, we discuss the available evidence for neurostimulation for childhood epilepsy.

• Most adults with Dravet syndrome obtained the minimum standard scores in the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) subdomains.
• The VABS-II raw score analysis showed interindividual and intraindividual variability.
• Individuals with myoclonic seizures and/or generalized spike-and-wave activity on electroencephalography showed a worse adaptive behaviour profile.

This original article is commented on by Meskis on pages 732–733 of this issue.

Antiseizure medication reduction and withdrawal in children with drug-resistant epilepsy after starting the ketogenic diet.

• Health-related quality of life (HRQoL) was lower with increasing numbers of antiseizure medications.
• Overall quality of life (QoL) scores were lower by a similar amount, independent of seizure frequency.
• HRQoL was lower in persons with recent hospital admissions for epilepsy.

The association between epilepsy characteristics and health-related quality of life was assessed in 164 children and young people with non-ambulatory cerebral palsy and epilepsy utilizing the Child Health Index of Life with Disabilities (CPCHILD). Total CPCHILD scores decreased across all degrees of seizure burden by a similar amount. Independently, total CPCHILD scores were lower in those taking more antiseizure medications.