OBJECTIVES: Up to 30% of adults with peripheral facial palsy (FP) develop synkinesis, but it's incidence in children remains unclear due to limited long-term data. METHODS: Children (<18 years) treated for acute peripher...OBJECTIVES: Up to 30% of adults with peripheral facial palsy (FP) develop synkinesis, but it's incidence in children remains unclear due to limited long-term data. METHODS: Children (<18 years) treated for acute peripheral FP at Jena University Hospital between 2009 and 2021 were screened in this cross-sectional study. Bell's palsy and infection-associated FP (e.g., Lyme disease, Zoster) were included, while secondary causes such as tumors, trauma, CNS disorders, and conditions like Guillain-Barré syndrome or Chiari malformation were excluded. Video follow-ups collected clinicodemographic information and PROMs including Facial Clinimetric Evaluation Scale (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Facial movements were video-recorded and assessed using Sunnybrook and eFACE. RESULTS: Of 85 eligible patients, 26 participated (46% female; response rate 30.6%). Mean age at onset was 8.5 years (range: 0.2-16); 54% had idiopathic FP (IFP) and 46% Lyme-associated FP (LFP). Median follow-up was 7.56 years (range: 2.5-13). All LFP participants and 11 out of 14 IFP participants achieved complete or near-complete recovery (eFACE and Sunnybrook scores 90-100). Four participants (28.6%), exclusively from the IFP group, developed synkinesis, three with functional impairments in PROMs and video-based assessment. Seven participants (five (35.7%) from the IFP group and two (16.7%) from the LFP group) reported that they still experience mental health-related effects of FP today. CONCLUSION: The data indicate that a relevant proportion (around 21.4%) of children with Bell's palsy develop moderate to severe synkinesis. Long-term follow-up and further research on corticosteroids use in pediatric FP are warranted.
Jaxybayeva A, Myrzaliyeva B, Lepessova M
… +7 more, Ayaganov D, Kazembekova M, Bayanova M, Mukhambetova G, Zharkinbekova N, Nurzhanova R, Bulekbayeva S
BACKGROUND: Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by progressive muscle weakness and atrophy, often leading to severe disability or early mortality. This study aimed to estimate...BACKGROUND: Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by progressive muscle weakness and atrophy, often leading to severe disability or early mortality. This study aimed to estimate the prevalence of pediatric SMA in Kazakhstan and to evaluate outcomes of the national disease-modifying treatment program with nusinersen. METHODS: Data from all patients registered in the national SMA registry were analyzed. SMA prevalence was calculated per 100,000 pediatric population. Survival was assessed using Kaplan-Meier analysis stratified by SMA type, and treatment outcomes were evaluated in relation to clinical characteristics and timing of therapy initiation. RESULTS: The national SMA prevalence was 2.9 cases per 100,000 pediatric population. Survival differed significantly across SMA types, with all recorded deaths occurring in patients with SMA type 1, while near-complete survival was observed in types 2 and 3. Kaplan-Meier analysis demonstrated a significantly reduced survival probability in SMA type 1 compared to other types (log-rank p < 0.001). Substantial delays in diagnosis and treatment initiation were observed, with a mean delay of 18 months. Earlier initiation of therapy was associated with more favorable outcomes. CONCLUSION: SMA prevalence in Kazakhstan is likely underestimated due to the absence of a national screening program. Survival outcomes vary significantly by SMA type, highlighting the importance of early diagnosis and timely treatment initiation, particularly in severe phenotypes. These findings may inform optimization of national SMA care strategies.
Pediatric arterial ischemic stroke can have a significant impact on visuospatial processing, with patients exhibiting deficits in tasks such as copying and drawing, block construction, and spatial localization. However,...Pediatric arterial ischemic stroke can have a significant impact on visuospatial processing, with patients exhibiting deficits in tasks such as copying and drawing, block construction, and spatial localization. However, given that these visuospatial tasks often also involve motor skills, it remains unclear to what extent patients' motor impairments may affect their performance. Therefore, this cross-sectional study aimed to examine the relationship between patients' motor-free visual perception and visuomotor integration, and to explore the impact of demographic and clinical characteristics on these skills. We investigated the visuospatial processing abilities of 16 pediatric stroke patients (M = 9.5 years, SD = 2.6 years) using the Rey-Osterrieth Complex Figure (ROCF) and Developmental Test of Visual Perception-3 (DTVP-3). Correlational analyses were conducted to examine associations between cognitive tests, as well as between age at stroke, socioeconomic status, modASPECTS, and test performance. The motor-free visual perception composite score of the DTVP-3 significantly correlated with the copy (r = .65) and delayed recall condition of the ROCF (r = .71). In contrast, the visuomotor integration composite score of the DTVP-3 did not correlate with any of the ROCF conditions (all p > .05). The modASPECTS was significantly related to the global visual perception (r = -.83), visuomotor integration (r = -.72), and motor-free visual perception (r = -.72) composite scores of the DTVP-3. These results suggest that the visuospatial processing deficits seen in pediatric stroke patients are independent of their visuomotor integration and that a larger initial lesion size negatively impacts their visuospatial abilities. Taken together, these findings contribute to our current understanding of the cognitive profile post stroke and to clinical predictors of visuospatial processing in pediatric stroke patients.
BACKGROUND: Familial, recurrent or genetic acute necrotizing encephalopathy (F/R/G ANE) is triggered by infections in children with genetic susceptibility. We conducted a systematic review to characterize clinical-neuror...BACKGROUND: Familial, recurrent or genetic acute necrotizing encephalopathy (F/R/G ANE) is triggered by infections in children with genetic susceptibility. We conducted a systematic review to characterize clinical-neuroradiological features, therapy and outcome of F/R/G ANE in children, and to evaluate vaccination implications. METHODS: A systematic literature review was conducted in PubMed, Scopus, and Web of Science, adhering to the PRISMA guidelines, and registered in PROSPERO. An institutional case was also described. RESULTS: Ninety-two patients were analysed (91 literature cases and 1 novel case) (median onset age 24 months; 62% male; RANBP2 mutations in 81% of tested individuals). In total, 142 clinical events occurred in the 92 patients: 108 definite/probable ANE events, and 34 atypical events (25 infection-triggered encehalopathy events without bithalamic involvement, 9 other acute neurological events without bithalamic involvement and encephalopathy). In 13% of patients, atypical episodes preceded a subsequent ANE event. Routine immunization was documented in 18/19 patients pre-ANE and 5/20 resumed vaccination post-ANE (no vaccine-related relapses over a median follow-up of 19 months). CONCLUSIONS: These findings highlight the central role of RANBP2 variants and the clinical-radiological variability of F/R/G ANE, including atypical pre-ANE events. Limited immunization data support the need for prospective studies to establish safe, prophylactic strategies.
Incidence calculations are crucial for understanding rare disorders, improving healthcare, and public health planning. Our study presents the incidence of peroxisomal disorders in Sweden. All patients diagnosed between 1...Incidence calculations are crucial for understanding rare disorders, improving healthcare, and public health planning. Our study presents the incidence of peroxisomal disorders in Sweden. All patients diagnosed between 1985 and 2024 at the two existing laboratories, which determine very long-chain fatty acids (VLCFA), phytanic, pristanic, and L-pipecolic acid in plasma, and plasmalogens in erythrocytes, were included in the study. Specifically, the incidence of X-linked adrenoleukodystrophy (X-ALD) is essential for evaluating its inclusion in the national neonatal screening for inborn diseases. Since the incidence of these disorders remained almost constant over the last 20 years of the study, these data were used for calculations. The incidence for the entire cohort (2005-2024) was 1:29,100, excluding female carriers of X-ALD. The most common subgroup was hemizygous X-ALD, with an incidence of 1:65,100, followed by peroxisomal biogenesis disorders (PBDs; Zellweger spectrum disorders) at 1:73,800. These incidences align with other estimates for clinically detected patients, but not for X-ALD detected through neonatal screening, where the incidence is at least three times higher. This discrepancy is partly explained by the discovery of genetic variants of uncertain significance. Over the years, the age at diagnosis and survival time for PBDs have increased, indicating heightened awareness of attenuated forms and improved supportive treatment.
OBJECTIVES: Climate change's impact on global health is increasingly recognized, with growing focus on its effects on the developing brain and on children with neurological disorders. This scoping review aims to update t...OBJECTIVES: Climate change's impact on global health is increasingly recognized, with growing focus on its effects on the developing brain and on children with neurological disorders. This scoping review aims to update the evidence on climate change's effects on paediatric neurological disorders. METHODS: A PRISMA-ScR-based protocol guided a systematic search across major databases (PubMed, Scopus, WoS, ClinicalTrials.gov, WHO ICTRP). We included all study types published in English up to September 2025 examining the impact of any climate-change related factor in children (0-18 years) with neurological disorders. Data extraction included study design, population, exposure/intervention and outcome variables. RESULTS: Out of 482 records, 17 studies met the inclusion criteria, involving over 340,000 children (54.6% male, in studies reporting sex distribution) across Asia, Africa, North America, and Europe. A total of 15 out of 17 studies were observational (OCEBM level 3-4). Epilepsy and seizures were the most frequently investigated conditions (8/17 studies). Extreme heat triggered immediate increases in hospitalisations, while cold exposure showed delayed but prolonged effects (up to 21 days). Temperature variability and air pollution further amplified seizure risk. Winter storms disrupted medication access which led to seizure worsening. Other studies (5/17 studies) linked meningitis and encephalitis incidence to high temperatures, humidity, and seasonal variability, particularly in low-resource settings. Sunlight and humidity were common migraine triggers, and cold-related illness was differentially co-diagnosed across behavioural health disorders groups. Prenatal and early childhood exposure to temperature extremes was associated with altered white matter development on MRI in one study. Across conditions, children in socioeconomically disadvantaged settings consistently emerged as the most vulnerable. CONCLUSIONS: Current evidence suggests that climate change-related exposures, particularly extreme temperatures, temperature variability, and natural disasters, negatively affect paediatric neurological health directly (increased seizure risk, impaired myelination) and indirectly (disrupted treatment access, emotional stress). Neuroinfectious diseases were also strongly associated with climatic variability, disproportionately affecting children in low-income areas. However, findings remain fragmented, heterogeneous, and largely context-specific, underscoring the urgent need for multicentric studies with harmonised methodologies and stronger longitudinal designs to clarify causal pathways and guide preventive strategies.
Yilmaz S, Serdaroglu E, Simsek E
… +44 more, Kara B, Turkdogan D, Yis U, Erol I, Yuksel D, Kanmaz S, Eroglu A, Canpolat M, Komur M, Cıtak Kurt N, Sakarya Gunes A, Soydemir D, Besen S, Bektas O, Kirik S, Atalay Celik H, Ardicli D, Aksoy A, Yarar C, Cerci Kubur C, Olgac Dundar N, Gungor O, Kamasak T, Olculu CB, Gumus H, Yildirim M, Isik E, Atik T, Cogulu O, Basak AN, Sunnetci Akkoyunlu D, Özbakır DH, Kayhan G, Gerik Çelebi HB, Karaer K, Dundar M, Kaiyrzhanov R, Ceylaner S, Per H, Hiz AS, Cansu A, Okuyaz C, Anlar B, Tekgul H
BACKGROUND: Childhood-onset dystonia (COD) encompasses a clinically and etiologically heterogeneous group of disorders, often with overlapping features. Genetic testing plays a pivotal role in uncovering underlying cause...BACKGROUND: Childhood-onset dystonia (COD) encompasses a clinically and etiologically heterogeneous group of disorders, often with overlapping features. Genetic testing plays a pivotal role in uncovering underlying causes, identifying treatable subtypes, and informing individualized management strategies. OBJECTIVE: To delineate the molecular genetic etiology, phenotypic characteristics, and treatment strategies in a multicenter cohort with gene-related CODs. METHODS: The study cohort comprised 81 patients with gene-related COD from 19 tertiary pediatric neurology centers in Turkiye. Clinical phenomenology, biochemical, electrophysiological, neuroimaging findings, diagnostic genetic tests, causative genes and variants, inheritance patterns, gene-related phenotypes, treatment modalities, and their efficacy were gathered. RESULTS: A diverse genetic landscape was identified in the cohort of 81 patients, revealing 62 distinct (pathogenic/likely pathogenic) variants across 26 genes. The genetic diagnoses were established through whole-exome sequencing (49.4%), single-gene testing (25.9%), and targeted gene panels (23.5%). Of the 81 patients, 59 had single-nucleotide variants (SNVs), 21 had deletions or duplications, and one patient carried a pathogenic trinucleotide repeat expansion. The common etiologies of gene-related COD were KMT2B (16%), GCH1 (11.1%), SLC2A1 (11.1%), GNAO1 (8.6%), TOR1A (8.6%), GNAL (6.2%). Rare etiologies were SLC18A2 and TH (each 4.9%), ATP1A3, NKX2-1, PRKN, SCN4A, THAP1 (each 2.5%), and ultra-rare etiologies (single patients) were: ACY5, ADPRS, ANO3, COL6A3, DNM1L, GNB1, HTT, PRKRA, PRRT2, RHOBTB2, SETX, SLC6A3, TUBB4A (1.2%). Based on Gene Ontology classification, the most represented functional categories were neurotransmission (n = 18, 22.2%), gene expression (n = 17, 20.9%), and signaling (n = 14, 17.3%). Genetic diagnosis influenced treatment modalities with pharmacotherapy modification or implementation of deep brain stimulation in 60.5% of the cohort, with targeted therapies being more effective than symptomatic treatments (p = 0.0118). CONCLUSION: This nationwide study highlights the phenotypic and genetic diversity of gene-related COD with certain therapeutic implications based on the molecular etiology-specific diagnosis.
AIM: GNAO1-related disorder (GNAO1-RD) is ultra-rare and clinically heterogeneous. Often, children with GNAO1-RD have (severe) motor impairments, which may lead to an underestimation of their communication abilities. To...AIM: GNAO1-related disorder (GNAO1-RD) is ultra-rare and clinically heterogeneous. Often, children with GNAO1-RD have (severe) motor impairments, which may lead to an underestimation of their communication abilities. To help these children achieve their full potential in daily life, it is essential to understand their communicative abilities and limitations. In this study, we aimed to investigate spoken language comprehension (SLC), speech and functional communication. METHODS: A cohort study including children with GNAO1-RD. SLC and functional communication were assessed using the Computer-Based instrument for Low motor Language Testing (C-BiLLT) and Communication Function Classification System (CFCS), respectively. Disease severity and motor functions were assessed using the GNAO1-Severity Scale, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Viking Speech Scale (VSS). RESULTS: Three girls and six boys with GNAO1-RD were included (median age: 11 years; range: 3-14). Median C-BiLLT score was 0 - 76 (out of 87). A strong, negative correlation was found between C-BiLLT scores and levels of CFCS (r(7) = -0,688, p = 0.040), indicating that better SLC correlated with better functional communication. No significant associations were found between C-BiLLT scores and GNAO1-Severity Scale scores, GMFCS, MACS or VSS levels. INTERPRETATION: This study shows considerable heterogeneity of communication performance in children with GNAO1-RD. Children with better SLC communicate more effectively in daily life. The level of SLC, however, was not related to the severity of motor impairments. These findings underline the need for tailored approaches to support communication in daily life.
Foiadelli T, Wassenberg T, Janssens I
… +7 more, Previtali R, Salazar-Villacorta A, Bartonickova M, Kadem N, Jansen AC, Papadopoulou MT, Young EPNS Climate Change & Sustainability Working Group
Climate change is accelerating toward and beyond critical warming thresholds, with profound implications for ecosystems and human health. Major uncertainties arise from socioeconomic and political responses, while the tr...Climate change is accelerating toward and beyond critical warming thresholds, with profound implications for ecosystems and human health. Major uncertainties arise from socioeconomic and political responses, while the transgression of Earth-system tipping points may trigger abrupt and irreversible climate dynamics. Climate-related health risks are mediated by direct and indirect exposures, disproportionately affecting vulnerable populations. Children with neurological and neurodevelopmental disorders exhibit heightened susceptibility due to biological, environmental, and disease-specific vulnerabilities, alongside the cumulative lifetime burden of extreme climate events. At the same time, healthcare systems contribute substantially to global greenhouse gas emissions, underscoring the need for climate-responsible clinical practice. Addressing knowledge and training gaps among clinicians is essential. Current initiatives within the European Pediatric Neurology Society highlight advocacy, sustainability actions, and the urgent need for high-quality evidence on climate impacts on brain health across the life span.
AIM: To evaluate the utility of the amplitude-integrated EEG (aEEG) continuity index (CI) in predicting neurodevelopmental outcomes in extremely low gestational-age newborns (ELGANs). METHODS: Between January 2020 and De...AIM: To evaluate the utility of the amplitude-integrated EEG (aEEG) continuity index (CI) in predicting neurodevelopmental outcomes in extremely low gestational-age newborns (ELGANs). METHODS: Between January 2020 and December 2022 80 newborns <28 weeks of gestational age were eligible for the study. The aEEG was analyzed using the Burdjalov score (BS) and the CI from day 1 to week 4 of life. Interrater reliability was calculated. Patients were classified as having an adverse short-term outcome if they died or survived with significant neuroimaging abnormalities. Otherwise, they were classified as having a favorable outcome. Long-term outcomes were evaluated using the Bayley Scales Third Edition at 24-months-corrected-age. RESULTS: Both CI and BS were strong predictors of adverse outcomes in the short- and long-term, with the greatest differences between children with adverse and favorable outcomes observed on day 4 of life. However, CI demonstrated superior interrater reliability compared to BS (intraclass correlation coefficient: 0.979 vs. 0.68). The lack of increase in CI from days 1-4 also proved to be a good predictor. Analysis of potential confounding factors revealed that CI was independent of sedation and pre-existing intraventricular hemorrhages. CONCLUSION: CI could be a valuable quantitative and easy-to-calculate screening tool for identifying ELGANs at risk for adverse outcomes.
OBJECTIVE: Sturge-Weber syndrome (SWS) is a rare neurocutaneous disorder. Up to 90% of children have epilepsy. Epilepsy surgery is a treatment option. However, the seizure and neurodevelopmental outcomes following this a...OBJECTIVE: Sturge-Weber syndrome (SWS) is a rare neurocutaneous disorder. Up to 90% of children have epilepsy. Epilepsy surgery is a treatment option. However, the seizure and neurodevelopmental outcomes following this are not well defined. This study aimed to determine the outcomes for children undergoing epilepsy surgery for SWS in relation to seizure control, cognition, language, motor function and social communication. METHODS: A retrospective case-note review was completed for children with SWS undergoing epilepsy surgery at Great Ormond Street Hospital from 1993 to 2022. Results of standardised developmental assessments for cognition, language and motor function were analysed. RESULTS: 36 children were operated on (17 hemispherotomies, 13 multilobar surgeries, 6 lobectomy/lesionectomies) with a median follow-up time of 66 months (range 8-198). 77.2% had Engel 1 outcomes (88.2% hemispherotomy, 46.2% multilobar surgery, 83.3% lobectomy/lesionectomy). Older age at surgery (OR for 1-year increase = 1.46, 95% CI 1.08-1.97, p = 0.013), but not type of surgical procedure, was independently associated with worse seizure outcomes. Good seizure control was still achieved in patients who had small residual pial angiomatoses following surgery. Most individual children showed no change or an improvement in their cognitive (67.8%) and language (72%) trajectories, although at group level this was not significant. All children undergoing hemispherotomies had a pre-existing hemiparesis. Following surgery, only 10% of children showed a decline in gross motor functional skills, but 60% had a deterioration in fine motor abilities. SIGNIFICANCE: This is the second largest SWS epilepsy surgery case series. Epilepsy surgery for SWS resulted in good seizure control, with evidence that younger age is associated with improved outcomes. Most children had stabilisation of their developmental trajectory following surgery. Multicentre studies are needed to better define the factors associated with improved seizure and developmental outcomes.
OBJECTIVE: In Azerbaijan, as in many other countries, duchenne muscular dystrophy DMD poses significant challenges for affected individuals and their families. The aim is to present clinical data and identify the mutatio...OBJECTIVE: In Azerbaijan, as in many other countries, duchenne muscular dystrophy DMD poses significant challenges for affected individuals and their families. The aim is to present clinical data and identify the mutation spectrum of the DMD gene in a first nationwide cohort of DMD patients with the goal of guiding future developments in Azerbaijan. METHODS: The research was conducted in the Azerbaijan Medical University Neurology department, involving boys with DMD. Assessments involve the evaluation of muscle strength, as well as timed motor performance tests, including the time to stand from a supine position, time to climb four standard stairs, The 6-Minute Walk Test, TUG (Timed Up and Go) test. Additionally, the Brooke and Vignos scales for limb function are used. Laboratory approaches involved biochemical evaluation of creatine kinase levels, multiplex ligation-dependent probe amplification (MLPA), and next-generation sequencing (NGS) analysis of the DMD gene. All participants gave written consent to participate in the study. Data were processed using medical statistics methods. RESULTS: 56 male patients, aged between 1 and 26 years (mean age 9.95 ± 4.19), were recruited. An average age for the disease's onset was 4 years and 3 months. The majority of patients underwent genetic testing based on clinical symptoms and average age at which genetic confirmation was obtained was 8 years and 5 months. At the time of enrollment, 28,5% of patients were dependent on wheelchairs for full-time use. Among the genetic variations in MLPA analysis identified, with 67,9 % being deletions 19,6 % duplications and negative results in 7 cases (12, 5 %). To identify point mutations, sequencing was performed on 7 boys with negative MLPA results, revealing point mutations in all of them, including four nonsense, one splicing, two frameshift. CONCLUSIONS: In Azerbaijan, as in many countries, DMD remains a significant concern due to its debilitating nature and the lack of widespread awareness and specialized treatment options. The initial results show that DMD is diagnosed at a relatively older age in Azerbaijan compared to other countries, emphasizing the need for improved compliance with international DMD care standards.
Neurofilaments, particularly neurofilament light chain (NfL), have emerged as promising biomarkers of neuroaxonal damage across a wide range of neurological diseases. While their application in adult neurological disorde...Neurofilaments, particularly neurofilament light chain (NfL), have emerged as promising biomarkers of neuroaxonal damage across a wide range of neurological diseases. While their application in adult neurological disorders such as Alzheimer's disease or Multiple sclerosis is becoming common practice, particularly in the realm of disease monitoring, their utility in pediatric neurological diseases remains under active investigation. This review summarizes current evidence on the potential role of neurofilaments with a focus on their potential clinical application, particularly in neuroinflammatory conditions, as well as in other relevant pediatric neurological disorders. The review further outlines the biological and pathophysiological aspects of NfL, laboratory techniques for the measurement of NfL in clinical practice, and the importance of age-dependent reference values. The purpose of this review is to provide pediatric neurologists with an overview of the available evidence on the potential role of NfL in pediatric neurological diseases including the pitfalls that should be addressed in future studies.
Arkush L, Komargodski R, Elazari HB
… +13 more, Uliel-Sibony S, Chernuha V, Hleihil A, Kraus D, Goldberg H, Gilboa T, Hamed N, Zohar-Dayan E, Lazinger M, Kohn E, Ben Zeev B, Heyman E, Tzadok M
BACKGROUND: There is increasing evidence supporting the use of cenobamate in adults with focal epilepsy yet pediatric data remain limited. METHODS: We performed a retrospective multicenter real-world study in pediatric e...BACKGROUND: There is increasing evidence supporting the use of cenobamate in adults with focal epilepsy yet pediatric data remain limited. METHODS: We performed a retrospective multicenter real-world study in pediatric epilepsy referral centers. Patients were included if they had drug-resistant epilepsy between the ages of 0-21 years and received cenobamate with at least 6 months follow-up. The primary outcome was a ≥50% reduction in seizure frequency at 6 and 12 months. Secondary outcomes were retention rates, seizure freedom, adverse effects, and change in concomitant anti-seizure medicines (ASMs). We extensively characterized seizure and epilepsy types, etiology, previous and concomitant ASMs, history of epilepsy surgery and neuromodulation and developmental background. RESULTS: Of 94 patients included, median age of epilepsy onset was 4.3 years, with developmental delay in 72%. Cenobamate was initiated after a median of 7 previous ASMs at a median age of 14 years, (range 1.2-21.8 years, SD 4.18) with mean final dosing of 3.22 mg/kg ≥50% seizure reduction at 6 months was achieved in 41%, increasing to 54% at 12 months. Median follow-up duration was 12 months with 40% retention. Adverse effects were reported in 24% of patients at 6 months. Dose reduction of concomitant ASMs was performed in 55% of patients with other ASMs discontinued in 35%. CONCLUSION: Our study provides evidence that cenobamate is an effective and well-tolerated ASM in children and adolescents, including in the younger pediatric population. Our findings support the administration of cenobamate in children with focal, drug-resistant epilepsy as adjunctive therapy alongside the use of more established ASMs.