Epilepsy treatment in resource-limited countries faces numerous challenges including limited access to antiepileptic drugs (AEDs), inadequate healthcare infrastructure, and social stigma. Advocacy efforts and private foundations play a vital role in addressing these barriers and improving epilepsy care outcomes. Global health projects focusing on clinical care, research, education, and advocacy have emerged to address the significant epilepsy treatment gap in low- and middle-income countries (LMICs). These collaborative initiatives aim to develop sustainable solutions, such as enhancing epilepsy care in marginalized communities and implementing strategies to mitigate treatment gaps and improve access to healthcare. The use of primary healthcare personnel to identify epilepsy cases and initiate simple treatment protocols has shown promise in addressing the shortage of specialized medical professionals in developing countries. Advocacy and private foundations focus on educating healthcare providers, increasing public awareness, improving drug availability, and developing cost-effective epilepsy surgery programs. However, challenges remain, including the need for country-specific assessments and the development of comprehensive epilepsy care models that consider the heterogeneity of the disorder and its impact on patients, families, and communities.

Cerebral Palsy (CP) is the most common pediatric physical disability worldwide presenting as a non-progressive motor dysfunction due to insults to the developing brain. While CP has a higher prevalence and burden in low- and middle-income countries, the most extensive research towards care and management of the patients with CP has been conducted in high-income countries. There is a disparate impact on CP from resource limited countries due to insufficient healthcare resources, barriers to healthcare access, inadequate public health awareness, and lack of accurate data. In this article we examine the state of CP in low- and middle-income countries. We explore the multitude of environmental, socioeconomic, and infrastructural factors that contribute to the clinical profile of CP in these regions. Finally, we high light the primary areas of burden that need to be addressed in low- and middle-income countries: inadequate healthcare infrastructure and resources, lack of registries, social stigma with the and limited public health education, and strain on primary caregivers.

Cerebral Palsy (CP) is the most common cause of childhood disability globally with a higher prevalence in low and middle-income countries (LMIC). Hypoxic-ischemic encephalopathy (HIE) caused by preventable perinatal insults is still the leading cause of CP in LMIC. Spastic quadriplegic CP is the most common subtype in LMIC accounting for 70-80 % of cases. Lack of awareness compounded by stigma delays initiation of intervention leading to a poorer outcome and reduced quality of. The comprehensive management of children with CP requires an interdisciplinary team of experts. Such expertise is often lacking in LMIC. When available, its distribution is largely skewed towards urban areas. Although there is a higher burden of comorbidities, screening and diagnosis of the related conditions are inadequate, leading to poor management. Surgical interventions such as intrathecal baclofen, selective dorsal rhizotomy for spasticity and gastrostomy tube insertion for children with severe gastroesophageal reflux disease is often limited by costs and shortage number of trained personnel. Evidence-based local guidelines are essential for managing children with CP, guiding government investments to improve the quality of life for entire families. Concerted efforts in healthcare system reforms, policymakers, community engagement and awareness to enhance early diagnosis and appropriate referral, management through locally generated evidence-based interventions are required in LMIC to improve care among of children with CP and their families.

The epilepsy treatment gap in low- and middle-income countries especially sub-Saharan countries is substantial, driven by socioeconomic challenges, inadequate infrastructure, and limited access to diagnosis, treatment and care. The diagnostic gap further compounds this, with many patients remaining undiagnosed or misdiagnosed due to lack of skilled healthcare professionals, inadequate diagnostic facilities, and limited access to specialized care. A comprehensive approach that uses sustainable solutions, prioritizing local ownership, capacity building and community engagement are crucial for bridging the epilepsy treatment and diagnostic gaps. This includes a collaborative effort between the neurology community and opinion leaders as well as policy makers. Targeted solutions such as training more neurologists through locally relevant programs and training of primary and community healthcare workers for task-shifting and task-sharing interventions. Also strengthening supply chains and procurement processes to ensure constant supply of affordable antiseizure medications. It is critical to promote leveraging of technology such as use of smartphone video recordings, remote EEG and telemedicine tools. Further collection of data is needed inclusive of registries for disease burden, to enhance consistency in diagnostic categorization, follow up and understandings of supply chain efficiency. Overlying these clinical interventions implementation of public awareness campaigns and policy reforms to reduce stigma and promote inclusivity are critical for bridging the epilepsy treatment and diagnostic gaps. Research should focus on understanding the socioeconomic and public health factors contributing to the treatment and diagnostic gaps, and evaluating the effectiveness of rolled-out interventions.

The prevalence of cerebral palsy (CP) is greater in resource limited countries than in higher income countries for several reasons. The etiology and risk factors for cerebral palsy are multifactorial, including perinatal, vascular, infectious, and genetic factors with significant regional variations. Whereas advancements in neonatal care and early intervention have improved outcomes in high-income countries, the burden of CP remains disproportionately high in resource-limited regions due to delayed diagnosis, inadequate access to specialized healthcare, and socioeconomic constraints. Early diagnosis of CP is crucial for timely intervention, which can significantly improve motor and cognitive outcomes. In low-resource settings, limited availability of trained healthcare professionals, lack of standardized screening tools, and inadequate neonatal follow-up programs can hinder early identification. Additionally, social and cultural norms can contribute to delayed medical attention, further exacerbating disability in affected children. This article explores the etiology and diagnostic challenges of CP in resource-limited regions, emphasizing the unique risk factors and diagnostic challenges prevalent in these settings. Potential low-cost solutions for early diagnosis and intervention, including the use of simple clinical assessment tools, mobile health technology, and community-based rehabilitation strategies are also discussed. Addressing these challenges through cost-effective, scalable and sustainable interventions can improve outcomes for children with CP, reducing the long-term economic and social burden on families and healthcare systems.

In this review, we explore the effects of malnutrition on childhood neurodevelopment. Early brain development is highly sensitive to nutritional status. Both undernutrition and overnutrition can disrupt critical neurodevelopmental processes, affecting cognition, emotional regulation, and long-term mental health. Nutrient deficiencies, such as iron, iodine, folate, and vitamin B12, have been linked to impaired brain growth and function. Similarly, excessive caloric intake can also negatively impact brain development as it may contribute to neuroinflammation and altered neurocircuitry. The effects are most pronounced during prenatal life and early childhood, with lasting consequences on academic performance, behavior, and productivity. In addition to health-related outcomes, undernutrition and overnutrition can also have significant social and financial repercussions for individuals and their communities. This review synthesizes current insights on the relationship between nutrition and brain development, explores specific nutrient effects, and highlights the role of public health interventions. Addressing both undernutrition and overnutrition through early and targeted action is essential for optimizing neurodevelopment and reducing the long-term societal burden of cognitive and mental health disorders. Continuous monitoring of both existing and emerging nutritional deficiencies is necessary, particularly in marginalized communities and low- and middle-income regions, where the risk of undernutrition remains high.

Epilepsy affects over 50 million individuals globally, with more than 80 % residing in resource-limited countries. While the majority of patients achieve seizure control with antiseizure medications, approximately one-third are diagnosed with drug-resistant epilepsy (DRE). For these individuals, epilepsy surgery represents a potentially effective therapeutic option. Expert consensus from the Surgical Therapies Commission of the International League Against Epilepsy (ILAE) recommends prompt referral for surgical evaluation upon diagnosis of DRE. Nevertheless, despite substantial supporting evidence, such referrals are frequently delayed-particularly in low- and middle-income countries (LMICs). This article examines the barriers to timely surgical evaluation and explores strategies to facilitate the development of epilepsy surgery programs in resource-constrained settings.

Infantile-onset epilepsies, a heterogenous group of epilepsies with onset up to two years of age, constitute a significant burden in developing countries and frequently result from various genetic variations. The phenomena of genetic heterogeneity and phenotypic pleiotropy are observed across epilepsy syndromes of infantile-onset epilepsies. In the current era of precision-based medicine, early genetic diagnosis and targeted management can significantly influence epilepsy and developmental outcomes. Despite rapid advancement in genetic testing, access to genetic diagnostic facilities is a global challenge, especially in resource-limited settings. The major barriers to genetic diagnosis are high costs, limited access to specialized laboratories, and the need for expert interpretation. Nevertheless, strategies like targeted gene panels, collaborations with reference laboratories, and clinical phenotyping can help maximize the diagnostic yield while considering resource constraints. Investments in infrastructure, policy support, and international collaboration can bridge the gap and ensure that affected children receive timely and accurate diagnoses. This review discusses the importance, challenges, and potential strategies for integrating genetic testing in resource-limited environments, emphasizing the need for affordable and accessible solutions that can enhance patient care.

Cerebral malaria is the most lethal form of Plasmodium falciparum infection. The disease is defined clinically as an otherwise unexplained coma in someone with malaria parasitemia. One in 6 children with cerebral malaria dies and many survivors are left with neurologic, cognitive, or behavioral sequelae. Acute seizures are common and increasing numbers of them during the index illness are associated with a greater likelihood of adverse outcomes. Optimal treatment pathways for children with cerebral malaria have been standardized but the search for an adjunctive therapy that decreases cerebral malaria mortality or morbidity has, so far, remained elusive. After hospital discharge, care gaps for survivors continue in the diagnosis and management of educational challenges, behavioral abnormalities, and epilepsy, especially in the rural settings where malaria incidence is highest. In the past decade, science has elucidated much about cerebral malaria pathogenesis. Observational studies using magnetic resonance imaging, electroencephalogram, and transcranial doppler have all provided insight on the pathway from the initial infection transmitted by a mosquito, to death. Findings from each of these high technology modalities are also associated with outcomes in children with cerebral malaria. We review the epidemiology, clinical features, diagnostic considerations, optimal clinical care pathways, neurological sequalae, and existing care gaps in the management of cerebral malaria and its complications.

The Zika virus (ZIKV) is a mosquito-borne flavivirus, transmitted by the genus Aedes, and is prevalent in tropical areas. It co-exists and shares a vector with other flaviviruses, such as the dengue virus. Its infection usually leads to a febrile illness undistinguishable of other viruses. Zika virus raised to prominence during an epidemic in the Americas during 2015 and 2016, as the increase in cases coincided with an increase in neonates born with severe microcephaly. This led to the description of congenital Zika syndrome and the establishment of the potential for ZIKV to cause congenital defects and long term neurodevelopmental adverse outcomes.

West Nile Virus (WNV) is a vector-borne pathogen that poses significant public health challenges worldwide, particularly in regions with limited resources. While the virus is endemic in many parts of the globe, its impact on low-income countries remains disproportionately high due to inadequate healthcare infrastructure, limited surveillance systems, and lack of public health awareness. This article explores the burden of WNV in these resource-constrained regions, focusing on the epidemiology, socio-economic consequences, and healthcare challenges faced by affected populations. It discusses the multifactorial factors contributing to the spread of WNV, including climate change, urbanization, and weak mosquito control measures. Additionally, the article examines the implications for healthcare systems, such as the overwhelming demand for medical resources, limited diagnostic capacity, and gaps in effective treatment and prevention strategies. The article emphasizes the need for enhanced surveillance, early detection systems, and integrated public health strategies tailored to low-resource settings. It also calls for international collaboration and funding to improve research, prevention, and response mechanisms in these vulnerable regions.

In the last decade, Dengue virus has become a major public health concern, with increasing numbers of infections, hospitalizations, and deaths worldwide. The Aedes mosquito vector's migration, aided by adaptation to climate change has allowed Dengue virus to spread into temperate regions. The major impact of the disease occurs in regions with limited resources, creating a significant burden for these countries. There is a growing body of information characterizing the neurological disorders related to pediatric Dengue infection. In addition to reviewing Dengue virus structure, disease diagnostic criteria and current WHO guidelines, this article discusses the neuropathogenic mechanisms of infection, and the resultant impact on the central and peripheral nervous systems. Our group has created a framework correlating the presentation of neurologic disorders to Dengue virus phases of infection. There is an urgent need for epidemiological analysis and a systematic approach to catalogue the emerging reports of pediatric neurological disorders related to dengue virus infection. We propose that key regional and professional stakeholders could foster educational advances and improve preventative, diagnostic and therapeutic care of pediatric patients impacted by Dengue virus.

Neurocysticercosis (NCC) is caused by the parasitic tapeworm Taenia solium, which frequently infects the central nervous system of children and adults. Diagnosis involves a thorough medical history, with an emphasis on the epidemiological conditions of the affected individuals. Understanding the parasite's life cycle and the host's immune response is for a deeper comprehension of their mutual interaction. The most common clinical manifestations include seizures, headaches, increased intracranial pressure, cranial nerve involvement, cognitive dysfunction, radicular and spinal compression symptoms, and ultimately, vision loss, depending on the locations of the lesions. It is essential to know the neuroradiological findings and how they can correlate with the viability and evolutionary stages of the parasite. Since seizures are noted as the most prevalent symptom in the pediatric population, it is crucial to understand how to manage them and the associated symptoms, such as inflammation and other complications. When appropriate, conducting immunological tests and utilizing molecular assays are vital to determine the specificity and sensitivity of these methods in aiding the diagnosis of NCC, especially when neuroimaging results are inconclusive. NCC is classified as active, transitional, or inactive to guide the selection of appropriate treatment options, including antiseizure medications, antiparasitic drugs, anti-inflammatory medications, and surgery when necessary. This document also aims to explore the differences in the natural history of this condition in pediatric populations compared to adults. Prevention and education are the most effective strategies for combating this infection, particularly in underdeveloped areas.

Affecting every country to some degree, disparities in healthcare access are a global challenge. Healthcare systems in low- and middle-income countries (LMICs) are, however, particularly fragile and more vulnerable to the unpredictable demands that arise from both natural and man-made disasters. Resource availability in the healthcare systems of LMICs is often inconsistent and, in many cases, insufficient to meet the needs of the local population. One major health concern in LMICs is the high burden of parasitic and viral infections of the nervous system, illnesses that cause significant morbidity and mortality. Over the past 50 years, several LMICs in tropical and subtropical regions have experienced an emergence, re-emergence, or upswing in arthropod-borne viral diseases such as dengue, chikungunya, and Zika. Herein we propose a series of practical and universally applicable solutions aimed at both reducing healthcare demand and strengthening at-risk healthcare systems in LMICs.

HIV affects both the central and peripheral nervous systems, resulting in a wide range of neurological complications due to direct viral effects, chronic inflammation, opportunistic infections, and adverse effects of antiretroviral therapy (ART), collectively referred to as neuroAIDS. In children, the underdeveloped blood-brain barrier heightens the vulnerability of the brain to neuroAIDS, impacting cognitive and motor development. Even HIV-exposed, uninfected children exhibit neurodevelopmental delays. Chronic infection leads to a sustained viral presence in the cerebrospinal fluid, resulting in neuroinflammation. HIV encephalopathy (HIVE) remains a major concern, causing developmental regression, cognitive impairment, and motor dysfunction. Although the prevalence of HIVE has declined with the advent of combination antiretroviral therapy, rates remain high in low-resource settings. Opportunistic infections such as tuberculous meningitis, viral encephalitis, and fungal infections are prevalent among children with HIV-AIDS. Children with HIV are also at risk for cerebrovascular diseases, neurocognitive impairments, and neuropsychiatric conditions such as mood disorders and high-risk behaviors. Epilepsy and peripheral neuropathy are more common in children with HIV, with ART regimens sometimes contributing to neuropathy. Early ART initiation remains crucial in improving neurodevelopmental outcomes. Careful drug selection and adequate treatment of opportunistic infections before ART initiation are important to prevent drug-drug interactions and immune reconstitution inflammatory syndrome, respectively. While treatment progress has improved neurological outcomes, disparities in access to healthcare continue to impact children in resource-limited settings.

Toxoplasma gondii, one of the most prevalent zoonotic parasites globally, may be transmitted to the fetus if a primary infection occurs during pregnancy. The earlier the gestational period, the lower the probability of transmission, but if it occurs, the higher the probability of pregnancy loss or severe fetal neurological or ocular damage. Primary prevention measures to pregnant women include avoiding eating or handling raw or undercooked meat, washing hands thoroughly after gardening, avoid handling contaminated soil or water or come in contact with cat feces. The infected fetus may exhibit a broad spectrum of clinical manifestations, ranging from death in utero, stillbirths, symptomatic neonatal forms with systemic involvement and/or severe and irreversible ocular or neurological damage, to asymptomatic forms. Neurological manifestations include macro- or microcephaly, hydrocephalus, intracranial calcifications, abnormal muscle tone, cerebral palsy, global developmental delay, sensorineural hearing loss, and epilepsy. The whole clinical picture of each patient with congenital toxoplasmosis depends on a variable combination of different factors including: (a) gestational age at which the maternal infection has occurred and transmitted to the fetus, (b) disease detection: were pregnant women systematically screened during pregnancy, and if so, the frequency of serological tests, (c) if infected pregnant women and neonates were treated and timing and doses of the anti-T. gondii drugs used, (d) differences in the parasite load and in virulence of the genotype of the implicated T gondii strains, (e) individual maternal immune response, and f) presence of specific clinical features such as ventriculomegaly, multiple calcifications and retinochoroiditis.

Subacute sclerosing panencephalitis (SSPE) is a devastating neurodegenerative disorder due to a persistent mutated, wild-measles virus infection of the nervous system. While the acute infection is generally self-limiting, defective viral clearance can lead to the emergence of neurovirulent strains that undergo mutations within the host, evade immune surveillance, establishing chronic central nervous system (CNS) infection. It predominantly affects children and young adults although no age, including infants, is immune to SSPE. The characteristic neurological manifestations include progressive behavioral and cognitive decline, neuromotor impairment, myoclonus, vegetative state and death within 1-3 years of diagnosis, although prolonged stabilization and spontaneous resolution have been reported in a minority of patients. Despite global efforts towards measles elimination, SSPE remains a challenging problem in the low- and middle-income countries (LMICs) due to inadequate vaccine coverage. Limited health infrastructure, suboptimal surveillance, and limited availability of diagnostic tests hinders early diagnosis and management making SSPE a public health crisis. The measles outbreaks in high-income countries with developed vaccination programs are commonly due to international travel, immigration, and vaccine hesitancy, making it a global problem. The lack of effective antiviral therapy makes supportive and palliative care the primary management strategy once SSPE is confirmed. Recent research highlights potential therapeutic strategies, novel molecular approaches targeting mutant measles viruses, and enhanced public health measures to contain the outbreaks. However, these remain largely inaccessible in LMICs with measles endemicity and the high disease burden of SSPE. Urgent action is needed to bridge this gap by strengthening vaccination programs, implementing early diagnostic strategies, and enhancing access to emerging treatments. The current review discusses the various aspects of SSPE and the importance of preventive strategies for SSPE as relevant to LMIC. Without holistic efforts and a multi-pronged approach to eliminate measles and prevent SSPE, the disease shall remain a global threat.

Chikungunya virus (CHIKV), a mosquito-borne alphavirus, has emerged as a significant global health concern, particularly due to its neurological complications in pediatric populations. This scope review summarizes current understanding of CHIKV virology, epidemiology, transmission dynamics, and clinical manifestations, with an emphasis on neurologic sequelae in neonates and children. We explore the mechanisms of neuroinvasion, describe central and peripheral nervous system involvement, and outline diagnostic strategies and therapeutic approaches. Although supportive care remains the mainstay of management, novel antiviral agents and vaccines are under active investigation. Understanding age-specific presentations and long-term outcomes is essential to mitigate the impact of this neurotropic virus.

Seizures associated with low-grade tumors in pediatric patients can be drug resistant and associated with significant morbidity. There are several low-grade tumor types associated with epilepsy in this population with the majority localized to the temporal lobe and some extra-temporal locations (frontal, parietal, and occipital lobes). The primary treatment of low-grade epilepsy-associated tumors is surgical resection, though the surgical approach and the use of intraoperative techniques remain controversial. Newer treatments are under investigation as primary and/or adjunctive therapy, including non-invasive surgical options and gene-targeted therapy. A multimodal approach to treatment may improve long-term outcomes and quality of life.

Central nervous system (CNS) tumors are the most common solid tumor type seen in the pediatric population and may present with a variety of neurological presentations, with seizure being the second most common. Supratentorial tumors commonly associated with seizures include low-grade gliomas such as pilocytic astrocytoma, subependymal giant cell astrocytoma (SEGA), gangliogliomas, and dysembryoplastic neuroepithelial tumors (DNET). The etiology of seizures in pediatric brain tumor patients is often multifactorial, often the result of multimodal therapy and possible contributions from surgery, radiation therapy, chemotherapy, and other metabolic disturbances. Seizures can also be secondary to mass effect, hydrocephalus, or metastases. Additionally, tumor characteristics including its location in the temporal lobe, the presence of mixed neuronal and glial components, and the tumor's size and growth rate influence the likelihood of seizures. Pediatric patients with a first lifetime unprovoked seizure should undergo further testing including electroencephalogram (EEG). MRI imaging is not warranted in all cases but should be strongly considered for children with focal presentation or EEG finding to identify possibly secondary causes such as brain tumors. The EEG can identify background activity alterations, epileptiform activity, and/or seizure activity, but sensitivity and specificity are limited and therefore, should be used in conjunction with neuroimaging like an MRI for a comprehensive evaluation. Anti-seizure medication (ASM) is not recommended to be started in patients with a brain tumor without seizures, but rather only in patients that were identified with brain tumor who presented with seizures. ASM choices are influenced by patient's co-morbidities, drug interactions with chemotherapy, and the patient's tolerance to potential adverse drug reactions. With its limited drug-drug interactions, the most commonly used ASM is levetiracetam. Ultimately, gross total resection of the tumor if feasible is often favored for both diagnostic and therapeutic benefits, as well as seizure control.

Pediatric CNS tumors may be associated with endocrinopathies at the time of initial diagnosis and as a sequalae of their treatment. Endocrine dysfunction is highly prevalent among tumors located along the hypothalamic pituitary axis and optic pathway, with manifestations such as precocious puberty, diabetes insipidus, or growth failure presenting initially without neurologic symptoms. Posterior fossa tumors, which are more common in pediatrics, can also present with endocrine dysfunction despite their relatively more distant location due to their propensity for causing hydrocephalus. The various treatment modalities for CNS tumors portend additional risks for developing endocrinopathies. Acute endocrine dysfunction often follows surgery involving the HP axis, while endocrine late effects, particularly following radiation exposure of the HP axis, can develop more insidiously years to decades after completion of treatment. Chemotherapy and newer targeted and immunotherapies can cause peripheral endocrine gland as well as HP axis dysfunction. With an increasing number of childhood cancer survivors in the population, recognition and treatment of endocrine late effects is increasingly important. We review here the common endocrine dysfunction associated with various CNS tumors at diagnosis and as a consequence of their treatment.