SUMMARYEpilepsy prevalence in the developing world is many fold that found in developed countries. For individuals whose conditions failed to respond to pharmacotherapy, surgery is the only opportunity for cure. In Uganda, we developed a center for treatment of intractable temporal lobe epilepsy (iTLE) that functions within the technologic and expertise constraints of a severely low resource area. Our model relies on partnership with epilepsy professionals and training of local staff. Patients were prescreened at regional clinics for iTLE. Individuals meeting inclusion criteria were referred to the treating Ugandan hospital (CURE Children's' Hospital of Uganda, CCHU) for video-EEG (electroencephalography), computed tomography (CT) imaging, and neuropsychological evaluation. Data were transferred to epilepsy experts for analysis and treatment recommendations. Ten patients were diagnosed with iTLE and surgically treated at CCHU. Six (60%) were seizure free, and there was no neurologic morbidity or mortality. Our model for surgical treatment of pharmacoresistant TLE has functioned successfully in a true developing world low resource setting. KEY WORDS: Epilepsy surgery, Temporal lobe epilepsy, Developing world.The majority of the world's population lives in the developing world where epilepsy prevalence is many fold that found in developed countries. In East Africa prevalence has been estimated to be 20 per 1,000 (Rwiza et al., 1992). For the approximately 30% of individuals who have medically intractable epilepsy, surgery for temporal lobe epilepsy (TLE) is more effective than medicine alone, and surgery is the only opportunity for cure in most (Wiebe et al., 2001). Likewise, cure is most effective for reducing morbidity and mortality as well as improving quality of life in individuals with epilepsy (Sperling et al., 1999).The aim of this study was to evaluate the feasibility of an epilepsy surgery program in a resource-limited setting. We developed a model for the diagnosis and treatment of medically intractable TLE (iTLE) to function in a severely underserved developing world site. TLE was targeted because it impacts the greatest number of individuals with intractable epilepsy, and it has an excellent opportunity for seizure freedom in response to surgery. Our model utilized technology and expertise that was reasonably available and could function sustainably in this setting. Information technology linked the developing world site (where patient care occurred) with epilepsy experts in the developed world for data analysis and treatment recommendations.

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Neurocognitive compromise, neuropsychiatric symptoms and psychopathology are all evident in the acute stages of autoimmune encephalitides. These factors considerably affect functional independence after discharge. Drawing on psychometric assessments and qualitative descriptions, this review explores the nature, extent and diagnosis of cognitive disorder in autoimmune encephalitides. Potential pathophysiological and neuroanatomical architecture related to neurocognitive compromise in the acute and chronic stages of this illness is examined. In regard to outcomes, the review highlights clinicodemographic factors currently known to be associated with poorer cognitive outcome. Finally, the review delves into neuropsychiatric symptomology and psychological concerns that should be considered at diagnosis and during follow up of these patients.

Background and purpose Despite the rapid increase in research examining outcomes in autoimmune encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. The current study aimed to characterise psychometric outcomes in this population, and explore variables that may predict psychometric outcomes. Methods This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Frequency and pattern analysis were employed to define and characterize psychometric outcomes. Univariable logistic regression was performed to examine predictors of intact and pathological psychometric outcomes. Results Deficits in psychometric markers of executive dysfunction were the most common finding in this cohort, followed by deficits on tasks sensitive to memory. A total of 54.2% of patients were classified as having psychometric impairments across at least two cognitive domains. Twenty‐nine patterns were observed, suggesting outcomes in AE are complex. None of the demographic data, clinical features or auxiliary examination variables were predictors of psychometric outcome. Conclusions Cognitive outcomes in AE are complex. Further detailed and standardized cognitive testing, in combination with magnetic resonance imaging volumetrics and serum/cerebrospinal fluid biomarkers, is required to provide rigorous assessments of disease outcomes.