Inappropriate diagnostic testing using electroencephalography (EEG) not only burdens the healthcare system but is especially concerning in Canada, where EEG demand is rising alongside a nationwide shortage of technologists. Understanding factors that influence yield, as well as patterns in requisition quality and completeness, may help improve both clinical utility and resource allocation.

We performed a single-center retrospective cohort study analyzing EEGs performed at Kingston Health Sciences Centre from March to August 2024. Demographic and clinical data were collected from paper EEG requisitions and digital reports. Diagnostic yield was assessed across clinical variables, physician specialty and patient setting using descriptive statistics, logistic regressions and odds ratios.

EEGs detected abnormalities in ∼40% of 1077 EEGs, mostly non-epileptiform. Yield was higher among older adults (60+ years), inpatients in critical care, emergency patients, and those on anti-seizure medications or sedatives. Indications like “neuro-prognostication” and “concern for non-convulsive status epilepticus” had high yield (100%), whereas “syncope/presyncope” had poor yield (12.8%). Sleep-deprived EEGs did not significantly differ in yield compared to routine EEGs. Over half (56%) of the EEG requisition forms were incomplete. Requisition completeness varied by physician specialty: neurologists were found least likely to complete requisition forms compared to other specialties.

By identifying clinical factors, physician specialties and settings associated with low diagnostic yield, interventions can be tailored to improve requisition practices and guide efficient resource allocation.

Lennox-Gastaut syndrome (LGS) is characterized by drug-resistant seizures, cognitive impairment, and significant comorbidities, requiring lifelong care. Despite therapeutic advances, real-world management and system-level barriers in Canada are not well defined. A national survey was conducted to examine Canadian practices in LGS diagnostic approaches, therapies, comorbidity management, counseling practices, and transition services, aiming to identify gaps and guide quality improvement initiatives.

Following a literature review, a 41-item web-based survey was developed and distributed to neurologists and allied health workers via the Canadian League Against Epilepsy and the Canadian Neurological Sciences Federation.

Among 111 respondents (77% physicians; 79% academic practice), diagnostic confidence was limited: 46% believed LGS is both over- and underdiagnosed, and only 5% felt most patients are accurately identified. Adult diagnosis was considered particularly challenging (46%). Genetic testing for unknown etiologies was routine for 67% and, however, was more common among pediatric than adult neurologists (81% vs 41%, p < 0.001). Valproic acid (98%), clobazam (82%), and lamotrigine (75%) were the most common first-line anti-seizure medications (ASMs), yet 67% rated available treatments as inadequate. Reported treatment barriers included limited ASM efficacy (68%), adverse effects (38%), and comorbidity management challenges (37%). Corpus callosotomy was perceived as underutilized (71% overall), suggesting access disparities. Time and resource limitations hindered comorbidity screening. Only 23% reported access to formal transition programs.

Significant gaps remain in the diagnosis and management of LGS in Canada, particularly in treatment, comorbidity screening, and transition care. National guidelines, standardized pathways, and improved access to multidisciplinary services are needed to enhance outcomes.

To review the historical, conceptual, and ethical foundations of intelligence testing in neuropsychology and to consider whether alternative cognitive performance labels offer greater conceptual precision while reducing stigma.

We conducted a narrative review of early twentieth century cognitive assessments, tracing the evolution of intelligence testing and its intersections with eugenic ideology. Key examples include the Army Alpha and Beta tests administered during World War I and Ellis Island immigration assessments, which were frequently interpreted without consideration of cultural or educational influences. We examine how these practices informed early interpretations of neuropsychological performance, particularly in individuals with epilepsy, and shaped initial characterizations of neurologically based cognitive abilities.

Early intelligence testing was grounded in the belief that intelligence was a fixed and directly genetically determined trait. Test performance was interpreted as an index of biological superiority, lending scientific legitimacy to eugenic ideologies and reinforcing stigma toward individuals with epilepsy. Although modern frameworks emphasize multidimensional cognitive abilities, intelligence-based characterization persists and continues to be frequently reported as a primary outcome of neuropsychological testing.

In contexts that require a single summary indicator of cognitive performance, labels such as Total Cognitive Composite are recommended since they avoid implying a fixed or unitary capacity. Continued reliance on the construct of “intelligence” is inconsistent with contemporary models of cognition, reflects outdated theoretical assumptions, and carries enduring psychosocial stigma. Moreover, its circular and internally inconsistent definitions substantially limit its validity and appropriateness within contemporary adult clinical neuropsychological practice.

Highly purified cannabidiol (CBD) represents a novel anti-seizure medication (ASM) with established efficacy in specific epilepsy syndromes; however, real-world evidence across diverse etiologies remains limited. Following Health Canada approval in November 2023, CBD provides an additional option for treatment-resistant seizures. This study describes early real-world experience with CBD within a Provincial Comprehensive Epilepsy Program during its inaugural year of availability in Canada.

A retrospective chart review examined all pediatric patients prescribed CBD between June 2024 and April 2025.

Sixty-one patients (median age 10.5 years) were included. Prior to CBD initiation, patients had trialed a median of eight ASMs and were receiving a median of three concomitant ASMs. Fifteen patients had prior CBD exposure, including nine who transitioned directly to the highly purified formulation. Diagnoses comprised Lennox–Gastaut syndrome (38%), Dravet syndrome (11%), other developmental and epileptic encephalopathies (39%) and focal/multifocal epilepsy (11%). After a median treatment duration of 172 days, 22% of patients achieved ≥50% seizure reduction, including 7% who became seizure-free, while 30% experienced a 25%–49% reduction. Forty-eight percent demonstrated ≤25% seizure reduction, and 11% experienced seizure exacerbation. Despite variable seizure outcomes, 70% continued CBD therapy, frequently attributable to benefits transcending seizure frequency, including diminished seizure severity, increased seizure-free intervals, improved behavior and enhanced sleep quality. Adverse effects occurred in 30% of patients, prompting treatment discontinuation in 6.5%.

This real-world analysis suggests that CBD may be effective and well tolerated in children with highly refractory epilepsy across heterogeneous etiologies, with potential benefits beyond seizure control.

Due to the high prevalence of depression and anxiety in people with epilepsy, the International League Against Epilepsy Commission on the Neuropsychiatric Aspects of Epilepsy recommends implementing routine screening for depression and anxiety symptoms. Our epilepsy group began administering three screening questionnaires to all clinic patients in 2016: the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Beck Anxiety Inventory (BAI) and the Generalized Anxiety Disorder-7 (GAD-7).

We aim to review our experience with this screening approach.

We reviewed 2253 sets of questionnaires completed from January 2018 to March 2020 and studied the actions taken by epileptologists in response to a positive screening.

Thirty-six percent of all assessed patients screened positive on at least one questionnaire: 13.6% screened positive for depression symptoms (NDDI-E ≥ 16), 12.3% for anxiety symptoms (BAI ≥ 22) and 30.3% for GAD symptoms (GAD-7 > 7). Among patients with a positive screening, 36% received a care intervention, 59% did not and 5% declined the neurologist’s recommendation. Among patients for whom an intervention was implemented, 58% were referred to a mental health professional (generally a neuropsychiatrist), 29% had their antiseizure medication adjusted to alleviate their symptoms and 13% received another intervention.

In our clinic, an important proportion of patients screened positive for depression and/or anxiety symptoms. Fewer than half received a management option to alleviate their symptoms. We conclude that while routine screening increases the detection of depression and anxiety among epilepsy patients, it must be accompanied by effective interventions and access to mental-health professionals.

People living with epilepsy (PWE) experience higher rates of depression compared with the general population. Depression in PWE is associated with increased seizure burden and reduced quality of life. We aimed to examine clinical and demographic correlates of depression severity using the nine-item Patient Health Questionnaire in PWE experiencing negative health events in the past 6 months.

1. (a) To assess how depressive severity correlated with seizure frequency;

2. (b) To examine how outcomes such as quality of life are influenced by depressive severity;

3. (c) To investigate how demographic factors affect depressive severity.

Depressive severity was defined as a score of 0–9 for no depression to mild symptoms (NMD), 10–19 for moderate depression (MOD) and 20–27 for severe depression. Continuous variables were analysed using the Kruskal–Wallis equality-of-populations rank test, and categorical variables were compared using Fisher’s exact test. Baseline data were taken from Sequential, Multiple Assignment Randomized Trial no. NCT04705441.

The sample of 159 participants had a mean age of 39.46 years (s.d., 12.15), with the majority (n = 131, 82.4%) identifying as White. A total of 48% (n = 76) of participants met the criteria for NMD, 41% (n = 65) met those for MOD and 11% (n = 18) met those for severe depression. The severe depression group had significantly more seizures in the past 30 days, as well as greater perceived stigma, lower social support and lower quality of life, compared with the other groups. Race was found to correlate with depressive severity in NMD and MOD versus the severe depression group.

Among adults with epilepsy, depressive severity was positively correlated with seizure frequency and stigma and negatively correlated with quality of life, social support and overall functioning. These results highlight the importance of routine screening for depression, and of providing management of these symptoms in comprehensive epilepsy care.