Hemimegalencephaly is a rare congenital malformation of cortical development involving hamartomatous overgrowth of part or all of one cerebral hemisphere. It commonly presents during infancy with early-onset, drug-resistant seizures, developmental impairment, and contralateral motor deficits. Infantile epileptic spasms may be an initial manifestation. Brain magnetic resonance imaging (MRI) is central to diagnosis and surgical planning. We report the case of an 11-month-old boy with West syndrome and severe developmental delay whose epileptic spasms persisted despite treatment with vigabatrin, sodium valproate, and levetiracetam. Brain MRI demonstrated marked asymmetric enlargement of the left cerebral hemisphere, diffuse cortical thickening, blurring of the gray-white matter differentiation, enlargement and morphological distortion of the left lateral ventricle, shallow sulcation, and extensive pachygyria with areas approaching an agyric appearance. The right cerebral hemisphere was structurally preserved. These findings were consistent with left hemimegalencephaly associated with an extensive malformation of cortical development. An anterior corpus callosotomy was performed as a palliative disconnective procedure; however, the epileptic spasms persisted, and the patient was subsequently referred for evaluation of definitive left hemispherotomy. This case illustrates the characteristic MRI appearance of hemimegalencephaly with diffuse cortical malformation and highlights the limitations of anterior corpus callosotomy when the epileptogenic substrate involves an entire malformed hemisphere. It also emphasizes the role of imaging in guiding escalation to definitive hemispheric disconnection when seizures remain drug-resistant.

Light-responsive photocages are attractive tools for controlled drug delivery, yet achieving efficient photo-release in aqueous media remains challenging. Herein, a symmetrical BODIPY bis(oxime ester) derivative (BD-diOE) was developed for visible-light-triggered release of valproic acid (VPA). The study confirmed a sequential photo-uncaging process resulting in the release of two equivalents of VPA. To improve aqueous performance, BD-diOE was encapsulated into Pluronic F127 micelles (BD-diOE@F127). Quantitative analysis revealed that BD-diOE@F127 in water releases approximately 30% more VPA than BD-diOE in a methanol-mixed water solvent under identical irradiation conditions. Moreover, BD-diOE@F127 exhibited pronounced light-dependent in vitro cytotoxicity. These results demonstrate that the combination of symmetric molecular design and micelle formulation provides a promising platform for photo-responsive biomaterials and controlled drug delivery applications.

We present a case of a man in his late 20s with psychiatric and metabolic comorbidities who developed acute necrotising pancreatitis in the setting of antiepileptic polypharmacy, including valproic acid. The patient presented with nausea, vomiting and progressive lethargy without the classic abdominal pain of pancreatitis, which contributed to diagnostic delay. He rapidly deteriorated into multiorgan failure and septic shock. Laboratory evaluation demonstrated markedly elevated lipase at 16 310 U/L, leucocytosis, metabolic acidosis, acute kidney injury and lactic acidosis. Serum triglycerides, calcium and glucose were within normal limits, excluding metabolic causes. Imaging confirmed necrotising pancreatitis with a large peripancreatic fluid collection. Following exclusion of alternative aetiologies, valproic acid was identified as the most likely cause. The patient improved with supportive management. This case underscores that valproic acid can cause life-threatening pancreatitis even at therapeutic levels and highlights the importance of reviewing medications, particularly in cases presenting atypically without abdominal pain.

Epilepsy in pregnancy is common, but it remains a major risk factor for maternal morbidity and mortality. Over the last decade, neurological causes have remained in the top three indirect causes of maternal death in the UK. National reports, including the recent maternity care bundle, have emphasised the importance of preconceptual counselling to optimise maternal health and reduce complications for epileptic women during pregnancy and postpartum. This study is a retrospective medical record review, examining records of epileptic women of childbearing age, taken from a general practitioner (GP) surgery covering more than 17,000 patients. It aims to assess whether documented preconceptual counselling is taking place for these patients. It was found that, excluding those on a legally required sodium valproate risk record, 93% of the patients did not have documented preconceptual counselling. A recommendation for a set of concise questions for GPs to utilise to normalise pregnancy planning and prompt referrals is proposed.