{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:56:33Z","timestamp":1791561393074,"version":"4.3.4"},"reference-count":65,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Climate\u2010related exposures, including air pollution, temperature extremes, humidity, and atmospheric conditions, are increasingly recognized as potential seizure triggers. As climate change intensifies, understanding the environmental contributors to pediatric seizure risk has important implications for anticipatory guidance and public health preparedness. Previous reviews have focused primarily on adults or basic science, with limited synthesis of pediatric evidence. Therefore, we conducted a systematic review to evaluate associations between climate\u2010related exposures and seizures in children, including those with and without epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses) 2020 guidelines, we conducted a systematic review registered in PROSPERO (Prospective Register of Systematic Reviews; CRD420251133772). We searched PubMed, Embase, Web of Science Core Collection, PsycInfo, Global Health, and Environment Index from date of database inception to August 29, 2025 and performed backward and forward citation tracking on June 9, 2026. Eligible studies examined associations between climate\u2010related exposures and seizure\u2010related outcomes in children \u226418\u2009years old. Two reviewers independently screened studies and extracted data. Findings were synthesized narratively, and risk of bias was assessed using ROBINS\u2010I V2 (Risk of Bias in Non\u2010Randomized Studies of Interventions, Version 2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010three studies met inclusion criteria; 20 examined temperature, 16 air pollution, and 10 other exposures. Only one study was conducted in a lower\u2013middle\u2010income country, and no studies were conducted in low\u2010income countries. Nitrogen dioxide (NO\n                      <jats:sub>2<\/jats:sub>\n                      ) showed the most consistent associations with seizures, particularly among children with established epilepsy, although effect sizes were generally modest. A representative study reported 2%\u20134% increases in hospitalizations per 10\u2009\u03bcg\/m\n                      <jats:sup>3<\/jats:sup>\n                      increase in NO\n                      <jats:sub>2<\/jats:sub>\n                      . Associations between ambient temperature and seizure were less consistent, although findings for febrile seizures were more consistent. Heterogeneity in findings likely reflected differences in exposure assessment, outcome definitions, and confounder adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>\n                      Climate\u2010related exposures, particularly NO\n                      <jats:sub>2<\/jats:sub>\n                      and temperature extremes, may increase seizure risk in children. These findings support consideration of environmental exposures in clinical counseling. The near absence of studies from low\u2010 and lower\u2013middle\u2010income countries limits generalizability and highlights an important priority for future research.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70455","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T16:06:06Z","timestamp":1787414766000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Climate\u2010related exposures and seizures in children: A systematic review"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2662-3025","authenticated-orcid":false,"given":"Caroline","family":"Sarpy","sequence":"first","affiliation":[{"name":"Department of Neurology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3456-5528","authenticated-orcid":false,"given":"Yoon Sik","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T. H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3059-1369","authenticated-orcid":false,"given":"Carol","family":"Mita","sequence":"additional","affiliation":[{"name":"Countway Library of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8565-9888","authenticated-orcid":false,"given":"Xingyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Harvard T. H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6373-1068","authenticated-orcid":false,"given":"Phillip L.","family":"Pearl","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Department of Neurology Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0380-2407","authenticated-orcid":false,"given":"Maitreyi","family":"Mazumdar","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Department of Environmental Health Harvard T. H. 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