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Research | DOI: https://doi.org/10.31579/2642-973X/159
1Neurology Department, Faculty of Medicine - Mansoura University
2 Radiology Department, Faculty of Medicine - Mansoura University.
*Corresponding Author: Ahmed Hamdy, Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura 355111, Egypt; E-mail: Ahmedhamdy@mans.edu.eg.
Citation: Ahmed Hamdy; Tamer Belal; Sieza Samir; Khaled Eltoukhy; Ibrahim Elmenshawi (2020), Sleep and Psychiatric Evaluation in Refractory Versus Controlled Epilepsy, J. Brain and Neurological Disorders, 3(1): DOI:10.31579/2642-973X/159
Copyright: © 2020, Ahmed Hamdy. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 01 December 2020 | Accepted: 08 December 2020 | Published: 16 December 2020
Keywords: refractory epilepsy; controlled epilepsy; sleep quality; sleep disturbances; antiepileptic drugs; psychiatric comorbidities
Background: Epilepsy, a prevalent neurological disorder affecting approximately 50 million people worldwide, is closely intertwined with sleep disturbances. These disturbances, often more profound in individuals with epilepsy, may arise from seizures, antiepileptic drugs (AEDs), or comorbid sleep disorders. Among epilepsy subtypes, refractory epilepsy—defined as failure of seizure control despite adequate AED therapy—may demonstrate greater sleep architecture disruption.
Objective: This study aimed to compare sleep abnormalities between patients with idiopathic drug-refractory epilepsy and those with well-controlled epilepsy using objective sleep assessment tools.
Methods: A comparative cross-sectional study was conducted on 90 adults with idiopathic epilepsy, divided into two groups: refractory epilepsy (n = 60) and controlled epilepsy (n = 30). An additional group of 20 healthy individuals served as controls. All participants underwent clinical evaluation, interictal EEG, psychiatric assessment using the Hamilton Anxiety Rating Scale (HAM-A) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and subjective sleep assessment using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS).
Results: Patients with refractory epilepsy reported significantly more sleep-related complaints, including insomnia, excessive daytime sleepiness, and snoring, compared to those with controlled epilepsy. PSQI and ESS scores were markedly higher in the refractory group, reflecting poorer sleep quality and greater daytime drowsiness. Additionally, anxiety and depression scores were significantly elevated in the refractory group.
Conclusions: Sleep disturbances and psychiatric comorbidities are more prevalent and severe in patients with drug-refractory epilepsy compared to those with well-controlled epilepsy. Addressing these non-seizure-related factors may offer additional strategies for improving quality of life and seizure control in this challenging patient population.
Epilepsy is a prevalent chronic neurological disorder affecting approximately 50 million individuals globally. It is characterized by recurrent, unprovoked seizures resulting from abnormal electrical discharges in the brain. Among its subtypes, refractory epilepsy—also known as drug-resistant epilepsy—poses a significant clinical challenge [1]. These patients fail to achieve seizure control despite adequate trials of at least two appropriate antiepileptic drugs (AEDs), and are often burdened by increased morbidity, reduced quality of life, and higher risk of complications, including sudden unexpected death in epilepsy (SUDEP) [2, 3].
A growing body of research supports a bidirectional relationship between epilepsy and sleep. Epileptic seizures can disturb normal sleep cycles, and conversely, disrupted sleep may increase seizure frequency or intensity. Furthermore, AEDs can variably impact sleep quality—some promoting sleep while others cause fragmentation. Despite this established interplay, most previous studies have focused broadly on sleep disorders in epilepsy patients, without stratifying individuals based on their response to treatment [4, 5].
There remains a significant gap in literature comparing sleep characteristics specifically between drug-refractory and well-controlled epilepsy patients. Such comparative assessments may help illuminate whether refractory epilepsy is associated with unique sleep-related challenges beyond those experienced in well-controlled cases [6, 7].
This study aims to bridge this gap by evaluating and comparing sleep-related complaints, subjective sleep quality, and related psychiatric comorbidities in patients with idiopathic drug-refractory epilepsy versus those with well-controlled epilepsy. The findings may help refine epilepsy management by addressing non-seizure-related contributors such as poor sleep and psychiatric distress that may compound disease burden in treatment-resistant cases.
This study was designed as a prospective cross-sectional analysis conducted at the Neurology Department of Mansoura University Hospital (MUH) between September 2017 and October 2019. Ethical approval was obtained from the Faculty of Medicine’s Ethical Committee, Mansoura University. All participants provided written informed consent prior to participation.
Study Participants
A total of 90 adult patients (aged >18 years) diagnosed with idiopathic epilepsy were enrolled from the MUH outpatient neurology clinic. Diagnosis and classification of epilepsy were based on the criteria of the International League Against Epilepsy (ILAE).
Participants were divided into two groups:
• Refractory Epilepsy Group (n = 60): Patients who continued to experience seizures at a frequency greater than once per month for at least six months, despite adherence to optimal doses of two or more AEDs.
• Controlled Epilepsy Group (n = 30): Patients who had been seizure-free for a minimum of six months while on one or more AEDs.
A control group of 20 age- and sex-matched healthy individuals without epilepsy or any known sleep or psychiatric disorders was included for baseline comparison.
Exclusion Criteria
Patients were excluded if they had:
• Structural brain abnormalities
• Pseudo-refractory epilepsy (e.g., due to poor compliance or misdiagnosis)
• Neurological conditions affecting sleep (e.g., stroke, encephalitis)
• Medical illnesses that disturb sleep (e.g., thyroid disorders, respiratory disease)
• A primary sleep disorder preceding the onset of epilepsy
• Current use of medications known to significantly affect sleep architecture
Clinical and Neurological Assessment
All participants underwent detailed clinical history-taking and neurological examination. Epilepsy-specific variables such as age at onset, seizure type, duration, frequency, and number/type of AEDs used were documented.
Electroencephalographic (EEG) Evaluation
Interictal EEG was conducted for all epilepsy patients using a 21-channel Nihon Kohden system with electrodes applied according to the international 10–20 system. Recordings included activation procedures such as hyperventilation and photic stimulation.
Psychiatric Assessment
Psychiatric comorbidities were evaluated using:
• Hamilton Anxiety Rating Scale (HAM-A): To assess anxiety symptoms.
• Neurological Disorders Depression Inventory for Epilepsy (NDDI-E): A validated tool for screening depressive symptoms in epilepsy patients.
Subjective Sleep Assessment
Patients completed:
• Pittsburgh Sleep Quality Index (PSQI): To evaluate sleep quality over the past month; scores >5 indicated poor sleep quality.
• Epworth Sleepiness Scale (ESS): To assess daytime sleepiness; scores >10 indicated excessive daytime sleepiness (EDS).
All data were entered, processed, and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA, 2017). Qualitative data were summarized as frequencies and percentages, while quantitative variables were expressed as mean ± standard deviation (SD) for normally distributed data, or as median and interquartile range (IQR) for non-normally distributed data. The normality of data distribution was assessed using both the Kolmogorov–Smirnov and Shapiro–Wilk tests, with a p-value greater than 0.05 indicating normality. The presence of significant outliers or extreme values was examined using boxplots.
For comparison of qualitative variables, the Chi-square test or Fisher’s exact test was applied as appropriate, with Monte Carlo significance used when needed. Bonferroni correction was applied to adjust p-values during multiple comparisons, and differences between column proportions were represented using letters (identical letters denoting non-significant differences and different letters denoting significant differences).
For quantitative data, comparisons between two groups were performed using the Independent-Samples t-test for normally distributed data or the Mann–Whitney U test for non-parametric data. For comparisons among more than two groups, one-way analysis of variance (ANOVA) or its non-parametric counterpart, the Kruskal–Wallis H test, was utilized. Post-hoc pairwise comparisons were conducted to identify specific intergroup differences, which were also represented by letter coding for clarity.
To assess associations between continuous variables, Pearson’s correlation coefficient (r) was used for normally distributed data, whereas Spearman’s rank-order correlation (ρ) was applied for non-parametric or ordinal data. Both correlation tests were used to evaluate the strength and direction of relationships, where r or ρ values ranged from -1 (perfect negative correlation) to +1 (perfect positive correlation), and a value of 0 indicated no correlation.
Additionally, multivariate logistic regression analysis was performed to determine independent predictors and to construct a prediction model for the likelihood of specific clinical outcomes. Results were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). For all statistical tests applied, a p-value ≤ 0.05 was considered to indicate statistical significance.
The results of the present study are demonstrated in the following tables.
Parameter |
Group |
Test of significance |
P | |
Healthy subjects (n=20) | Epilepsy patients’ (n=90) | |||
Gender: - Male - Female |
9 (45%) 11 (55%) |
53 (58.9%) 37 (41.1%) |
c2 = 4.181 |
0.143 |
| Age: | 29.5 (23.5-33) | 31.50 (23-36) | KW = -0.450 | 0.653 |
| BMI: | 26.4 (23.7-29.8) | 28 (25-31) | KW = -1.201 | 0.230 |
Age: years, BMI: Body Mass Index (kg/m2)
Data expression: gender: frequency (percentage) - age and BMI: median (IQR).
P value: gender: Chi-Square test - age and BMI: Kruskal-Wallis test.
Table 1: Demographic data of studied groups:
Fifty-three male patients (58.9%) and 37 females (41.1%) with idiopathic epilepsy were enrolled in our study. In addition, 9 males (45%) and 11 females (55%) were included as a group of healthy subjects. This distribution of gender together with age and BMI between the 2 groups were of no statistical significance.
| Variables | Cases (n=90) | |
| Number | % | |
| Epilepsy and seizure classification: | ||
| Generalized epilepsy: | ||
| -Generalized motor tonic clonic seizure: | 81 | 90 |
| -Generalized onset non motor typical absence seizures: | 6 | 6.6 |
| Focal epilepsy: | ||
| -Focal onset aware motor clonic seizures: | 4 | 4.4 |
| -Focal onset non motor with impaired awareness seizures: | 2 | 2.2 |
| Epilepsy syndrome: | ||
| -Juvenile myoclonic epilepsy: | 13 | 14.4 |
Age at onset of epilepsy (years): Median (IQR) |
14 (8-18) | |
Duration of epilepsy (years): Median (IQR) | 14 (10-20) | |
| Seizure control: | ||
| Drug refractory: | 60 | 66.7 |
| Drug controlled: | 30 | 33.3 |
| Frequency of seizures/month: Median (IQR) | ||
| Drug refractory: | 3 (2-12) | |
| Drug controlled: | 0 | |
| Duration since last seizure: Median (IQR) | ||
| Drug refractory: | 7 (4-14) days | |
| Drug controlled: | 1 (1-3) years | |
Duration of intractability in the refractory epilepsy group: Median (IQR)
|
9 (7-13) years | |
| AEDs: | ||
| Single: | 4 | 4.4 |
| Multiple: | 86 | 95.6 |
Number of used AEDs: Median (min.-max.) | 3 (1-5) | |
| Types of used AEDs: | ||
| Levetiracetam, | 74 | 82.2 |
| Valproate, | 70 | 77.8 |
| Carbamazepine, | 39 | 43.3 |
| Lamotrigine, | 31 | 34.4 |
| Phenytoin, | 11 | 12.2 |
| Oxcarbazepine, | 10 | 11.1 |
| Clonazepam, | 10 | 11.1 |
| Zonisamide, | 6 | 6.7 |
| Topiramate, | 4 | 4.4 |
IQR: Interquartile range, AEDs: antiepileptic drugs,
Data expression: frequency and percentage
Table 2: Clinical characteristics of epilepsy patients:
Generalized onset motor tonic clonic seizure was the most prevalent seizure type in our patients and Juvenile myoclonic epilepsy was the only epilepsy syndrome included. Those who suffered from refractory epilepsy represented 66.7 % (60 patients) while 33.3 % (30 patients) were controlled. 95.6% of the included patients were on poly-therapy of antiepileptic drugs. Different generations of AEDs were used by patients; levetiracetam, valproate and carbamazepine were the most commonly used.
Parameter |
Group |
Test of significance |
P | ||
Healthy subjects (n=20) |
Drug Controlled epilepsy (n=30) |
Drug Refractory Epilepsy (n=60) | |||
Gender: - Male - Female |
9 (45%) 11 (55%) |
17 (56.7%) 13 (43.3%) |
36 (60%) 24 (40%) |
c2 = 4.178 |
0.124 |
| Age: | 29.5(23.5-33) | 33 (22.75-36.25) | 29 (23-35) | KW = 0.79 | 0.675 |
| BMI: | 26.4 (23.7-29.8) | 28 (26-29.8) | 26.5 (24-31) | KW = 2.4 | 0.297 |
Age: years, BMI: Body Mass Index (kg/m2)
Data expression: gender: frequency (percentage) - age and BMI: median (IQR).
P value: gender: Chi-Square test - age and BMI: Kruskal-Wallis test.
Table 3: Demographic data of 3 studied groups:
Distribution of gender together with age and BMI among groups were of no statistical significance.
| Parameter | Group | Test of significance | P-value | |
Controlled (n=30) | Refractory (n=60) | |||
Age at onset of epilepsy Median (IQR) | 15 (12-18) | 12.5 (8-18) | U= 759 Z = -1.209 | 0.227 |
Duration of epilepsy Median (IQR) | 14.5 (8-21) | 14.5 (11-18) | U = 869 Z = -0.266 | 0.790 |
| Timing of seizure: | ||||
| -Day: | 15 (50%) a | 32 (53.3%) a | c2 = 0.543 |
0.797 (MC) |
| -Night: | 2 (6.7%) a | 2 (3.3%) a | ||
| -Day & Night: | 13 (43.3%) a | 26 (43.3%) a | ||
| Epilepsy and seizure classification:* | ||||
| Generalized epilepsy: |
c2 = 9.243 |
0.042 | ||
| -Generalized onset motor tonic clonic seizures: | 27 (90%) a | 54 (90%) a | ||
| -Generalized onset non motor typical absence seizures: | 1 (3.3%) a | 5 (8.3%) a | ||
| Focal epilepsy: | ||||
| -Focal onset aware motor clonic seizures: | 2 (6.7%) a | 2 (3.3%) a | ||
| -Focal onset non motor with impaired awareness seizures: | 0 (0%) a | 2 (3.3%) a | ||
| Epilepsy syndromes: | ||||
-Juvenile myoclonic epilepsy:
| 0 (0%) a | 13 (21.7%) b | ||
Number of AEDs Median (min.-max.) | 2 (1-3) | 3 (2-5) | U = 355 Z = -5.078 | <0> |
| Used AEDs: | c2 = | |||
| Levetiracetam | 23 (76.7%) a | 51 (85%) a | 0.950 | 0.330 |
| Valproate | 24 (80%) a | 46 (76.7%) a | 0.129 | 0.720 |
| Carbamazepine, | 11 (36.7%) a | 28 (46.7%) a | 0.814 | 0.367 |
| Lamotrigine, | 6 (20%) a | 25 (41.7%) b | 4.158 | 0.041 |
| Phenytoin, | 1 (3.3%) a | 10 (16.7%) a | FET | 0.092 |
| Oxcarbazepine, | 0 (0%) a | 10 (16.7%) b | FET | 0.027 |
| Clonazepam, | 0 (0%) a | 10 (16.7%) b | FET | 0.027 |
| Zonisamide, | 0 (0%) a | 6 (10%) a | FET | 0.173 |
| Topiramate | 0 (0%) a | 4 (6.7%) a | FET | 0.297 |
Table 4: Clinical characteristics of the drug controlled and drug refractory epilepsy groups’:
There was no statistically significant difference in age at onset, duration of epilepsy or timing of seizures in the refractory vs. the controlled epilepsy group. As regard seizure type, generalized onset motor tonic clonic seizure type was the most prevalent seizure type in both groups of refractory and controlled epilepsy. Among the 13 patients suffered from JME, no one showed any evidence of being controlled on medications.
Valproate, levetiracetam and carbamazepine were the most commonly used drugs by the 2 groups. Patients with refractory epilepsy were taking more AEDs, as expected, compared to those with drug controlled epilepsy, a difference that achieved a statistical significance (P<0>
Sleep complaint | Drug controlled epilepsy (N=30) | Drug refractory epilepsy (N=60) |
p-value |
| Insomnia | 6 (20%) | 25 (41.7%) | 0.041 |
| Excessive daytime sleepiness | 8 (26.7%) | 38 (63.3%) | 0.01 |
| Snoring | 8 (26.7%) | 30 (50%) | 0.035 |
| Restless leg syndrome | 0 | 0 | |
| Parasomnia | 0 | 0 |
Table 5: Self-reported clinical sleep problems in the 2 epilepsy groups:
Subjective sleep complaints of insomnia, EDS and snoring were more significantly predominant with patients of refractory epilepsy. Those sleep complaints were reported by patients after diagnosis of epilepsy (patients with sleep complaints before having epilepsy were not enrolled in the study). None of the healthy subjects reported any sleep complaint.
Parameter |
Group |
Test of significance |
P | ||
Healthy subjects (n=20) |
Drug Controlled epilepsy (n=30) |
Drug Refractory Epilepsy (n=60) | |||
| PSQI | 2.5 (1- 7)a | 3 (2- 11)a | 7 (2 - 20) b | KW = 26.5 | <0> |
| ESS (>10) | 1 (5%)a | 5 (16.7%)a | 34 (56.7%)b | c2 = 24.220 | <0> |
| HAM-A | 7 (4 - 10)a | 11 (4- 20)a | 23 (10- 34)b | KW = 66.744 | <0> |
| NDDI-E | 8 (6 - 9)a | 8 (6 - 12)a | 11 (8 - 17)b | KW = 53.775 | <0> |
PSQI: Pittsburg Sleep Quality Index, ESS: Epworth Sleepiness Scale, HAM-A: Hamilton anxiety rating scale, NDDI-E: Neurological disorders depression inventory for epilepsy Data expression: PSQI, HAM-A, NDDI-E: median (min..-max.), ESS: frequency (percentage). P value: PSQI: Kruskal-Wallis test, ESS: Chi-Square test. a and b: Similar letters = insignificant difference, different letters = significant difference.
Table 6: Comparison of different clinical scores among the 3 groups:
Both epilepsy groups showed poor sleep quality and excessive daytime sleepiness (shown by high PSQI and ESS scores, respectively) rather than the group of healthy subjects. The severity of these sleep abnormalities was significantly higher in the refractory epilepsy group. Scores of HAM-A and NDDI-E were also significantly higher with the group of refractory epilepsy.
| Parameter | Number of AEDs | |
| rs | P | |
| PSQI | 0.252* | 0.017 |
| ESS | 0.360** | <0> |
rs: spearman correlation * : significant **: highly significant
Table 7: Correlation of number of antiepileptic drugs (AEDs) with sleep parameters in all
As previously shown in table (7), number of AEDs was significantly higher in the refractory vs. the controlled epilepsy group. In this table, increased number of used AEDs was significantly associated with higher scores of PSQI and ESS scores indicating subjective poor subjective sleep quality and more likelihood of excessive daytime sleepiness respectively.
| Variable | frequency of seizures | Duration since last seizure | Duration of epilepsy | Duration of intractability | Age at onset of epilepsy | |||||
| rs | P | rs | P | rs | P | rs | P | rs | P | |
| PSQI | 0.07 | 0.616 | 0.016 | 0.905 | -0.115 | 0.392 | 0.104 | 0.456 | 0.118 | 0.370 |
| ESS | 0.304* | 0.018 | 0.220 | 0.091 | -0.211 | 0.807 | 0.179 | 0.194 | 0.145 | 0.127 |
PSQI: Pittsburg sleep quality Index, ESS: Epworth Sleepiness Scale, *: significant, **: highly significant.
Table 8: Correlation of different epilepsy characteristics with sleep parameters among refractory
In the refractory epilepsy group; increased seizure frequency was significantly associated with increased likelihood of excessive daytime sleepiness (as shown by higher scores of ESS). Duration since last seizure had only significant inverse correlation with the arousal index. None of duration of epilepsy, duration of intractability or age at onset of epilepsy had an impact on sleep profile of patients.
| Variable | Duration since last seizure | Duration of epilepsy | Age at onset of epilepsy | |||
| rs | P | rs | P | rs | P | |
| PSQI | -0.419* | 0.021 | -0.178 | 0.375 | 0.178 | 0.140 |
| ESS | -0.306 | 0.100 | -0.381 | 0.052 | 0.087 | 0.649 |
Table 9: Correlation of different epilepsy characteristics with sleep parameters in the controlled epilepsy group:
rs: spearman correlation * : significant **: highly significant
Increased duration of seizure control was significantly associated with lower scores on PSQI indicating better subjective sleep quality.
| Parameter | Refractory group | Controlled group | ||||||
| HAM-A | NDDI-E | HAM-A | NDDI-E | |||||
| rs | P | rs | P | rs | P | rs | P | |
| PSQI | -0.038 | 0.771 | 0.034 | 0.858 | -0.197 | 0.297 | -0.248 | 0.056 |
| ESS | 0.005 | 0.969 | 0.038 | 0.841 | -0.144 | 0.448 | -0.119 | 0.364 |
HAM-A: Hamilton Anxiety Scale, NDDI-E: Neurological disorders depression inventory for epilepsy, rs: spearman correlation
Table 10: Correlation between scores of psychiatric scales and sleep profile in the refractory versus controlled epilepsy groups:
In the refractory epilepsy group; scores of both HAM-A and NDDI-E were significantly inversely correlated with sleep efficiency and significantly positively correlated with sleep onset latency.
Epilepsy affects nearly 50 million people globally, with 30–40% of patients remaining refractory to pharmacological treatment despite appropriate AED use [8]. This persistent seizure activity is linked to several adverse outcomes, including cognitive, psychological, and social burdens [9]. Sleep disturbances are closely intertwined with epilepsy, with early observations by Gowers (1885) highlighting the timing of seizures in relation to the sleep–wake cycle [10].
Sleep deprivation is known to lower seizure thresholds, while nocturnal seizures, AED side effects, and psychiatric comorbidities can disrupt sleep quality [11-13]. This bidirectional relationship negatively impacts quality of life [14,15]. Although studies have explored sleep differences between epilepsy patients and healthy individuals [10,16], direct comparisons between refractory and controlled epilepsy patients are limited [17].
Our study addressed this gap by evaluating 90 adult patients with idiopathic epilepsy, comparing 60 with drug-refractory epilepsy to 30 with controlled epilepsy, along with 20 healthy controls. Despite similarities in age, gender, and BMI, patients with refractory epilepsy used significantly more AEDs [3 (2–5) vs. 2 (1–3)], reflecting the complexity of achieving seizure control [18]. Valproate, levetiracetam, and carbamazepine were the most frequently prescribed drugs, consistent with prior efficacy reports [19].
No significant difference was found in age at onset or epilepsy duration between groups, aligning with findings from Xue-Ping et al. [20], though earlier onset has been suggested as a potential risk factor by Kalilani et al. [21]. Psychiatric comorbidities were notably higher in refractory cases, as reflected by elevated HAM-A and NDDI-E scores, emphasizing the role of mental health in epilepsy management [22].
Sleep disorders such as insomnia, EDS, and OSAS were markedly more prevalent among epilepsy patients than the general population [23]. These disturbances may worsen seizure control and reinforce the need for integrated care targeting both neurological and sleep-related outcomes.
Our study revealed that sleep disturbances were frequently reported in both drug-refractory and controlled epilepsy groups, but significantly more so in patients with refractory epilepsy. The most common complaint was excessive daytime sleepiness (EDS), affecting 63.3% of the refractory group compared to 26.7% of the controlled group (p = 0.01). This subjective complaint was supported by Epworth Sleepiness Scale (ESS) scores >10, which were significantly higher in the refractory group (56.7%) than the controlled (16.7%) and healthy groups (5%) (p < 0.0005). Notably, ESS scores positively correlated with the number of AEDs (p < 0.0005) and seizure frequency (p = 0.018), aligning with findings from Çilliler and Güven [24] and Zanzmera et al. [17].
Snoring and insomnia were also more prevalent among the refractory group (50% and 41.7%, respectively) compared to the controlled group (26.7% and 20%; p = 0.035 and p = 0.041). These complaints were corroborated by higher Pittsburgh Sleep Quality Index (PSQI) scores in the refractory group (median = 7) than both the controlled (median = 3) and healthy groups (median = 2.5) (p < 0.0005), consistent with Carrion et al. [25] and Ismayilova et al. [26].
Psychiatric comorbidities were also relevant. Although no direct correlation was found between anxiety/depression scores and subjective sleep measures (ESS/PSQI), significant associations emerged with objective sleep parameters. These findings highlight the underestimated role of psychiatric symptoms in disrupting sleep in refractory epilepsy
Several limitations should be noted. The sample size was modest, and polytherapy among patients precluded isolating AED-specific effects on sleep or metabolism. Future studies with larger cohorts, stratified by epilepsy subtype and AED regimen, are essential to validate these findings.
This study demonstrates that patients with drug-refractory epilepsy experience significantly greater disruptions in sleep compared to those with controlled epilepsy. The results suggest that disturbed sleep may contribute to seizure intractability and is not merely a consequence of the disease. Moreover, the presence of psychiatric comorbidities further compounds the issue, indicating the need for holistic patient management. Our findings underscore the importance of addressing sleep and psychiatric health as integral components of epilepsy care.
Abbreviation Full Term
AEDs Antiepileptic Drugs
BMI Body Mass Index
CE Controlled Epilepsy
EDS Excessive Daytime Sleepiness
EEG Electroencephalogram
ESS Epworth Sleepiness Scale
HAM-A Hamilton Anxiety Rating Scale
ILAE International League Against Epilepsy
MRI Magnetic Resonance Imaging
NDDI-E Neurological Disorders Depression Inventory for Epilepsy
PSQI Pittsburgh Sleep Quality Index
SUDEP Sudden Unexpected Death in Epilepsy
The authors would like to thank the staff of the Neurology and Radiology Departments at Mansoura University Hospital for their collaboration and technical support in conducting this study. We also thank the patients and healthy volunteers for their participation.
All authors have reviewed and approved the final manuscript.
The authors declare that there are no conflicts of interest regarding the publication of this paper.
All collected data were anonymized and stored securely. Only the research team had access to patient data, which were used solely for research purposes under ethical approval and institutional guidelines.
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As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
