Current Therapeutic Strategies for Rasmussen Encephalitis: A Systematic Review of Functional Hemispherectomy and Immunotherapy in Pediatric Intractable Epilepsy

The dominant paradigm is the immunological understanding of Rasmussen Encephalitis (RE), encompassing the role of cytotoxic T-cells, inflammation, and the rationale for immunomodulatory therapies. The preprint also acknowledges the surgical paradigm, where hemispherectomy is the most effective intervention for seizure control.

This systematic review operates within the dominant paradigms of RE management. It examines the efficacy of established treatments (hemispherectomy and immunotherapy) without proposing fundamentally new theoretical frameworks. Therefore, it falls under the "Normal Science" classification. However, the review also highlights the limitations of current immunotherapies and explores the potential of combined approaches and emerging biologic treatments, suggesting a degree of "Model Drift." The exploration of combined treatments and the acknowledgment of the limitations of existing therapies suggest that the field may be experiencing some dissatisfaction with the current model, although not a full-blown crisis. This points towards the potential for future paradigm shifts if novel therapeutic strategies demonstrate superior efficacy to hemispherectomy or provide long-term disease modification. The emphasis on identifying early biomarkers also suggests the field is looking for ways to refine the current model and improve patient outcomes, which is a characteristic of model drift. Therefore, while primarily "Normal Science," elements of "Model Drift" are also present.