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It is well established that despite the availability of numerous novel antiseizure medications (ASMs), one third of children with new-onset seizures will not achieve seizure remission [1–3]. These children endure the physical, psychological and social consequences of intractable seizures and face an elevated risk of death [4,5]. Despite its clinical importance, the early prediction of treatment outcome remains a major challenge [6], with only a limited number of large, community-based, long-term studies evaluating early predictors of medical refractoriness in childhood epilepsy [7–9].