Teaching LLMs to Recommend and Defer in Underrepresented Epilepsy Care

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.

Panini: Continual Learning in Token Space via Structured Memory

Language models are increasingly used to reason over content they were not trained on, such as new documents, evolving knowledge, and user-specific data. A common approach is retrieval-augmented generation (RAG), which stores verbatim documents externally (as chunks) and retrieves only a relevant subset at inference time for an LLM to reason over. However, this results in inefficient usage of test-time compute (LLM repeatedly reasons over the same documents); moreover, chunk retrieval can inject irrelevant context that increases unsupported generation. We propose a human-like non-parametric continual learning framework, where the base model remains fixed, and learning occurs by integrating each new experience into an external semantic memory state that accumulates and consolidates itself continually. We present Panini, which realizes this by representing documents as Generative Semantic Workspaces (GSW) -- an entity- and event-aware network of question-answer (QA) pairs, sufficient for an LLM to reconstruct the experienced situations and mine latent knowledge via reasoning-grounded inference chains on the network. Given a query, Panini only traverses the continually-updated GSW (not the verbatim documents or chunks), and retrieves the most likely inference chains. Across six QA benchmarks, Panini achieves the highest average performance, 5%-7% higher than other competitive baselines, while using 2-30x fewer answer-context tokens, supports fully open-source pipelines, and reduces unsupported answers on curated unanswerable queries. The results show that efficient and accurate structuring of experiences at write time -- as achieved by the GSW framework -- yields both efficiency and reliability gains at read time. Code is available at https://github.com/roychowdhuryresearch/gsw-memory.