Journal of Child Neurology最新文献

Multiple autoimmune syndrome (MAS) is characterized by the coexistence of 3 or more autoimmune disorders in the same individual and is exceptionally rare in childhood. Pediatric-onset multiple sclerosis (POMS) represents 3% to 5% of all multiple sclerosis (MS) cases and is increasingly recognized within the broader spectrum of immune-mediated diseases. We describe 2 pediatric patients fulfilling MAS criteria in association with POMS-one with type 1 diabetes mellitus and autoimmune thyroiditis, and another with rheumatoid arthritis and autoimmune thyroiditis. Both exhibited HLA-DRB1*15:01 positivity, Epstein-Barr virus IgG seropositivity, and severe vitamin D deficiency, suggesting shared immunogenetic and environmental risk factors. These cases highlight the potential of POMS to manifest as part of a systemic autoimmune diathesis. Early recognition, proactive screening, and multidisciplinary management are essential. Further multicenter studies and registry-based data are needed to clarify the prevalence, mechanisms, and prognostic implications of MAS in pediatric MS.

Juvenile neuronal ceroid lipofuscinosis, linked to mutations in the ceroid lipofuscinosis, neuronal 3 (CLN3) gene, is a childhood-onset neurodegenerative disorder. Although mood and behavioral symptoms are described in this group, it's unclear whether these meet diagnostic criteria. We investigated the occurrence of neurodevelopmental and psychiatric disorders in a nationally representative sample, using a semistructured psychiatric interview, as well as the use of psychotropic medication. Ten of 20 individuals met the criteria for one or more current diagnoses, with an additional 5 having past diagnoses, resulting in a lifetime occurrence in 15 individuals. Anxiety disorders were the most frequent diagnostic group, followed by neurodevelopmental disorders. Attention-deficit hyperactivity disorder was the most common single diagnosis. Subthreshold psychiatric symptoms were present in all individuals. Although psychiatric disorders were frequent, few used psychotropic medication. These findings underscore the need for routine monitoring of neurodevelopmental and psychiatric disorders in individuals with CLN3 and the provision of evidence-based treatments.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder involving systemic inflammation and multi-organ damage, which often affects the central nervous system (CNS). Familial HLH, which is caused by mutations in genes such as PRF1 and UNC13D, impairs the function of cytotoxic cells, leading to uncontrolled immune activation. CNS involvement occurs in 30% to 73% of cases and manifests as seizures, encephalopathy or status epilepticus, which often mimics other neurologic conditions. This article presents the case of a 28-month-old boy with PRF1-related HLH who developed super-refractory status epilepticus during CNS relapse, despite having undergone a prior hematopoietic stem cell transplantation (HSCT). An initial MRI scan revealed diffuse cortical and cerebellar abnormalities, whereas systemic HLH findings emerged later. Treatment included antiseizure medications, immunotherapy and etoposide, but severe neurologic deficits persisted. A review of the literature on 20 pediatric HLH cases presenting with status epilepticus revealed a variety of presentations, including focal, generalized and febrile infection-related epilepsy syndrome (FIRES). Neuroimaging showed white matter lesions, atrophy or diffusion abnormalities, whereas CSF findings ranged from normal to elevated protein and neopterin levels. Mortality was high (45%), with survivors often experiencing cognitive or motor impairments. HLH relapse can initially present with isolated CNS involvement, emphasizing the need for early neuroimaging and cerebrospinal fluid (CSF) analysis in suspected cases. Despite aggressive treatment, outcomes remain poor, highlighting the need for further research into optimal management strategies.

BackgroundChildhood primary angiitis of the central nervous system is a rare inflammatory disorder affecting the central nervous system in children. High-resolution magnetic resonance vessel wall imaging is less frequently used in the childhood primary angiitis of the central nervous system. This study aimed to investigate the value of high-resolution magnetic resonance vessel wall imaging in childhood primary angiitis of the central nervous system.MethodsWe retrospectively reviewed patients <18 years old who met the diagnostic criteria for primary angiitis of the central nervous system at Xiangya Hospital from January 2020 to April 2024. High-resolution magnetic resonance vessel wall imaging was performed to assess vessel wall enhancement, which was subsequently quantified for analysis.ResultA total of 6 patients were included in the study, 3 of whom were male, with a mean age of onset of 10.3 years. The most common presenting symptoms were headache/dizziness and hemiplegia. Ischemic brain lesions were caused by stenosis of vessels in the anterior circulation in 4 patients and in the posterior circulation in 2 patients. Intravenous methylprednisolone was the primary immunotherapy used and was administered to all patients. None experienced relapse. A total of 174 arteries were evaluated, of which 38 exhibited grade 1 enhancement and 31 exhibited grade 2 enhancement. Bilateral internal carotid artery wall enhancement was noted in all patients. Corresponding offending arteries were identified in each case, all of which showed predominant enhancement and varying degrees of stenosis. The vessel wall enhancement score at the initial assessment was 16.7 ± 2.8, which significantly decreased to 12.7 ± 2.4 at the final assessment (P = .012).ConclusionHigh-resolution magnetic resonance vessel wall imaging appears to be a potentially effective tool for both diagnosing childhood primary angiitis of the central nervous system and monitoring response to treatment.

Spinal muscular atrophies are a group of genetically and clinically heterogeneous neuromuscular disorders characterized by progressive loss of lower motor neurons, muscle weakness, and atrophy. Approximately 95% of spinal muscular atrophy cases are associated with a deletion of exons 7 and 8 in the survival motor neuron 1 (SMN1) gene, resulting in insufficient levels of SMN protein. The remaining 5% of cases involve mutations in approximately 30 different genes, collectively referred to as non-SMN-related spinal muscular atrophies. These variants often present with distinct clinical features beyond typical spinal muscular atrophy symptoms, including arthrogryposis, extraocular movement abnormalities, brainstem signs, or cardiomyopathy. This review aims to provide an updated genetic landscape of non-SMN-linked spinal muscular atrophy phenotypes and propose a diagnostic protocol to assist clinicians in cases where SMN1 gene sequencing yields no conclusive findings.

Soccer is the most popular sport worldwide, with participation across all levels of play. Heading the ball raises concerns about subconcussive impacts and their cumulative effects, which remain uncertain. This review aims to synthesize current literature on heading across different levels of play. A narrative review was conducted using the PubMed database to search for articles related to soccer heading and its neurologic outcomes. Articles were categorized by level of play: youth, adolescent, college, adult amateur, and professional. Twenty-seven studies met the inclusion criteria. There was lack of consensus on the neurologic effects of heading across any age group, and only 3 studies followed players through a season. The use of various tools among these studies prevented meaningful comparisons. Overall, the need for longitudinal studies across different levels of play with standardized evaluation tools is crucial for assessing the neurologic outcomes of soccer players.