Pediatric neurology最新文献

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Childhood Dementia: The Collective Impact and the Urgent Need for Greater Awareness and Action

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-20 DOI: 10.1016/j.pediatrneurol.2025.02.005

Kristina L. Elvidge , Michelle A. Farrar , John Christodoulou , Maina P. Kava , Alexandra M. Johnson , Marc C. Patterson , Simon A. Jones , Sameer Zuberi , Jo M. Wilmshurst , Nicholas J.C. Smith

引用次数: 0

Editorial Board and Masthead

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-20 DOI: 10.1016/S0887-8994(25)00036-0

引用次数: 0

Anxiety Disorders Are Associated With Greater Tic Severity in Youth With Chronic Tic Disorder

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-11 DOI: 10.1016/j.pediatrneurol.2025.02.004

Yelizaveta Sapozhnikov MD , Jonathan W. Mink MD, PhD , Heather R. Adams PhD , Nicole Walsh PNP , Andrew Ross MA , Erika C. Esposito PhD , Leona Oakes PhD , Jennifer Vermilion MD

Background

Anxiety disorders are common in and may affect the severity of chronic tic disorder (CTD). We assessed anxiety phenotype in youth with CTD and evaluated for relationships among anxiety, tics, and related symptoms.

Methods

Participants ages 6-17 years with a diagnosis of CTD were enrolled from clinic into a cross-sectional study. Participants and one parent were interviewed by a psychology study team member and a neurology study team member at separate visits. Anxiety disorder presence was determined by the Anxiety Disorders Interview Schedule Child/Parent Version (ADIS-IV). Anxiety symptom severity and specific anxiety symptom types were determined by the Pediatric Anxiety Rating Scale. Tic and premonitory urge severities were determined by clinician-administered instruments.

Results

We enrolled 42 participants with CTD. Most participants had at least one anxiety disorder based on the ADIS-IV (n = 33, 79%). Generalized anxiety disorder was the most common anxiety diagnosis (n = 26, 62%). However, specific anxiety symptoms were often not isolated to specific diagnostic domains. Clinically significant anxiety as measured by the Pediatric Anxiety Rating Scale was present in most participants (n = 25, 60%). Presence of an anxiety disorder was associated with worse severity of tics (z = −3.58, p = 0.0003) and premonitory urge (z = 2.17, p = 0.03).

Conclusions

Assessing anxiety dimensionally rather than categorically is important. Worse anxiety severity is associated with worse severity of tics and premonitory urge. Understanding how anxiety impacts tics and urge in CTD may provide important insights into factors perpetuating tics and guide the approach managing symptoms in anxious youth with CTD.

{"title":"Anxiety Disorders Are Associated With Greater Tic Severity in Youth With Chronic Tic Disorder","authors":"Yelizaveta Sapozhnikov MD , Jonathan W. Mink MD, PhD , Heather R. Adams PhD , Nicole Walsh PNP , Andrew Ross MA , Erika C. Esposito PhD , Leona Oakes PhD , Jennifer Vermilion MD","doi":"10.1016/j.pediatrneurol.2025.02.004","DOIUrl":"10.1016/j.pediatrneurol.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Anxiety disorders are common in and may affect the severity of chronic tic disorder (CTD). We assessed anxiety phenotype in youth with CTD and evaluated for relationships among anxiety, tics, and related symptoms.</div></div><div><h3>Methods</h3><div>Participants ages 6-17 years with a diagnosis of CTD were enrolled from clinic into a cross-sectional study. Participants and one parent were interviewed by a psychology study team member and a neurology study team member at separate visits. Anxiety disorder presence was determined by the Anxiety Disorders Interview Schedule Child/Parent Version (ADIS-IV). Anxiety symptom severity and specific anxiety symptom types were determined by the Pediatric Anxiety Rating Scale. Tic and premonitory urge severities were determined by clinician-administered instruments.</div></div><div><h3>Results</h3><div>We enrolled 42 participants with CTD. Most participants had at least one anxiety disorder based on the ADIS-IV (<em>n</em> = 33, 79%). Generalized anxiety disorder was the most common anxiety diagnosis (<em>n</em> = 26, 62%). However, specific anxiety symptoms were often not isolated to specific diagnostic domains. Clinically significant anxiety as measured by the Pediatric Anxiety Rating Scale was present in most participants (<em>n</em> = 25, 60%). Presence of an anxiety disorder was associated with worse severity of tics (z = −3.58, <em>p</em> = 0.0003) and premonitory urge (z = 2.17, <em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>Assessing anxiety dimensionally rather than categorically is important. Worse anxiety severity is associated with worse severity of tics and premonitory urge. Understanding how anxiety impacts tics and urge in CTD may provide important insights into factors perpetuating tics and guide the approach managing symptoms in anxious youth with CTD.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"166 ","pages":"Pages 7-15"},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Manifestations and Treatments of Patients With Tuberous Sclerosis With Subependymal Giant Cell Astrocytoma

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-10 DOI: 10.1016/j.pediatrneurol.2025.02.003

Hun Kim MD , Seung Ryul Lee MD , Hui Jin Shin MD , Shinyoung Jang MD , Se Hee Kim MD , Joon Soo Lee MD, PhD , Heung Dong Kim MD, PhD , Ara Ko MD, PhD , Hoon-Chul Kang MD, PhD

Background

This study aims to investigate the clinical and genetic characteristics of patients with tuberous sclerosis complex (TSC) with subependymal giant cell astrocytomas (SEGAs).

Methods

We conducted a retrospective study involving 263 patients with TSC, comparing clinical histories, genetic variants, and imaging data between patients with and without SEGAs. Additionally, we analyzed brain magnetic resonance imaging (MRI) findings of patients with TSC with SEGAs and evaluated the efficacy of everolimus in reducing SEGA volume.

Results

SEGA was identified in 34 (12.9%) patients with TSC. The prevalence of pathogenic TSC2 variants was significantly higher in patients with SEGAs compared with those without SEGA. Patients with SEGAs also exhibited increased frequencies of retinal hamartomas, renal cysts, and hepatic angiomyolipomas. SEGAs were present in the initial brain imaging of 28 (82.4%) patients. Everolimus significantly reduced SEGA volume, with a median reduction of 33.7%. The most substantial reduction occurred during the first year of treatment, with a median decrease of 28.1%.

Conclusions

This study highlights that patients TSC with SEGAs are more likely to harbor pathogenic variants in the TSC2 gene and present with extracerebral manifestations of TSC, including retinal hamartomas, renal cysts, and hepatic angiomyolipomas. Most SEGAs were detectable from the initial brain imaging, suggesting that their presence can often be anticipated at the time of diagnosis. Everolimus proved effective and safe in significantly reducing SEGA volume during the first year of treatment in pediatric patients, although the rate of volume reduction decreased in subsequent years.

{"title":"Clinical Manifestations and Treatments of Patients With Tuberous Sclerosis With Subependymal Giant Cell Astrocytoma","authors":"Hun Kim MD , Seung Ryul Lee MD , Hui Jin Shin MD , Shinyoung Jang MD , Se Hee Kim MD , Joon Soo Lee MD, PhD , Heung Dong Kim MD, PhD , Ara Ko MD, PhD , Hoon-Chul Kang MD, PhD","doi":"10.1016/j.pediatrneurol.2025.02.003","DOIUrl":"10.1016/j.pediatrneurol.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to investigate the clinical and genetic characteristics of patients with tuberous sclerosis complex (TSC) with subependymal giant cell astrocytomas (SEGAs).</div></div><div><h3>Methods</h3><div>We conducted a retrospective study involving 263 patients with TSC, comparing clinical histories, genetic variants, and imaging data between patients with and without SEGAs. Additionally, we analyzed brain magnetic resonance imaging (MRI) findings of patients with TSC with SEGAs and evaluated the efficacy of everolimus in reducing SEGA volume.</div></div><div><h3>Results</h3><div>SEGA was identified in 34 (12.9%) patients with TSC. The prevalence of pathogenic <em>TSC2</em> variants was significantly higher in patients with SEGAs compared with those without SEGA. Patients with SEGAs also exhibited increased frequencies of retinal hamartomas, renal cysts, and hepatic angiomyolipomas. SEGAs were present in the initial brain imaging of 28 (82.4%) patients. Everolimus significantly reduced SEGA volume, with a median reduction of 33.7%. The most substantial reduction occurred during the first year of treatment, with a median decrease of 28.1%.</div></div><div><h3>Conclusions</h3><div>This study highlights that patients TSC with SEGAs are more likely to harbor pathogenic variants in the <em>TSC2</em> gene and present with extracerebral manifestations of TSC, including retinal hamartomas, renal cysts, and hepatic angiomyolipomas. Most SEGAs were detectable from the initial brain imaging, suggesting that their presence can often be anticipated at the time of diagnosis. Everolimus proved effective and safe in significantly reducing SEGA volume during the first year of treatment in pediatric patients, although the rate of volume reduction decreased in subsequent years.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"166 ","pages":"Pages 1-6"},"PeriodicalIF":3.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fetal Callosal Anomalies: A Narrative Review and Practical Recommendations for Pediatric Neurologists

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-10 DOI: 10.1016/j.pediatrneurol.2025.01.022

Andrea C. Pardo MD , Sonika Agarwal MBBS, MD , Brigitte Vollmer MD, PhD , Charu Venkatesan MD, PhD , Barbara Scelsa MD , Monic E. Lemmon MD , Sarah B. Mulkey MD, PhD , Mark Scher MD , Anthony R. Hart MBChB, PhD , Dawn Gano MD, MAS , Tomo Tarui MD

Agenesis of the corpus callosum is a common indication for fetal neurology consultation, increasingly identified through advances in fetal sonography and fetal magnetic resonance imaging. Despite improvements in diagnostic accuracy, prognostic counseling is challenging due to highly variable neurodevelopmental outcomes. Several factors contribute to neurodevelopmental outcome variability, including associated anomalies and etiologic considerations such as genetic, acquired, and environmental factors. This narrative review discusses existing literature on prenatal findings, postnatal outcomes, and comorbidities to provide practical guidelines for prenatal diagnosis, counseling, and postnatal management. Additionally, practice and research gaps are identified to advocate for guidelines to improve counseling, management, and optimization of outcomes for affected children and families.

{"title":"Fetal Callosal Anomalies: A Narrative Review and Practical Recommendations for Pediatric Neurologists","authors":"Andrea C. Pardo MD , Sonika Agarwal MBBS, MD , Brigitte Vollmer MD, PhD , Charu Venkatesan MD, PhD , Barbara Scelsa MD , Monic E. Lemmon MD , Sarah B. Mulkey MD, PhD , Mark Scher MD , Anthony R. Hart MBChB, PhD , Dawn Gano MD, MAS , Tomo Tarui MD","doi":"10.1016/j.pediatrneurol.2025.01.022","DOIUrl":"10.1016/j.pediatrneurol.2025.01.022","url":null,"abstract":"<div><div>Agenesis of the corpus callosum is a common indication for fetal neurology consultation, increasingly identified through advances in fetal sonography and fetal magnetic resonance imaging. Despite improvements in diagnostic accuracy, prognostic counseling is challenging due to highly variable neurodevelopmental outcomes. Several factors contribute to neurodevelopmental outcome variability, including associated anomalies and etiologic considerations such as genetic, acquired, and environmental factors. This narrative review discusses existing literature on prenatal findings, postnatal outcomes, and comorbidities to provide practical guidelines for prenatal diagnosis, counseling, and postnatal management. Additionally, practice and research gaps are identified to advocate for guidelines to improve counseling, management, and optimization of outcomes for affected children and families.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"165 ","pages":"Pages 117-127"},"PeriodicalIF":3.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound-Based Analysis of Fetal Conus Medullaris Anomalies: A Comprehensive Study on Prenatal Diagnosis and Postnatal Outcomes

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-07 DOI: 10.1016/j.pediatrneurol.2025.02.001

Bin Zhang MD , Zhengchun Yang MD , Jing Tang MD , Suzhen Ran MD , Chunyan Zhong PhD

Background

To explore prenatal characteristics and the long-term prognosis in fetal conus medullaris (CM) location anomalies.

Methods

This was a retrospective observational study of all fetuses diagnosed with CM location anomalies using ultrasound between November 2016 and June 2022 at our institution. Clinical data, including general information, prenatal CM location changes, associated malformations, genetic information, and pregnancy outcomes, were collected and analyzed.

Results

In total, 210 fetuses were selected and allocated to the simple group (with isolated CM location anomalies) or the anomaly group (with other congenital anomalies). Among the anomaly group, the most frequently involved congenital anomalies were related to the spine, heart, and limbs. The probability of chromosomal abnormalities was 4.1% in the simple group and 12.5% in the abnormal group, and the live birth rates were 94.6% and 22.1%, respectively. Prenatal tracking revealed that CM ascended above L3 in 89.2% and 19.1% in the two groups, respectively. Receiver operating characteristic curve analysis indicated that a CM located below L4 was the diagnostic cutoff for predicting lumbosacral anomalies. During the one- to five-year follow-up, except for three cases with adverse outcomes, all live-born children from both groups had good growth and development with no evident symptoms of tethered cord syndrome.

Conclusions

The prenatal CM location is closely related to lumbosacral anomalies. Fetuses with CM located above L4 and without other congenital anomalies or with only minor anomalies other than lumbosacral anomalies generally have a favorable prognosis. However, caution is warranted when examining lumbosacral anomalies when the CM is located below L4.

{"title":"Ultrasound-Based Analysis of Fetal Conus Medullaris Anomalies: A Comprehensive Study on Prenatal Diagnosis and Postnatal Outcomes","authors":"Bin Zhang MD , Zhengchun Yang MD , Jing Tang MD , Suzhen Ran MD , Chunyan Zhong PhD","doi":"10.1016/j.pediatrneurol.2025.02.001","DOIUrl":"10.1016/j.pediatrneurol.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>To explore prenatal characteristics and the long-term prognosis in fetal conus medullaris (CM) location anomalies.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study of all fetuses diagnosed with CM location anomalies using ultrasound between November 2016 and June 2022 at our institution. Clinical data, including general information, prenatal CM location changes, associated malformations, genetic information, and pregnancy outcomes, were collected and analyzed.</div></div><div><h3>Results</h3><div>In total, 210 fetuses were selected and allocated to the simple group (with isolated CM location anomalies) or the anomaly group (with other congenital anomalies). Among the anomaly group, the most frequently involved congenital anomalies were related to the spine, heart, and limbs. The probability of chromosomal abnormalities was 4.1% in the simple group and 12.5% in the abnormal group, and the live birth rates were 94.6% and 22.1%, respectively. Prenatal tracking revealed that CM ascended above L3 in 89.2% and 19.1% in the two groups, respectively. Receiver operating characteristic curve analysis indicated that a CM located below L4 was the diagnostic cutoff for predicting lumbosacral anomalies. During the one- to five-year follow-up, except for three cases with adverse outcomes, all live-born children from both groups had good growth and development with no evident symptoms of tethered cord syndrome.</div></div><div><h3>Conclusions</h3><div>The prenatal CM location is closely related to lumbosacral anomalies. Fetuses with CM located above L4 and without other congenital anomalies or with only minor anomalies other than lumbosacral anomalies generally have a favorable prognosis. However, caution is warranted when examining lumbosacral anomalies when the CM is located below L4.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"165 ","pages":"Pages 105-112"},"PeriodicalIF":3.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Roles and Realities of Pediatric Neurologists: A Call to Look Back and Continue to Push Forward

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-07 DOI: 10.1016/j.pediatrneurol.2025.01.024

Emily Garavatti MD

引用次数: 0

Common Data Elements Regarding Social Determinants of Health in Pediatric Epilepsy Research: A Concept Mapping Study

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-06 DOI: 10.1016/j.pediatrneurol.2025.01.025

Laura Kirkpatrick MD , Chethan K. Rao DO , Christopher W. Beatty MD , Sonal Bhatia MBBS , Charuta Joshi MD , Kristina Julich MD , Shital H. Patel MD , Rachit Patil MD , Janelle L. Wagner PhD , Christina Briscoe Abath MD, MEd , Alexandria Melendez-Zaidi MD, PhD , Sara E. Baumann PhD, MPH , Jessica G. Burke PhD, MHS , Qian-Zhou JoJo Yang MD

Background

The Pediatric Epilepsy Research Consortium (PERC) Health Equity Special Interest Group (SIG) used Concept Mapping to begin developing Common Data Elements (CDE) about social determinants of health to standardize data collection and facilitate robust evaluation of health disparities in pediatric epilepsy research.

Methods

Concept Mapping is a structured participatory mixed method suited for developing group consensus. PERC members (1) identified social factors that are important to measure in pediatric epilepsy research, (2) sorted factors into meaningful categories, and (3) rated the factors on importance and ease of measurement. The authors applied multidimensional scaling to the sorting data, created spatial point maps, and used hierarchical cluster analysis to define concepts. A bivariate scatterplot was used to explore importance versus ease of measurement to prioritize factors for inclusion. The PERC Health Equity SIG met on three occasions to interpret research findings and finalize a CDE set.

Results

Eighty-one PERC members generated 110 candidate factors. Thirty PERC members completed sorting, and 48 completed rating. The factors grouped into a five-cluster solution: “Household and Neighborhood Resources,” “Family Context,” “Individual Demographics,” “Healthcare Experiences,” and “School.” Sixty-two items were rated with high importance, of which 34 were rated with high ease. The PERC Health Equity SIG decided by consensus to include most items with high importance and high ease ratings, plus selected additional items. The final CDE set consists of 42 items.

Conclusions

Inclusion of CDE in future pediatric epilepsy research will enable researchers to undertake systematic analyses of health disparities.

{"title":"Common Data Elements Regarding Social Determinants of Health in Pediatric Epilepsy Research: A Concept Mapping Study","authors":"Laura Kirkpatrick MD , Chethan K. Rao DO , Christopher W. Beatty MD , Sonal Bhatia MBBS , Charuta Joshi MD , Kristina Julich MD , Shital H. Patel MD , Rachit Patil MD , Janelle L. Wagner PhD , Christina Briscoe Abath MD, MEd , Alexandria Melendez-Zaidi MD, PhD , Sara E. Baumann PhD, MPH , Jessica G. Burke PhD, MHS , Qian-Zhou JoJo Yang MD","doi":"10.1016/j.pediatrneurol.2025.01.025","DOIUrl":"10.1016/j.pediatrneurol.2025.01.025","url":null,"abstract":"<div><h3>Background</h3><div>The Pediatric Epilepsy Research Consortium (PERC) Health Equity Special Interest Group (SIG) used Concept Mapping to begin developing Common Data Elements (CDE) about social determinants of health to standardize data collection and facilitate robust evaluation of health disparities in pediatric epilepsy research.</div></div><div><h3>Methods</h3><div>Concept Mapping is a structured participatory mixed method suited for developing group consensus. PERC members (1) identified social factors that are important to measure in pediatric epilepsy research, (2) sorted factors into meaningful categories, and (3) rated the factors on importance and ease of measurement. The authors applied multidimensional scaling to the sorting data, created spatial point maps, and used hierarchical cluster analysis to define concepts. A bivariate scatterplot was used to explore importance versus ease of measurement to prioritize factors for inclusion. The PERC Health Equity SIG met on three occasions to interpret research findings and finalize a CDE set.</div></div><div><h3>Results</h3><div>Eighty-one PERC members generated 110 candidate factors. Thirty PERC members completed sorting, and 48 completed rating. The factors grouped into a five-cluster solution: “Household and Neighborhood Resources,” “Family Context,” “Individual Demographics,” “Healthcare Experiences,” and “School.” Sixty-two items were rated with high importance, of which 34 were rated with high ease. The PERC Health Equity SIG decided by consensus to include most items with high importance and high ease ratings, plus selected additional items. The final CDE set consists of 42 items.</div></div><div><h3>Conclusions</h3><div>Inclusion of CDE in future pediatric epilepsy research will enable researchers to undertake systematic analyses of health disparities.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"165 ","pages":"Pages 87-95"},"PeriodicalIF":3.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic Value of Brain Magnetic Resonance Imaging in Children After Out-of-Hospital Cardiac Arrest: Predictive Value of Normal Magnetic Resonance Imaging for a Favorable Two-Year Outcome

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-03 DOI: 10.1016/j.pediatrneurol.2025.01.023

Marijn Albrecht MD , Rogier de Jonge MD, PhD , Corinne Buysse MD, PhD , Marjolein H.G. Dremmen MD , Anke W. van der Eerden MD, PhD , Matthijs de Hoog MD, PhD , Dick Tibboel MD, PhD , Maayke Hunfeld MD, PhD

Background

Determine the predictive value of brain magnetic resonance imaging (MRI) findings less than or equal to seven days post–pediatric out-of-hospital cardiac arrest (OHCA) for long-term outcomes.

Methods

This retrospective single-center study included children (zero to 17 years) with OHCA admitted to a tertiary care hospital pediatrc intensive care unit from 2012 to 2020 who underwent brain MRI at most seven days postarrest. A neuroimaging scoring system was designed, using T1-, T2-, and diffusion-weighted images based on previously published scores and brain injury patterns. Extensive brain injury was defined as ≥50% cortex/white matter injury or four or more of nine predefined brain regions. Pediatric cerebral performance category (PCPC) scores were determined at hospital discharge and two years post-OHCA as part of routine follow-up care. Favorable neurological outcomes were defined as PCPC scores of 1 to 2 or no change from prearrest status.

Results

Among 142 children, 56 had a brain MRI at less than or equal to seven days postarrest. Median arrest age was 3.3 years (first and third quartiles [Q1, Q3]: 0.6, 13.6), and 64% were male. Brain MRI was obtained four days post-OHCA (Q1, Q3: 3, 5). Normal brain MRI findings (i.e., negative test result) predicted favorable outcomes with 100% negative predictive value, whereas extensive injury (i.e., positive test result) predicted unfavorable outcomes and death with 100% positive predictive value.

Conclusions

A normal brain MRI at less than or equal to seven days postarrest predicts favorable neurological outcomes two years later, whereas extensive brain injury predicts unfavorable neurological outcomes or death at discharge and two years post-OHCA.

{"title":"Prognostic Value of Brain Magnetic Resonance Imaging in Children After Out-of-Hospital Cardiac Arrest: Predictive Value of Normal Magnetic Resonance Imaging for a Favorable Two-Year Outcome","authors":"Marijn Albrecht MD , Rogier de Jonge MD, PhD , Corinne Buysse MD, PhD , Marjolein H.G. Dremmen MD , Anke W. van der Eerden MD, PhD , Matthijs de Hoog MD, PhD , Dick Tibboel MD, PhD , Maayke Hunfeld MD, PhD","doi":"10.1016/j.pediatrneurol.2025.01.023","DOIUrl":"10.1016/j.pediatrneurol.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Determine the predictive value of brain magnetic resonance imaging (MRI) findings less than or equal to seven days post–pediatric out-of-hospital cardiac arrest (OHCA) for long-term outcomes.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included children (zero to 17 years) with OHCA admitted to a tertiary care hospital pediatrc intensive care unit from 2012 to 2020 who underwent brain MRI at most seven days postarrest. A neuroimaging scoring system was designed, using T1-, T2-, and diffusion-weighted images based on previously published scores and brain injury patterns. Extensive brain injury was defined as ≥50% cortex/white matter injury or four or more of nine predefined brain regions. Pediatric cerebral performance category (PCPC) scores were determined at hospital discharge and two years post-OHCA as part of routine follow-up care. Favorable neurological outcomes were defined as PCPC scores of 1 to 2 or no change from prearrest status.</div></div><div><h3>Results</h3><div>Among 142 children, 56 had a brain MRI at less than or equal to seven days postarrest. Median arrest age was 3.3 years (first and third quartiles [Q1, Q3]: 0.6, 13.6), and 64% were male. Brain MRI was obtained four days post-OHCA (Q1, Q3: 3, 5). Normal brain MRI findings (i.e., negative test result) predicted favorable outcomes with 100% negative predictive value, whereas extensive injury (i.e., positive test result) predicted unfavorable outcomes and death with 100% positive predictive value.</div></div><div><h3>Conclusions</h3><div>A normal brain MRI at less than or equal to seven days postarrest predicts favorable neurological outcomes two years later, whereas extensive brain injury predicts unfavorable neurological outcomes or death at discharge and two years post-OHCA.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"165 ","pages":"Pages 96-104"},"PeriodicalIF":3.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Virtual Reality Task-Oriented Training on Upper Extremity Motor Function in Children With Cerebral Palsy: A Randomised Controlled Trial 虚拟现实任务导向训练对脑瘫儿童上肢运动功能的影响：一项随机对照试验。

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology

Pub Date : 2025-02-01 DOI: 10.1016/j.pediatrneurol.2024.12.001

Mahla Daliri MD , Fatemeh Salehi Nasab MSc , Saeid Fatorehchy PhD , Maryam Farzad PhD , Ali Moradi MD, PhD

Background

This study aims to investigate the effect of a newly developed virtual reality task-oriented training (VR-TOT) video game on upper extremity fine motor function compared with conventional occupational therapy through leap motion in children with spastic hemiplegic cerebral palsy (CP).

Methods

In this double-blind randomized clinical trial, 30 children with spastic hemiplegic CP aged six to 10 years were included and randomly allocated into two groups. During six weeks, 15 patients in the intervention group received VR_TOT-based video game in addition to conventional occupational therapy, whereas 15 patients in the control group received only conventional occupational therapy. The outcomes of spoon and knife use time, as well as wrist extension range of motion (ROM), and handgrip strength were evaluated pre- and postintervention, and also at six-week follow-up.

Results

The reduction in spoon (6.27 ± 3.08 vs 2.55 ± 2.08; P < 0.001) and knife (7.44 ± 1.95 vs 2.74 ± 2.46; P < 0.001) usage time was significantly greater among children in the intervention group compared with the control group. The increase in grip strength was significantly higher among intervention group children (1.57 ± 1.28 vs 0.50 ± 0.77; P = 0.011). However, the wrist extension ROM was not different between intervention and control groups.

Conclusions

The results show that combining the VR-TOT with traditional occupational therapy methods improves fine motor function and grip strength in children with CP.

背景：本研究旨在探讨新开发的虚拟现实任务训练（VR-TOT）视频游戏对痉挛偏瘫脑瘫（CP）儿童上肢精细运动功能的影响，并与传统的跳跃运动职业治疗进行比较。方法：采用双盲随机临床试验，选取6 ~ 10岁痉挛性偏瘫CP患儿30例，随机分为两组。在6周的时间里，干预组的15名患者在常规的职业治疗的基础上接受了基于vr_tot的视频游戏，而对照组的15名患者只接受了常规的职业治疗。在干预前和干预后以及六周的随访中，评估了勺子和刀的使用时间、手腕伸展活动范围（ROM）和握力的结果。结果：调羹减少（6.27±3.08 vs 2.55±2.08）；结论：将VR-TOT与传统的职业治疗方法相结合，可改善脑瘫患儿的精细运动功能和握力。

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