Independent evaluation of overnight polysomnography and autonomic function in primary monosymptomatic nocturnal enuresis (PMNE) have produced variable results. The objective of this study was to simultaneously evaluate both to improve pathophysiological understanding with consequent therapeutic implications.
Methods
Five- to eighteen-year-olds with PMNE, presenting to a North Indian tertiary care teaching hospital (exclusion criteria: chronic systemic illness, intelligence quotient<70, and treated for PMNE in the last 6 months) were enrolled. Overnight polysomnography and autonomic function testing were preceded by Childhood and Adolescent Sleep Evaluation Questionnaire, Childhood behavior Checklist, and projective personality testing evaluations. Subsequently, they received standard behavioral therapy for 12 weeks.
Results
Twenty-one cases were enrolled (10.6 ± 3.2 years, 16 boys). Impaired behavior was seen in 47.6% (majority inattention) and family/academics/self-esteem-related stressors were present in 42.9%. Sleep-related breathing disorder and sleep-related movement disorder (SRMD) were reported in 71.4% (15/21) and 61.9% (13/21), respectively. Cases had significantly lower sleep efficiency (72.3 ± 10.9% vs 80.6 ± 9.1%), higher proportion of N2 (76.4 ± 2% vs 63.1 ± 2.8%), and lower proportion of N3 (16.3 ± 1.7% vs 28.2 ± 1.5%) compared to controls. The diurnal median low frequency/high frequency variability was minimal (one [interquartile range (IQR):0.8-1.9] in sleep and 1.4 [IQR:0.5-2] while awake, P = 0.4). Median root mean square of successive differences was higher in sleep than awake state (81.04 ms [IQR:56.4-189.4] vs 60.6 ms ([QR:46-194.5], P = 0.5). One third responded favorably to standard behavioral therapy. Presence of other primary sleep disorders, particularly SRMD was significantly associated with poor response.
Conclusions
A dopamine depletion state with therapeutic implications can be speculated in PMNE, in those with impaired sleep and SRMD along with loss of diurnal sympathetic variation.
背景：对原发性单症状性夜间遗尿（PMNE）的夜间多导睡眠图和自主神经功能的独立评估产生了不同的结果。本研究的目的是同时评估这两种方法，以提高对病理生理学的理解，并由此产生治疗意义。方法入选了在北印度三级医疗教学医院就诊的5 - 18岁PMNE患者（排除标准：慢性全身性疾病，智商≥70，近6个月接受PMNE治疗）。在进行夜间多导睡眠仪和自主神经功能测试之前，进行儿童和青少年睡眠评估问卷、儿童行为检查表和投射性人格测试评估。随后，他们接受了为期12周的标准行为治疗。结果共入组21例，年龄10.6±3.2岁，男孩16例。47.6%的人行为受损（主要是注意力不集中），42.9%的人存在家庭/学业/自尊相关的压力源。睡眠相关呼吸障碍和睡眠相关运动障碍（SRMD）分别占71.4%（15/21）和61.9%（13/21）。与对照组相比，患者睡眠效率明显降低（72.3±10.9% vs 80.6±9.1%），N2比例明显升高（76.4±2% vs 63.1±2.8%），N3比例明显降低（16.3±1.7% vs 28.2±1.5%）。低频/高频的日中位数变异性最小（睡眠时为1[四分位数间距（IQR）：0.8-1.9]，清醒时为1.4 [IQR:0.5-2], P = 0.4）。睡眠状态的连续差异中位数均方根高于清醒状态(81.04 ms [IQR:56.4-189.4] vs 60.6 ms （[QR:46-194.5], P = 0.5）。三分之一的人对标准行为疗法反应良好。存在其他原发性睡眠障碍，特别是重度睡眠障碍与不良反应显著相关。结论多巴胺耗竭状态在PMNE、睡眠受损患者和重度睡眠障碍患者以及交感神经昼夜变化丧失患者中具有治疗意义。
{"title":"Polysomnography and Autonomic Function Signatures of Nocturnal Enuresis: An Observational Study","authors":"Parag Thosare MD (Dr.) , Biswaroop Chakrabarty DM (Dr.) , Sheffali Gulati MD (Prof) , Ashok Jariyal MD (Prof) , Pankaj Hari MD (Prof) , Prashant Jauhari DM (Dr.) , Sushil Kabra MD (Prof) , Kapil Sikka MS (Prof) , Ravindra M. Pandey PhD (Prof) , Ashish Dutt Upadhyay PhD (Dr.) , Sanjida Khan PhD (Dr.)","doi":"10.1016/j.pediatrneurol.2025.11.003","DOIUrl":"10.1016/j.pediatrneurol.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Independent evaluation of overnight polysomnography and autonomic function in primary monosymptomatic nocturnal enuresis (PMNE) have produced variable results. The objective of this study was to simultaneously evaluate both to improve pathophysiological understanding with consequent therapeutic implications.</div></div><div><h3>Methods</h3><div>Five- to eighteen-year-olds with PMNE, presenting to a North Indian tertiary care teaching hospital (exclusion criteria: chronic systemic illness, intelligence quotient<70, and treated for PMNE in the last 6 months) were enrolled. Overnight polysomnography and autonomic function testing were preceded by Childhood and Adolescent Sleep Evaluation Questionnaire, Childhood behavior Checklist, and projective personality testing evaluations. Subsequently, they received standard behavioral therapy for 12 weeks.</div></div><div><h3>Results</h3><div>Twenty-one cases were enrolled (10.6 ± 3.2 years, 16 boys). Impaired behavior was seen in 47.6% (majority inattention) and family/academics/self-esteem-related stressors were present in 42.9%. Sleep-related breathing disorder and sleep-related movement disorder (SRMD) were reported in 71.4% (15/21) and 61.9% (13/21), respectively. Cases had significantly lower sleep efficiency (72.3 ± 10.9% vs 80.6 ± 9.1%), higher proportion of N2 (76.4 ± 2% vs 63.1 ± 2.8%), and lower proportion of N3 (16.3 ± 1.7% vs 28.2 ± 1.5%) compared to controls. The diurnal median low frequency/high frequency variability was minimal (one [interquartile range (IQR):0.8-1.9] in sleep and 1.4 [IQR:0.5-2] while awake, <em>P</em> = 0.4). Median root mean square of successive differences was higher in sleep than awake state (81.04 ms [IQR:56.4-189.4] vs 60.6 ms ([QR:46-194.5], <em>P</em> = 0.5). One third responded favorably to standard behavioral therapy. Presence of other primary sleep disorders, particularly SRMD was significantly associated with poor response.</div></div><div><h3>Conclusions</h3><div>A dopamine depletion state with therapeutic implications can be speculated in PMNE, in those with impaired sleep and SRMD along with loss of diurnal sympathetic variation.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 102-107"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616287","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}
<div><h3>Background</h3><div>Recently, mycoplasma pneumoniae pneumonia (MPP) has been prevalent among children in China. Literature on the clinical manifestations and neuroradiological findings in pediatric patients with MPP-associated arterial ischemic stroke (AIS) is scarce. This study aimed to describe the clinical characteristics, laboratory and neuroimaging data on pediatric MPP-associated AIS.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective cohort study (COIST study) conducted in Beijing Children's Hospital, consisting of 380 patients with first-ever, imaging-verified ischemic stroke between September 2015 and April 2024. Following rigorous diagnostic protocols, the underlying cause of AIS was definitively determined as mycoplasma pneumoniae infection in a subset of 14 children. A descriptive statistical approach was employed to encapsulate the clinical manifestations, laboratory findings, and neuroradiological characteristics observed in this cohort. The severity of stroke was systematically evaluated using the pediatric National Institutes of Health Stroke Scale, whereas the stroke outcome was assessed with a dual methodology: the pediatric stroke outcome measure and the modified Rankin Scales.</div></div><div><h3>Results</h3><div>A total of 14 children with MPP-associated AIS were enrolled, comprising 8 males (57.14%), with a median age of 6.70 years (interquartile range: 5.12-9.08 years). The incidence of AIS among all hospitalized MPP patients stood at 1.1‰, accounting for 3.68% of all childhood AISs. Notably 12 of the 14 patients exhibited severe MPP. Regarding cerebrospinal fluid analysis, the occurrence of pleocytosis was rarely noted, and the detection of antibodies to mycoplasma pneumoniae within the cerebrospinal fluid was equally rare. The primary neurological manifestations were hemiplegia and facial paralysis, both observed in 78.57% of patients (n = 11). In addition, disturbance of consciousness and aphasia were frequent symptoms, each present in 57.14% of cases (n = 8). Anterior circulation infarcts were the most prevalent, occurring in 78.57% of patients (n = 11), and vascular occlusion was noted in 9 of 14 patients (64.29%). Multiple infarctions were identified in 8 patients (57.14%), while 4 patients (28.57%) experienced bilateral infarctions. The middle cerebral artery was the most commonly affected vascular territory, affected in 50.00% of patients (n = 7), followed by the internal carotid artery and anterior cerebral artery, each affected in 21.43% of cases (n = 3). Hemorrhagic transformation occurred in half of the patients. Regarding treatment, 50% of patients (n = 7) received low molecular weight heparin (LMWH) monotherapy, while 2 patients were treated with both LMWH and aspirin, one with LMWH and dipyridamole, and one with aspirin monotherapy. Despite the onset-to-door time being mostly ≤6 hours, a poor outcome was experienced by 71.43% of patients, with a median pediatric National Insti
{"title":"Mycoplasma Pneumoniae-Associated Arterial Ischemic Stroke in Pediatric Patients: Clinical Manifestations and Neuroimaging Findings","authors":"Zemou Yu PhD , Lingbing Meng PhD , Jingjing Jia PhD , Weihua Zhang MD , Hui Xiong MD , Fang Fang MD , Jiuwei Li MD , Xiuwei Zhuo MD","doi":"10.1016/j.pediatrneurol.2025.10.016","DOIUrl":"10.1016/j.pediatrneurol.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Recently, mycoplasma pneumoniae pneumonia (MPP) has been prevalent among children in China. Literature on the clinical manifestations and neuroradiological findings in pediatric patients with MPP-associated arterial ischemic stroke (AIS) is scarce. This study aimed to describe the clinical characteristics, laboratory and neuroimaging data on pediatric MPP-associated AIS.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective cohort study (COIST study) conducted in Beijing Children's Hospital, consisting of 380 patients with first-ever, imaging-verified ischemic stroke between September 2015 and April 2024. Following rigorous diagnostic protocols, the underlying cause of AIS was definitively determined as mycoplasma pneumoniae infection in a subset of 14 children. A descriptive statistical approach was employed to encapsulate the clinical manifestations, laboratory findings, and neuroradiological characteristics observed in this cohort. The severity of stroke was systematically evaluated using the pediatric National Institutes of Health Stroke Scale, whereas the stroke outcome was assessed with a dual methodology: the pediatric stroke outcome measure and the modified Rankin Scales.</div></div><div><h3>Results</h3><div>A total of 14 children with MPP-associated AIS were enrolled, comprising 8 males (57.14%), with a median age of 6.70 years (interquartile range: 5.12-9.08 years). The incidence of AIS among all hospitalized MPP patients stood at 1.1‰, accounting for 3.68% of all childhood AISs. Notably 12 of the 14 patients exhibited severe MPP. Regarding cerebrospinal fluid analysis, the occurrence of pleocytosis was rarely noted, and the detection of antibodies to mycoplasma pneumoniae within the cerebrospinal fluid was equally rare. The primary neurological manifestations were hemiplegia and facial paralysis, both observed in 78.57% of patients (n = 11). In addition, disturbance of consciousness and aphasia were frequent symptoms, each present in 57.14% of cases (n = 8). Anterior circulation infarcts were the most prevalent, occurring in 78.57% of patients (n = 11), and vascular occlusion was noted in 9 of 14 patients (64.29%). Multiple infarctions were identified in 8 patients (57.14%), while 4 patients (28.57%) experienced bilateral infarctions. The middle cerebral artery was the most commonly affected vascular territory, affected in 50.00% of patients (n = 7), followed by the internal carotid artery and anterior cerebral artery, each affected in 21.43% of cases (n = 3). Hemorrhagic transformation occurred in half of the patients. Regarding treatment, 50% of patients (n = 7) received low molecular weight heparin (LMWH) monotherapy, while 2 patients were treated with both LMWH and aspirin, one with LMWH and dipyridamole, and one with aspirin monotherapy. Despite the onset-to-door time being mostly ≤6 hours, a poor outcome was experienced by 71.43% of patients, with a median pediatric National Insti","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 58-66"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571145","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}
This article explores the manifestations, radiological findings, associated diseases, treatment, and outcomes in pediatric chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (C.L.I.P.P.E.R.S.). It was inspired by an 11-year-old male who presented with headache, ataxia, nystagmus, persistent vomiting, nausea, and constipation. He was diagnosed with C.L.I.P.P.E.R.S. based on clinical and radiologic findings, and positive response to treatment. The ensuing literature review led us to conclude that pediatric C.L.I.P.P.E.R.S. has a clinical presentation, etiology, evolution, course and prognosis different from adult cases. Future pediatric workup should include genetic studies because of commonly associated mutations such as PRF1. Treatment in pediatric cases should account for a delayed response to steroids, frequent recurrences, and especially in genetic cases, definitive treatment may require hematopoietic stem cell transplant. It seems that C.L.I.P.P.E.R.S. is not an isolated disease, rather a syndrome with unique radiologic findings, a wide range of etiologies, and clinical and neurologic manifestations that distinguish pediatric from adult cases. In order to optimize treatment and follow-up, future diagnostic approaches of C.L.I.P.P.E.R.S. in children should include workup for a primary disease such as EBV B cell lymphoma or hemophagocytic lymphohistiocytosis.
{"title":"Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive to Steroids Clinical Manifestations in Children Versus Adults","authors":"Angel Phan MS4 , Gilbert Handal MD , Dale W. Quest PhD , Josh Nichols MD , Seunghong Rhee MD , Diana Moreno MS4","doi":"10.1016/j.pediatrneurol.2025.11.011","DOIUrl":"10.1016/j.pediatrneurol.2025.11.011","url":null,"abstract":"<div><div>This article explores the manifestations, radiological findings, associated diseases, treatment, and outcomes in pediatric chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (C.L.I.P.P.E.R.S.). It was inspired by an 11-year-old male who presented with headache, ataxia, nystagmus, persistent vomiting, nausea, and constipation. He was diagnosed with C.L.I.P.P.E.R.S. based on clinical and radiologic findings, and positive response to treatment. The ensuing literature review led us to conclude that pediatric C.L.I.P.P.E.R.S. has a clinical presentation, etiology, evolution, course and prognosis different from adult cases. Future pediatric workup should include genetic studies because of commonly associated mutations such as PRF1. Treatment in pediatric cases should account for a delayed response to steroids, frequent recurrences, and especially in genetic cases, definitive treatment may require hematopoietic stem cell transplant. It seems that C.L.I.P.P.E.R.S. is not an isolated disease, rather a syndrome with unique radiologic findings, a wide range of etiologies, and clinical and neurologic manifestations that distinguish pediatric from adult cases. In order to optimize treatment and follow-up, future diagnostic approaches of C.L.I.P.P.E.R.S. in children should include workup for a primary disease such as EBV B cell lymphoma or hemophagocytic lymphohistiocytosis.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 180-186"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768776","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}
Pub Date : 2026-02-01Epub Date: 2025-11-04DOI: 10.1016/j.pediatrneurol.2025.10.030
Miles Fisher DO , Kristen Bolte DO , Shilpa B. Reddy MD , Mark Rodeghier PhD , Lori C. Jordan MD, PhD
Background
To identify predictors of drug-resistant epilepsy (DRE) in children with a history of perinatal ischemic stroke (PIS).
Methods
This single-center retrospective observational study analyzed children with PIS using international classification of diseases, ninth revision (ICD-9) codes, institutional databases, medical records, and neuroimaging from 2012 to 2023. DRE was defined as seizures unresponsive to ≥2 antiseizure medications. The Pediatric Stroke Outcome Measure (PSOM) was retrospectively scored.
Results
Of 96 children with PIS, 56% developed epilepsy and 20 (21%) had DRE. Median age at the last visit was 7.9 years (interquartile range, 3.1-11.7 years.) Among those with DRE, 70% had presumed perinatal stroke and 30% had symptomatic neonatal stroke. PSOM scores differed by epilepsy status: median PSOM was 2.5 for DRE, 1.8 for non-DRE epilepsy and 1.0 for children without epilepsy; paired comparisons for neurological outcome found a difference between those with DRE compared to those without epilepsy (P < 0.001). Hippocampal volume reduction was the only predictor of DRE (odds ratio 6.45, 95% confidence interval 1.80-23.16, P = 0.004) in a multivariable model including sex, neonatal seizures, and total PSOM. Children with DRE tried a median of four antiseizure medications after the newborn period, and 13 (65%) underwent epilepsy surgery. Favorable outcomes (seizure-free or >90% reduction) were seen in 62% postsurgery, including three focal resections, four functional hemispherectomies, and one posterior quadrant disconnection.
Conclusions
Hippocampal volume reduction is a strong predictor of DRE following PIS. Epilepsy and DRE were more common in older children. Hemispherectomy and focal resections were associated with favorable seizure outcomes.
{"title":"Predictors of Drug-Resistant Epilepsy After Perinatal Stroke","authors":"Miles Fisher DO , Kristen Bolte DO , Shilpa B. Reddy MD , Mark Rodeghier PhD , Lori C. Jordan MD, PhD","doi":"10.1016/j.pediatrneurol.2025.10.030","DOIUrl":"10.1016/j.pediatrneurol.2025.10.030","url":null,"abstract":"<div><h3>Background</h3><div>To identify predictors of drug-resistant epilepsy (DRE) in children with a history of perinatal ischemic stroke (PIS).</div></div><div><h3>Methods</h3><div>This single-center retrospective observational study analyzed children with PIS using international classification of diseases, ninth revision (ICD-9) codes, institutional databases, medical records, and neuroimaging from 2012 to 2023. DRE was defined as seizures unresponsive to ≥2 antiseizure medications. The Pediatric Stroke Outcome Measure (PSOM) was retrospectively scored.</div></div><div><h3>Results</h3><div>Of 96 children with PIS, 56% developed epilepsy and 20 (21%) had DRE. Median age at the last visit was 7.9 years (interquartile range, 3.1-11.7 years.) Among those with DRE, 70% had presumed perinatal stroke and 30% had symptomatic neonatal stroke. PSOM scores differed by epilepsy status: median PSOM was 2.5 for DRE, 1.8 for non-DRE epilepsy and 1.0 for children without epilepsy; paired comparisons for neurological outcome found a difference between those with DRE compared to those without epilepsy (<em>P</em> < 0.001). Hippocampal volume reduction was the only predictor of DRE (odds ratio 6.45, 95% confidence interval 1.80-23.16, <em>P</em> = 0.004) in a multivariable model including sex, neonatal seizures, and total PSOM. Children with DRE tried a median of four antiseizure medications after the newborn period, and 13 (65%) underwent epilepsy surgery. Favorable outcomes (seizure-free or >90% reduction) were seen in 62% postsurgery, including three focal resections, four functional hemispherectomies, and one posterior quadrant disconnection.</div></div><div><h3>Conclusions</h3><div>Hippocampal volume reduction is a strong predictor of DRE following PIS. Epilepsy and DRE were more common in older children. Hemispherectomy and focal resections were associated with favorable seizure outcomes.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 1-7"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537056","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}
Pub Date : 2026-02-01Epub Date: 2025-10-31DOI: 10.1016/j.pediatrneurol.2025.10.026
Marian Michael Bercu MD, MSc , Kathryn E. Spykman BSN , Velisa M. Johnson PhD , Angel W. Hernandez MD
Background
Drug-resistant epilepsy (DRE) in the pediatric population is a challenging disease, with limited surgical interventions available. We report the preliminary outcomes for pediatric patients with multifocal DRE epilepsy treated with centromedian responsive neurostimulation.
Methods
A retrospective chart review was conducted in 11 pediatric patients with multifocal epilepsy who were treated with bilateral responsive neurostimulation (RNS) of the centromedian nucleus. All patients were implanted with at least one RNS system; three patients had two RNS systems implanted, with additional leads targeting bilateral cortical or subcortical epileptogenic areas.
Results
Ten out of the 11 patients (90%) treated with RNS (ages 5-20 years old, average 13.73 years old, median 14 years old) were found to have at least a 50% reduction in seizures using at least two modalities of data analysis. The average follow-up time was 1.33 years. Upon reviewing the data from the electronic medical records, 6 patients (55%) experienced a reduction in seizures of 75% or higher, 4 patients (36%) experienced a reduction in seizures between 50 and 74% and 1 patient (9%) was nonresponsive. At least 8 patients (72%) experienced subjective improvements in behavior, interactions, and/or academic performance. This was most pronounced in the subgroup of 4 patients diagnosed with autism spectrum disorder. Ninety percent of patients and families reported improvements in quality of life secondary to neurostimulation. No surgical or stimulation-related complications or side effects were encountered.
Conclusions
The preliminary outcomes suggest a robust response to central neurostimulation in pediatric patients suffering from multifocal DRE, with an excellent safety profile.
{"title":"Preliminary Outcomes of Central Responsive Neurostimulation for Multifocal Epilepsy in Pediatric Patients","authors":"Marian Michael Bercu MD, MSc , Kathryn E. Spykman BSN , Velisa M. Johnson PhD , Angel W. Hernandez MD","doi":"10.1016/j.pediatrneurol.2025.10.026","DOIUrl":"10.1016/j.pediatrneurol.2025.10.026","url":null,"abstract":"<div><h3>Background</h3><div>Drug-resistant epilepsy (DRE) in the pediatric population is a challenging disease, with limited surgical interventions available. We report the preliminary outcomes for pediatric patients with multifocal DRE epilepsy treated with centromedian responsive neurostimulation.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted in 11 pediatric patients with multifocal epilepsy who were treated with bilateral responsive neurostimulation (RNS) of the centromedian nucleus. All patients were implanted with at least one RNS system; three patients had two RNS systems implanted, with additional leads targeting bilateral cortical or subcortical epileptogenic areas.</div></div><div><h3>Results</h3><div>Ten out of the 11 patients (90%) treated with RNS (ages 5-20 years old, average 13.73 years old, median 14 years old) were found to have at least a 50% reduction in seizures using at least two modalities of data analysis. The average follow-up time was 1.33 years. Upon reviewing the data from the electronic medical records, 6 patients (55%) experienced a reduction in seizures of 75% or higher, 4 patients (36%) experienced a reduction in seizures between 50 and 74% and 1 patient (9%) was nonresponsive. At least 8 patients (72%) experienced subjective improvements in behavior, interactions, and/or academic performance. This was most pronounced in the subgroup of 4 patients diagnosed with autism spectrum disorder. Ninety percent of patients and families reported improvements in quality of life secondary to neurostimulation. No surgical or stimulation-related complications or side effects were encountered.</div></div><div><h3>Conclusions</h3><div>The preliminary outcomes suggest a robust response to central neurostimulation in pediatric patients suffering from multifocal DRE, with an excellent safety profile.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 40-49"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571168","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}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.pediatrneurol.2025.11.020
Natalie Kukulka MD , Paul Vermilion MD , Bo Lee MD
Duchenne Muscular Dystrophy (DMD) is a progressive and life-limiting neuromuscular disorder with profound implications for affected individuals and their families. Advances in genetic and molecular therapies, including exon skipping agents, gene therapy, and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based approaches have ushered in a new era of disease-modifying treatments. However, these breakthroughs also introduce complex ethical and psychosocial challenges. As we continue to extend life expectancy and improve motor outcomes for individuals with DMD, there is also a need to ensure autonomy-supportive environments, particularly during the transition to adulthood. This review provides a comprehensive exploration of the evolving landscape of DMD management, the long-term and ethical considerations of experimental therapies, and the psychosocial impacts on patients and caregivers. In the context of recent major advancements in medical care, we reflect on the impact of the growing group of DMD “boys” navigating the transition to adulthood. Lastly, this review highlights the critical need for multidisciplinary care models that address not only the biological but also the evolving psychological and social dimensions of the disease. By synthesizing perspectives from treatment innovation and ethical discourse, this article equips readers with a holistic understanding of the transformative potential and challenges associated with DMD therapies. This review aims to support multidisciplinary neuromuscular clinics to more fully meet the needs of an increasingly diverse population of patients with an ever-expanding potential.
{"title":"Duchenne Muscular Dystrophy: Clinical Innovations, Ethical Considerations, and Evolving the Path to Adulthood","authors":"Natalie Kukulka MD , Paul Vermilion MD , Bo Lee MD","doi":"10.1016/j.pediatrneurol.2025.11.020","DOIUrl":"10.1016/j.pediatrneurol.2025.11.020","url":null,"abstract":"<div><div>Duchenne Muscular Dystrophy (DMD) is a progressive and life-limiting neuromuscular disorder with profound implications for affected individuals and their families. Advances in genetic and molecular therapies, including exon skipping agents, gene therapy, and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based approaches have ushered in a new era of disease-modifying treatments. However, these breakthroughs also introduce complex ethical and psychosocial challenges. As we continue to extend life expectancy and improve motor outcomes for individuals with DMD, there is also a need to ensure autonomy-supportive environments, particularly during the transition to adulthood. This review provides a comprehensive exploration of the evolving landscape of DMD management, the long-term and ethical considerations of experimental therapies, and the psychosocial impacts on patients and caregivers. In the context of recent major advancements in medical care, we reflect on the impact of the growing group of DMD “boys” navigating the transition to adulthood. Lastly, this review highlights the critical need for multidisciplinary care models that address not only the biological but also the evolving psychological and social dimensions of the disease. By synthesizing perspectives from treatment innovation and ethical discourse, this article equips readers with a holistic understanding of the transformative potential and challenges associated with DMD therapies. This review aims to support multidisciplinary neuromuscular clinics to more fully meet the needs of an increasingly diverse population of patients with an ever-expanding potential.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 210-217"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774519","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}
Electrophysiological subtypes of Guillain-Barré Syndrome (GBS) vary in pathophysiology and clinical presentation, but comparative data on their intensive care needs in critically ill children remain limited.
Methods
In this retrospective cohort study, we analyzed 224 children (1 month to 12 years) diagnosed with GBS and admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in North India from January 2010 to December 2022. GBS was subtyped based on nerve conduction studies into acute motor axonal neuropathy (AMAN), acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor-sensory axonal neuropathy (AMSAN), inexcitable, or equivocal patterns. Clinical features, intensive care interventions, and outcomes were compared across subtypes.
Results
AMAN was the most common subtype (61.6%), followed by AIDP (20.1%) and AMSAN (8%). A prodromal illness was reported in 47.3% of cases. Mechanical ventilation was required in 54.9%, and tracheostomy in 24.2% of children. AMSAN was associated with a significantly longer duration of symptoms at presentation (P = 0.006). Autonomic instability, particularly hypertension (P = 0.04), was significantly more frequent in the AIDP group. However, Hughes disability scores, respiratory and cranial nerve involvement, and intensive care needs were similar across subtypes.
Conclusions
AMAN was the predominant GBS subtype in critically ill children. While AMSAN was associated with delayed presentation and AIDP with greater autonomic dysfunction, overall intensive care needs and short-term outcomes were comparable across subtypes.
{"title":"Axonal Versus Demyelinating Guillain-Barré Syndrome Subtypes in Critically Ill Children: Clinical and Autonomic Profiles","authors":"Deepankar Bansal DM, Manjinder Singh Randhawa DM, Rajalakshmi Iyer DM, Shivan Kesavan DM, Suresh Kumar Angurana DM, Karthi Nallasamy DM, Renu Suthar DM, Naveen Sankhyan DM, Jayashree Muralidharan MD, Arun Bansal MD","doi":"10.1016/j.pediatrneurol.2025.11.016","DOIUrl":"10.1016/j.pediatrneurol.2025.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Electrophysiological subtypes of Guillain-Barré Syndrome (GBS) vary in pathophysiology and clinical presentation, but comparative data on their intensive care needs in critically ill children remain limited.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we analyzed 224 children (1 month to 12 years) diagnosed with GBS and admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in North India from January 2010 to December 2022. GBS was subtyped based on nerve conduction studies into acute motor axonal neuropathy (AMAN), acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor-sensory axonal neuropathy (AMSAN), inexcitable, or equivocal patterns. Clinical features, intensive care interventions, and outcomes were compared across subtypes.</div></div><div><h3>Results</h3><div>AMAN was the most common subtype (61.6%), followed by AIDP (20.1%) and AMSAN (8%). A prodromal illness was reported in 47.3% of cases. Mechanical ventilation was required in 54.9%, and tracheostomy in 24.2% of children. AMSAN was associated with a significantly longer duration of symptoms at presentation (<em>P</em> = 0.006). Autonomic instability, particularly hypertension (<em>P</em> = 0.04), was significantly more frequent in the AIDP group. However, Hughes disability scores, respiratory and cranial nerve involvement, and intensive care needs were similar across subtypes.</div></div><div><h3>Conclusions</h3><div>AMAN was the predominant GBS subtype in critically ill children. While AMSAN was associated with delayed presentation and AIDP with greater autonomic dysfunction, overall intensive care needs and short-term outcomes were comparable across subtypes.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 168-173"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736661","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}
Pub Date : 2026-02-01Epub Date: 2025-11-04DOI: 10.1016/j.pediatrneurol.2025.10.029
Lakshmi Balaji DNB , Didu S. Kariyawasam PhD , Karen Herbert DPT , Hugo A. Sampaio MBBS , Esther Tantsis PhD , Michelle A. Farrar PhD
Background
The use of disease modifying therapies has altered the natural history of spinal muscular atrophy (SMA) leading to changing needs and recognition of multisystem involvement, including cognitive processes. We aimed to investigate the prevalence of, and characterize the behavioral and emotional profiles of children/young people with symptomatic SMA.
Methods
This single-centre, cross-sectional study of children 4-17 years with symptomatic SMA, assessed emotional and behavioral problems using Strengths and Difficulties Questionnaire (SDQ). Clinical characteristics and parent- and child/young person-reported outcomes (Pediatric Quality of Life neuromuscular module) specific to a neuromuscular disorder were also collated. Fisher's exact, Kruskal-Wallis, and regression tests were used for analyses.
Results
Forty-eight children were enrolled (median age [interquartile range]: 7.8 years [5.4-11.4]). Total SDQ scores identified difficulties in 17/48 (35.4%) children with SMA, compared to population frequency of 10%; 16/4 8 (33.3%) parents perceived that their child's emotional/behavioral difficulties were burden on the family, which were chronic for 9/16 (56.3%) and substantial for 10/16 (62.5%), interfering with child's everyday life. Difficulties within at least one domain of the SDQ were identified in 29/48 (60.4%). Of the cohort, 12/48(25%) had difficulties in the domains of hyperactivity, emotional regulation and conduct. For those with abnormal SDQ scores, there was significant association with lower total Pediatric Quality of Life neuromuscular module scores (odds ratio: 1.09, 95% confidence intervals: 1.02, 1.16, P = 0.009).
Conclusions
The study found clinically significant level of emotional and behavioral dysregulation in children/young people with SMA in all categories of motor function, and with negative impact on everyday life. In the context of changing phenotypes and function with treatment, these were evident across varying severities of motor function. These findings support routine mental health surveillance as a means of early identification and intervention, alongside the provision of psychological support to optimize health outcomes.
{"title":"Behavioral and Emotional Challenges in Children With Spinal Muscular Atrophy","authors":"Lakshmi Balaji DNB , Didu S. Kariyawasam PhD , Karen Herbert DPT , Hugo A. Sampaio MBBS , Esther Tantsis PhD , Michelle A. Farrar PhD","doi":"10.1016/j.pediatrneurol.2025.10.029","DOIUrl":"10.1016/j.pediatrneurol.2025.10.029","url":null,"abstract":"<div><h3>Background</h3><div>The use of disease modifying therapies has altered the natural history of spinal muscular atrophy (SMA) leading to changing needs and recognition of multisystem involvement, including cognitive processes. We aimed to investigate the prevalence of, and characterize the behavioral and emotional profiles of children/young people with symptomatic SMA.</div></div><div><h3>Methods</h3><div>This single-centre, cross-sectional study of children 4-17 years with symptomatic SMA, assessed emotional and behavioral problems using Strengths and Difficulties Questionnaire (SDQ). Clinical characteristics and parent- and child/young person-reported outcomes (Pediatric Quality of Life neuromuscular module) specific to a neuromuscular disorder were also collated. Fisher's exact, Kruskal-Wallis, and regression tests were used for analyses.</div></div><div><h3>Results</h3><div>Forty-eight children were enrolled (median age [interquartile range]: 7.8 years [5.4-11.4]). Total SDQ scores identified difficulties in 17/48 (35.4%) children with SMA, compared to population frequency of 10%; 16/4 8 (33.3%) parents perceived that their child's emotional/behavioral difficulties were burden on the family, which were chronic for 9/16 (56.3%) and substantial for 10/16 (62.5%), interfering with child's everyday life. Difficulties within at least one domain of the SDQ were identified in 29/48 (60.4%). Of the cohort, 12/48(25%) had difficulties in the domains of hyperactivity, emotional regulation and conduct. For those with abnormal SDQ scores, there was significant association with lower total Pediatric Quality of Life neuromuscular module scores (odds ratio: 1.09, 95% confidence intervals: 1.02, 1.16, <em>P</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>The study found clinically significant level of emotional and behavioral dysregulation in children/young people with SMA in all categories of motor function, and with negative impact on everyday life. In the context of changing phenotypes and function with treatment, these were evident across varying severities of motor function. These findings support routine mental health surveillance as a means of early identification and intervention, alongside the provision of psychological support to optimize health outcomes.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 81-87"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605636","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}
Pub Date : 2026-02-01Epub Date: 2025-10-30DOI: 10.1016/j.pediatrneurol.2025.10.022
Christian Surí-Báez MD, MPH , Han Jun Kim MD , Janice Lester MLS , Robin T. Varughese MD , Sanjeev V. Kothare MD
New onset refractory status epilepticus and febrile infection-related epilepsy syndrome are rare and devastating entities in the pediatric population. While no known therapies have formally been established as the “gold standard” for management of the acute phase, consensus guidelines do establish interleukin therapies such as anakinra and tocilizumab as safe and effective second-line immunotherapeutic options. Despite the use of interleukin therapies, many patients continue to have super refractory status epilepticus. A number of publications (mainly case reports and case series) have described various adjunctive therapies in the management of new onset refractory status epilepticus/febrile infection-related epilepsy syndrome, including neuromodulatory therapies (such as vagal nerve stimulation, deep brain stimulation, and electroconvulsive therapy), surgical resection, noninterleukin immunotherapies (such as intrathecal dexamethasone, intravenous rituximab, and cyclophosphamide), infusions (such as lidocaine and magnesium), and anesthetic agents (such as sevoflurane). Utilizing a modified Preferred Reporting Items for Systematic reviews and Meta-Analyses approach, this narrative review summarizes the effectiveness and safety of second-line immunotherapies such as tocilizumab and anakinra, as well as the various adjunctive third-line therapies that aim to abort seizures and mitigate comorbidities within an intensive care setting, such as prolonged sedation and secondary systemic complications.
{"title":"Beyond Anakinra and Tocilizumab: Additional Adjunctive Therapies in Pediatric New Onset Refractory Status Epilepticus and Febrile Infection-Related Epilepsy Syndrome – A Narrative Review","authors":"Christian Surí-Báez MD, MPH , Han Jun Kim MD , Janice Lester MLS , Robin T. Varughese MD , Sanjeev V. Kothare MD","doi":"10.1016/j.pediatrneurol.2025.10.022","DOIUrl":"10.1016/j.pediatrneurol.2025.10.022","url":null,"abstract":"<div><div>New onset refractory status epilepticus and febrile infection-related epilepsy syndrome are rare and devastating entities in the pediatric population. While no known therapies have formally been established as the “gold standard” for management of the acute phase, consensus guidelines do establish interleukin therapies such as anakinra and tocilizumab as safe and effective second-line immunotherapeutic options. Despite the use of interleukin therapies, many patients continue to have super refractory status epilepticus. A number of publications (mainly case reports and case series) have described various adjunctive therapies in the management of new onset refractory status epilepticus/febrile infection-related epilepsy syndrome, including neuromodulatory therapies (such as vagal nerve stimulation, deep brain stimulation, and electroconvulsive therapy), surgical resection, noninterleukin immunotherapies (such as intrathecal dexamethasone, intravenous rituximab, and cyclophosphamide), infusions (such as lidocaine and magnesium), and anesthetic agents (such as sevoflurane). Utilizing a modified Preferred Reporting Items for Systematic reviews and Meta-Analyses approach, this narrative review summarizes the effectiveness and safety of second-line immunotherapies such as tocilizumab and anakinra, as well as the various adjunctive third-line therapies that aim to abort seizures and mitigate comorbidities within an intensive care setting, such as prolonged sedation and secondary systemic complications.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 27-39"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564700","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}
Pub Date : 2026-02-01Epub Date: 2025-11-03DOI: 10.1016/j.pediatrneurol.2025.10.028
Ria Pal MD, Chrisoula Cheronis MD, Elizabeth Mayne MD, PhD, Gary K. Steinberg MD, PhD, Sarah Lee MD
Background
To assess variability in postoperative blood pressure management and its association with stroke incidence in pediatric Moyamoya disease (MMD) patients undergoing surgical revascularization.
Methods
This retrospective cohort study was conducted at Stanford University Medical Center from 1992 to 2023. It included 109 pediatric MMD patients (≤18 years) who underwent revascularization surgery. The study the study evaluated outpatient systolic blood pressures, inpatient mean arterial pressure targets, and the use of vasoactive medications.
Results
Postoperative blood pressure management varied significantly based on patient age, syndrome group, and preoperative stroke status. There was no correlation between preoperative systolic blood pressure and postoperative blood pressure targets. Vasoactive medications were used in 55% of patients intravenously and 53% orally, often for extended durations, but without a clear association with transient neurological symptoms. Major strokes occurred in 6.4% of patients, primarily within the first postoperative week. Stroke incidence was associated with longer durations of vasoactive therapy (IV: 3.0 vs 0.0 days, P = 0.026; oral: 53.0 vs 0.0 days, P = 0.035), but not with specific blood pressure targets.
Conclusions
There is significant variability in postoperative blood pressure management in pediatric MMD, reflecting the absence of standardized guidelines. The increased risk of stroke during the first postoperative week, particularly among patients receiving prolonged vasoactive therapy, underscores the need for prospective studies to establish individualized hemodynamic targets and reduce practice variability.
背景：评估接受外科血运重建术的儿童烟雾病（MMD）患者术后血压管理的变异性及其与卒中发生率的关系。方法：回顾性队列研究于1992年至2023年在斯坦福大学医学中心进行。纳入109例接受血运重建术的儿童烟雾病患者（≤18岁）。这项研究评估了门诊病人的收缩压，住院病人的平均动脉压目标，以及血管活性药物的使用。结果：术后血压管理根据患者年龄、综合征组和术前卒中状态有显著差异。术前收缩压与术后血压指标无相关性。55%的患者静脉注射血管活性药物，53%的患者口服血管活性药物，通常持续时间较长，但与短暂性神经症状无明显关联。6.4%的患者发生严重中风，主要发生在术后第一周。卒中发生率与较长的血管活性治疗持续时间相关（静脉注射：3.0 vs 0.0天，P = 0.026；口服：53.0 vs 0.0天，P = 0.035），但与特定的血压目标无关。结论：儿童烟雾病术后血压管理存在显著差异，反映了标准化指南的缺乏。术后第一周卒中风险的增加，特别是在接受长期血管活性治疗的患者中，强调了前瞻性研究的必要性，以建立个体化的血流动力学目标并减少实践的可变性。
{"title":"Blood Pressure Management and Postoperative Stroke Risk in Pediatric Moyamoya Disease","authors":"Ria Pal MD, Chrisoula Cheronis MD, Elizabeth Mayne MD, PhD, Gary K. Steinberg MD, PhD, Sarah Lee MD","doi":"10.1016/j.pediatrneurol.2025.10.028","DOIUrl":"10.1016/j.pediatrneurol.2025.10.028","url":null,"abstract":"<div><h3>Background</h3><div>To assess variability in postoperative blood pressure management and its association with stroke incidence in pediatric Moyamoya disease (MMD) patients undergoing surgical revascularization.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted at Stanford University Medical Center from 1992 to 2023. It included 109 pediatric MMD patients (≤18 years) who underwent revascularization surgery. The study the study evaluated outpatient systolic blood pressures, inpatient mean arterial pressure targets, and the use of vasoactive medications.</div></div><div><h3>Results</h3><div>Postoperative blood pressure management varied significantly based on patient age, syndrome group, and preoperative stroke status. There was no correlation between preoperative systolic blood pressure and postoperative blood pressure targets. Vasoactive medications were used in 55% of patients intravenously and 53% orally, often for extended durations, but without a clear association with transient neurological symptoms. Major strokes occurred in 6.4% of patients, primarily within the first postoperative week. Stroke incidence was associated with longer durations of vasoactive therapy (IV: 3.0 vs 0.0 days, <em>P</em> = 0.026; oral: 53.0 vs 0.0 days, <em>P</em> = 0.035), but not with specific blood pressure targets.</div></div><div><h3>Conclusions</h3><div>There is significant variability in postoperative blood pressure management in pediatric MMD, reflecting the absence of standardized guidelines. The increased risk of stroke during the first postoperative week, particularly among patients receiving prolonged vasoactive therapy, underscores the need for prospective studies to establish individualized hemodynamic targets and reduce practice variability.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 19-26"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564850","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}
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