首页 > 最新文献

Pediatric neurology最新文献

英文 中文
The Face and Features of RNU4-2: A New, Common, Recognizable, Yet Hidden Neurodevelopmental Disorder RNU4-2 的面貌和特征:一种新的、常见的、可识别的但却隐藏的神经发育障碍
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-21 DOI: 10.1016/j.pediatrneurol.2024.09.015
Kristen Barbour MD , Matthew N. Bainbridge PhD , Kristen Wigby MD , Aaron D. Besterman MD , Nathaniel A. Chuang MD , Laura E. Tobin MPH , Miguel Del Campo MD , Jerica Lenberg MS , Lynne M. Bird MD , Jennifer Friedman MD

Background

RNU4-2 is a newly identified, noncoding gene responsible for a significant proportion of individuals with neurodevelopmental disorders (NDDs). Diagnosis is hampered by the inability of commonly employed clinical testing methods, including exome sequencing and currently formulated multigene panels, to detect variants in the noncoding region. The relatively high prevalence of this condition, predicted to affect thousands of undiagnosed children with NDDs, makes it even more relevant to have better tools to facilitate diagnosis. The initial report of the gene-disease association outlined aggregate phenotypic features but lacked detailed patient evaluations, potentially under-reporting phenotypic features and failing to highlight unique aspects. We aimed to identify individuals with RNU4-2 gene variants to deeply phenotype the clinical profile. We sought to define key features that may suggest the diagnosis, to highlight individuals for whom specialized testing, able to detect noncoding region variants, may be indicated.

Methods

We reviewed genomic data from 6,734 individuals, identifying five with recurrent de novo RNU4-2 (n.64_65insT) variants. We clinically evaluated four. Findings were compared with those previously reported.

Results

We identify common clinical features, a distinctive dysmorphic facial pattern, and shared imaging abnormalities. We describe novel aspects including longitudinal trajectory and treatment response.

Conclusions

Enhanced recognition of the RNU4-2 (n.64_65insT-common variant) phenotype, particularly the dysmorphic facial features, will facilitate earlier diagnosis. Distinctive characteristics will guide the selection of patients for testing able to detect RNU4-2 variants: genome sequencing or targeted gene testing. Furthermore, health and research systems may identify undiagnosed patients by querying databases for individuals exhibiting the traits described herein.
背景RNU4-2是一种新发现的非编码基因,在神经发育障碍(NDD)患者中占很大比例。由于常用的临床检测方法(包括外显子组测序和目前制定的多基因面板)无法检测到非编码区的变异,因此影响了诊断。这种疾病的发病率相对较高,预计会影响成千上万名未确诊的 NDD 儿童,因此更需要有更好的工具来促进诊断。基因与疾病相关的最初报告概述了综合表型特征,但缺乏对患者的详细评估,因此可能对表型特征报告不足,也未能突出其独特性。我们的目标是识别具有 RNU4-2 基因变异的个体,对临床特征进行深入的表型分析。我们试图定义可能提示诊断的关键特征,以突出可检测非编码区变异的专业检测的适用人群。方法我们回顾了 6,734 例患者的基因组数据,确定了 5 例具有复发性 RNU4-2 (n.64_65insT) 基因变异的患者。我们对其中四人进行了临床评估。结果我们发现了共同的临床特征、独特的面部畸形模式和共同的影像学异常。结论加强对 RNU4-2(n.64_65insT-常见变异体)表型的识别,尤其是畸形面部特征的识别,将有助于早期诊断。通过基因组测序或靶向基因检测,可根据患者的不同特征选择检测RNU4-2变体的方法。此外,医疗和研究系统还可以通过查询数据库中表现出本文所述特征的个体来确定未确诊的患者。
{"title":"The Face and Features of RNU4-2: A New, Common, Recognizable, Yet Hidden Neurodevelopmental Disorder","authors":"Kristen Barbour MD ,&nbsp;Matthew N. Bainbridge PhD ,&nbsp;Kristen Wigby MD ,&nbsp;Aaron D. Besterman MD ,&nbsp;Nathaniel A. Chuang MD ,&nbsp;Laura E. Tobin MPH ,&nbsp;Miguel Del Campo MD ,&nbsp;Jerica Lenberg MS ,&nbsp;Lynne M. Bird MD ,&nbsp;Jennifer Friedman MD","doi":"10.1016/j.pediatrneurol.2024.09.015","DOIUrl":"10.1016/j.pediatrneurol.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div><em>RNU4</em>-<em>2</em> is a newly identified, noncoding gene responsible for a significant proportion of individuals with neurodevelopmental disorders (NDDs). Diagnosis is hampered by the inability of commonly employed clinical testing methods, including exome sequencing and currently formulated multigene panels, to detect variants in the noncoding region. The relatively high prevalence of this condition, predicted to affect thousands of undiagnosed children with NDDs, makes it even more relevant to have better tools to facilitate diagnosis. The initial report of the gene-disease association outlined aggregate phenotypic features but lacked detailed patient evaluations, potentially under-reporting phenotypic features and failing to highlight unique aspects. We aimed to identify individuals with <em>RNU4</em>-<em>2</em> gene variants to deeply phenotype the clinical profile. We sought to define key features that may suggest the diagnosis, to highlight individuals for whom specialized testing, able to detect noncoding region variants, may be indicated.</div></div><div><h3>Methods</h3><div>We reviewed genomic data from 6,734 individuals, identifying five with recurrent <em>de novo RNU4</em>-<em>2</em> (n.64_65insT) variants. We clinically evaluated four. Findings were compared with those previously reported.</div></div><div><h3>Results</h3><div>We identify common clinical features, a distinctive dysmorphic facial pattern, and shared imaging abnormalities. We describe novel aspects including longitudinal trajectory and treatment response.</div></div><div><h3>Conclusions</h3><div>Enhanced recognition of the <em>RNU4</em>-<em>2</em> (n.64_65insT-common variant) phenotype, particularly the dysmorphic facial features, will facilitate earlier diagnosis. Distinctive characteristics will guide the selection of patients for testing able to detect <em>RNU4</em>-<em>2</em> variants: genome sequencing or targeted gene testing. Furthermore, health and research systems may identify undiagnosed patients by querying databases for individuals exhibiting the traits described herein.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 188-193"},"PeriodicalIF":3.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444955","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
Precision in Progress: Unraveling the Clinimetric Properties of Beery-Buktenica Developmental Test of Visual-Motor Integration in Children With Cerebral Palsy Across Diverse Motor Severities 精准进行时:揭示Beery-Buktenica视觉-运动整合发展测试在不同运动严重程度脑瘫儿童中的临床测量特性。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-20 DOI: 10.1016/j.pediatrneurol.2024.09.017
Yu-Hsin Chen MD , Chia-Ling Chen MD, PhD , Wei-Hsien Hong PhD , Chung-Yao Chen MD , Chia-Ying Chung MD , Katie P.H. Wu MD , Ching-Yi Wu ScD , Keh-Chung Lin ScD, OTR

Background

In the realm of pediatric cerebral palsy (CP), visual motor challenges often overshadow a child's developmental journey. This study delves into the responsiveness and crucial benchmarks, specifically the minimal clinically important difference (MCID), of the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) among children with varying motor severities.

Method

Eighty-eight children with CP (50 males, 38 females; aged three to 12 years) with Gross Motor Function Classification System (GMFCS) levels I to III were recruited from the rehabilitation department of Chang Gung Memorial Hospital in Taiwan. Each participant received the Beery VMI tests at baseline and at one-year follow-up. The standardized response mean (SRM) was calculated to determine the responsiveness of Beery VMI, and a distribution-based approach was used to estimate MCID.

Results

The Beery VMI exhibited remarkable responsiveness across GMFCS levels I to III (SRM = 0.98-2.36). MCIDs for Beery VMI varied across severities, with ranges of 2.93 to 4.41 (0.2 S.D.), 7.31 to 11.49 (0.5 S.D.), and 11.70 to 18.38 (0.8 S.D.). Notably, in the visual perception subset, MCIDs were 3.93 to 4.03 (0.2 S.D.), 9.83 to 10.07 (0.5 S.D.), and 15.73 to 16.11 (0.8 S.D.). In the supplemental motor coordination subtest, MCIDs spanned 1.67 to 4.87 (0.2 S.D.), 4.18 to 12.17 (0.5 S.D.), and 6.68 to 19.47 (0.8 S.D.).

Conclusions

Beery VMI demonstrates robust responsiveness in children with CP. Motor-severity-tailored MCIDs offer a guide for clinicians and researchers, hinting at treatment efficacy. Particularly, lower change scores in VMI and motor coordination subtests may signal effective interventions for moderate motor disability over mild cases.
背景:在小儿脑瘫(CP)领域,视觉运动方面的挑战往往给儿童的成长历程蒙上阴影。本研究探讨了不同运动严重程度的儿童对 Beery-Buktenica 视觉-运动整合发育测试(Beery VMI)的反应能力和关键基准,特别是最小临床重要差异(MCID):方法:从台湾长庚纪念医院康复科招募了88名患有CP的儿童(男50名,女38名;年龄在3至12岁之间),他们的粗大运动功能分级系统(GMFCS)处于I至III级。每位受试者在基线和一年随访时均接受了 Beery VMI 测试。通过计算标准化反应平均值(SRM)来确定比瑞 VMI 的反应性,并采用基于分布的方法来估计 MCID:结果:Beery VMI 在 GMFCS I 至 III 级(SRM = 0.98-2.36)中表现出显著的反应性。不同严重程度的 Beery VMI 的 MCID 各不相同,范围分别为 2.93 至 4.41(0.2 S.D.)、7.31 至 11.49(0.5 S.D.)和 11.70 至 18.38(0.8 S.D.)。值得注意的是,在视觉感知子测试中,MCID 分别为 3.93 至 4.03(0.2 S.D.)、9.83 至 10.07(0.5 S.D.)和 15.73 至 16.11(0.8 S.D.)。在补充运动协调分测验中,MCID 的范围分别为 1.67 至 4.87(0.2 S.D.)、4.18 至 12.17(0.5 S.D.)和 6.68 至 19.47(0.8 S.D.):结论:Beery VMI 对患有 CP 的儿童具有很强的反应能力。运动性定制的 MCID 为临床医生和研究人员提供了指导,暗示了治疗效果。特别是,VMI 和运动协调分测验中较低的变化分可能预示着对中度运动障碍的干预比轻度病例有效。
{"title":"Precision in Progress: Unraveling the Clinimetric Properties of Beery-Buktenica Developmental Test of Visual-Motor Integration in Children With Cerebral Palsy Across Diverse Motor Severities","authors":"Yu-Hsin Chen MD ,&nbsp;Chia-Ling Chen MD, PhD ,&nbsp;Wei-Hsien Hong PhD ,&nbsp;Chung-Yao Chen MD ,&nbsp;Chia-Ying Chung MD ,&nbsp;Katie P.H. Wu MD ,&nbsp;Ching-Yi Wu ScD ,&nbsp;Keh-Chung Lin ScD, OTR","doi":"10.1016/j.pediatrneurol.2024.09.017","DOIUrl":"10.1016/j.pediatrneurol.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>In the realm of pediatric cerebral palsy (CP), visual motor challenges often overshadow a child's developmental journey. This study delves into the responsiveness and crucial benchmarks, specifically the minimal clinically important difference (MCID), of the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) among children with varying motor severities.</div></div><div><h3>Method</h3><div>Eighty-eight children with CP (50 males, 38 females; aged three to 12 years) with Gross Motor Function Classification System (GMFCS) levels I to III were recruited from the rehabilitation department of Chang Gung Memorial Hospital in Taiwan. Each participant received the Beery VMI tests at baseline and at one-year follow-up. The standardized response mean (SRM) was calculated to determine the responsiveness of Beery VMI, and a distribution-based approach was used to estimate MCID.</div></div><div><h3>Results</h3><div>The Beery VMI exhibited remarkable responsiveness across GMFCS levels I to III (SRM = 0.98-2.36). MCIDs for Beery VMI varied across severities, with ranges of 2.93 to 4.41 (0.2 S.D.), 7.31 to 11.49 (0.5 S.D.), and 11.70 to 18.38 (0.8 S.D.). Notably, in the visual perception subset, MCIDs were 3.93 to 4.03 (0.2 S.D.), 9.83 to 10.07 (0.5 S.D.), and 15.73 to 16.11 (0.8 S.D.). In the supplemental motor coordination subtest, MCIDs spanned 1.67 to 4.87 (0.2 S.D.), 4.18 to 12.17 (0.5 S.D.), and 6.68 to 19.47 (0.8 S.D.).</div></div><div><h3>Conclusions</h3><div>Beery VMI demonstrates robust responsiveness in children with CP. Motor-severity-tailored MCIDs offer a guide for clinicians and researchers, hinting at treatment efficacy. Particularly, lower change scores in VMI and motor coordination subtests may signal effective interventions for moderate motor disability over mild cases.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 139-143"},"PeriodicalIF":3.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392412","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
Cortical Gyrification Is Associated With the Clinical Phenotype in Tuberous Sclerosis Complex 皮质回旋与结节性硬化症复合体的临床表型有关。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.pediatrneurol.2024.09.012
Nicolò Trevisan PhD , Francesco Brunello MD , Fabio Sambataro MD, PhD , Gaia Biscalchin MD , Margherita Nosadini MD, PhD , Stefano Sartori MD, PhD , Concetta Luisi MD, PhD , Maria Federica Pelizza MD , Renzo Manara MD , Irene Toldo MD, PhD

Background

Tuberous sclerosis complex (TSC) is characterized by cortical tubers, determining cortical disarrangement and consequently drug-resistant epilepsy, intellectual disability, and TSC-associated neuropsychiatric disorders (TAND).

Aim of the study

To establish whether gyrification index (GI), a software-based neuroradiological parameter, could be associated with the severity of phenotype in TSC, identifying the cortical regions that are more associated with the severity of the main clinical manifestations.

Methods

This was a retrospective cross-sectional study. Magnetic resonance imaging was acquired on a 1.5-T scanner. CAT12 toolbox was used for the estimation of GI. Data analysis was performed with Jamovi. The level of significance was set to P < 0.05 for all tests.

Results

Forty-five patients with TSC and 42 healthy controls were included. Patients with TSC were characterized by higher total GI (P = 0.002) compared with healthy controls. Among patients with TSC, a higher total GI was associated with impaired neurological examination (P = 0.039), epilepsy (P = 0.017), intellectual disability (P = 0.013), TAND (P = 0.013), and higher number of cortical tubers (P < 0.001). An increased local GI in specific cortical areas was associated with TAND and autism spectrum disorders.

Conclusions

GI is a software-based neuroradiological parameter that could represent a reliable overall prognostic marker in TSC. Local GI can be used to identify phenotype-specific gyrification patterns allowing an early characterization of patients with TSC.
背景:结节性硬化综合征(TSC)的特点是皮质管状结构,决定了皮质的错乱,进而导致耐药性癫痫、智力障碍和TSC相关神经精神障碍(TAND):研究目的:确定回旋指数(GI)这一基于软件的神经放射学参数是否与TSC表型的严重程度相关,从而确定与主要临床表现的严重程度更相关的皮质区域:这是一项回顾性横断面研究。磁共振成像由 1.5-T 扫描仪采集。CAT12 工具箱用于估算 GI。使用 Jamovi 进行数据分析。显著性水平设定为 P 结果:共纳入 45 名 TSC 患者和 42 名健康对照者。与健康对照组相比,TSC 患者的总消化道指数较高(P = 0.002)。在 TSC 患者中,较高的总 GI 与神经系统检查受损(P = 0.039)、癫痫(P = 0.017)、智力障碍(P = 0.013)、TAND(P = 0.013)和较多的皮质管数量(P 结论:总 GI 是一种基于软件的神经网络成像技术:GI是一种基于软件的神经放射学参数,可作为TSC可靠的总体预后标志。局部 GI 可用于识别表型特异性回旋模式,从而对 TSC 患者进行早期定性。
{"title":"Cortical Gyrification Is Associated With the Clinical Phenotype in Tuberous Sclerosis Complex","authors":"Nicolò Trevisan PhD ,&nbsp;Francesco Brunello MD ,&nbsp;Fabio Sambataro MD, PhD ,&nbsp;Gaia Biscalchin MD ,&nbsp;Margherita Nosadini MD, PhD ,&nbsp;Stefano Sartori MD, PhD ,&nbsp;Concetta Luisi MD, PhD ,&nbsp;Maria Federica Pelizza MD ,&nbsp;Renzo Manara MD ,&nbsp;Irene Toldo MD, PhD","doi":"10.1016/j.pediatrneurol.2024.09.012","DOIUrl":"10.1016/j.pediatrneurol.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Tuberous sclerosis complex (TSC) is characterized by cortical tubers, determining cortical disarrangement and consequently drug-resistant epilepsy, intellectual disability, and TSC-associated neuropsychiatric disorders (TAND).</div></div><div><h3>Aim of the study</h3><div>To establish whether gyrification index (GI), a software-based neuroradiological parameter, could be associated with the severity of phenotype in TSC, identifying the cortical regions that are more associated with the severity of the main clinical manifestations.</div></div><div><h3>Methods</h3><div>This was a retrospective cross-sectional study. Magnetic resonance imaging was acquired on a 1.5-T scanner. CAT12 toolbox was used for the estimation of GI. Data analysis was performed with Jamovi. The level of significance was set to <em>P</em> &lt; 0.05 for all tests.</div></div><div><h3>Results</h3><div>Forty-five patients with TSC and 42 healthy controls were included. Patients with TSC were characterized by higher total GI (<em>P</em> = 0.002) compared with healthy controls. Among patients with TSC, a higher total GI was associated with impaired neurological examination (<em>P</em> = 0.039), epilepsy (<em>P</em> = 0.017), intellectual disability (<em>P</em> = 0.013), TAND (<em>P</em> = 0.013), and higher number of cortical tubers (<em>P</em> &lt; 0.001). An increased local GI in specific cortical areas was associated with TAND and autism spectrum disorders.</div></div><div><h3>Conclusions</h3><div>GI is a software-based neuroradiological parameter that could represent a reliable overall prognostic marker in TSC. Local GI can be used to identify phenotype-specific gyrification patterns allowing an early characterization of patients with TSC.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 170-175"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406694","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
Biallelic Variants in LIPT2 as a Cause of Infantile-Onset Dystonia: Expanding the Clinical and Molecular Spectrum LIPT2的双拷贝变异是婴儿期发病肌张力障碍的病因之一:扩展临床和分子谱系。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-18 DOI: 10.1016/j.pediatrneurol.2024.09.013
Kuntal Sen MD , Alonso Zea Vera MD , Anna Puronurmi MD , Andrea Gropman MD , Parith Wongkittichote MD , Rebecca Ganetzky MD , Kaija Autio PhD , Alexander Kastaniotis PhD

Background

Lipoyl transferase 2 is involved in the biosynthesis of lipoate. Lipoate is the cofactor for the glycine cleavage system and four dehydrogenase enzymes. Biallelic variants in LIPT2 causing severe neonatal encephalopathy was first described in 2017.

Methods

Clinical data were collected by retrospective chart review after obtaining consent from parents. The pathogenicity of these variants was further delineated using a yeast model. The YEp352-LIPT2 plasmid was used as a template to generate the two patient variants using QuickChange Lightning Site-Directed Mutagenesis Kit.

Results

The patient was a 15-month-old female who presented at one month with dystonia, developmental delay, and feeding difficulties. Brain magnetic resonance imaging showed cortical malformations including colpocephaly, polymicrogyria, and heterotopia. Patient had elevations in lactate (6.1 mmol/L) and glycine. Exome sequencing showed two variants of uncertain significance in trans in the LIPT2 gene: c.346 G>T and c.418C>T. Patient was started on lipoic acid, thiamine, and COQ10. Yeast complementation experiments indicate that both patient mutant variants result in diminished function versions of the LIPT2 protein.

Conclusion

We report the fourth case of LIPT2-related disorder. Proband shared significant overlap with previous patients; however, there was a distinct movement disorder and brain malformations, which have not been previously described. Unlike most neurometabolic disorders where dystonia develops later after metabolic stroke in basal ganglia, LIPT2-related disorder seems unique due to early onset of dystonia due to energy deficit in the developing brain. Lipoic acid supplementation has not led to significant clinical improvement. Analyses in yeast indicate that novel variants are deleterious but have retained some functionality.
背景:脂酰转移酶 2 参与脂酸的生物合成。脂酸是甘氨酸裂解系统和四种脱氢酶的辅助因子。2017年首次描述了导致严重新生儿脑病的LIPT2双唇变异:在征得家长同意后,通过回顾性病历审查收集临床数据。利用酵母模型进一步确定了这些变异的致病性。以YEp352-LIPT2质粒为模板,使用QuickChange Lightning定点突变试剂盒生成患者的两个变体:患者是一名15个月大的女性,一个月大时出现肌张力障碍、发育迟缓和喂养困难。脑磁共振成像显示大脑皮层畸形,包括头盖骨畸形、多小脑畸形和异位畸形。患者的乳酸(6.1毫摩尔/升)和甘氨酸升高。外显子组测序显示,LIPT2 基因有两个意义不确定的反式变异:c.346 G>T 和 c.418C>T。患者开始服用硫辛酸、硫胺素和 COQ10。酵母互补实验表明,患者的两个突变变体都会导致 LIPT2 蛋白的功能减弱:我们报告了第四例 LIPT2 相关疾病。我们报告了第四例 LIPT2 相关疾病患者,该病例与之前的患者有明显的重叠;但是,患者有明显的运动障碍和脑部畸形,这在之前的病例中还没有出现过。与大多数神经代谢性疾病不同的是,肌张力障碍是在基底节发生代谢中风后才出现的,而LIPT2相关障碍则是由于发育中的大脑能量不足而导致肌张力障碍提前出现。补充硫辛酸并不能显著改善临床症状。在酵母中进行的分析表明,新的变体是有害的,但保留了一些功能。
{"title":"Biallelic Variants in LIPT2 as a Cause of Infantile-Onset Dystonia: Expanding the Clinical and Molecular Spectrum","authors":"Kuntal Sen MD ,&nbsp;Alonso Zea Vera MD ,&nbsp;Anna Puronurmi MD ,&nbsp;Andrea Gropman MD ,&nbsp;Parith Wongkittichote MD ,&nbsp;Rebecca Ganetzky MD ,&nbsp;Kaija Autio PhD ,&nbsp;Alexander Kastaniotis PhD","doi":"10.1016/j.pediatrneurol.2024.09.013","DOIUrl":"10.1016/j.pediatrneurol.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Lipoyl transferase 2 is involved in the biosynthesis of lipoate. Lipoate is the cofactor for the glycine cleavage system and four dehydrogenase enzymes. Biallelic variants in LIPT2 causing severe neonatal encephalopathy was first described in 2017.</div></div><div><h3>Methods</h3><div>Clinical data were collected by retrospective chart review after obtaining consent from parents. The pathogenicity of these variants was further delineated using a yeast model. The YEp352-LIPT2 plasmid was used as a template to generate the two patient variants using QuickChange Lightning Site-Directed Mutagenesis Kit.</div></div><div><h3>Results</h3><div>The patient was a 15-month-old female who presented at one month with dystonia, developmental delay, and feeding difficulties. Brain magnetic resonance imaging showed cortical malformations including colpocephaly, polymicrogyria, and heterotopia. Patient had elevations in lactate (6.1 mmol/L) and glycine. Exome sequencing showed two variants of uncertain significance in <em>trans</em> in the LIPT2 gene: c.346 G&gt;T and c.418C&gt;T. Patient was started on lipoic acid, thiamine, and COQ10. Yeast complementation experiments indicate that both patient mutant variants result in diminished function versions of the LIPT2 protein.</div></div><div><h3>Conclusion</h3><div>We report the fourth case of LIPT2-related disorder. Proband shared significant overlap with previous patients; however, there was a distinct movement disorder and brain malformations, which have not been previously described. Unlike most neurometabolic disorders where dystonia develops later after metabolic stroke in basal ganglia, LIPT2-related disorder seems unique due to early onset of dystonia due to energy deficit in the developing brain. Lipoic acid supplementation has not led to significant clinical improvement. Analyses in yeast indicate that novel variants are deleterious but have retained some functionality.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"162 ","pages":"Pages 32-39"},"PeriodicalIF":3.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624826","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
Rate of Autoimmune Encephalitis in Children With First-Episode Psychosis 首发精神病儿童的自身免疫性脑炎发病率。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.pediatrneurol.2024.09.011
Geffen Treiman MD, MPH , Laura Blackwell PhD , Robyn Howarth PhD , Grace Gombolay MD, MSc

Background

Autoimmune encephalitis (AE) can present as first-episode psychosis (FEP) in children. An FEP diagnostic algorithm has been proposed, but how this algorithm applies to children is unknown. We assess the FEP diagnostic algorithm in children with FEP.

Methods

The FEP algorithm was applied to a retrospective cohort of children with FEP without other neurological symptoms.

Results

Twenty-four patients were included, with five AE (anti-N-methyl-d-aspartate receptor encephalitis) and 19 non-AE patients (12 primary psychiatric, two headaches, mycoplasma-related encephalitis, post–coronavirus disease 2019 encephalitis, drug reaction with eosinophilia and systemic symptoms [DRESS] syndrome, cobalamin C deficiency, and two unknown). Some non-AE patients (five of 19 = 26%) received immunotherapies, with symptom resolution in one of five (20%) with immunotherapy and in four of 14 (29%) without immunotherapy. The FEP algorithm recommended cerebrospinal fluid (CSF) testing in all (five of five = 100%) patients with AE and in six of 19 (32%) non-AE patients, resulting in 100% sensitivity (95% confidence interval [CI]: 100% to 100%) and 45.5% specificity (95% CI: 16% to 75%), with a negative predictive value of 100% (95% CI: 100% to 100%).

Conclusions

FEP can occur in children from different causes, including AE and metabolic conditions. Evaluation of FEP should be broad, especially without CSF evidence of inflammation. The FEP algorithm is useful to assess patients who would benefit from CSF testing and should be assessed in larger cohorts.
背景:自身免疫性脑炎(AE)可表现为儿童首发精神病(FEP)。有人提出了一种 FEP 诊断算法,但这种算法如何适用于儿童尚不清楚。我们对FEP诊断算法在儿童FEP患者中的应用进行了评估:方法:将 FEP 算法应用于无其他神经症状的 FEP 儿童回顾性队列:结果:共纳入24名患者,其中5名AE患者(抗N-甲基-d-天冬氨酸受体脑炎)和19名非AE患者(12名原发性精神病患者、2名头痛患者、支原体相关脑炎患者、2019年冠状病毒病后脑炎患者、药物反应伴嗜酸性粒细胞增多和全身症状[DRESS]综合征患者、钴胺素C缺乏症患者和2名未知患者)。一些非 AE 患者(19 人中有 5 人,占 26%)接受了免疫治疗,接受免疫治疗的 5 人中有 1 人(占 20%)症状得到缓解,未接受免疫治疗的 14 人中有 4 人(占 29%)症状得到缓解。FEP算法建议对所有AE患者(5例中的5例=100%)和19例非AE患者中的6例(32%)进行脑脊液(CSF)检测,结果灵敏度为100%(95%置信区间[CI]:100%至100%),特异性为45.5%(95%置信区间:16%至75%),阴性预测值为100%(95%置信区间:100%至100%):结论:FEP可由不同原因引起,包括AE和代谢性疾病。对 FEP 的评估应该广泛,尤其是在没有 CSF 炎症证据的情况下。FEP算法有助于评估哪些患者可从脑脊液检测中获益,应在更大的群体中进行评估。
{"title":"Rate of Autoimmune Encephalitis in Children With First-Episode Psychosis","authors":"Geffen Treiman MD, MPH ,&nbsp;Laura Blackwell PhD ,&nbsp;Robyn Howarth PhD ,&nbsp;Grace Gombolay MD, MSc","doi":"10.1016/j.pediatrneurol.2024.09.011","DOIUrl":"10.1016/j.pediatrneurol.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Autoimmune encephalitis (AE) can present as first-episode psychosis (FEP) in children. An FEP diagnostic algorithm has been proposed, but how this algorithm applies to children is unknown. We assess the FEP diagnostic algorithm in children with FEP.</div></div><div><h3>Methods</h3><div>The FEP algorithm was applied to a retrospective cohort of children with FEP without other neurological symptoms.</div></div><div><h3>Results</h3><div>Twenty-four patients were included, with five AE (anti-<em>N</em>-methyl-d-aspartate receptor encephalitis) and 19 non-AE patients (12 primary psychiatric, two headaches, mycoplasma-related encephalitis, post–coronavirus disease 2019 encephalitis, drug reaction with eosinophilia and systemic symptoms [DRESS] syndrome, cobalamin C deficiency, and two unknown). Some non-AE patients (five of 19 = 26%) received immunotherapies, with symptom resolution in one of five (20%) with immunotherapy and in four of 14 (29%) without immunotherapy. The FEP algorithm recommended cerebrospinal fluid (CSF) testing in all (five of five = 100%) patients with AE and in six of 19 (32%) non-AE patients, resulting in 100% sensitivity (95% confidence interval [CI]: 100% to 100%) and 45.5% specificity (95% CI: 16% to 75%), with a negative predictive value of 100% (95% CI: 100% to 100%).</div></div><div><h3>Conclusions</h3><div>FEP can occur in children from different causes, including AE and metabolic conditions. Evaluation of FEP should be broad, especially without CSF evidence of inflammation. The FEP algorithm is useful to assess patients who would benefit from CSF testing and should be assessed in larger cohorts.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 113-116"},"PeriodicalIF":3.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378174","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
Potential Role of Sleep Disturbance in the Development of Early Puberty: Past Clinical Evidence for Future Management 睡眠障碍在青春期早期发育中的潜在作用:过去的临床证据为未来的管理提供了依据。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-15 DOI: 10.1016/j.pediatrneurol.2024.09.010
Dolrutai Puttawong MD , Karn Wejaphikul MD, PhD , Chanisa Thonusin MD, PhD , Prapai Dejkhamron MD , Nipon Chattipakorn MD, PhD , Siriporn C. Chattipakorn DDS, PhD
The incidence of early puberty in children has been increasing. It has been suspected that both genetic and various environmental factors such as nutrition and hormonal exposure could influence the mechanisms underlying the earlier onset of puberty. Interestingly, several previous studies have reported a strong connection between sleep and puberty. Specifically, it was discovered that luteinizing hormone (LH), a potential marker for the onset of puberty, was increased during the deep sleep period. Furthermore, a high prevalence of early puberty was observed in patients with sleep disorders, especially in those experiencing narcolepsy. In this review article, findings related to the association between sleep disturbance and early puberty have been comprehensively summarized. Any contrary findings are also included and discussed. Advances in the knowledge surrounding sleep disturbance have led to a greater understanding of a correlation between early puberty and sleep disorder and provide alternative therapeutic options for the treatment of central precocious puberty in the future.
儿童青春期提前的发生率越来越高。人们一直怀疑,遗传和各种环境因素(如营养和荷尔蒙接触)都可能影响青春期提前到来的机制。有趣的是,之前的一些研究报告显示,睡眠与青春期之间存在密切联系。具体来说,研究发现,作为青春期开始的潜在标志物的黄体生成素(LH)在深度睡眠期间会增加。此外,在睡眠障碍患者中,尤其是在嗜睡症患者中,发现青春期提前的发病率很高。在这篇综述文章中,我们全面总结了与睡眠障碍和青春期提前之间的关系有关的研究结果。任何与此相反的研究结果也包括在内并进行了讨论。睡眠障碍相关知识的进步使人们对青春期早期与睡眠障碍之间的相关性有了更深入的了解,并为今后治疗中枢性性早熟提供了其他治疗方案。
{"title":"Potential Role of Sleep Disturbance in the Development of Early Puberty: Past Clinical Evidence for Future Management","authors":"Dolrutai Puttawong MD ,&nbsp;Karn Wejaphikul MD, PhD ,&nbsp;Chanisa Thonusin MD, PhD ,&nbsp;Prapai Dejkhamron MD ,&nbsp;Nipon Chattipakorn MD, PhD ,&nbsp;Siriporn C. Chattipakorn DDS, PhD","doi":"10.1016/j.pediatrneurol.2024.09.010","DOIUrl":"10.1016/j.pediatrneurol.2024.09.010","url":null,"abstract":"<div><div>The incidence of early puberty in children has been increasing. It has been suspected that both genetic and various environmental factors such as nutrition and hormonal exposure could influence the mechanisms underlying the earlier onset of puberty. Interestingly, several previous studies have reported a strong connection between sleep and puberty. Specifically, it was discovered that luteinizing hormone (LH), a potential marker for the onset of puberty, was increased during the deep sleep period. Furthermore, a high prevalence of early puberty was observed in patients with sleep disorders, especially in those experiencing narcolepsy. In this review article, findings related to the association between sleep disturbance and early puberty have been comprehensively summarized. Any contrary findings are also included and discussed. Advances in the knowledge surrounding sleep disturbance have led to a greater understanding of a correlation between early puberty and sleep disorder and provide alternative therapeutic options for the treatment of central precocious puberty in the future.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 117-124"},"PeriodicalIF":3.2,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378173","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
A Comparison of Treatment Practices for Newborn Seizure Management Across Level II and III Neonatal Intensive Care Units in the United States 美国二级和三级新生儿重症监护病房新生儿癫痫发作治疗方法比较。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.pediatrneurol.2024.09.006
Jacky A. Dickman BS , Jennifer C. Keene MD , Niranjana Natarajan MD , Lindsey A. Morgan MD , Melisa Carrasco MD, PhD

Background

Neonatal seizures (NS) represent an important clinical manifestation among critically ill infants and are often the first sign of underlying brain injury. Early recognition and treatment are essential to reduce morbidity and mortality. The present study investigated the NS management and treatment approaches employed by level II/III neonatal intensive care units (NICUs) across the United States to identify areas of consensus and variability.

Methods

Personnel associated with level II/III NICUs were directly surveyed with an electronic questionnaire. Access to neurology specialists, on-site electroencephalography (EEG) monitoring, and use of antiseizure medications was directly queried. A total of 51 NICUs participated in this survey.

Results

Twenty-five percent of the surveyed NICUs reported having an established clinical practice pathway available for treating NS. Twenty-four percent endorsed having written guidelines that provided a formal definition for the concept of “neonatal seizures.” Although the majority of NICUs reported having phenobarbital available for rapid seizure management, most NICUs lacked access to additional antiseizure medications for treatment escalation. Twenty-four percent of the surveyed NICUs had no access to EEG monitoring available to them on-site. Daytime and overnight access to neurology consultants was limited and variable.

Conclusions

Findings were consistent with a lack of equitable access for NS treatment. Areas of potential improvement include development and implementation of a protocol for rapidly treating NS that emphasizes enhanced access to EEG and rapid neurology consultation, acknowledging and improving upon resource limitations. These developments may eventually provide earlier detection, evaluation, and treatment of seizures in newborns, contributing to improved long-term outcomes.
背景:新生儿癫痫发作(NS)是重症婴儿的一种重要临床表现,通常是潜在脑损伤的首发症状。早期识别和治疗对降低发病率和死亡率至关重要。本研究调查了美国 II/III 级新生儿重症监护病房(NICU)采用的 NS 管理和治疗方法,以确定存在共识和差异的领域:通过电子问卷直接调查了 II/III 级新生儿重症监护病房的相关人员。直接询问了神经病学专家的使用情况、现场脑电图(EEG)监测以及抗癫痫药物的使用情况。共有 51 家新生儿监护病房参与了此次调查:接受调查的新生儿重症监护室中有 25% 称已制定了治疗 NS 的临床实践路径。24%的新生儿重症监护室表示已制定书面指南,对 "新生儿癫痫发作 "的概念进行了正式定义。尽管大多数新生儿重症监护病房都报告说有苯巴比妥可用于快速控制癫痫发作,但大多数新生儿重症监护病房都无法获得更多的抗癫痫药物用于治疗升级。在接受调查的新生儿重症监护室中,有 24% 的监护室没有现场脑电图监测设备。神经科顾问的日间和夜间接诊时间有限且不固定:结论:调查结果显示,NS 治疗缺乏公平性。潜在的改进领域包括制定和实施快速治疗 NS 的方案,该方案强调加强脑电图监测和快速神经内科会诊,承认并改进资源限制。这些发展最终可能会为新生儿癫痫发作提供更早的检测、评估和治疗,从而改善长期预后。
{"title":"A Comparison of Treatment Practices for Newborn Seizure Management Across Level II and III Neonatal Intensive Care Units in the United States","authors":"Jacky A. Dickman BS ,&nbsp;Jennifer C. Keene MD ,&nbsp;Niranjana Natarajan MD ,&nbsp;Lindsey A. Morgan MD ,&nbsp;Melisa Carrasco MD, PhD","doi":"10.1016/j.pediatrneurol.2024.09.006","DOIUrl":"10.1016/j.pediatrneurol.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal seizures (NS) represent an important clinical manifestation among critically ill infants and are often the first sign of underlying brain injury. Early recognition and treatment are essential to reduce morbidity and mortality. The present study investigated the NS management and treatment approaches employed by level II/III neonatal intensive care units (NICUs) across the United States to identify areas of consensus and variability.</div></div><div><h3>Methods</h3><div>Personnel associated with level II/III NICUs were directly surveyed with an electronic questionnaire. Access to neurology specialists, on-site electroencephalography (EEG) monitoring, and use of antiseizure medications was directly queried. A total of 51 NICUs participated in this survey.</div></div><div><h3>Results</h3><div>Twenty-five percent of the surveyed NICUs reported having an established clinical practice pathway available for treating NS. Twenty-four percent endorsed having written guidelines that provided a formal definition for the concept of “neonatal seizures.” Although the majority of NICUs reported having phenobarbital available for rapid seizure management, most NICUs lacked access to additional antiseizure medications for treatment escalation. Twenty-four percent of the surveyed NICUs had no access to EEG monitoring available to them on-site. Daytime and overnight access to neurology consultants was limited and variable.</div></div><div><h3>Conclusions</h3><div>Findings were consistent with a lack of equitable access for NS treatment. Areas of potential improvement include development and implementation of a protocol for rapidly treating NS that emphasizes enhanced access to EEG and rapid neurology consultation, acknowledging and improving upon resource limitations. These developments may eventually provide earlier detection, evaluation, and treatment of seizures in newborns, contributing to improved long-term outcomes.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 108-112"},"PeriodicalIF":3.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378171","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
A Retrospective Review of Reclassification of Variants of Uncertain Significance in a Pediatric Epilepsy Cohort Undergoing Genetic Panel Testing 对接受基因组测试的小儿癫痫队列中意义不确定的变异体进行重新分类的回顾性研究。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.pediatrneurol.2024.09.009
Nitish Chourasia MD , Rohan Vaidya DO , Soham Sengupta PhD , Heather C. Mefford MD, PhD , James Wheless MD

Background

The interpretation and communication of variant of uncertain significance (VUS) genetic results often present a challenge in clinical practice. VUSs can be reclassified over time into benign/likely benign (B/LB) or pathogenic/likely pathogenic (P/LP) based on the availability of updated data. We evaluate the frequency of VUS reclassification in our tertiary care epilepsy cohort undergoing epilepsy genetic panel (EGP) testing.

Methods

Patients with established diagnoses of epilepsy (neonates to 18 years of age) who underwent EGP testing between 2017 and 2022 from a single commercial laboratory were evaluated. Patients who had any variant reclassified from their initial EGP report were included. Duration between reclassification of VUSs and types of reclassifications were compared between developmental and epileptic encephalopathy (DEE) versus non-DEE phenotypes.

Results

Over the five years, 1025 probands were tested using EGP. Eighty-five probands (8%) had at least one genetic variant reclassified. A total of 252 initial VUSs were reported in the 85 probands, of which 113 (45%) VUSs were reclassified. Of 113 reclassification events, 21 (19%) were upgraded to P/LP and 92 (81%) were reclassified to B/LB. The median (interquartile range) duration between variant reinterpretations in the cohort was 12 (14.5) months. There were no significant differences in the duration between reclassification and the likelihood of reclassification of VUSs to B/LB or P/LP between the two groups (DEE versus non-DEE).

Conclusions

VUS reclassification over time can lead to clinically significant variant reinterpretation in patients with unknown genetic diagnoses. Periodic genomic test reinterpretation, preferably yearly, is recommended in routine clinical practice.
背景:在临床实践中,如何解释和交流意义不确定的基因变异(VUS)结果往往是一项挑战。随着时间的推移,根据更新数据,VUS 可被重新分类为良性/可能良性(B/LB)或致病性/可能致病性(P/LP)。我们对接受癫痫基因面板(EGP)检测的三级医疗机构癫痫队列中 VUS 重新分类的频率进行了评估:我们对 2017 年至 2022 年期间在一家商业实验室接受 EGP 检测的确诊癫痫患者(新生儿至 18 岁)进行了评估。纳入了与最初的 EGP 报告相比有任何变异重新分类的患者。比较了发育性癫痫性脑病(DEE)与非DEE表型之间VUS重新分类的持续时间和重新分类的类型:在这五年中,共有 1025 名受试者接受了 EGP 检测。85名受试者(8%)至少有一个基因变异被重新分类。这 85 名受试者共报告了 252 个初始 VUS,其中 113 个(45%)VUS 被重新分类。在 113 个重新分类事件中,21 个(19%)升级为 P/LP,92 个(81%)重新分类为 B/LB。队列中变异重新解释之间的中位时间(四分位数间距)为 12(14.5)个月。两组之间(DEE与非DEE)在重新分类之间的持续时间以及VUS重新分类为B/LB或P/LP的可能性方面没有明显差异:结论:随着时间的推移,VUS 的重新分类可导致对基因诊断不明的患者进行具有临床意义的变异重新解释。建议在常规临床实践中定期对基因组测试进行重新解读,最好每年一次。
{"title":"A Retrospective Review of Reclassification of Variants of Uncertain Significance in a Pediatric Epilepsy Cohort Undergoing Genetic Panel Testing","authors":"Nitish Chourasia MD ,&nbsp;Rohan Vaidya DO ,&nbsp;Soham Sengupta PhD ,&nbsp;Heather C. Mefford MD, PhD ,&nbsp;James Wheless MD","doi":"10.1016/j.pediatrneurol.2024.09.009","DOIUrl":"10.1016/j.pediatrneurol.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>The interpretation and communication of variant of uncertain significance (VUS) genetic results often present a challenge in clinical practice. VUSs can be reclassified over time into benign/likely benign (B/LB) or pathogenic/likely pathogenic (P/LP) based on the availability of updated data. We evaluate the frequency of VUS reclassification in our tertiary care epilepsy cohort undergoing epilepsy genetic panel (EGP) testing.</div></div><div><h3>Methods</h3><div>Patients with established diagnoses of epilepsy (neonates to 18 years of age) who underwent EGP testing between 2017 and 2022 from a single commercial laboratory were evaluated. Patients who had any variant reclassified from their initial EGP report were included. Duration between reclassification of VUSs and types of reclassifications were compared between developmental and epileptic encephalopathy (DEE) versus non-DEE phenotypes.</div></div><div><h3>Results</h3><div>Over the five years, 1025 probands were tested using EGP. Eighty-five probands (8%) had at least one genetic variant reclassified. A total of 252 initial VUSs were reported in the 85 probands, of which 113 (45%) VUSs were reclassified. Of 113 reclassification events, 21 (19%) were upgraded to P/LP and 92 (81%) were reclassified to B/LB. The median (interquartile range) duration between variant reinterpretations in the cohort was 12 (14.5) months. There were no significant differences in the duration between reclassification and the likelihood of reclassification of VUSs to B/LB or P/LP between the two groups (DEE versus non-DEE).</div></div><div><h3>Conclusions</h3><div>VUS reclassification over time can lead to clinically significant variant reinterpretation in patients with unknown genetic diagnoses. Periodic genomic test reinterpretation, preferably yearly, is recommended in routine clinical practice.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 101-107"},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366195","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
Helmet Therapy for Positional Plagiocephaly: A Systematic Review of the Tools Used to Diagnose, Offer Treatment Recommendations, and Assess Treatment Outcomes of the Condition 头盔疗法治疗位置性头畸形:用于诊断、提供治疗建议和评估治疗效果的工具的系统性综述。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.pediatrneurol.2024.09.007
L. Kate Lamberta DO, Thomas R. Murray DO, Alison Gehred MLIS, Pedro Weisleder MD, PhD

Background

Positional plagiocephaly (PP) is an asymmetric deformation of the skull as a consequence of external forces acting on a normal and pliable skull. The prevalence of PP ranges between 19.6% and 46.6%. Treatment options for PP include repositioning, physical therapy, and helmet orthoses. Consensus regarding the treatment of PP remains elusive due to the condition's imprecise natural history, dissimilar diagnostic strategies, and unreliable data asserting treatments' efficacy. Our aim was to conduct a systematic review of the tools used to diagnose, suggest treatment strategies, and assess outcomes for PP.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to query a variety of databases. A total of 444 articles were imported into Covidence, a screening and data extraction tool for conducting systematic reviews.

Results

After a series of screenings, 60 articles met inclusion criteria and were reviewed in detail. The information was entered into a data extraction list consisting of 16 variables in the categories of general information, diagnostic strategies, treatment modalities, and treatment outcomes. Most articles reported retrospective case series, which yielded level 4 evidence. Only one article reported the results of a randomized and blinded outcomes assessment trial. Such article yielded level 1 evidence and was rated as high quality for allocation, concealment, and blinding of personnel.

Conclusion

The strategies used to diagnose and classify PP are a disparate list of measures most of which have no parallels making it impossible to offer treatment recommendations and generate generalizable knowledge.
背景:位置性头盖骨畸形(PP)是由于外力作用于正常而柔韧的头盖骨所导致的头盖骨不对称变形。PP的发病率在19.6%至46.6%之间。PP 的治疗方法包括复位、物理治疗和头盔矫形器。由于PP的自然病史不精确、诊断策略各异、疗效数据不可靠,因此关于PP的治疗仍未达成共识。我们的目的是对用于诊断 PP、建议治疗策略和评估疗效的工具进行系统性回顾:我们使用《系统综述和元分析首选报告项目》指南查询了各种数据库。共有 444 篇文章被导入到 Covidence 中,Covidence 是一种用于进行系统综述的筛选和数据提取工具:经过一系列筛选,有 60 篇文章符合纳入标准,并进行了详细审查。相关信息被输入数据提取列表,该列表由一般信息、诊断策略、治疗方式和治疗结果等类别的 16 个变量组成。大多数文章报告了回顾性病例系列,获得了4级证据。只有一篇文章报告了随机和盲法结果评估试验的结果。这篇文章的证据等级为1级,在分配、隐藏和人员盲法方面被评为高质量:结论:用于诊断和分类 PP 的策略是一系列不同的测量方法,其中大多数都没有相似之处,因此无法提供治疗建议,也无法产生可推广的知识。
{"title":"Helmet Therapy for Positional Plagiocephaly: A Systematic Review of the Tools Used to Diagnose, Offer Treatment Recommendations, and Assess Treatment Outcomes of the Condition","authors":"L. Kate Lamberta DO,&nbsp;Thomas R. Murray DO,&nbsp;Alison Gehred MLIS,&nbsp;Pedro Weisleder MD, PhD","doi":"10.1016/j.pediatrneurol.2024.09.007","DOIUrl":"10.1016/j.pediatrneurol.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Positional plagiocephaly (PP) is an asymmetric deformation of the skull as a consequence of external forces acting on a normal and pliable skull. The prevalence of PP ranges between 19.6% and 46.6%. Treatment options for PP include repositioning, physical therapy, and helmet orthoses. Consensus regarding the treatment of PP remains elusive due to the condition's imprecise natural history, dissimilar diagnostic strategies, and unreliable data asserting treatments' efficacy. Our aim was to conduct a systematic review of the tools used to diagnose, suggest treatment strategies, and assess outcomes for PP.</div></div><div><h3>Methods</h3><div>We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to query a variety of databases. A total of 444 articles were imported into Covidence, a screening and data extraction tool for conducting systematic reviews.</div></div><div><h3>Results</h3><div>After a series of screenings, 60 articles met inclusion criteria and were reviewed in detail. The information was entered into a data extraction list consisting of 16 variables in the categories of general information, diagnostic strategies, treatment modalities, and treatment outcomes. Most articles reported retrospective case series, which yielded level 4 evidence. Only one article reported the results of a randomized and blinded outcomes assessment trial. Such article yielded level 1 evidence and was rated as high quality for allocation, concealment, and blinding of personnel.</div></div><div><h3>Conclusion</h3><div>The strategies used to diagnose and classify PP are a disparate list of measures most of which have no parallels making it impossible to offer treatment recommendations and generate generalizable knowledge.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 125-131"},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378172","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
Low Incidence of Neurological Adverse Events Among Pediatric Patients With Moyamoya Undergoing General Anesthesia for NonRevascularization Procedures 接受全身麻醉进行非血管重建手术的小儿 Moyamoya 患者神经系统不良事件发生率低。
IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.pediatrneurol.2024.09.008
Shiri Zarour MD , Nitzan Zohar MD , Jonathan Roth MD , Shelly I. Shiran MD , Tali Jonas Kimchi MD , Udi Sadeh-Gonik MD , Margaret Ekstein MD , Moran Hausman-Kedem MD

Background

General anesthesia poses a significant risk for patients with MMA, yet its risk in the setting of nonrevascularization procedures remains unclear. Data regarding the risk of general anesthesia for nonrevascularization procedures are scarce. We therefore aimed to assess the incidence of neurological adverse events (NAEs) among pediatric patients with MMA undergoing general anesthesia for nonrevascularization procedures.

Methods

We conducted a retrospective cohort study at a tertiary referral pediatric center of patients with MMA aged ≤18 years, who underwent general anesthesia for nonrevascularization procedures between January 2014 and July 2023. Postanesthesia NAEs were defined as occurrence of transient ischemic attacks, seizures, altered mental status, severe headache, or evidence of arterial ischemic stroke (AIS) in the 30 days postprocedure.

Results

Among 149 procedures on 38 patients (median age [interquartile range]: 8.3 [5.0, 12.7] years; 57% female), 124 (83.2%) procedures were imaging studies and angiographies and 25 (16.8%) were surgical procedures. Preprocedural hyperhydration treatment was administered before most (111, 74.5%) procedures per our institutional protocol. The incidence of postanesthesia NAEs was 0.67% (one of 149), as a result of acute AIS following a ventriculoperitoneal shunt revision surgery, in a patient with postradiation MMA, panhypopituitarism, and uncontrolled diabetes insipidus, despite preprocedural hyperhydration treatment. There were no NAEs after imaging studies performed under general anesthesia.

Conclusions

Our results suggest that general anesthesia for nonrevascularization procedures in pediatric patients with MMA prepared with hyperhydration is safe. As neuroradiological follow-up is central in children with MMA, this information can be valuable for reassuring patients and their families.
背景:全身麻醉对 MMA 患者有很大风险,但在非血管重建手术中的风险仍不清楚。有关非血管重建手术中全身麻醉风险的数据很少。因此,我们旨在评估因非血管重建手术而接受全身麻醉的 MMA 儿科患者中神经系统不良事件(NAEs)的发生率:我们在一家三级儿科转诊中心开展了一项回顾性队列研究,研究对象为2014年1月至2023年7月期间接受非血管重建手术全身麻醉的18岁以下MMA患者。麻醉后NAE是指术后30天内出现短暂性脑缺血发作、癫痫发作、精神状态改变、严重头痛或动脉缺血性卒中(AIS)的证据:在 38 名患者(中位年龄[四分位间差]:8.3 [5.0, 12.7]岁;57%为女性)的 149 例手术中,124 例(83.2%)为影像学检查和血管造影,25 例(16.8%)为外科手术。大多数(111 例,74.5%)手术前都按照本机构的方案进行了术前高水化治疗。一名放射后MMA、泛垂体功能亢进和糖尿病未得到控制的患者在接受脑室腹腔分流改造手术后发生急性AIS,尽管在术前进行了高补液治疗,但仍发生了麻醉后NAE,发生率为0.67%(149例中有1例)。在全身麻醉下进行造影检查后,没有发生非器官功能障碍:结论:我们的研究结果表明,对患有 MMA 的儿童患者进行全身麻醉以进行非血管重建手术是安全的。由于神经放射学随访对 MMA 患儿非常重要,因此这些信息对于安抚患者及其家属的情绪非常有价值。
{"title":"Low Incidence of Neurological Adverse Events Among Pediatric Patients With Moyamoya Undergoing General Anesthesia for NonRevascularization Procedures","authors":"Shiri Zarour MD ,&nbsp;Nitzan Zohar MD ,&nbsp;Jonathan Roth MD ,&nbsp;Shelly I. Shiran MD ,&nbsp;Tali Jonas Kimchi MD ,&nbsp;Udi Sadeh-Gonik MD ,&nbsp;Margaret Ekstein MD ,&nbsp;Moran Hausman-Kedem MD","doi":"10.1016/j.pediatrneurol.2024.09.008","DOIUrl":"10.1016/j.pediatrneurol.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>General anesthesia poses a significant risk for patients with MMA, yet its risk in the setting of nonrevascularization procedures remains unclear. Data regarding the risk of general anesthesia for nonrevascularization procedures are scarce. We therefore aimed to assess the incidence of neurological adverse events (NAEs) among pediatric patients with MMA undergoing general anesthesia for nonrevascularization procedures.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study at a tertiary referral pediatric center of patients with MMA aged ≤18 years, who underwent general anesthesia for nonrevascularization procedures between January 2014 and July 2023. Postanesthesia NAEs were defined as occurrence of transient ischemic attacks, seizures, altered mental status, severe headache, or evidence of arterial ischemic stroke (AIS) in the 30 days postprocedure.</div></div><div><h3>Results</h3><div>Among 149 procedures on 38 patients (median age [interquartile range]: 8.3 [5.0, 12.7] years; 57% female), 124 (83.2%) procedures were imaging studies and angiographies and 25 (16.8%) were surgical procedures. Preprocedural hyperhydration treatment was administered before most (111, 74.5%) procedures per our institutional protocol. The incidence of postanesthesia NAEs was 0.67% (one of 149), as a result of acute AIS following a ventriculoperitoneal shunt revision surgery, in a patient with postradiation MMA, panhypopituitarism, and uncontrolled diabetes insipidus, despite preprocedural hyperhydration treatment. There were no NAEs after imaging studies performed under general anesthesia.</div></div><div><h3>Conclusions</h3><div>Our results suggest that general anesthesia for nonrevascularization procedures in pediatric patients with MMA prepared with hyperhydration is safe. As neuroradiological follow-up is central in children with MMA, this information can be valuable for reassuring patients and their families.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 162-166"},"PeriodicalIF":3.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400971","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
期刊
Pediatric neurology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1