Pediatric neurology最新文献

{"title":"Doxepin and Mirtazapine Use in Children and Adolescents With Symptoms of Insomnia — A Single-Center Retrospective Review","authors":"Robin Varughese MD ,&nbsp;Josie Whelan ,&nbsp;Taylor Koehler ,&nbsp;Christine Palladino PNP ,&nbsp;Ivan Pavkovic MD ,&nbsp;Sanjeev Kothare MD","doi":"10.1016/j.pediatrneurol.2025.11.004","DOIUrl":"10.1016/j.pediatrneurol.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Sleep disorders are a common issue in children with pediatric insomnia, an under-recognized and undertreated problem affecting children. Beyond melatonin and behavioral interventions, there are few options known to clinicians that have been studied for use in pediatric insomnia. The objective of this study is to assess the efficacy, tolerability, and safety of doxepin and mirtazapine in pediatric insomnia.</div></div><div><h3>Methods</h3><div>This is a retrospective single-center chart review of children less than 18 years of age at the time of treatment initiation who have previously failed behavioral intervention and melatonin, who were then treated with doxepin and/or mirtazapine. Patients were started on doxepin maintenance treatments ranging from 2 to 10 mg and/or mirtazapine, which ranged from 1.875 to 15 mg. Improvement in sleep was assessed on follow-up visits and recorded using a 4-point Likert scale.</div></div><div><h3>Results</h3><div>There were 318 pediatric patients included for analysis. We identified 183 patients on doxepin, 24 patients on mirtazapine, and 19 patients who were on dual doxepin-mirtazapine. In the doxepin group, 167 patients (91.26%) experienced improvement in insomnia symptoms. In the mirtazapine group, 16 patients (66.67%) experienced improvement in insomnia symptoms. In the doxepin-mirtazapine group, 13 patients (68.42%) experienced improvement in insomnia symptoms. Thirty-two patients (10%) and three patients (7%) who took doxepin and mirtazapine, respectively, experienced adverse effects, most commonly aggression/irritability.</div></div><div><h3>Conclusions</h3><div>We found both doxepin and mirtazapine as effective and tolerable treatments options in improving subjective sleep onset and maintenance issues in children with insomnia.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 111-115"},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669192","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}

{"title":"Editorial Board and Masthead","authors":"","doi":"10.1016/S0887-8994(25)00333-9","DOIUrl":"10.1016/S0887-8994(25)00333-9","url":null,"abstract":"","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"173 ","pages":"Pages A1-A2"},"PeriodicalIF":2.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525413","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}

{"title":"Polysomnography and Autonomic Function Signatures of Nocturnal Enuresis: An Observational Study","authors":"Parag Thosare MD (Dr.) ,&nbsp;Biswaroop Chakrabarty DM (Dr.) ,&nbsp;Sheffali Gulati MD (Prof) ,&nbsp;Ashok Jariyal MD (Prof) ,&nbsp;Pankaj Hari MD (Prof) ,&nbsp;Prashant Jauhari DM (Dr.) ,&nbsp;Sushil Kabra MD (Prof) ,&nbsp;Kapil Sikka MS (Prof) ,&nbsp;Ravindra M. Pandey PhD (Prof) ,&nbsp;Ashish Dutt Upadhyay PhD (Dr.) ,&nbsp;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&lt;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":"2025-11-08","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}

{"title":"Orthostatic Tachycardia in Children With and Without Persisting Post-concussion Symptoms Following Mild Traumatic Brain Injury: A Prospective Controlled Study","authors":"Athena Stein PhD, MPH ,&nbsp;Karen M. Barlow PhD, MSc, MBChB, MRCPCH","doi":"10.1016/j.pediatrneurol.2025.11.001","DOIUrl":"10.1016/j.pediatrneurol.2025.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Twenty five percent of children who sustain a mild traumatic brain injury (mTBI) or concussion experience persisting post-concussion symptoms (PPCS). The symptoms of PPCS significantly overlap with postural orthostatic tachycardia syndrome (POTS). We aimed to review the literature and investigate the prevalence of POTS in children and adolescents recovering from mTBI.</div></div><div><h3>Methods</h3><div>This single centre controlled cross-sectional cohort study recruited children (aged 8-18 years inclusive) diagnosed with mTBI in the emergency department. At 4-6 weeks postinjury, children completed the Active Stand Test. The primary outcome was change in heart rate alongside clinical symptoms consistent with POTS.</div></div><div><h3>Results</h3><div>A total of 113 participants (64 PPCS, 24 mTBI with no clinical symptoms [asymptomatic], and 25 healthy controls) of similar age (mean 13.9 years) and sex (n = 55 [48.7%] male) underwent orthostatic testing. There were no significant group differences in heart rate or blood pressure at baseline, or within 10 minutes of standing. Three (4.8%) symptomatic participants satisfied POTS diagnostic criteria, compared to 0 asymptomatic and one (4.2%) control participant.</div></div><div><h3>Conclusions</h3><div>Using the Active Stand Test, a small proportion of children with PPCS satisfied clinical POTS criteria. Although it should be considered in the differential diagnosis, POTS is not common nor overrepresented in PPCS.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 72-80"},"PeriodicalIF":2.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605627","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}

{"title":"Counseling Reproductive-Age Youth With Epilepsy: Literature Review and Expert Opinion From the Epilepsy in the Child-Bearing Ages Through Menopause Consortium","authors":"Marie E. Clements MD ,&nbsp;Christina Briscoe MD, EdM ,&nbsp;Angela M. Curcio MD ,&nbsp;Laurie M. Douglass MD ,&nbsp;Janani Kassiri MD, PhD ,&nbsp;Lynn C. Liu MD, MS ,&nbsp;Sally V. Mathias MD ,&nbsp;Debra T. Moore-Hill MD, MPH ,&nbsp;Deepthi Nalluri MD ,&nbsp;Audrey Nath MD, PhD ,&nbsp;Amanda M. Romeu DO ,&nbsp;Tahniat Syed MD, MPH ,&nbsp;Victoria Vinarsky DO ,&nbsp;Susan Wiener MD, MPH ,&nbsp;Qian-Zhou JoJo Yang MD ,&nbsp;Sarah J. Betstadt MD, MPH ,&nbsp;Elizabeth I. Harrison MD, MS ,&nbsp;Neil Kulkarni MD ,&nbsp;Preeti Puntambekar MD ,&nbsp;Debopam Samanta MD, MS ,&nbsp;Laura Kirkpatrick MD","doi":"10.1016/j.pediatrneurol.2025.11.002","DOIUrl":"10.1016/j.pediatrneurol.2025.11.002","url":null,"abstract":"<div><div>Epilepsy in the Child-Bearing Ages through Menopause is an international consortium of clinicians dedicated to improving the health of women with epilepsy across the lifespan. Epilepsy in the Child-Bearing Ages through Menopause's Adolescent and Young Adult Committee addresses quality of care for female youth with epilepsy. The Committee developed a literature review and expert opinion guidance for child neurologists on performing optimal counseling about epilepsy and reproductive health for female youth with epilepsy. To do so, we identified and voted on key topics essential for this counseling, then conducted comprehensive literature reviews for each topic, iteratively developed key statements about counseling content and style for each topic and voted on final content for inclusion. The included topics were teratogenesis, folic acid supplementation, pregnancy and fertility, contraception, heritability of epilepsy, menstrual and hormonal disorders, catamenial epilepsy, and taking a sexual history. This review provides a clear, novel framework for pediatric neurologists to counsel adolescent and young adult women with epilepsy about their reproductive health, supporting improvement in practices recommended by professional organization such as the American Academy of Neurology and Child Neurology Foundation.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 90-101"},"PeriodicalIF":2.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616289","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}

{"title":"Incorporating Measures of Cognitive Processing Speed and Brain Volume in Clinical Management of Pediatric Onset Multiple Sclerosis","authors":"Anna Sosa BS ,&nbsp;Kimberly A. O'Neill MD ,&nbsp;Thibo Billiet PhD ,&nbsp;Jingyun Chen PhD ,&nbsp;Laura Couvreur MD ,&nbsp;Stijn Denissen PhD ,&nbsp;Matthew Lustberg MA ,&nbsp;Shayna Pehel BS ,&nbsp;Annemie Ribbens PhD ,&nbsp;Lauren Krupp MD","doi":"10.1016/j.pediatrneurol.2025.10.027","DOIUrl":"10.1016/j.pediatrneurol.2025.10.027","url":null,"abstract":"<div><h3>Background</h3><div>While cognitive processing and brain volume assessments are commonly used in multiple sclerosis (MS) research, they are not routinely incorporated into clinical care. Advances in neuroimaging software now allow for brain volume measurement to be incorporated into standard practice and guide clinical decision-making.</div></div><div><h3>Methods</h3><div>In this single-center, outpatient, cohort study, pediatric-onset multiple sclerosis (POMS) patients underwent at least two volumetric brain magnetic resonance imagings (MRIs) and two Symbol Digit Modalities Tests (SDMT) at least 6 months apart. Associations were analyzed using Pearson's correlation coefficient and linear regressions.</div></div><div><h3>Results</h3><div>Forty patients with POMS were included. The first volumetric brain MRI occurred at a median of 2.7 years after symptom onset. At the first volumetric MRI, 12% of patients had white matter brain volumes within 1% of normative values (n = 2000 healthy controls). Whole brain volume percentile (r = 0.4, <em>P</em> = 0.01), white matter percentile (r = 0.4, <em>P</em> = 0.01), and white matter lesion volume (r = −0.4, <em>P</em> = 0.005) were associated with SDMT score. Annualized percent brain volume change of the hippocampus (measured a median of 1.6 years apart) significantly correlated with follow-up SDMT (r = 0.4, <em>P</em> = 0.02), and annualized percent brain volume change of the thalamus correlated with annual change in SDMT z-score (r = 0.4, <em>P</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>Application of new software allows for volumetric assessment to be incorporated into clinical scans and provides clinicians with added data for patient management. This is critical for patients with POMS as the neurological examination often shows few to no abnormalities. Furthermore, a subset of POMS patients have smaller than expected brain volume which links to subsequent poorer cognitive performance.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 50-57"},"PeriodicalIF":2.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571169","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}

{"title":"Predictors of Drug-Resistant Epilepsy After Perinatal Stroke","authors":"Miles Fisher DO ,&nbsp;Kristen Bolte DO ,&nbsp;Shilpa B. Reddy MD ,&nbsp;Mark Rodeghier PhD ,&nbsp;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> &lt; 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 &gt;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":"2025-11-04","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}

{"title":"Behavioral and Emotional Challenges in Children With Spinal Muscular Atrophy","authors":"Lakshmi Balaji DNB ,&nbsp;Didu S. Kariyawasam PhD ,&nbsp;Karen Herbert DPT ,&nbsp;Hugo A. Sampaio MBBS ,&nbsp;Esther Tantsis PhD ,&nbsp;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":"2025-11-04","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}

{"title":"Reply to Chen et al. “A Postmarketing Pharmacovigilance Study of Fenfluramine: Adverse Event Data Mining and Analysis Based on the US Food and Drug Administration Public Data Open Project (openFDA)”","authors":"Ann Biehl PharmD, MS,&nbsp;Lionel Van Holle MS,&nbsp;Nayla Chaijale PhD,&nbsp;Rebecca Zhang Roper MD, PhD","doi":"10.1016/j.pediatrneurol.2025.10.025","DOIUrl":"10.1016/j.pediatrneurol.2025.10.025","url":null,"abstract":"","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"175 ","pages":"Pages 88-89"},"PeriodicalIF":2.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616288","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}

{"title":"Blood Pressure Management and Postoperative Stroke Risk in Pediatric Moyamoya Disease","authors":"Ria Pal MD,&nbsp;Chrisoula Cheronis MD,&nbsp;Elizabeth Mayne MD, PhD,&nbsp;Gary K. Steinberg MD, PhD,&nbsp;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":"2025-11-03","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}