<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":"2025-10-23","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}
Pub Date : 2025-10-23DOI: 10.1016/j.pediatrneurol.2025.10.018
Grant L. Lin MD, PhD , Lauren Treat MD
Background
Child neurologists provide care for children with complex chronic health conditions often accompanied by logistical and emotional complexities, as well as acute decision-making scenarios. Pediatric neuropalliative medicine is a nascent subspecialty that aims to augment standard child neurology practice by attending to not only the physical domains of neurologic disease but also the nonphysical issues that accompany advancing illness. The perceptions of clinicians who refer families for this kind of care have not previously been elucidated.
Methods
This survey project queried referrers to a newly established pediatric neuropalliative medicine clinic to characterize their perceptions, including barriers and facilitators of referral and the impact of this service line on clinicians. Specifically, the authors sought to understand whether neurologists viewed this clinic differently than other referring clinicians.
Results
A total of 94 surveys were completed, with 22% (n = 21) of respondents being neurology clinicians and 78% (n = 73) representing other pediatric specialties. Neurology clinicians were significantly more likely to report a preference for a neurologist in the palliative medicine role (76% of neurologists vs 16% of non-neurologists, P < 0.001). While all referrers identified at least one benefit of referral to this clinic, neurologists were more likely to report that this new resource positively impacted their understanding of palliative medicine and their ability to devote more energy to their area of focus.
Conclusions
Pediatric neuropalliative expertise is valued by referring clinicians, with the greatest impact described by neurologists. Referrers noted benefit to patient care as well as enhancement in professional domains.
{"title":"Impacts of a Novel Pediatric Neuropalliative Medicine Clinic: Characterization of Referrer Feedback","authors":"Grant L. Lin MD, PhD , Lauren Treat MD","doi":"10.1016/j.pediatrneurol.2025.10.018","DOIUrl":"10.1016/j.pediatrneurol.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Child neurologists provide care for children with complex chronic health conditions often accompanied by logistical and emotional complexities, as well as acute decision-making scenarios. Pediatric neuropalliative medicine is a nascent subspecialty that aims to augment standard child neurology practice by attending to not only the physical domains of neurologic disease but also the nonphysical issues that accompany advancing illness. The perceptions of clinicians who refer families for this kind of care have not previously been elucidated.</div></div><div><h3>Methods</h3><div>This survey project queried referrers to a newly established pediatric neuropalliative medicine clinic to characterize their perceptions, including barriers and facilitators of referral and the impact of this service line on clinicians. Specifically, the authors sought to understand whether neurologists viewed this clinic differently than other referring clinicians.</div></div><div><h3>Results</h3><div>A total of 94 surveys were completed, with 22% (n = 21) of respondents being neurology clinicians and 78% (n = 73) representing other pediatric specialties. Neurology clinicians were significantly more likely to report a preference for a neurologist in the palliative medicine role (76% of neurologists vs 16% of non-neurologists, <em>P</em> < 0.001). While all referrers identified at least one benefit of referral to this clinic, neurologists were more likely to report that this new resource positively impacted their understanding of palliative medicine and their ability to devote more energy to their area of focus.</div></div><div><h3>Conclusions</h3><div>Pediatric neuropalliative expertise is valued by referring clinicians, with the greatest impact described by neurologists. Referrers noted benefit to patient care as well as enhancement in professional domains.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Pages 140-146"},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517803","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 study discusses results of multimodal evaluation of biomarkers of neuroinflammation and neurodegeneration in cerebrospinal fluid (CSF) and Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) findings in Subacute sclerosing panencephalitis (SSPE).
Methods
Consecutive children (3-14 years) with SSPE fulfilling the Dyken criteria during the study period (2020-2022) were enrolled. Clinical profile, radiological and electroencephalography data were chronicled. CSF interleukins (ILs) IL-4, IL-6, and IL-10; interferon-gamma; and neurofilament heavy chain (NFH) levels were analysed and compared with age matched pseudo-controls. 18F-FDG-PET imaging was performed in a subset of children who consented for the same.
Results
Thirty-three children with SSPE were enrolled [mean age 8.06 ± 2.67 years; males: 82%; Jabbour Stage I-6%, Stage II-67%, Stage III-27%]. Two forms of presentation were seen: short/absent stage I with early onset myoclonic jerks (N = 22; mean age of onset 7.85 ± 2.45) and prolonged stage I with late onset epilepsy (N = 11; mean age 6 ± 1.9 years, P = 0.03). CSF NFH was significantly elevated in SSPE [132.62 (53.6-388.9) vs 0.0 (0-16.9) pg/ml; P = 0.0001] compared to the pseudo-controls. CSF IL-6 (pg/ml) in 21/22 SSPE [1.72 (0.85-3.04)] children and 16/17 pseudo-controls [2.60 (1.72-3.83); P = 0.17] were similar. IL-4, IL-10, and interferon-gammas were undetectable in both the groups. 18F-FDG-PET showed putaminal hypermetabolism in 7/9 (78%) and thalamo-cerebellar hypometabolism in 8/9 (88%) with variable foci of cortical hypometabolism.
Conclusions
Elevated CSF NFH levels suggest ongoing neuronal loss in SSPE. Cell mediated immunity is altered, and active neuroinflammation (T-cell mediated) may not be contributing to the ongoing neurodegeneration. 18F-FDG-PET imaging consistently reveals putaminal hypermetabolism alongside thalamo-cerebellar hypometabolism, which may prove valuable in diagnosing challenging SSPE cases.
{"title":"Unravelling the Inflammatory and Metabolic Insights in Subacute Sclerosing Panencephalitis: A Prospective Multimodal Evaluation","authors":"Prashant Jauhari MD, DM , Sakshi Ojha MD, DM , Madhavi Tripathi MD , Lata Singh PhD , Vishwesh Bharadiya MBBS , Amulya Gupta MBBS , Parul Berry MBBS , Gagneet Kaur MBBS , Atin Kumar MD , Ashish Upadhyay PhD , Sheffali Gulati MD","doi":"10.1016/j.pediatrneurol.2025.10.012","DOIUrl":"10.1016/j.pediatrneurol.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>This study discusses results of multimodal evaluation of biomarkers of neuroinflammation and neurodegeneration in cerebrospinal fluid (CSF) and Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) findings in Subacute sclerosing panencephalitis (SSPE).</div></div><div><h3>Methods</h3><div>Consecutive children (3-14 years) with SSPE fulfilling the Dyken criteria during the study period (2020-2022) were enrolled. Clinical profile, radiological and electroencephalography data were chronicled. CSF interleukins (ILs) IL-4, IL-6, and IL-10; interferon-gamma; and neurofilament heavy chain (NFH) levels were analysed and compared with age matched pseudo-controls. 18F-FDG-PET imaging was performed in a subset of children who consented for the same.</div></div><div><h3>Results</h3><div>Thirty-three children with SSPE were enrolled [mean age 8.06 ± 2.67 years; males: 82%; Jabbour Stage I-6%, Stage II-67%, Stage III-27%]. Two forms of presentation were seen: short/absent stage I with early onset myoclonic jerks (N = 22; mean age of onset 7.85 ± 2.45) and prolonged stage I with late onset epilepsy (N = 11; mean age 6 ± 1.9 years, <em>P</em> = 0.03). CSF NFH was significantly elevated in SSPE [132.62 (53.6-388.9) vs 0.0 (0-16.9) pg/ml; <em>P</em> = 0.0001] compared to the pseudo-controls. CSF IL-6 (pg/ml) in 21/22 SSPE [1.72 (0.85-3.04)] children and 16/17 pseudo-controls [2.60 (1.72-3.83); <em>P</em> = 0.17] were similar. IL-4, IL-10, and interferon-gammas were undetectable in both the groups. 18F-FDG-PET showed putaminal hypermetabolism in 7/9 (78%) and thalamo-cerebellar hypometabolism in 8/9 (88%) with variable foci of cortical hypometabolism.</div></div><div><h3>Conclusions</h3><div>Elevated CSF NFH levels suggest ongoing neuronal loss in SSPE. Cell mediated immunity is altered, and active neuroinflammation (T-cell mediated) may not be contributing to the ongoing neurodegeneration. 18F-FDG-PET imaging consistently reveals putaminal hypermetabolism alongside thalamo-cerebellar hypometabolism, which may prove valuable in diagnosing challenging SSPE cases.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Pages 110-117"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496397","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 : 2025-10-22DOI: 10.1016/j.pediatrneurol.2025.10.015
Jennifer V. Gettings BMBS, FRCPC
{"title":"First Line Management of Pediatric Status Epilepticus","authors":"Jennifer V. Gettings BMBS, FRCPC","doi":"10.1016/j.pediatrneurol.2025.10.015","DOIUrl":"10.1016/j.pediatrneurol.2025.10.015","url":null,"abstract":"","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Page 118"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506367","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 : 2025-10-22DOI: 10.1016/j.pediatrneurol.2025.10.010
Emma Lott BA , Alyssa Rust BS , Leon Dure MD , Darcy Fehlings MD , Toni Pearson MBBS , Roser Pons MD , Jonathan W. Mink MD, PhD , Bhooma R. Aravamuthan MD, DPhil
Background
Dystonia in childhood is typically associated with cerebral palsy (CP). Dystonia severity scales for CP require prolonged exam protocols with numerous tasks, often making them onerous for routine clinical use. We aimed to identify which individual tasks best approximate dystonia severity compared to the gold standard full protocol.
Methods
In this cross-sectional study, comprehensive exam protocol videos were taken during routine care of ambulatory people with CP age 5 years and up. Five pediatric dystonia experts reviewed individual tasks and the full protocol for dystonia using the Global Dystonia Severity Rating Scale. Experts’ written scoring justifications were qualitatively analyzed to determine commonly cited features of dystonia.
Results
When examining the difference in dystonia severity ratings between each task and the full protocol, seated upper extremity tasks had the lowest variance (P < 0.05, F-test) and had lower score differences than the stand/walk/run and seated lower extremity tasks (P < 0.05, repeated measures Friedman test). Experts most commonly identified the following movements as dystonic: wrist flexion (8.4% of all movement statements), finger flexion (7.3%), wrist ulnar deviation (6.8%), toe dorsiflexion (8.4%), ankle inversion (7.9%), and ankle plantarflexion (6.4%). Experts rated dystonic movements as more severe if they were consistently triggered by multiple stimuli (26.8% of all severity statements) or functionally impactful (20.7%).
Conclusions
Seated upper extremity tasks may be valuable for identifying dystonia and estimating its severity during routine clinical care. Clinical dystonia severity assessment could be guided by assessing specific dystonic movements, the consistency with which they are triggered, and their functional impact.
{"title":"Tasks for Assessing Dystonia in Young People With Cerebral Palsy","authors":"Emma Lott BA , Alyssa Rust BS , Leon Dure MD , Darcy Fehlings MD , Toni Pearson MBBS , Roser Pons MD , Jonathan W. Mink MD, PhD , Bhooma R. Aravamuthan MD, DPhil","doi":"10.1016/j.pediatrneurol.2025.10.010","DOIUrl":"10.1016/j.pediatrneurol.2025.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Dystonia in childhood is typically associated with cerebral palsy (CP). Dystonia severity scales for CP require prolonged exam protocols with numerous tasks, often making them onerous for routine clinical use. We aimed to identify which individual tasks best approximate dystonia severity compared to the gold standard full protocol.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, comprehensive exam protocol videos were taken during routine care of ambulatory people with CP age 5 years and up. Five pediatric dystonia experts reviewed individual tasks and the full protocol for dystonia using the Global Dystonia Severity Rating Scale. Experts’ written scoring justifications were qualitatively analyzed to determine commonly cited features of dystonia.</div></div><div><h3>Results</h3><div>When examining the difference in dystonia severity ratings between each task and the full protocol, seated upper extremity tasks had the lowest variance (<em>P</em> < 0.05, F-test) and had lower score differences than the stand/walk/run and seated lower extremity tasks (<em>P</em> < 0.05, repeated measures Friedman test). Experts most commonly identified the following movements as dystonic: wrist flexion (8.4% of all movement statements), finger flexion (7.3%), wrist ulnar deviation (6.8%), toe dorsiflexion (8.4%), ankle inversion (7.9%), and ankle plantarflexion (6.4%). Experts rated dystonic movements as more severe if they were consistently triggered by multiple stimuli (26.8% of all severity statements) or functionally impactful (20.7%).</div></div><div><h3>Conclusions</h3><div>Seated upper extremity tasks may be valuable for identifying dystonia and estimating its severity during routine clinical care. Clinical dystonia severity assessment could be guided by assessing specific dystonic movements, the consistency with which they are triggered, and their functional impact.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Pages 126-134"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506326","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 : 2025-10-21DOI: 10.1016/j.pediatrneurol.2025.10.011
Savannah Stultz BS , Darcy A. Krueger MD, PhD , David N. Franz MD , Paul S. Horn PhD , David M. Ritter MD, PhD
Background
Tuberous sclerosis complex (TSC) is a genetic disorder leading to multiorgan disease. Three cerebral structural manifestations in TSC are tubers, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). Head ultrasound (HUS) has been established as a diagnostic tool for early head imaging. However, the utility of HUS in detecting TSC cerebral manifestations is not known.
Methods
We conducted a retrospective chart review of clinical brain imaging reports in TSC patients followed by the Cincinnati Children's TSC Clinic. From the clinical reports, the presence of TSC and other lesions were recorded. 373 individuals had either a HUS (N = 42) or a magnetic resonance imaging (MRI; N = 372) before 5 years of age.
Results
Of the 42 patients with HUS, 24 were found to have completely normal HUS (57%). However, on the first MRI, only 3 had normal brain MRIs (13% of normal HUS). One had not had an MRI at the time of data collection and the other 20 had typical TSC lesions. No SEGA was seen on the HUS reports although 5 in the total cohort had a SEGA on MRI reports before 1 month of age. If the HUS was normal, there was a trend toward delaying the first MRI (0.2 ± 0.49 years vs 0.66 ± 0.98 years, P = 0.06).
Conclusions
Compared to the patient's initial MRI results, HUS underdetected the cerebral changes associated with TSC and a normal HUS tends to delay definitive MRI imaging. Thus, HUS has limited utility during the routine workup for TSC.
背景：结节性硬化症（TSC）是一种导致多器官疾病的遗传性疾病。TSC的三种脑结构表现为结节、室管膜下结节和室管膜下巨细胞星形细胞瘤（SEGAs）。头部超声（HUS）已被确立为早期头部成像的诊断工具。然而，HUS在检测TSC脑表现方面的应用尚不清楚。方法回顾性分析辛辛那提儿童TSC诊所对TSC患者的临床脑成像报告。从临床报告中，记录了TSC和其他病变的存在。373例患者在5岁前有溶血性尿毒综合征（N = 42）或磁共振成像（MRI; N = 372）。结果42例溶血性尿毒综合征患者中，24例溶血性尿毒综合征完全正常（57%）。然而，在第一次MRI中，只有3例脑MRI正常（正常溶血性尿毒综合征的13%）。其中一人在数据收集时未进行MRI检查，另外20人有典型的TSC病变。在HUS报告中未发现世嘉，尽管在整个队列中有5例在1个月前的MRI报告中有世嘉。如果HUS正常，则有延迟首次MRI检查的趋势（0.2±0.49年vs 0.66±0.98年，P = 0.06）。结论与患者最初的MRI结果相比，溶血性尿毒综合征未发现与TSC相关的大脑变化，正常的溶血性尿毒综合征往往会延迟最终的MRI成像。因此，在TSC的常规检查中，HUS的效用有限。
{"title":"Limited Utility for Head Ultrasounds in the Evaluation of Tuberous Sclerosis Complex","authors":"Savannah Stultz BS , Darcy A. Krueger MD, PhD , David N. Franz MD , Paul S. Horn PhD , David M. Ritter MD, PhD","doi":"10.1016/j.pediatrneurol.2025.10.011","DOIUrl":"10.1016/j.pediatrneurol.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Tuberous sclerosis complex (TSC) is a genetic disorder leading to multiorgan disease. Three cerebral structural manifestations in TSC are tubers, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). Head ultrasound (HUS) has been established as a diagnostic tool for early head imaging. However, the utility of HUS in detecting TSC cerebral manifestations is not known.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of clinical brain imaging reports in TSC patients followed by the Cincinnati Children's TSC Clinic. From the clinical reports, the presence of TSC and other lesions were recorded. 373 individuals had either a HUS (N = 42) or a magnetic resonance imaging (MRI; N = 372) before 5 years of age.</div></div><div><h3>Results</h3><div>Of the 42 patients with HUS, 24 were found to have completely normal HUS (57%). However, on the first MRI, only 3 had normal brain MRIs (13% of normal HUS). One had not had an MRI at the time of data collection and the other 20 had typical TSC lesions. No SEGA was seen on the HUS reports although 5 in the total cohort had a SEGA on MRI reports before 1 month of age. If the HUS was normal, there was a trend toward delaying the first MRI (0.2 ± 0.49 years vs 0.66 ± 0.98 years, <em>P</em> = 0.06).</div></div><div><h3>Conclusions</h3><div>Compared to the patient's initial MRI results, HUS underdetected the cerebral changes associated with TSC and a normal HUS tends to delay definitive MRI imaging. Thus, HUS has limited utility during the routine workup for TSC.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Pages 86-90"},"PeriodicalIF":2.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468459","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}
Dose of rehabilitation services is important for optimizing developmental outcomes for children with cerebral palsy (CP). However, little is known about how much in-person rehabilitation infants and toddlers with CP currently receive, and how dose relates to function. The purpose of this study is to describe the dose of in-person rehabilitation services received by infants and toddlers with CP and to evaluate the relationship between physical therapy (PT) dose, age, and gross motor function.
Methods
We enrolled 53 participants (6 months-2 years old) with moderate-to-severe CP, defined as Gross Motor Function Classification System levels III–V. Parent-reported data on outpatient and early intervention PT, occupational therapy, and speech-language pathology services over the past 6 months were used to calculate monthly service dose. The Gross Motor Function Measure, 88-item was administered to quantify motor function.
Results
Participants received very low doses of therapy across disciplines. The mean total hours of rehabilitation services the participants received were between 0.4 and 3.0 hours per discipline per month. Combined in-person services averaged less than 9 total hours per month. There was no relationship found between the total hours of PT the child received and their age (P = 0.27, F = 1.22) or gross motor function (as measured by the Gross Motor Function Measure, 88-item) (P = 0.82, F = 0.05).
Conclusions
Infants and toddlers with moderate-to-severe CP receive low doses of in-person rehabilitation, and the dose of PT does not appear to be individualized based on age or functional severity. These findings suggest a need for more tailored, intensive, and family-centered rehabilitation planning in early childhood.
康复服务的剂量对于优化脑瘫儿童的发育结局是重要的。然而，对于目前患有CP的婴幼儿接受了多少面对面的康复治疗，以及剂量与功能之间的关系，人们知之甚少。本研究的目的是描述婴幼儿CP患者接受的面对面康复服务的剂量，并评估物理治疗（PT）剂量、年龄和大运动功能之间的关系。方法我们招募了53名患有中度至重度CP的参与者（6个月-2岁），定义为大运动功能分类系统等级III-V。过去6个月的门诊和早期干预PT、职业治疗和语言病理学服务的家长报告数据用于计算每月服务剂量。采用大运动功能量表（共88项）量化运动功能。结果：参与者接受了非常低剂量的跨学科治疗。参与者接受康复服务的平均总时间在每个学科每月0.4至3.0小时之间。综合起来，每个月的上门服务时间平均少于9小时。儿童接受PT的总时数与他们的年龄（P = 0.27, F = 1.22）或大运动功能（用大运动功能量表测量，88项）（P = 0.82, F = 0.05）之间没有关系。结论：中重度CP的婴幼儿接受低剂量的面对面康复治疗，并且PT的剂量似乎并不是基于年龄或功能严重程度的个体化治疗。这些发现表明，需要在儿童早期制定更有针对性、更密集、更以家庭为中心的康复计划。
{"title":"Infants and Toddlers With Moderate-To-Severe Cerebral Palsy Receive Very Low Doses of In-Person Rehabilitation","authors":"Rachel Bican PT, DPT, PhD , Jill Heathcock PT, MPT, PhD","doi":"10.1016/j.pediatrneurol.2025.10.009","DOIUrl":"10.1016/j.pediatrneurol.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Dose of rehabilitation services is important for optimizing developmental outcomes for children with cerebral palsy (CP). However, little is known about how much in-person rehabilitation infants and toddlers with CP currently receive, and how dose relates to function. The purpose of this study is to describe the dose of in-person rehabilitation services received by infants and toddlers with CP and to evaluate the relationship between physical therapy (PT) dose, age, and gross motor function.</div></div><div><h3>Methods</h3><div>We enrolled 53 participants (6 months-2 years old) with moderate-to-severe CP, defined as Gross Motor Function Classification System levels III–V. Parent-reported data on outpatient and early intervention PT, occupational therapy, and speech-language pathology services over the past 6 months were used to calculate monthly service dose. The Gross Motor Function Measure, 88-item was administered to quantify motor function.</div></div><div><h3>Results</h3><div>Participants received very low doses of therapy across disciplines. The mean total hours of rehabilitation services the participants received were between 0.4 and 3.0 hours per discipline per month. Combined in-person services averaged less than 9 total hours per month. There was no relationship found between the total hours of PT the child received and their age (<em>P</em> = 0.27, F = 1.22) or gross motor function (as measured by the Gross Motor Function Measure, 88-item) (<em>P</em> = 0.82, F = 0.05).</div></div><div><h3>Conclusions</h3><div>Infants and toddlers with moderate-to-severe CP receive low doses of in-person rehabilitation, and the dose of PT does not appear to be individualized based on age or functional severity. These findings suggest a need for more tailored, intensive, and family-centered rehabilitation planning in early childhood.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Pages 91-96"},"PeriodicalIF":2.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468461","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 : 2025-10-14DOI: 10.1016/j.pediatrneurol.2025.09.020
Ilona Kopyta , Manish Parakh , Gabrielle deVeber , Yenny C. Zuñiga Z , Maria Fernanda Rios Pistoia , Kevin O'Connor , Fernanda Paz Balut , Jenny Wilson , Marilyn Tan , Allyson Schenk , Piotr Rodak , Ankit Kumar Meena , Suman Das
Background
Pediatric stroke care varies across institutions, but global differences have not been explored. Our objective was to evaluate global variability and challenges in pediatric stroke care.
Methods
The Global Alliance for Pediatric Stroke Epidemiology and Resources Working Group of the International Pediatric Stroke Organization distributed a 43-question online survey to international child neurology organizations.
Results
A total of 135 responses were received, from Europe, North America, and Australia (n = 66), South America (n = 27) and Asia and Africa (AA; n = 42). Respondents were mainly pediatric neurologists from quaternary/tertiary teaching hospitals (>90%) and worked in urban areas (85%-90%) or large cities (40%-60%). Outside of Asia, women comprised 70% of the respondents, whereas males made up the majority in Asia. Globally, pediatric neurologists manage emergency room triage and inpatient treatment stroke in most facilities (65%-68%). Experienced (>20 years) pediatric stroke subspecialists were available in a minority of centers (7%-17%). Multidisciplinary teams and institutional algorithms were more common in Europe and the Americas compared to Asia (53% vs 7-11% and 80-85% vs 20%, respectively). Reduced awareness of pediatric stroke was identified as a reason for the delay in seeking care in Europe, North America, and Australia by caregivers (44%) and health providers (38%), while in AA it was 67% and 58%.
Conclusions
Across all regions, significant challenges in pediatric stroke management exist. Serious gaps exist in Asia related to personnel, expertise, and infrastructure. Development and improvement of local policies and resources are urgently needed in AA to improve pediatric stroke outcomes.
{"title":"Current State of the Global Pediatric Stroke Care-Results From the Global Alliance for Pediatric Stroke Epidemiology and Resources Survey","authors":"Ilona Kopyta , Manish Parakh , Gabrielle deVeber , Yenny C. Zuñiga Z , Maria Fernanda Rios Pistoia , Kevin O'Connor , Fernanda Paz Balut , Jenny Wilson , Marilyn Tan , Allyson Schenk , Piotr Rodak , Ankit Kumar Meena , Suman Das","doi":"10.1016/j.pediatrneurol.2025.09.020","DOIUrl":"10.1016/j.pediatrneurol.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric stroke care varies across institutions, but global differences have not been explored. Our objective was to evaluate global variability and challenges in pediatric stroke care.</div></div><div><h3>Methods</h3><div>The Global Alliance for Pediatric Stroke Epidemiology and Resources Working Group of the International Pediatric Stroke Organization distributed a 43-question online survey to international child neurology organizations.</div></div><div><h3>Results</h3><div>A total of 135 responses were received, from Europe, North America, and Australia (n = 66), South America (n = 27) and Asia and Africa (AA; n = 42). Respondents were mainly pediatric neurologists from quaternary/tertiary teaching hospitals (>90%) and worked in urban areas (85%-90%) or large cities (40%-60%). Outside of Asia, women comprised 70% of the respondents, whereas males made up the majority in Asia. Globally, pediatric neurologists manage emergency room triage and inpatient treatment stroke in most facilities (65%-68%). Experienced (>20 years) pediatric stroke subspecialists were available in a minority of centers (7%-17%). Multidisciplinary teams and institutional algorithms were more common in Europe and the Americas compared to Asia (53% vs 7-11% and 80-85% vs 20%, respectively). Reduced awareness of pediatric stroke was identified as a reason for the delay in seeking care in Europe, North America, and Australia by caregivers (44%) and health providers (38%), while in AA it was 67% and 58%.</div></div><div><h3>Conclusions</h3><div>Across all regions, significant challenges in pediatric stroke management exist. Serious gaps exist in Asia related to personnel, expertise, and infrastructure. Development and improvement of local policies and resources are urgently needed in AA to improve pediatric stroke outcomes.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"174 ","pages":"Pages 101-109"},"PeriodicalIF":2.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467817","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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