European Journal of Paediatric Neurology最新文献

英文中文

CSF IL-6 in pediatric neuroinflammation: Diagnosing disease or driving therapy? CSF IL-6在小儿神经炎症中的作用：诊断疾病还是驱动治疗？

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-09-01 DOI: 10.1016/j.ejpn.2025.08.007

Kumaran Deiva

引用次数: 0

Deepening the understanding of mechanisms of antiepileptic effects of the ketogenic diet in children with AFG2A-related encephalopathy 加深对生酮饮食对afg2a相关脑病患儿抗癫痫作用机制的认识。

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-09-01 DOI: 10.1016/j.ejpn.2025.08.003

Coriene Catsman-Berrevoets

引用次数: 0

Improving understanding of long-term cognitive recovery after childhood ischemic stroke 提高对儿童缺血性脑卒中后长期认知恢复的认识。

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-09-01 DOI: 10.1016/j.ejpn.2025.08.006

Christine K. Fox

引用次数: 0

Mid-to long-term disability and functional outcomes in pediatric patients with monophasic acute disseminated encephalomyelitis 儿童单相急性播散性脑脊髓炎患者的中长期残疾和功能结局

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-09-01 DOI: 10.1016/j.ejpn.2025.08.008

Lorna Stemberger Marić , Vladimir Trkulja , Andrea Nikčević , Goran Tešović

Background

Acute disseminated encephalomyelitis (ADEM) is a rare disease characterized by encephalopathy, polyfocal symptoms and demyelination. Although its prognosis is generally favorable, there is growing evidence that subtle neuropsychological and motoric sequelae may persist years after the initial episode.

Aim

To assess the relationship between clinical, laboratory and radiological characteristics of the acute monophasic ADEM episode in children, and its immediate outcome, and long(er) term disability/functional status.

Methods

Retrospective chart review embraced all children managed for monophasic ADEM over 18 years at a single tertiary center. They were invited for a follow-up medical, neurological assessment, and disability/functional outcomes assessment [modified Rankin scale (mRS), Extended Disability Status Scale and Functional Systems Scores (EDSS-FSS)].

Results

Of the 65 children (age 10–250 months, median 90; 46.2 % boys), 40 (61.5 %) were judged as fully recovered, and 25 had sequelae, two of whom (aged 23 and 13 months) suffered severe ocular or cortical symptoms. Follow-up assessment 21–211 months (median 154) after hospital discharge embraced 41 children, 27 discharged as recovered, 14 with sequelae. Of the latter, the two children with severe sequelae were seriously disabled with decrease in mentation, while 11/14 had mRS 0, and EDSS-FSS 0. Of the former, 7 had mRS = 1 and one had mRS = 2, whereas 5 had EDSS-FSS = 2, and 2 had EDSS-FSS = 3, including 2 children with mood alterations and 2 with mild decrease in mentation.

Conclusions

Unless truly severe, acute episode sequelae do not predict long-term disability/functional deficiency. Children recovered after the acute episode may have mild symptoms/deficiencies in long term.

背景：急性播散性脑脊髓炎（ADEM）是一种罕见的疾病，以脑病、多灶性症状和脱髓鞘为特征。尽管其预后通常良好，但越来越多的证据表明，轻微的神经心理和运动后遗症可能在首发发作后持续数年。目的评估儿童急性单相ADEM发作的临床、实验室和影像学特征及其直接预后与长期残疾/功能状态之间的关系。方法回顾性回顾所有在单一三级中心治疗18年以上单相ADEM的儿童。他们被邀请进行随访医学、神经学评估和残疾/功能结局评估[修正兰金量表（mRS）、扩展残疾状态量表和功能系统评分（EDSS-FSS）]。结果65例患儿（年龄10-250个月，中位90个月，男孩占46.2%），40例（61.5%）完全康复，25例有后遗症，其中2例（年龄23个月和13个月）有严重的眼部或皮质症状。41例患儿出院后随访21-211个月（中位154个月），27例康复出院，14例有后遗症。其中2例严重后遗症患儿严重残疾，智力下降，11/14 mRS为0，EDSS-FSS为0。其中mRS = 1的有7例，mRS = 2的有1例，EDSS-FSS = 2的有5例，EDSS-FSS = 3的有2例，其中2例有情绪改变，2例有轻度的精神状态下降。结论非真正严重的急性发作后遗症不能预测长期残疾/功能缺陷。急性发作后恢复的儿童长期可能有轻微的症状/缺陷。

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引用次数: 0

Mortality in Tuberous sclerosis Complex: Current understandings 结节性硬化症复合体的死亡率：目前的认识

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-08-11 DOI: 10.1016/j.ejpn.2025.08.002

Rowan Pentz , Lauren Sham , Maria Zak , Katherine Muir , Elisabetta Trinari , Elizabeth J. Donner , Maryam N. Nouri , Robyn Whitney

Background

Tuberous Sclerosis Complex (TSC) is a multisystemic neurocutaneous disorder caused by pathogenic loss of function variants in the tumour suppressor genes TSC1 and TSC2. The resultant hamartomas confer significant medical risks by disruption of local tissues. Risk of mortality in TSC is known to be elevated, but only recently have multiple studies assessed specific causes of mortality in TSC.

Methods

A critical literature review of all available studies examining mortality in TSC was conducted using the terms “TSC”, “Tuberous Sclerosis Complex”, “mortality”, “death”, and “life expectancy”, in PubMed and Google Scholar, until December 15, 2024.

Results

We identified 13 studies that reported a total of 411 deaths from 6735 TSC individuals. Data were typically incomplete and causes of death in many cases were obtained from death certificates. Crude mortality per 100 individuals ranged from 1.4 to 13.8 over average intervals of 11–45 years. Standardized Mortality Ratios or hazard ratios (versus control group) ranged from 3.0 to 4.9 (mean 4.3). Mean life expectancy was 66.2 years compared to an average of 81.8 in the general population. In the seven studies that reported specific causes of mortality in the general TSC population, 6/7 studies (85 %) had renal or central nervous system disease as the most common cause of mortality. Lymphangioleiomyomatosis was also found to confer significant risk of mortality in adult women and cardiac rhabdomyomas were the dominant cause of neonatal mortality. TSC-associated neuropsychiatric disorders-related mortality and morbidity may be underestimated.

Conclusion

Mortality in TSC is elevated compared to the general population, with central nervous system and renal disease most frequently culpable. Further cohort studies will be required to establish and characterize the risk of mortality in TSC in the age of disease-modifying therapies.

结节性硬化症（TSC）是一种多系统神经皮肤疾病，由肿瘤抑制基因TSC1和TSC2功能变异的致病性丧失引起。由此产生的错构瘤由于局部组织的破坏而带来重大的医疗风险。已知TSC的死亡风险升高，但直到最近才有多项研究评估了TSC死亡的具体原因。方法对截至2024年12月15日，PubMed和谷歌Scholar上所有可用的关于TSC死亡率的研究进行批判性文献综述，检索词为“TSC”、“结节性硬化症”、“死亡率”、“死亡”和“预期寿命”。结果：我们确定了13项研究，报告了6735例TSC患者的411例死亡。数据通常是不完整的，在许多情况下，死亡原因是从死亡证明获得的。在11-45年的平均时间间隔内，每100个人的粗死亡率为1.4至13.8。标准化死亡率或危险比（相对于对照组）范围为3.0至4.9（平均4.3）。平均预期寿命为66.2岁，而普通人群的平均预期寿命为81.8岁。在报告一般TSC人群具体死亡原因的7项研究中，6/7（85%）的研究将肾脏或中枢神经系统疾病作为最常见的死亡原因。淋巴管平滑肌瘤病也被发现在成年女性中具有显著的死亡风险，心脏横纹肌瘤是新生儿死亡的主要原因。tsc相关的神经精神疾病相关的死亡率和发病率可能被低估。结论与一般人群相比，TSC的死亡率升高，中枢神经系统和肾脏疾病是最常见的罪魁祸首。需要进一步的队列研究来确定和描述TSC在疾病改善疗法时代的死亡风险。

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引用次数: 0

Rethinking the Brighton Criteria for pediatric Guillain-Barré syndrome: Toward clinical flexibility and global relevance 重新思考儿童格林-巴- <s:1>综合征的布莱顿标准：走向临床灵活性和全球相关性

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-08-06 DOI: 10.1016/j.ejpn.2025.08.001

Bassel Alrabadi, Natalie Bandak

引用次数: 0

Can inter-stride variability capture signs of mixed tone in individuals with cerebral palsy? An exploratory study 跨步幅变异性是否能捕捉脑瘫患者混合音调的迹象？探索性研究

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-08-05 DOI: 10.1016/j.ejpn.2025.07.014

Gilad Sorek , Marije Goudriaan , Itai Schurr , Simon-Henri Schless

Introduction

The identification of dystonia in addition to spasticity (mixed-tone) for individuals with cerebral-palsy (CP) is important, as it can alter clinical management. This study aims to examine if the inter-stride variability of conventionally used gait features can be used for recognizing mixed-tone during gait in individuals with CP.

Methods

Retrospective treadmill-based 3D gait-analysis data for 20 individuals (mean ± SD age 10.4 ± 3.3 years) with mixed-tone CP were extracted (mixed-tone-group). A control group of individuals diagnosed with spastic-CP and no dystonia during gait were individually matched (spastic-group). Gait-kinematics were evaluated using Spatiotemporal characteristics and the Gait-Profile-Score (GPS). Selective-motor-control was assessed by the dynamic-motor-control-index (walk-DMC). Inter-stride variability was calculated per-individual using the coefficient-of-variation (CV; (SD/mean)∗100).

Results

The mixed-tone-group presented with significantly smaller step-length and higher CV only in spatiotemporal parameters (p < 0.050). After controlling for walking-speed, only the CV for cadence remained significant (p < 0.001); a cut-off of 11.5 % CV in cadence could identify individuals with mixed-tone CP with 65 % sensitivity and 85 % specificity.

Interpretation

Larger inter-stride variability was identified for spatiotemporal characteristics in individuals with mixed-tone CP, compared to individuals with spastic CP. Capturing the highly variable movements may be a biomarker of dystonia during gait. Further prospective studies with larger sample size are needed.

脑瘫（CP）患者除痉挛（混合性）外，肌张力障碍的识别很重要，因为它可以改变临床管理。本研究旨在探讨常规步态特征的跨步变异性是否可以用于识别CP患者步态中的混合音调。方法提取20例混合音调CP患者（平均±SD年龄10.4±3.3岁）的回顾性跑步机三维步态分析数据（混合音调组）。诊断为痉挛性脑瘫且步态中无肌张力障碍的对照组被单独匹配（痉挛组）。利用时空特征和步态轮廓评分（GPS）对步态运动学进行评价。采用动态电机控制指数（walk-DMC）评价电机控制的选择性。跨步变异性计算采用变异系数(CV；(SD /意味着)∗100)。结果混合音调组仅在时空参数上表现出较低的步长和较高的CV (p <；0.050)。在控制步行速度后，只有节奏的CV仍然显著(p <；0.001);以11.5%的CV为截断值，以65%的敏感性和85%的特异性识别混合性CP患者。解释：与痉挛性脑瘫患者相比，混合性脑瘫患者在时空特征上的跨步变异性更大。捕捉高度可变的运动可能是步态肌张力障碍的生物标志物。需要进一步的更大样本量的前瞻性研究。

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引用次数: 0

CSF IL-6 in children with neuroinflammatory conditions 脑脊液IL-6与儿童神经炎症的关系

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-07-30 DOI: 10.1016/j.ejpn.2025.07.013

Valeria Pozzilli , Manori Prasadani Thambiliyagodage , Kshitij Mankad , Austen Worth , Paul Brogan , Sara Ghorashian , Alasdair Bamford , Cheryl Hemingway , Marios Kaliakatsos , Kimberly Gilmour , Yael Hacohen

Introduction

Cerebrospinal fluid (CSF) cytokines may contribute to immune-mediated processes affecting the central nervous system (CNS). We evaluated CSF cytokine profiles in children with suspected neuroinflammatory conditions to explore their clinical relevance.

Methods

Between 2019 and 2024, CSF from children <18 years were analyzed using BD Biosciences cytokine bead array for interleukin-2 (IL-2), IL-4, IL-6, IL-10, interferon-alpha (IFN-α), and tumour necrosis-factor-alpha (TNF-α). Clinical phenotyping was conducted. Serum cytokine levels were measured in cases with abnormal CSF, when available.

Results

112 patients were included (median age 6 years [IQR 3.6–11.2]; 54 % male). CSF IL-6 was raised in 35/112 (31 %; median 107 pg/ml, IQR 24–329). No other cytokine was raised without concurrent IL-6. Raised CSF IL-6 occurred in 16/50 acquired neuroimmune conditions (including myelin oligodendrocyte glycoprotein antibody-associated disease, seronegative demyelination, seronegative autoimmune encephalitis, and febrile-infection-related epilepsy syndrome), 5/9 CNS infections; 9/17 monogenic autoinflammatory syndromes, and 5/7 cancer treatment-related neurotoxicities.

Of the 35 patients with raised CSF IL-6, 21 had serum cytokines tested; 13 (62 %) showed elevated serum IL-6. In demyelinating cases, higher IL-6 was associated with increased CSF protein (p = 0.007). Follow-up CSF samples (n = 16, median 34 days) showed persistent elevation in 7 and normalisation in 9. IL-6 inhibitors (tocilizumab and/or siltuximab) were used in 10 patients with variable outcomes, depending on the underlying etiology.

Conclusions

CSF IL-6 was the most frequently elevated cytokine in our cohort, observed across a range of primary and secondary neuroinflammatory disorders. While not diagnostic of a specific condition, its elevation may help guide treatment decisions.

脑脊液（CSF）细胞因子可能有助于影响中枢神经系统（CNS）的免疫介导过程。我们评估了疑似神经炎症的儿童脑脊液细胞因子谱，以探讨其临床相关性。方法采用BD Biosciences细胞因子头阵列分析2019年至2024年间来自18岁儿童的脑脊液中白细胞介素-2 （IL-2）、IL-4、IL-6、IL-10、干扰素-α (IFN-α)和肿瘤坏死因子-α (TNF-α)的含量。进行临床表型分析。在脑脊液异常的情况下，测定血清细胞因子水平。结果纳入112例患者(中位年龄6岁[IQR 3.6-11.2]；54%男性)。CSF IL-6升高35/112 (31%；中位数107 pg/ml， IQR 24-329)。没有IL-6的同时，其他细胞因子均未升高。CSF IL-6升高发生在16/50的获得性神经免疫疾病（包括髓鞘少突胶质细胞糖蛋白抗体相关疾病、血清阴性脱髓鞘、血清阴性自身免疫性脑炎和发热感染相关性癫痫综合征）和5/9的中枢神经系统感染中；9/17是单基因自身炎症综合征，5/7是癌症治疗相关的神经毒性。在35例CSF IL-6升高的患者中，21例进行了血清细胞因子检测；13例（62%）血清IL-6升高。在脱髓鞘病例中，高IL-6与CSF蛋白升高相关（p = 0.007）。随访的脑脊液样本（n = 16，中位34天）显示7例持续升高，9例恢复正常。IL-6抑制剂（tocilizumab和/或siltuximab）用于10例患者，根据潜在病因，结果不同。结论：在我们的队列中，在一系列原发性和继发性神经炎性疾病中观察到，scsf IL-6是最常升高的细胞因子。虽然不能诊断出特定的疾病，但它的升高可能有助于指导治疗决策。

{"title":"CSF IL-6 in children with neuroinflammatory conditions","authors":"Valeria Pozzilli , Manori Prasadani Thambiliyagodage , Kshitij Mankad , Austen Worth , Paul Brogan , Sara Ghorashian , Alasdair Bamford , Cheryl Hemingway , Marios Kaliakatsos , Kimberly Gilmour , Yael Hacohen","doi":"10.1016/j.ejpn.2025.07.013","DOIUrl":"10.1016/j.ejpn.2025.07.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebrospinal fluid <strong>(</strong>CSF) cytokines may contribute to immune-mediated processes affecting the central nervous system (CNS). We evaluated CSF cytokine profiles in children with suspected neuroinflammatory conditions to explore their clinical relevance.</div></div><div><h3>Methods</h3><div>Between 2019 and 2024, CSF from children <18 years were analyzed using BD Biosciences cytokine bead array for interleukin-2 (IL-2), IL-4, IL-6, IL-10, interferon-alpha (IFN-α), and tumour necrosis-factor-alpha (TNF-α). Clinical phenotyping was conducted. Serum cytokine levels were measured in cases with abnormal CSF, when available.</div></div><div><h3>Results</h3><div>112 patients were included (median age 6 years [IQR 3.6–11.2]; 54 % male). CSF IL-6 was raised in 35/112 (31 %; median 107 pg/ml, IQR 24–329). No other cytokine was raised without concurrent IL-6. Raised CSF IL-6 occurred in 16/50 acquired neuroimmune conditions (including myelin oligodendrocyte glycoprotein antibody-associated disease, seronegative demyelination, seronegative autoimmune encephalitis, and febrile-infection-related epilepsy syndrome), 5/9 CNS infections; 9/17 monogenic autoinflammatory syndromes, and 5/7 cancer treatment-related neurotoxicities.</div><div>Of the 35 patients with raised CSF IL-6, 21 had serum cytokines tested; 13 (62 %) showed elevated serum IL-6. In demyelinating cases, higher IL-6 was associated with increased CSF protein (p = 0.007). Follow-up CSF samples (n = 16, median 34 days) showed persistent elevation in 7 and normalisation in 9. IL-6 inhibitors (tocilizumab and/or siltuximab) were used in 10 patients with variable outcomes, depending on the underlying etiology.</div></div><div><h3>Conclusions</h3><div>CSF IL-6 was the most frequently elevated cytokine in our cohort, observed across a range of primary and secondary neuroinflammatory disorders. While not diagnostic of a specific condition, its elevation may help guide treatment decisions.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"58 ","pages":"Pages 42-49"},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763776","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

Neurological manifestations in children with SARS-CoV-2 infection: a French multicentric cohort SARS-CoV-2感染儿童的神经系统表现：法国多中心队列研究

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-07-23 DOI: 10.1016/j.ejpn.2025.07.010

J. Roux , F. Angoulvant , M. Aubart , S. Auvin , C. Brehin , E. Cheuret , M.-A. Dommergues , F. Girard , D. Graber , V. Hoeusler , E. Lametery , C. Le Stradic , A. Lepine , S. Nguyen , S. Peudenier , C. Pons , A.-L. Poulat , S. Rivera , B. Robert , M. Shum , K. Deiva

Objectives

This study aimed to assess neurological manifestations in French children hospitalized with SARS-CoV-2 infection. Secondary objectives were to evaluate the severity of these presentations and estimate the frequency of long-term neurological sequelae.

Methods

A multicenter observational study was conducted, including 71 children hospitalized for neurological manifestations of SARS-CoV-2 infection from January 2020 to March 2022.

Results

The median age was 8.7 years (range 4.2–13), with 49 % being girls. The most common neurological manifestations were encephalitis and meningoencephalitis (32 %). Brain imaging was abnormal in 68 % of cases. Half of the children required admission in intensive care unit (ICU). Nearly one-third of the children had neurological symptoms at the end of the follow-up, with cognitive difficulties being the most reported complaints. No significant associations were made between sex, age, neurological comorbidities, and the severity nor presence of sequelae. However, abnormal brain imaging was significantly associated with a higher risk of ICU stay (OR = 8.01 [95 % CI 2.37–27.1], p < 0.01) and with the presence of sequelae at discharge (OR = 4.65 [1.45–14.9], p = 0.011) and last follow-up (OR = 5.14 [1.40–18.9], p = 0.015).

Conclusion

Although rare, neurological manifestations in children with SARS-CoV-2 infection can be severe, with encephalitis as the most common clinical presentation. Abnormal brain imaging is a strong prognostic marker of acute severity and long-term neurological and cognitive sequelae. Objective assessment tools and longer follow-up are necessary to evaluate the long-term outcomes in these children.

目的评价法国住院儿童SARS-CoV-2感染的神经学表现。次要目的是评估这些症状的严重程度和估计长期神经系统后遗症的频率。方法对2020年1月至2022年3月因SARS-CoV-2感染神经系统症状住院的71例患儿进行多中心观察性研究。结果中位年龄为8.7岁（4.2 ~ 13岁），女孩占49%。最常见的神经学表现为脑炎和脑膜脑炎（32%）。68%的病例脑成像异常。半数儿童需要入住重症监护病房（ICU）。在随访结束时，近三分之一的儿童出现了神经系统症状，其中认知困难是报告最多的症状。性别、年龄、神经合并症和严重程度及是否存在后遗症之间没有明显的关联。然而，脑成像异常与ICU住院风险升高显著相关(OR = 8.01 [95% CI 2.37-27.1], p <；出院时存在后遗症（OR = 4.65 [1.45-14.9], p = 0.011）和末次随访时（OR = 5.14 [1.40-18.9], p = 0.015）。结论SARS-CoV-2感染患儿的神经系统表现虽然少见，但可能很严重，以脑炎为最常见的临床表现。异常脑成像是急性严重程度和长期神经和认知后遗症的预后标志。客观的评估工具和更长的随访是评估这些儿童长期预后的必要条件。

{"title":"Neurological manifestations in children with SARS-CoV-2 infection: a French multicentric cohort","authors":"J. Roux , F. Angoulvant , M. Aubart , S. Auvin , C. Brehin , E. Cheuret , M.-A. Dommergues , F. Girard , D. Graber , V. Hoeusler , E. Lametery , C. Le Stradic , A. Lepine , S. Nguyen , S. Peudenier , C. Pons , A.-L. Poulat , S. Rivera , B. Robert , M. Shum , K. Deiva","doi":"10.1016/j.ejpn.2025.07.010","DOIUrl":"10.1016/j.ejpn.2025.07.010","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess neurological manifestations in French children hospitalized with SARS-CoV-2 infection. Secondary objectives were to evaluate the severity of these presentations and estimate the frequency of long-term neurological sequelae.</div></div><div><h3>Methods</h3><div>A multicenter observational study was conducted, including 71 children hospitalized for neurological manifestations of SARS-CoV-2 infection from January 2020 to March 2022.</div></div><div><h3>Results</h3><div>The median age was 8.7 years (range 4.2–13), with 49 % being girls. The most common neurological manifestations were encephalitis and meningoencephalitis (32 %). Brain imaging was abnormal in 68 % of cases. Half of the children required admission in intensive care unit (ICU). Nearly one-third of the children had neurological symptoms at the end of the follow-up, with cognitive difficulties being the most reported complaints. No significant associations were made between sex, age, neurological comorbidities, and the severity nor presence of sequelae. However, abnormal brain imaging was significantly associated with a higher risk of ICU stay (OR = 8.01 [95 % CI 2.37–27.1], p < 0.01) and with the presence of sequelae at discharge (OR = 4.65 [1.45–14.9], p = 0.011) and last follow-up (OR = 5.14 [1.40–18.9], p = 0.015).</div></div><div><h3>Conclusion</h3><div>Although rare, neurological manifestations in children with SARS-CoV-2 infection can be severe, with encephalitis as the most common clinical presentation. Abnormal brain imaging is a strong prognostic marker of acute severity and long-term neurological and cognitive sequelae. Objective assessment tools and longer follow-up are necessary to evaluate the long-term outcomes in these children.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"58 ","pages":"Pages 57-63"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763778","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

Impact of lesion metrics and neurological functions on long-term cognitive outcome in childhood stroke 损伤指标和神经功能对儿童中风长期认知结果的影响

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology

Pub Date : 2025-07-23 DOI: 10.1016/j.ejpn.2025.07.012

Saskia Salzmann , Leonie Steiner , Tatia Aprasidze , Andrea Klein , Gabriela Oesch , Hakim Arsany , Maja Steinlin , Regula Everts

The prevalence of cognitive impairment after childhood stroke is high and various risk factors influence long-term cognitive outcome. Whether and how risk factors are associated with cognitive outcome is still incompletely understood. This study investigated how lesion volume, lesion location and neurological functions at discharge, 6 months and 2 years after childhood stroke contribute to long-term cognitive outcome.

This observational study included patients after childhood arterial ischemic stroke. Long-term cognitive outcome (intelligence, processing speed, working memory) was assessed at least one year after stroke (Md = 3.52, IQR = 5.57). Neurological functions were measured using the pediatric stroke outcome measure at discharge, at 6-month and 2-year follow-up. Magnetic resonance imaging at stroke manifestation was applied to analyze acute to subacute lesion metrics (volume & location).

43 patients aged 6–23 years (Md = 6.17, IQR = 7.58) were enrolled in the study. Cognitive functions significantly correlated with lesion volume (processing speed: r = −.423, p = .005; working memory: r = −.478, p = .002). Working memory was worse if the left caudate nucleus was involved (U = 284.5, p < .001, d = 1.43). Long-term cognitive outcome correlated with neurological functions at discharge, 6-month and 2-year follow-up, although effects varied depending on the cognitive domain measured (discharge: r = .449, p = .003; 6-month; r = .509 to .538, p <.001; 2-year follow-up: r = .588 to .744, p <.001).

Long-term cognitive outcome was associated with lesion volume, lesion location and neurological functions. Our study adds to the determination of risk factors for long-term cognitive rehabilitation and highlights the need for the combined evaluation of neurological and cognitive outcome.

儿童中风后认知功能障碍的患病率很高，各种危险因素影响长期认知预后。风险因素是否以及如何与认知结果相关联仍不完全清楚。本研究调查了儿童中风后出院时、6个月和2年的病变体积、病变位置和神经功能对长期认知预后的影响。这项观察性研究包括儿童动脉缺血性卒中后的患者。卒中后至少一年评估长期认知结果（智力、处理速度、工作记忆）（Md = 3.52, IQR = 5.57）。在出院时、6个月和2年随访时使用小儿卒中结局测量法测量神经功能。应用脑卒中表现时的磁共振成像分析急性到亚急性病变指标(体积&；位置)。43例6 ~ 23岁患者（Md = 6.17, IQR = 7.58）入组研究。认知功能与病变体积（处理速度：r =−）显著相关。423, p = 0.005；工作记忆：r =−。478, p = .002)。当左尾状核受累时，工作记忆较差(U = 284.5, p <；.001, d = 1.43)。长期认知结果与出院、6个月和2年随访时的神经功能相关，尽管影响因所测量的认知领域而异(出院：r = .449, p = .003；6个月;R = .509 ~ .538, p <；2年随访：r = .588 ~ .744, p <.001)。长期认知结果与病变体积、病变位置和神经功能有关。我们的研究增加了长期认知康复的危险因素的确定，并强调了对神经和认知结果进行综合评估的必要性。

{"title":"Impact of lesion metrics and neurological functions on long-term cognitive outcome in childhood stroke","authors":"Saskia Salzmann , Leonie Steiner , Tatia Aprasidze , Andrea Klein , Gabriela Oesch , Hakim Arsany , Maja Steinlin , Regula Everts","doi":"10.1016/j.ejpn.2025.07.012","DOIUrl":"10.1016/j.ejpn.2025.07.012","url":null,"abstract":"<div><div>The prevalence of cognitive impairment after childhood stroke is high and various risk factors influence long-term cognitive outcome. Whether and how risk factors are associated with cognitive outcome is still incompletely understood. This study investigated how lesion volume, lesion location and neurological functions at discharge, 6 months and 2 years after childhood stroke contribute to long-term cognitive outcome.</div><div>This observational study included patients after childhood arterial ischemic stroke. Long-term cognitive outcome (intelligence, processing speed, working memory) was assessed at least one year after stroke (<em>Md</em> = 3.52, <em>IQR</em> = 5.57). Neurological functions were measured using the pediatric stroke outcome measure at discharge, at 6-month and 2-year follow-up. Magnetic resonance imaging at stroke manifestation was applied to analyze acute to subacute lesion metrics (volume & location).</div><div>43 patients aged 6–23 years (<em>Md</em> = 6.17, <em>IQR</em> = 7.58) were enrolled in the study. Cognitive functions significantly correlated with lesion volume (processing speed: <em>r</em> = −.423, <em>p</em> = .005; working memory: <em>r</em> = −.478, <em>p</em> = .002). Working memory was worse if the left caudate nucleus was involved (<em>U</em> = 284.5, <em>p</em> < .001, <em>d</em> = 1.43). Long-term cognitive outcome correlated with neurological functions at discharge, 6-month and 2-year follow-up, although effects varied depending on the cognitive domain measured (discharge: <em>r</em> = .449, <em>p</em> = .003; 6-month; <em>r</em> = .509 to .538, <em>p</em> <.001; 2-year follow-up: <em>r</em> = .588 to .744, <em>p</em> <.001).</div><div>Long-term cognitive outcome was associated with lesion volume, lesion location and neurological functions. Our study adds to the determination of risk factors for long-term cognitive rehabilitation and highlights the need for the combined evaluation of neurological and cognitive outcome.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"58 ","pages":"Pages 34-41"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764157","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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