Pediatric neurology最新文献

{"title":"Recovery From Adolescent Sports Concussion During the School Year Compared With Summer","authors":"Sean C. Rose MD ,&nbsp;Jason Benedict MS ,&nbsp;Thomas L. Pommering DO ,&nbsp;Julie Young PhD","doi":"10.1016/j.pediatrneurol.2025.04.001","DOIUrl":"10.1016/j.pediatrneurol.2025.04.001","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with acute concussion may experience increased symptoms when returning to school. We sought to compare time to concussion resolution during the academic school year and summer break.</div></div><div><h3>Methods</h3><div>This retrospective chart review assessed adolescents aged 13-18 years presenting within 14 days of concussion to an outpatient sports medicine clinic. The primary outcome was days to concussion resolution. Participants were categorized into “school” or “summer” groups based on the timing of their concussion in relation to local school calendars.</div></div><div><h3>Results</h3><div>A total of 2500 patients (42% female) were included: 2371 with school concussion and 129 with summer concussion. By the first clinic visit (median: 5-6 days), median symptom score in the school group was twice that of the summer group (16 vs 8). Median days to resolution differed (<em>P</em> &lt; 0.001) between the school group (15 days, 95% confidence interval [CI]: 15-16) and the summer group (12 days, 95% CI: 11-14). Earlier concussion resolution was associated with injury during the summer (hazard ratio: 1.51, 95% CI: 1.25-1.82, <em>P</em> &lt; 0.001, when controlling for other variables). Longer concussion resolution was associated with female sex, greater symptoms on the day of injury, two or more previous concussions, and amnesia. Somatic, cognitive, and sleep symptoms were higher in the school group (all <em>P</em> &lt; 0.05), whereas emotional symptoms did not differ between groups.</div></div><div><h3>Conclusions</h3><div>Adolescents take longer to recover from concussion during the school year. Academic accommodations may not be sufficient to normalize recovery time. Earlier management, as well as treatments targeting somatic, cognitive, and sleep symptoms, should be offered.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 110-116"},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860582","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)00080-3","DOIUrl":"10.1016/S0887-8994(25)00080-3","url":null,"abstract":"","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"166 ","pages":"Pages A1-A2"},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791988","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":"Severity of Germinal Matrix-Intraventricular Hemorrhage Impacts Thalamic Growth and Neurodevelopmental Outcomes in Preterm Infants: A Longitudinal Magnetic Resonance Study","authors":"Carmen Rodríguez-Barrios MD ,&nbsp;Irene Gutiérrez-Rosa MD ,&nbsp;Manuel Lubián-Gutiérrez MD, PhD ,&nbsp;Emiliano Trimarco PsyD ,&nbsp;Bahram Jafrasteh PhD ,&nbsp;Simón Lubián-López MD, PhD ,&nbsp;Isabel Benavente-Fernández MD, PhD","doi":"10.1016/j.pediatrneurol.2025.03.015","DOIUrl":"10.1016/j.pediatrneurol.2025.03.015","url":null,"abstract":"<div><h3>Background</h3><div>Preterm birth and germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) can significantly affect neurodevelopment in very-low-birth-weight infants (VLBWI). This study examined the impact of GMH-IVH on thalamic volume (TV) during the neonatal period and its relationship with cognitive, motor, and language outcomes at two years corrected age.</div></div><div><h3>Methods</h3><div>Preterm infants admitted to the neonatal intensive care unit at Hospital Puerta del Mar underwent early (<em>&lt;</em>36 weeks postmenstrual age) and term-equivalent magnetic resonance imaging to assess thalamic growth. Neurodevelopmental outcomes were evaluated using the Bayley Scales of Infant and Toddler Development.</div></div><div><h3>Results</h3><div>The severity of GMH-IVH correlated with greater reductions in TV. At term, infants without GMH-IVH had a mean TV of 3.72 ± 0.65 cm³, compared with 2.76 ± 0.55 cm³ in those with grade III GMH-IVH (<em>P</em> = 0.0001). Grade III GMH-IVH and parenchymal hemorrhagic infarction were linked to significantly lower cognitive (<em>P</em> = 0.024), language (<em>P</em> = 0.001), and motor scores (<em>P</em> = 0.006) at two years, with reduced TV contributing to poorer language outcomes (β = 9.857; <em>P</em> = 0.028). Our findings suggest that GMH-IVH negatively affects thalamic growth, which in turn leads to neurodevelopmental delays in preterm infants.</div></div><div><h3>Conclusions</h3><div>The severity of GMH-IVH is associated with decreased TV and adverse cognitive, language, and motor outcomes, highlighting the need for early identification and targeted interventions in this vulnerable population. Further research should explore additional brain structures affected by GMH-IVH to better understand the mechanisms driving these impairments.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 117-124"},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874381","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":"Difficult Conversations in Fetal-Neonatal Neurology: National Survey of Educational Experiences and Needs of Child Neurology Residents","authors":"Ashley M. Bach MD, MPH ,&nbsp;Dawn Gano MD, MAS ,&nbsp;Charu Venkatesan MD, PhD ,&nbsp;Monica E. Lemmon MD ,&nbsp;Sonika Agarwal MBBS, MD","doi":"10.1016/j.pediatrneurol.2025.03.014","DOIUrl":"10.1016/j.pediatrneurol.2025.03.014","url":null,"abstract":"<div><h3>Background</h3><div>Fetal-neonatal neurology (FNN) is a growing subspecialty within child neurology that often involves difficult conversations with families regarding new neurological diagnoses and prognoses. We assessed child neurology residents’ educational experiences and needs regarding difficult conversations in FNN.</div></div><div><h3>Methods</h3><div>We performed a descriptive survey-based study of the educational experiences of child neurology residents in their neurology training. An anonymous RedCap survey was distributed by e-mail to program directors of all US child neurology programs for distribution to residents for optional, voluntary completion.</div></div><div><h3>Results</h3><div>Forty-seven child neurology residents in training programs in 12 states participated. Nearly all (92%) spent at least one week during the academic year providing consultations in the neonatal intensive care unit. About half participated in at least one fetal neurology consultation over the course of six months. A majority of respondents (87%) had been part of a difficult conversation in FNN, defined as delivering serious news or discussing neurological prognosis, and 68% led at least one difficult conversation over the course of six months. Respondents were more often comfortable delivering diagnoses and prognoses in neonatal neurology than in fetal neurology. A minority (32%) had communication training specific to FNN, and almost all (96%) were interested in improving their ability to conduct difficult conversations in FNN.</div></div><div><h3>Conclusions</h3><div>Child neurology residents were variably exposed to FNN and often actively participated in difficult conversations with families. Most residents had not had communication training specific to FNN and were interested in improving their ability to conduct difficult conversations in FNN.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 103-109"},"PeriodicalIF":3.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852322","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":"Patterns of Use and Benefit of Triptans in the Treatment of Acute Headache Worsening in Youth With Post-Traumatic Headache","authors":"Ryan Shah BS ,&nbsp;Soumyaa Das ,&nbsp;Caroline F. Gentile Kruse MD ,&nbsp;Blanca Marquez de Prado PhD ,&nbsp;Nichelle Raj MS ,&nbsp;Morgan Evans BA ,&nbsp;Pratishtha Panigrahi BS ,&nbsp;Andrew D. Hershey MD, PhD ,&nbsp;Christina L. Master MD ,&nbsp;Christina L. Szperka MD, MSCE ,&nbsp;Carlyn Patterson Gentile MD, PhD","doi":"10.1016/j.pediatrneurol.2025.03.013","DOIUrl":"10.1016/j.pediatrneurol.2025.03.013","url":null,"abstract":"<div><h3>Background</h3><div>Triptans are used to treat migraine attacks, but little to no evidence supports their use for youth with post-traumatic headache (PTH). This study evaluated patterns of use and benefit of triptans in the treatment of acute headache worsening in youth with PTH.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was conducted by reviewing charts for 332 patients aged eight to 17 years seen in a child neurology clinic for PTH within one year of concussion. Treatment responses and side effects were recorded. Demographic and headache characteristics associated with triptan use and treatment response were examined.</div></div><div><h3>Results</h3><div>Eighty of 332 patients (24.1%) used a triptan. Of those, 34 (42.5%) had acute (less than three months) PTH and 46 (57.5%) had persistent (greater than or equal to three months) PTH. Median time from injury to triptan prescription was 123 days (interquartile range, 50, 242). Older patients, those with headache phenotype consistent with migraine, those who previously used a greater number of treatments for acute headache worsening, and those seen by the headache program were more likely to use triptans (<em>χ</em>² &gt; 7.00, <em>P</em> &lt; 0.01). Sixty percent reported at least partial headache relief with their first triptan, whereas 25% reported side effects, all of which were minor.</div></div><div><h3>Conclusions</h3><div>These findings show triptans are more likely to be used for youth with PTH with phenotype consistent with migraine that are unrelieved by other treatments for acute headache worsening. Triptans may be an effective treatment for acute headache worsening in youth with PTH, although randomized controlled trials are needed.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 96-102"},"PeriodicalIF":3.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847903","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":"Glycosylphosphatidylinositol Biosynthesis Defect Due To Novel Biallelic Pathogenic Variants in PIGW","authors":"Nazim Rabouhi MSc ,&nbsp;Smrithi Salian PhD ,&nbsp;Hind Benkerroum MSc ,&nbsp;Takeshi Yoshida MD, PhD ,&nbsp;Humayra Uddin BSc ,&nbsp;Thi Tuyet Mai Nguyen PhD ,&nbsp;Takako Fujita PhD ,&nbsp;Shinichi Hirose MD, PhD ,&nbsp;Kenjiro Kosaki MD ,&nbsp;Mathilde Lefebvre MD, PhD ,&nbsp;Nicolas Bourgon MD, MSc ,&nbsp;Christel Thauvin-Robinet PhD ,&nbsp;Aelita Kamalova MD, PhD ,&nbsp;Almaziya Shakhirova MD ,&nbsp;Harinder Gill MSc, MD ,&nbsp;Hyun Kyung Lee MSc ,&nbsp;Leonie A. Menke MD, PhD ,&nbsp;Taroh Kinoshita PhD ,&nbsp;Yoshiko Murakami PhD ,&nbsp;Philippe M. Campeau MD","doi":"10.1016/j.pediatrneurol.2025.03.012","DOIUrl":"10.1016/j.pediatrneurol.2025.03.012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Inherited glycosylphosphatidylinositol (GPI) deficiencies are a heterogeneous group of inherited disorders of glycosylation, caused by mutations in genes involved in GPI-anchored proteins (GPI-AP) biosynthesis. &lt;em&gt;PIGW&lt;/em&gt; is a gene known to be involved in the early steps of the GPI-anchor biosynthesis, as well as functional studies for most patients. Biallelic mutations in &lt;em&gt;PIGW&lt;/em&gt; have been previously linked to hyperphosphatasia with mental retardation syndrome 5, also known as glycosylphosphatidylinositol biosynthesis defect 11 (GPIBD11).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We report seven individuals, including two fetuses from six unrelated families. Whole exome sequencing and chromosome analysis were performed, with variant interpretation based on ACMG and AMP guidelines. Magnetic resonance imaging (MRI) was also conducted on some of the patients. Blood samples were collected from patients to analyze GPI-AP expression using flow cytometry on markers like CD16, CD24, and FLAER. Functional analyses were performed using &lt;em&gt;PIGW&lt;/em&gt; KO HEK 293 cells generated with CRISPR/Cas9 technology. The cells were transfected with rat Pigw cDNA that contained patient variants. The restoration of GPI-AP expression was measured by flow cytometry. Western blotting was used to assess protein expression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Affected patients exhibited a wide range of clinical features. Some patients presented classic GPIBD11 symptoms like developmental delay, hyperphosphatasia, and intellectual disability. Other patients showed atypical or milder phenotypes. The magnetic resonance imaging scans revealed variable neurological abnormalities in the affected individuals. Whole exome sequencing results identified &lt;em&gt;PIGW&lt;/em&gt; mutations in all patients, which confirms the genetic basis of the disorder. Flow cytometry analysis of blood samples from patients P1, P4, and P5 using various markers showed a significant reduction in GPI-AP expression. The CD16 marker decreased to 1.8% in P1 and 21% in P5 compared to controls. CD24 was reduced to 22% in P1 granulocytes. Also, a minor decrease in CD14 on monocytes was observed in P4, as well as a slight reduction in the expression of FLAER in lymphocytes. Functional studies on &lt;em&gt;PIGW&lt;/em&gt;-deficient CHO cells and HEK293 cells, using flow cytometry, showed that GPI-AP expression is affected by the PIGW variants. Western blotting showed reduced PIGW protein expression, except for P153L and R36G, which were similar to wild-type levels.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;To date, six patients and two fetuses with biallelic variants in &lt;em&gt;PIGW&lt;/em&gt; have been reported. Here, we describe five new patients and two fetuses harboring homozygous or compound heterozygous variants in the &lt;em&gt;PIGW&lt;/em&gt; gene. Our results illustrate the clinical variability of GPIBD11, highlighting the importance of broad genomic sequencing assays for patients who do not show typical symptoms. ","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 89-95"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829819","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":"Effect of Propofol and Sevoflurane on Vanishing White Matter Models","authors":"Ellen Oudejans MSc ,&nbsp;Diede Witkamp PhD ,&nbsp;Pleun Schonewille MSc ,&nbsp;Marcos Ross Adelman MSc ,&nbsp;Gino V. Hu-A-Ng BSc ,&nbsp;Leoni Hoogterp MSc ,&nbsp;Gemma van Rooijen-van Leeuwen BSc ,&nbsp;Rika van der Laan BSc ,&nbsp;Raphaela P. Kerindongo MSc ,&nbsp;Janneke J. Witvliet MSc ,&nbsp;Nina C. Weber PhD ,&nbsp;Benedikt Preckel MA, MD, PhD ,&nbsp;Truus E.M. Abbink PhD ,&nbsp;Marjo S. van der Knaap MD, PhD","doi":"10.1016/j.pediatrneurol.2025.03.009","DOIUrl":"10.1016/j.pediatrneurol.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>The leukodystrophy vanishing white matter (VWM) most often has its onset in childhood and is characterized by chronic decline and additionally stress-provoked acute neurological deterioration. Anesthesia is a stressor that can trigger this acute decline. The commonly used inhalational anesthetic sevoflurane has been reported to activate the integrated stress response (ISR), whereas the intravenous anesthetic propofol has not. We aimed to assess the differential effects of these anesthetics in models of VWM.</div></div><div><h3>Methods</h3><div>We investigated the molecular effects of sevoflurane and propofol on the ISR in a murine neural cell line and in cultured astrocytes from patients with VWM and control subjects with immunostainings for prototypic ISR marker activating transcription factor 4 (ATF4). We determined the effects of these anesthetics on clinical signs and expression of ISR mRNAs in VWM and wild-type mice.</div></div><div><h3>Results</h3><div>In the murine cell line, sevoflurane increased ATF4 accumulation compared with its vehicle (+157%); in contrast, propofol's vehicle without (−22%) and with (−23%) propofol decreased tunicamycin-increased levels of ATF4 to similar degree. Sevoflurane activated the ISR in astrocytes from control subjects (+17-33%) but not from patients with VWM (+1-2%). Propofol and its vehicle did not impact the ISR in astrocytes. The anesthetics did not have prolonged effects on motor skills in VWM mice but had small differential effects on ISR mRNA levels, consistently higher with sevoflurane than with propofol.</div></div><div><h3>Conclusions</h3><div>We observed differential effects of the anesthetics in cultured neural cells and on expression levels of ISR markers in VWM mice, but not on clinical signs in VWM mice.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 66-76"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143814970","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":"Persistent Cognitive Dysfunction After Chimeric Antigen Receptor T-Cell Therapy in Adolescents and Young Adults","authors":"Yusa Nagai MD ,&nbsp;Itaru Hayakawa MD ,&nbsp;Masahiro Sugawa MD, PhD ,&nbsp;Yoshihiro Gocho MD, PhD ,&nbsp;Hirotoshi Sakaguchi MD, PhD ,&nbsp;Daisuke Tomizawa MD, PhD ,&nbsp;Yuichi Abe MD, PhD","doi":"10.1016/j.pediatrneurol.2025.03.010","DOIUrl":"10.1016/j.pediatrneurol.2025.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Chimeric antigen receptor T-cell (CAR-T) therapy for hematological malignancies causes a neurological complication known as immune effector cell-associated neurotoxicity syndrome (ICANS). The precise neurocognitive pathology underlying ICANS remains incompletely described. The aim of this study is to elucidate that persistent cognitive dysfunction as potential neurotoxicity of CAR-T therapy.</div></div><div><h3>Methods</h3><div>This was a single-center consecutive study of ICANS caused by CAR-T therapy for B-cell acute lymphoblastic leukemia. We determined the cognitive functions of all patients with ICANS at the onset of ICANS symptoms and followed them up in the neurology department thereafter.</div></div><div><h3>Results</h3><div>Among the 10 CAR-T cases between 2020 and 2022, three patients had ICANS. None of the patients experienced seizures. Of the three patients, the preadolescent patient showed decreased levels of consciousness, tremors, and striatal signs without cognitive dysfunction. The other two adolescent and young adult patients presented with cognitive decline, short- and long-term memory loss, and emotional disturbances. Although the Immune Effector Cell–Associated Encephalopathy score remained low, the cognitive impairment was profound and disabling in both cases. The neurological status of all patients fully recovered to pre-CAR-T status within one month.</div></div><div><h3>Conclusions</h3><div>The findings in our cases indicate that persistent cognitive dysfunction may be a potentially under-recognized outcome of neurotoxicity due to CAR-T therapy for B-cell acute lymphoblastic leukemia in adolescents and young adults. Detailed neuropsychologic assessments may be beneficial for CAR-T therapy.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 77-81"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824007","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":"Acute Effects of Pediatric Primary Brain Tumors","authors":"Mekka R. Garcia MD,&nbsp;Nora Jandhyala MD,&nbsp;Devorah Segal MD, PhD","doi":"10.1016/j.pediatrneurol.2025.01.026","DOIUrl":"10.1016/j.pediatrneurol.2025.01.026","url":null,"abstract":"<div><div>Primary brain tumors are the most common solid tumor and cause of cancer-related deaths in children. Their clinical presentation depends on the age of the child and the location of tumor. Tumors in infancy often present with nonspecific symptoms, while focal neurological symptoms are more evident in older children. In this article, we review the most common acute neurological effects of pediatric primary brain tumors and their treatments.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 60-65"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143814972","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":"Combined Ketamine and Midazolam Versus Midazolam Alone for Initial Treatment of Pediatric Generalized Convulsive Status Epilepticus (Ket-Mid Study): A Randomized Controlled Trial","authors":"Amr A. Othman MD, PhD ,&nbsp;Abdelrahim A. Sadek MD, PhD ,&nbsp;Esraa A. Ahmed MD ,&nbsp;Elsayed Abdelkreem MD, PhD","doi":"10.1016/j.pediatrneurol.2025.03.011","DOIUrl":"10.1016/j.pediatrneurol.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div>Approximately one third of children with generalized convulsive status epilepticus (GCSE) are not controlled by initial benzodiazepine therapy. We investigated the efficacy of adding ketamine to midazolam for first-line treatment of pediatric GCSE.</div></div><div><h3>Methods</h3><div>This randomized controlled trial included 144 children with GCSE aged between six months and 16 years, who were equally randomized to receive ketamine plus midazolam (Ket-Mid group) or placebo plus midazolam (Pla-Mid group). Primary outcome was cessation of clinical seizures at five-minute study timepoint. Secondary outcomes were the need for a second midazolam bolus; cessation of clinical seizures at 15-, 35-, and 55-minute timepoints; 24-hour seizure control; and adverse effects.</div></div><div><h3>Results</h3><div>Cessation of clinical seizures at five-minute occurred in 76% of children in the Ket-Mid group compared with 21% in the Pla-Mid group (risk ratio [RR] 3.7; 95% confidence interval [CI] 2.3-5.9; <em>P</em> &lt; 0.001). Compared with the Pla-Mid group, the Ket-Mid group had higher percentages of seizure cessation at 15-minute (76.4% vs 23.6%; RR, 3.2; 95% CI, 2.1-5.0), 35-minute (83.3% vs 45.8%; RR, 1.8; 95% CI, 1.4-2.4), and 55-minute (88.9% vs 72.2%; RR, 1.2; 95% CI, 1.04-1.45) study timepoints as well as lower percentages of repeating midazolam (23.6% vs 79.2%; RR, 0.3; 95% CI, 0.19-0.46) and endotracheal intubation (4.2% vs 20.8%; RR, 0.2; 95% CI, 0.06-0.66). Both groups showed no significant differences in other outcome measures.</div></div><div><h3>Conclusions</h3><div>Ketamine-midazolam combination may be more effective than midazolam alone for the initial treatment of pediatric GCSE, but this should be confirmed in future research.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"167 ","pages":"Pages 24-32"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768031","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}