Seminars in Pediatric Neurology最新文献

{"title":"Beyond the grey scale: A focus review of microstructural, metabolic, and AI-driven advances in TBI neuroimaging","authors":"Wilson A Chavez ,&nbsp;V Carlota Andreu-Arasa ,&nbsp;Bindu N Setty","doi":"10.1016/j.spen.2026.101261","DOIUrl":"10.1016/j.spen.2026.101261","url":null,"abstract":"<div><div>Traumatic Brain Injury (TBI) presents a significant diagnostic challenge due to the frequent dissociation between severe clinical symptoms and absence of abnormal findings on conventional neuroimaging. This focus review synthesizes pivotal peer-reviewed literature to characterize the shift from anatomical to microstructural, physiological, and computational diagnostics. We examine the implementation of the 2024 NINDS CBI-M (Clinical, Biomarker, Imaging, Modifiers) framework, which recommends a multimodal approach. Key advances reviewed include Neurite Orientation Dispersion and Density Imaging (NODDI) for detecting microstructural reorganization; Quantitative Susceptibility Mapping (QSM) for quantifying chronic iron and indirectly inflammation; Arterial Spin Labeling (ASL) for assessing cerebral perfusion and neurovascular health; systematic evidence of functional connectivity disruption via fMRI; and the emergence of Artificial Intelligence (AI) for accurate prognosis. These technologies collectively support a move toward precision medicine, characterizing TBI by specific biotypes rather than broad severity scores.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101261"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based Management Strategies for Adult Concussion","authors":"Bianca E. Carson","doi":"10.1016/j.spen.2026.101262","DOIUrl":"10.1016/j.spen.2026.101262","url":null,"abstract":"<div><div>Traumatic brain injury (TBI) is a growing public health concern. Majority are estimated to be mild in severity, also referred to as a concussion. Although most concussions are self-limiting, there has been more interest in investigating somatic symptoms, cognitive dysfunction, mood disturbances, and sleep abnormality in the acute setting as prognostic markers for persistent symptoms. This article serves to provide a comprehensive review on acute management of concussions sustained in various mechanisms of injury including sports acquired and military-related. This article will also offer up-to-date evidence-based strategies in re-integrating the patient to full return of functional activity. Regardless of mechanism of injury, the initial step of management is recognition and then removal from further risk of injury. Education and further reassurance should be provided, followed by a supervised incremental return to activity protocol that monitors tolerance and exacerbation of symptoms. Since concussions have a heterogenous presentation, management should be individualized and symptom based. Prolonged symptoms may warrant specialty-specific referrals and further diagnostic evaluation. Management is optimized when treatment is patient-centered and with interdisciplinary collaboration.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101262"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric sequelae of single and repetitive concussions","authors":"Angelica G. Montilla ,&nbsp;Laura Goldstein ,&nbsp;Shabnam Nohesara ,&nbsp;Edgard Andrade ,&nbsp;Alcy R. Torres","doi":"10.1016/j.spen.2026.101263","DOIUrl":"10.1016/j.spen.2026.101263","url":null,"abstract":"<div><h3>Objective</h3><div>Summarize current evidence on neuropsychiatric sequelae of pediatric concussions; delineate risk modifiers and symptom trajectories, review assessment tools and management strategies, and highlight gaps to guide care and research.</div></div><div><h3>Methods</h3><div>Narrative review of PubMed/MEDLINE through October 2025, prioritizing systematic reviews, meta-analyses, longitudinal cohorts, controlled trials, and large registry studies in individuals &lt;18 years. Evidence was qualitatively synthesized to describe epidemiology, risk modifiers, symptom trajectories, psychiatric outcomes, assessment approaches, and management strategies. Studies in young adults were included only when they provided mechanistic or clinical insights directly applicable to pediatric populations.</div></div><div><h3>Results</h3><div>Concussion in youth produces acute to chronic neuropsychiatric symptoms, including irritability, anxiety/depression, sleep disturbance, attentional inefficiency, executive dysfunction, and behavioral dysregulation. Recovery varies by age, sex, injury severity, prior concussion, mental health history, and socioeconomic context. Repetitive injuries show dose-response patterns with slower recovery and greater symptom burden. Up to one third experience symptoms &gt;4 weeks. Population data associate concussion with higher risks of self-harm, psychiatric hospitalization, and later psychotic or bipolar disorders. Standardized tools such as SCAT6 and Child SCAT6, as well as SCOAT6 and Child SCOAT6, support initial screening, while instruments including the Post-Concussion Symptom Inventory facilitate longitudinal monitoring. Management centers on psychoeducation, graded return-to-learn/play, CBT, and school supports; medications are adjunctive. Evidence for biomarkers and neuroimaging correlates is emerging but remains limited.</div></div><div><h3>Conclusions</h3><div>A youth-centered model emphasizing prevention, early identification, mental-health screening, and coordinated school/sports policies is key to reducing neuropsychiatric burden. Future work should prioritize longitudinal pediatric cohorts, validation of scalable screening pathways and biomarkers, and trials of school and community based interventions.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101263"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Pediatric Care: Technological Innovations for Concussion Prevention and Monitoring","authors":"Harshitha Valluri ,&nbsp;Alcy R. Torres","doi":"10.1016/j.spen.2026.101264","DOIUrl":"10.1016/j.spen.2026.101264","url":null,"abstract":"<div><div>Concussion is a common type of pediatric mild traumatic brain injury caused by head or body trauma, leading to transient disruptions in brain function. Sports-related injuries account for most cases, followed by falls, motor vehicle accidents, and recreational activities. The growing incidence of pediatric concussions highlights the need for improved prevention, monitoring, and management.</div><div>This article offers an updated overview of pediatric concussion, with a focus on technological innovations in prevention and monitoring. We review emerging tools including instrumented mouthguards, biomarkers, virtual reality devices, and artificial intelligence prediction models that offer opportunities for risk reduction, real-time detection, and individualized management.</div><div>These advancements may enhance safety in sports, recreation, and daily activities while providing data to guide further research and clinical decision-making. Technological innovations show promise in transforming the prevention, detection, monitoring, and management of pediatric concussion, ultimately improving outcomes for children. Further research is needed to validate these technologies in the pediatric population, especially in underserved groups.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101264"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining concussion: Current concepts and diagnostic criteria","authors":"Taha Fathima Khan","doi":"10.1016/j.spen.2026.101260","DOIUrl":"10.1016/j.spen.2026.101260","url":null,"abstract":"<div><div>Concussions are some of the most common neurological diagnoses in the world, affecting millions of people every year. There have been attempts over the years to define concussion as part of the spectrum of traumatic brain injury (TBI). Symptoms of a concussion can be varied, and the duration of symptoms can differ based on pre-morbid conditions. While concussions are diagnosed clinically, there is a role for standardized tools in aiding this diagnosis. There may also be a clinical role for various forms of neuroimaging, biomarkers, and other diagnostic measures in the future.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101260"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiological pathways in mild traumatic brain injury","authors":"Mugdha Mohanty ,&nbsp;Alcy R. Torres","doi":"10.1016/j.spen.2026.101257","DOIUrl":"10.1016/j.spen.2026.101257","url":null,"abstract":"<div><div>Mild traumatic brain injury (mTBI) is a disorder of physiologic dysfunction of the brain from trauma, and is the most common form of traumatic brain injury across all age groups.<span><span>¹</span></span>^,<span><span>²</span></span>^,<span><span>³</span></span>^,<span><span>⁶</span></span> Its clinical manifestations are diverse, ranging from loss of consciousness, dizziness, seizures, headache, irritability, lethargy which are immediately recognized, but a small subset of patients are left with prolonged somatic and cognitive symptoms affecting their quality of life and academic functioning.<span><span>⁴</span></span>^,<span><span>⁹</span></span>^,<span><span>¹⁰</span></span> Insight into the pathophysiology of mTBI has shown that it is a complex process where mechanical force to the neuron triggers a cascade of multiple reactions at the cellular and molecular level, starting with disruption of ionic homeostasis, glutamate-mediated excitotoxicity, mitochondrial dysfunction, altered cerebral blood flow, neuroinflammation, glial activation, and traumatic axonal injury.<span><span>⁵</span></span>^,<span><span>13</span></span>, <span><span>14</span></span>, <span><span>15</span></span>, <span><span>16</span></span>, <span><span>17</span></span>, <span><span>18</span></span>, <span><span>19</span></span>^,<span><span>21</span></span>, <span><span>22</span></span>, <span><span>23</span></span>, <span><span>24</span></span> There is a mismatch between energy supply and demand of the brain, which further potentiates the injury.<span><span>¹⁶</span></span>^,<span><span>³⁰</span></span> Although the standard consideration is that mTBI is not accompanied by structural changes, insight into pathophysiological mechanisms reveals that structural changes, some of which are permanent are also seen in mild TBI. This review summarizes the key pathophysiological alterations and processes in mTBI and briefly discusses biomarkers and advanced imaging techniques that may support clinical detection, especially in patients with protracted and prolonged symptoms.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101257"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal effects of pediatric concussion into adulthood","authors":"Rachael S. Mathew ,&nbsp;Caitlin Segura ,&nbsp;Abigail Lemons ,&nbsp;Alcy R. Torres","doi":"10.1016/j.spen.2026.101259","DOIUrl":"10.1016/j.spen.2026.101259","url":null,"abstract":"<div><div>Each year, millions of children are diagnosed with concussions. This review summarizes current evidence on the long-term effects of pediatric concussion into adulthood. Findings regarding long-term neuropsychiatric outcomes are heterogeneous. Advanced neuroimaging studies provide limited evidence of lasting neurobiological alterations, and long-term studies remain scarce. Rodent models that mimic adolescent mild traumatic brain injury consistently demonstrate chronic neuroinflammation, neuronal loss, and memory deficits. Overall, conclusions are constrained by substantial methodological heterogeneity. Further high-quality longitudinal studies are needed to clarify the long-term impact of pediatric concussion.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101259"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EEG findings in Lennox-Gastaut syndrome: Pursuing a moving target","authors":"Juliann M Paolicchi ,&nbsp;Otakhon A. Matchanov","doi":"10.1016/j.spen.2025.101245","DOIUrl":"10.1016/j.spen.2025.101245","url":null,"abstract":"<div><div>Lennox-Gastaut Syndrome (LGS) is a life-long, drug-resistant developmental epileptic encephalopathy (DEE) that develops in young children between 18 and 24 months of age and up to 18 years of age. The overall incidence is estimated at 0.1 to 0.28 per 100,000 people per year and a lifetime prevalence at age 10 of about 0.26 per 1,000 children. LGS accounts for 1–2 % of all epilepsy cases and 2–5 % of childhood epilepsies, with a higher ratio of males. The disruption of LGS on the lives of patients and their caretakers is considerable given its chronic nature, the injury from the seizures, the need for a high degree of medical supervision, and the toll the syndrome takes on the patients’ cognitive and neurologic development. There is variability in the literature on the overall incidence of LGS due to changes in the definitions in past classifications regarding age of inclusion, mandatory seizure types, and mandatory EEG findings. This review focuses on the evolution of the ictal and interictal EEG findings over the course of the syndrome and the developing nature of the seizure types.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101245"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preclinical models of Lennox-Gastaut syndrome: Progress and priorities","authors":"Cordelia Katharine Lindhard Smidth ,&nbsp;Kala P. Nair ,&nbsp;Katryn Ashley ,&nbsp;Juliet K. Knowles","doi":"10.1016/j.spen.2025.101246","DOIUrl":"10.1016/j.spen.2025.101246","url":null,"abstract":"<div><div>In the last decade, the increasing availability of genetic testing and rapid discovery of genes causing developmental and epileptic encephalopathies such as Lennox-Gastaut syndrome (LGS), together with technology such as CRISPR/Cas9 gene editing, has enabled the generation of new preclinical models, particularly using mice. Mice engineered to express disease-causing genetic changes, through either gene \"knock-out\" or \"knock-in\" of specific variants, recapitulate key features of LGS. In this review, we review past and recently developed preclinical models of LGS, and we highlight select insights already gleaned in preclinical studies. We argue that the availability of these new preclinical models should prompt renewed attention to basic and translational studies aimed at understanding fundamental biological mechanisms that enable secondary network evolution to LGS as well as novel, mechanistically informed therapeutic strategies.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101246"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving landscape of concussion","authors":"Pedro Weisleder","doi":"10.1016/j.spen.2026.101265","DOIUrl":"10.1016/j.spen.2026.101265","url":null,"abstract":"","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"57 ","pages":"Article 101265"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147631377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}