Seminars in Pediatric Neurology最新文献

{"title":"Subacute sclerosing panencephalitis","authors":"Pradeep Kumar Gunasekaran ,&nbsp;Arushi Gahlot Saini","doi":"10.1016/j.spen.2025.101207","DOIUrl":"10.1016/j.spen.2025.101207","url":null,"abstract":"<div><div>Subacute sclerosing panencephalitis (SSPE) is a devastating neurodegenerative disorder due to a persistent mutated, wild-measles virus infection of the nervous system. While the acute infection is generally self-limiting, defective viral clearance can lead to the emergence of neurovirulent strains that undergo mutations within the host, evade immune surveillance, establishing chronic central nervous system (CNS) infection. It predominantly affects children and young adults although no age, including infants, is immune to SSPE. The characteristic neurological manifestations include progressive behavioral and cognitive decline, neuromotor impairment, myoclonus, vegetative state and death within 1-3 years of diagnosis, although prolonged stabilization and spontaneous resolution have been reported in a minority of patients. Despite global efforts towards measles elimination, SSPE remains a challenging problem in the low- and middle-income countries (LMICs) due to inadequate vaccine coverage. Limited health infrastructure, suboptimal surveillance, and limited availability of diagnostic tests hinders early diagnosis and management making SSPE a public health crisis. The measles outbreaks in high-income countries with developed vaccination programs are commonly due to international travel, immigration, and vaccine hesitancy, making it a global problem. The lack of effective antiviral therapy makes supportive and palliative care the primary management strategy once SSPE is confirmed. Recent research highlights potential therapeutic strategies, novel molecular approaches targeting mutant measles viruses, and enhanced public health measures to contain the outbreaks. However, these remain largely inaccessible in LMICs with measles endemicity and the high disease burden of SSPE. Urgent action is needed to bridge this gap by strengthening vaccination programs, implementing early diagnostic strategies, and enhancing access to emerging treatments. The current review discusses the various aspects of SSPE and the importance of preventive strategies for SSPE as relevant to LMIC. Without holistic efforts and a multi-pronged approach to eliminate measles and prevent SSPE, the disease shall remain a global threat.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101207"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679908","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":"Pediatric Zika virus: The virus and its neurologic impact","authors":"Diego A. Cruz-Vidal ,&nbsp;Ana M. Cabal-Herrera ,&nbsp;Christian A. Rojas","doi":"10.1016/j.spen.2025.101209","DOIUrl":"10.1016/j.spen.2025.101209","url":null,"abstract":"<div><div>The Zika virus (ZIKV) is a mosquito-borne flavivirus, transmitted by the genus <em>Aedes</em>, and is prevalent in tropical areas. It co-exists and shares a vector with other flaviviruses, such as the dengue virus. Its infection usually leads to a febrile illness undistinguishable of other viruses. Zika virus raised to prominence during an epidemic in the Americas during 2015 and 2016, as the increase in cases coincided with an increase in neonates born with severe microcephaly. This led to the description of congenital Zika syndrome and the establishment of the potential for ZIKV to cause congenital defects and long term neurodevelopmental adverse outcomes.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101209"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679903","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":"Chikungunya virus infection: A scoping review highlighting pediatric systemic and neurologic complications","authors":"Rosana Huerta Albarrán ,&nbsp;Amanda Weber ,&nbsp;Martha Avilés Robles ,&nbsp;Juan Pablo Appendino","doi":"10.1016/j.spen.2025.101213","DOIUrl":"10.1016/j.spen.2025.101213","url":null,"abstract":"<div><div>Chikungunya virus (CHIKV), a mosquito-borne alphavirus, has emerged as a significant global health concern, particularly due to its neurological complications in pediatric populations. This scope review summarizes current understanding of CHIKV virology, epidemiology, transmission dynamics, and clinical manifestations, with an emphasis on neurologic sequelae in neonates and children. We explore the mechanisms of neuroinvasion, describe central and peripheral nervous system involvement, and outline diagnostic strategies and therapeutic approaches. Although supportive care remains the mainstay of management, novel antiviral agents and vaccines are under active investigation. Understanding age-specific presentations and long-term outcomes is essential to mitigate the impact of this neurotropic virus.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101213"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679905","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":"Cerebral malaria","authors":"Douglas G. Postels ,&nbsp;Thembi Katangwe-Chirwa","doi":"10.1016/j.spen.2025.101206","DOIUrl":"10.1016/j.spen.2025.101206","url":null,"abstract":"<div><div>Cerebral malaria is the most lethal form of <em>Plasmodium falciparum</em> infection. The disease is defined clinically as an otherwise unexplained coma in someone with malaria parasitemia. One in 6 children with cerebral malaria dies and many survivors are left with neurologic, cognitive, or behavioral sequelae. Acute seizures are common and increasing numbers of them during the index illness are associated with a greater likelihood of adverse outcomes. Optimal treatment pathways for children with cerebral malaria have been standardized but the search for an adjunctive therapy that decreases cerebral malaria mortality or morbidity has, so far, remained elusive. After hospital discharge, care gaps for survivors continue in the diagnosis and management of educational challenges, behavioral abnormalities, and epilepsy, especially in the rural settings where malaria incidence is highest. In the past decade, science has elucidated much about cerebral malaria pathogenesis. Observational studies using magnetic resonance imaging, electroencephalogram, and transcranial doppler have all provided insight on the pathway from the initial infection transmitted by a mosquito, to death. Findings from each of these high technology modalities are also associated with outcomes in children with cerebral malaria. We review the epidemiology, clinical features, diagnostic considerations, optimal clinical care pathways, neurological sequalae, and existing care gaps in the management of cerebral malaria and its complications.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101206"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679901","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":"Neurological disorders related to pediatric dengue infection","authors":"Manuel Vides-Rosales ,&nbsp;Diego Vides-Tesorero ,&nbsp;Jaime Twanow","doi":"10.1016/j.spen.2025.101210","DOIUrl":"10.1016/j.spen.2025.101210","url":null,"abstract":"<div><div>In the last decade, Dengue virus has become a major public health concern, with increasing numbers of infections, hospitalizations, and deaths worldwide. The Aedes mosquito vector’s migration, aided by adaptation to climate change has allowed Dengue virus to spread into temperate regions. The major impact of the disease occurs in regions with limited resources, creating a significant burden for these countries. There is a growing body of information characterizing the neurological disorders related to pediatric Dengue infection. In addition to reviewing Dengue virus structure, disease diagnostic criteria and current WHO guidelines, this article discusses the neuropathogenic mechanisms of infection, and the resultant impact on the central and peripheral nervous systems. Our group has created a framework correlating the presentation of neurologic disorders to Dengue virus phases of infection. There is an urgent need for epidemiological analysis and a systematic approach to catalogue the emerging reports of pediatric neurological disorders related to dengue virus infection. We propose that key regional and professional stakeholders could foster educational advances and improve preventative, diagnostic and therapeutic care of pediatric patients impacted by Dengue virus.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101210"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679904","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":"Exploring the burden of West Nile Virus in resource limited regions: Challenges and implications for pediatric neurology","authors":"Alcy Torres ,&nbsp;Irving Zhao ,&nbsp;Jombo Namushi ,&nbsp;Gwen Kandawasvika","doi":"10.1016/j.spen.2025.101208","DOIUrl":"10.1016/j.spen.2025.101208","url":null,"abstract":"<div><div>West Nile Virus (WNV) is a vector-borne pathogen that poses significant public health challenges worldwide, particularly in regions with limited resources. While the virus is endemic in many parts of the globe, its impact on low-income countries remains disproportionately high due to inadequate healthcare infrastructure, limited surveillance systems, and lack of public health awareness.</div><div>This article explores the burden of WNV in these resource-constrained regions, focusing on the epidemiology, socio-economic consequences, and healthcare challenges faced by affected populations. It discusses the multifactorial factors contributing to the spread of WNV, including climate change, urbanization, and weak mosquito control measures.</div><div>Additionally, the article examines the implications for healthcare systems, such as the overwhelming demand for medical resources, limited diagnostic capacity, and gaps in effective treatment and prevention strategies. The article emphasizes the need for enhanced surveillance, early detection systems, and integrated public health strategies tailored to low-resource settings. It also calls for international collaboration and funding to improve research, prevention, and response mechanisms in these vulnerable regions.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101208"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679906","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":"Viral and parasitic infections of the nervous system: Impact on resource-limited healthcare systems and suggestions on how to address them","authors":"Jorge Vidaurre ,&nbsp;Pedro Weisleder","doi":"10.1016/j.spen.2025.101201","DOIUrl":"10.1016/j.spen.2025.101201","url":null,"abstract":"<div><div>Affecting every country to some degree, disparities in healthcare access are a global challenge. Healthcare systems in low- and middle-income countries (LMICs) are, however, particularly fragile and more vulnerable to the unpredictable demands that arise from both natural and man-made disasters. Resource availability in the healthcare systems of LMICs is often inconsistent and, in many cases, insufficient to meet the needs of the local population. One major health concern in LMICs is the high burden of parasitic and viral infections of the nervous system, illnesses that cause significant morbidity and mortality. Over the past 50 years, several LMICs in tropical and subtropical regions have experienced an emergence, re-emergence, or upswing in arthropod-borne viral diseases such as dengue, chikungunya, and Zika. Herein we propose a series of practical and universally applicable solutions aimed at both reducing healthcare demand and strengthening at-risk healthcare systems in LMICs.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101201"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679902","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":"Pediatric Neurocysticercosis. Burden of pediatric neurological disorders in resource-limited regions","authors":"Bolivar Quito-Betancourt ,&nbsp;Monica Cajas-Palomino ,&nbsp;Manuel Vides-Tesorero ,&nbsp;Arturo Carpio","doi":"10.1016/j.spen.2025.101211","DOIUrl":"10.1016/j.spen.2025.101211","url":null,"abstract":"<div><div>Neurocysticercosis (NCC) is caused by the parasitic tapeworm Taenia solium, which frequently infects the central nervous system of children and adults. Diagnosis involves a thorough medical history, with an emphasis on the epidemiological conditions of the affected individuals. Understanding the parasite's life cycle and the host's immune response is for a deeper comprehension of their mutual interaction. The most common clinical manifestations include seizures, headaches, increased intracranial pressure, cranial nerve involvement, cognitive dysfunction, radicular and spinal compression symptoms, and ultimately, vision loss, depending on the locations of the lesions. It is essential to know the neuroradiological findings and how they can correlate with the viability and evolutionary stages of the parasite. Since seizures are noted as the most prevalent symptom in the pediatric population, it is crucial to understand how to manage them and the associated symptoms, such as inflammation and other complications. When appropriate, conducting immunological tests and utilizing molecular assays are vital to determine the specificity and sensitivity of these methods in aiding the diagnosis of NCC, especially when neuroimaging results are inconclusive. NCC is classified as active, transitional, or inactive to guide the selection of appropriate treatment options, including antiseizure medications, antiparasitic drugs, anti-inflammatory medications, and surgery when necessary. This document also aims to explore the differences in the natural history of this condition in pediatric populations compared to adults. Prevention and education are the most effective strategies for combating this infection, particularly in underdeveloped areas.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"54 ","pages":"Article 101211"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679910","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":"Neuro-ophthalmic sequelae of pediatric brain tumors","authors":"Evguenia Ivakhnitskaia ,&nbsp;Dhristie Bhagat","doi":"10.1016/j.spen.2025.101182","DOIUrl":"10.1016/j.spen.2025.101182","url":null,"abstract":"<div><div>Brain tumors are a leading cause of mortality and morbidity in the pediatric population. Neuro-ophthalmic symptoms can be a consequence of the disease process, as well as a feature of long-term complications from treatment. Compressive lesions of the visual pathway lead to changes in visual acuity and field defects. Double vision and strabismus can be some of the earliest clues of underlying posterior fossa tumors, which frequently cause hydrocephalus and manifest as optic nerve edema on neuro-ophthalmic examination due to increased intracranial pressure. Persistent complaints of blurry vision in combination with nonspecific neurologic concerns warrant ophthalmoscopy to appreciate optic nerve appearance and magnetic resonance imaging as the earliest steps in the investigation of possible compressive or infiltrative malignancies. In many cases, treatment of pediatric brain tumors relies on maximal surgical resection and radiation, which can have permanent consequences not only affecting the patients’ visual function but also their neurologic development. This review will summarize the neuro-ophthalmic presentations and consequences of pediatric tumors affecting the brain, highlighting classic neuro-ophthalmic correlates and describing the known sequelae of tumor progression or treatment.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"53 ","pages":"Article 101182"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808347","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":"Epilepsy in patients with pediatric brain tumors: Etiology, treatment & management","authors":"Anna Ku,&nbsp;Abdolreza Esfahanizadeh","doi":"10.1016/j.spen.2025.101187","DOIUrl":"10.1016/j.spen.2025.101187","url":null,"abstract":"<div><div>Central nervous system (CNS) tumors are the most common solid tumor type seen in the pediatric population and may present with a variety of neurological presentations, with seizure being the second most common. Supratentorial tumors commonly associated with seizures include low-grade gliomas such as pilocytic astrocytoma, subependymal giant cell astrocytoma (SEGA), gangliogliomas, and dysembryoplastic neuroepithelial tumors (DNET).</div><div>The etiology of seizures in pediatric brain tumor patients is often multifactorial, often the result of multimodal therapy and possible contributions from surgery, radiation therapy, chemotherapy, and other metabolic disturbances. Seizures can also be secondary to mass effect, hydrocephalus, or metastases. Additionally, tumor characteristics including its location in the temporal lobe, the presence of mixed neuronal and glial components, and the tumor's size and growth rate influence the likelihood of seizures.</div><div>Pediatric patients with a first lifetime unprovoked seizure should undergo further testing including electroencephalogram (EEG). MRI imaging is not warranted in all cases but should be strongly considered for children with focal presentation or EEG finding to identify possibly secondary causes such as brain tumors. The EEG can identify background activity alterations, epileptiform activity, and/or seizure activity, but sensitivity and specificity are limited and therefore, should be used in conjunction with neuroimaging like an MRI for a comprehensive evaluation.</div><div>Anti-seizure medication (ASM) is not recommended to be started in patients with a brain tumor without seizures, but rather only in patients that were identified with brain tumor who presented with seizures. ASM choices are influenced by patient's co-morbidities, drug interactions with chemotherapy, and the patient's tolerance to potential adverse drug reactions. With its limited drug-drug interactions, the most commonly used ASM is levetiracetam. Ultimately, gross total resection of the tumor if feasible is often favored for both diagnostic and therapeutic benefits, as well as seizure control.</div></div>","PeriodicalId":49284,"journal":{"name":"Seminars in Pediatric Neurology","volume":"53 ","pages":"Article 101187"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808414","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}