Developmental Medicine and Child Neurology最新文献

{"title":"The AI-augmented clinician: Are we ready?","authors":"Bernard Dan","doi":"10.1111/dmcn.16291","DOIUrl":"10.1111/dmcn.16291","url":null,"abstract":"<p>Artificial intelligence (AI) will soon become indispensable across many aspects of health care and across all disciplines. A growing body of research suggests that AI-driven analysis of complex data sets has the potential to enhance diagnostics, optimize management strategies, and improve outcome measurement, ultimately enabling more personalized care.<span><sup>1-3</sup></span> The outlook in the literature has so far largely been optimistic, often describing AI's progress as ‘promising’, although several risks have been highlighted. One major concern is the potential decline in clinical competence if clinicians rely too heavily on AI at the expense of hands-on clinical observation and reasoning. Another significant challenge is the phenomenon known as AI ‘hallucinations’, where AI-generated information appears credible but is, in fact, incorrect or nonsensical. This issue is particularly concerning if clinicians fail to verify AI outputs thoroughly against established clinical guidelines and their own expertise. Similar considerations apply to research and academic publication, which AI is also transforming, while the principles of integrity and human responsibility and accountability remain paramount.<span><sup>4</sup></span></p><p>The anticipated evolution of health care envisions a collaborative model in which human expertise and AI-driven technology work in tandem for the benefit of patients. The prevailing assumption is that AI will empower health care professionals to deliver more accurate, efficient, and personalized care; while human judgment, empathy, and ethical decision-making will continue to play a crucial role in ensuring that technology serves patients effectively. It is widely hypothesized that AI will perform many tasks more efficiently and accurately than unaided humans, yet human decision-making, when informed by AI, is ultimately more reliable and relevant than either alone. Studies using various methodologies have confirmed the first hypothesis, demonstrating that AI technologies can surpass health professionals in certain tasks, including diagnosing complex clinical cases. However, multiple studies have documented that AI alone can significantly outperform clinicians who use AI-assisted tools. For instance, a recent randomized clinical trial examined physicians' diagnostic reasoning on challenging cases, comparing those who used conventional diagnostic resources alone versus those who supplemented their approach with a large language model chatbot (a machine-learning model designed to understand and generate human-like text).<span><sup>5</sup></span> Regardless of the physicians' level of training and experience, AI alone significantly outperformed those using AI as an adjunct.</p><p>These findings should not be interpreted as a call for AI to function autonomously in diagnosis without physician oversight. Instead, they may reflect how clinicians interact with AI tools. Large language models are highly sensitive to user","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 5","pages":"554-555"},"PeriodicalIF":3.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functioning and activity outcomes of the Akwenda Intervention Program for children and young adults with cerebral palsy in Uganda: A cluster-randomized trial","authors":"","doi":"10.1111/dmcn.16290","DOIUrl":"10.1111/dmcn.16290","url":null,"abstract":"<p>This study looked at whether the Akwenda Intervention Program, specially developed for low-resource settings, could help children and young adults with cerebral palsy (CP) do better in their daily activities.</p><p>The study involved 100 children and young adults, ages 2 to 23 years, from rural Eastern Uganda. Half of them took part in the Akwenda Intervention Program, while the other half waited without the program. Researchers used two tools to measure how the children were doing before and after the program, looking at things like movement, mobility, self-care skills, and social interaction.</p><p>The children who participated in the program showed bigger improvements compared to the group that did not. They got better at interacting with others, taking care of themselves, and performing basic physical movements. The biggest improvement was seen in how much help they needed from caregivers, meaning they became more independent.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e95"},"PeriodicalIF":3.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and effectiveness of stiripentol in patients with Dravet syndrome: A prospective, 3-year, postmarketing surveillance study","authors":"","doi":"10.1111/dmcn.16285","DOIUrl":"10.1111/dmcn.16285","url":null,"abstract":"<p>To conduct a postmarketing surveillance study of patients with Dravet syndrome in Japan to investigate the safety and effectiveness of long-term, real-world, clinical use of stiripentol (STP), an oral antiseizure medication. Dravet syndrome, one of the epilepsy syndromes most resistant to treatment,¹ is characterized by disease onset in the first year of life and repeated episodes of seizures. Developmental delay and ataxia (poor muscle control causing clumsy movements) emerge after the first year of life.</p><p>This prospective study was conducted over 156 weeks in all patients with Dravet syndrome who started STP treatment from its launch in Japan in November 2012 until August 2017. Adverse drug reactions (ADRs) were investigated by degree of seriousness. Effectiveness was determined based on a comprehensive assessment by the physician in charge as well as on the percent change in the number of seizures from the pretreatment period.</p><p>In total, 520 patients (266 males/254 females; mean age 10 years 6 months; age range 0–50 years) were included in the safety analysis set (all patients taking one dose of the study drug), and 515 patients in the effectiveness analysis set (that compares the costs and effects of alternative health interventions). ADRs occurred in 69.2%, including somnolence (strong desire for sleep or sleeping for unusually long periods), decreased appetite, dizziness, in order of frequency. Twelve deaths occurred, the rate of which was not higher than the reported rates. No new safety concerns were identified. The rate of overall improvement (marked or moderate) after 156 weeks or at treatment discontinuation was 37.7%. Decreases in the number of all seizure types over the long term were confirmed.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e92"},"PeriodicalIF":3.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of epilepsy following neonatal seizures","authors":"","doi":"10.1111/dmcn.16288","DOIUrl":"10.1111/dmcn.16288","url":null,"abstract":"<p>One of the most frequent acute neurological conditions among infants admitted to a neonatal intensive care unit is seizures. Seizures in the neonatal period can be caused by many different conditions, such as lack of oxygen to the brain before, during, and right after birth (asphyxia); cerebral stroke; or cerebral infection. A frequent question asked by parents after the seizures have ceased is whether they will return at some point during childhood.</p><p>In this study we examine the risk of epilepsy among children with neonatal seizures compared to children who have not had seizures during neonatal life, and we examine whether the risk of epilepsy differs between conditions known to cause seizures in the neonatal period. The study is based on registry data including all children born in Denmark between 1997 and 2018. We followed a total of 1 294 377 children of whom 1998 have had seizures in the neonatal period. Follow-up period was 22 years.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e93"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing epilepsy diagnostic and treatment gaps: Standardized paediatric epilepsy training courses for health care professionals","authors":"","doi":"10.1111/dmcn.16284","DOIUrl":"10.1111/dmcn.16284","url":null,"abstract":"<p>Epilepsy is the most common serious chronic childhood neurological disorder, with 80% of individuals living with epilepsy in low- and middle-income countries.</p><p>Since 2005, Paediatric Epilepsy Training (PET) courses have been taught by the British Paediatric Neurology Association (BPNA), a charitable organization of neurologists, paediatricians, and allied health care professionals. The courses aim to improve the diagnosis and management of children with epilepsy. They have been taught internationally since 2012 in 17 countries across five continents. From 2005 until September 2021, over 14 000 participants attended PET courses.</p><p>PET1 is an entry level course for all health care professionals who look after children with suspected epilepsy. Course participants are primarily paediatricians, medical officers, or specialist nurses. It is a one-day course with a standardized curriculum that teaches evidence-based best practice.</p><p>Course evaluation is an integral component of PET1. This study reports the findings, using a well-established evaluation framework, of 250 PET1 courses delivered in 17 countries over 15 years. Data were gathered from participants immediately after the course and then 6 months later.</p><p>Ninety-eight per cent of participants reported that the PET course improved their clinical practice. For example, over 70% of responders reported improvements in both their ability to take a thorough medical history and their ability to distinguish between epileptic and non-epileptic seizures, which require very different treatment plans. Sixty-four per cent of participants reported that the PET course prompted improvements beyond their personal practice and into their wider clinical service. These included improved management of prolonged seizures and starting dedicated epilepsy clinics. Improvements in knowledge and clinical practice were most notable in low-resource settings.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e91"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of cortical activity, functional connectivity, and neuroplasticity in cerebral palsy using functional near-infrared spectroscopy: A scoping review","authors":"","doi":"10.1111/dmcn.16286","DOIUrl":"10.1111/dmcn.16286","url":null,"abstract":"<p>Cerebral palsy (CP) is caused by an early brain injury and can lead to lifelong movement challenges. Understanding brain function in CP is important for designing effective treatments, but traditional brain imaging methods are costly, require children to stay still, and cannot measure brain activity during real-world tasks.</p><p>This review examined how functional near-infrared spectroscopy (fNIRS), an innovative tool that uses light to measure brain activity, contributes to understanding brain function in individuals with CP. Unlike conventional imaging, fNIRS is child-friendly, portable, and affordable, making it ideal for studying brain activity in everyday settings. Sixteen studies that used fNIRS in children and adults with CP aged 3 to 43 years were analyzed.</p><p>Key findings included: (1) Brain activity in individuals with CP is different from typically developing peers, even during simple movements. (2) Higher activity in motor regions of the brain often reflect more severe movement difficulties. (3) Therapy-induced changes in brain activity are frequently linked to functional improvements.</p><p>Despite its benefits, fNIRS has limitations. It cannot assess brain structure or activity of the deeper regions of the brain, and data collection can be challenging for individuals with darker skin tones or thick hair. Other challenges include small study sizes, inconsistent research methods, uncertain reliability, and underrepresentation of individuals with severe CP, making comparisons with other studies difficult.</p><p>The authors recommend larger, standardized studies that involve families in study planning and design, and include individuals with severe CP. They also suggest using fNIRS to study brain activity during real-world tasks (such as playing or walking in everyday settings at home or in therapy clinics) to address practical challenges and reflect the needs of people living with CP.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 5","pages":"e96"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating uncertainty following paediatric disorders of consciousness.","authors":"Lorna Wales","doi":"10.1111/dmcn.16280","DOIUrl":"https://doi.org/10.1111/dmcn.16280","url":null,"abstract":"","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gross Motor Family Report: Refinement and evaluation of psychometric properties","authors":"","doi":"10.1111/dmcn.16270","DOIUrl":"10.1111/dmcn.16270","url":null,"abstract":"<p>The Gross Motor Family Report (GM-FR) is a new way for families in their own homes and communities to tell us about what their children with cerebral palsy (CP) can do to move around in their everyday life. Doctors and therapists have usually looked at what <i>they</i> thought was important about the motor skills of young people with CP. This new study set out to ask different questions. We wanted to hear the opinion of <i>families</i> about what is important for doctors and therapists to know about what their children can do.</p><p>Once the new measure was created, we needed to test its usefulness with parents of children and adolescents with CP. Twelve families shared their opinions with the researchers. Their ideas and advice helped us make changes in the GM-FR. We added a new scoring system, pictures of children doing the activities, and descriptions of what we were interested in. The result was the creation of the GM-FR, with 28 items. After that, 146 families scored the GM-FR v.2.0, and we calculated how accurate the measure was. Then, 46 parents scored the measure twice within 7 to 30 days. Through this, we learned that the two measures showed similar results.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e87-e88"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gross Motor Function Measure-66 Item Sets for use with infants and toddlers at high risk for cerebral palsy: Construct validity and responsiveness","authors":"","doi":"10.1111/dmcn.16289","DOIUrl":"10.1111/dmcn.16289","url":null,"abstract":"<p>There is a critical need to develop, evaluate, deliver, and monitor response to quality interventions designed for young children with cerebral palsy (CP). To do so requires measures of children's gross motor skills (movement involving the whole body such as walking, running, jumping, and hopping) that are accurate, reliable, and practically feasible. One such promising tool is the Gross Motor Function Measure-66 Item Sets (GMFM-66-IS), but this tool has not been sufficiently evaluated for use with very young children with CP. The GMFM measures how much of a task the child can do versus how well the child performs the task.</p><p>The purpose of this non-experimental study was to examine the accuracy of the GMFM-66-IS in evaluating the gross motor skills of children less than 24 months of age who have or are at high risk for CP. Non-experimental studies take place in real-life settings, where the researchers cannot control all possible variables. Analyses were based on existing data from three clinical trials of children with or at high risk for CP (79 infants and toddlers) and one observational study of typically developing children (32 infants). Children's gross motor skills were measured at two timepoints, 3 months apart.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e94"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Movements Assessment and Hammersmith Infant Neurological Examination for early diagnosis of cerebral palsy in infants born at term treated with therapeutic hypothermia.","authors":"Sara N Moss, Jennifer C Keene, Sarah L Winter, Mariana Baserga, Lauren Ayala, Wendy G Evans, Betsy E Ostrander","doi":"10.1111/dmcn.16277","DOIUrl":"https://doi.org/10.1111/dmcn.16277","url":null,"abstract":"<p><strong>Aim: </strong>To establish if the General Movements Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) support the early diagnosis of cerebral palsy (CP) in a cohort of infants who have undergone therapeutic hypothermia.</p><p><strong>Method: </strong>This was a retrospective cohort study from a large single center between 2018 and 2022. Sample size included surviving 112 infants with follow-up (68 males, 44 females) with a mean gestational age of 39 weeks (interquartile range 38-40), diagnosed with moderate or severe neonatal encephalopathy who underwent therapeutic hypothermia. Groups were compared using Fisher's exact and Mann-Whitney U tests.</p><p><strong>Results: </strong>The absence of normal fidgety movements at the 3-month GMA was highly associated with CP (p < 0.001, sensitivity 89%, specificity 89%). HINE scores were associated with CP at 3 months, 6 months, and 9 months (p < 0.001; sensitivity 82%-90%, specificity 95%-100%). The HINE scores, which optimally differentiated those with and without CP, were less than 47 at 3 months, less than 51 at 6 months, and less than 64 at the 9-month follow-up.</p><p><strong>Interpretation: </strong>The GMA and HINE were predictive of CP in infants born at term with neonatal encephalopathy who had undergone therapeutic hypothermia. Atypical (absent or abnormal) fidgety movements on the GMA at 3 months and the HINE score at 3 months, 6 months, and 9 months were all highly associated with CP diagnosis with more than 80% sensitivity and more than 90% specificity. The optimal HINE cutoff score for predicting CP may differ from infants born preterm and will benefit from further analysis.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}