Annals of the Child Neurology Society最新文献

{"title":"Influenza-Associated Encephalopathy","authors":"Andrew Silverman,&nbsp;Chrisoula Cheronis","doi":"10.1002/cns3.70010","DOIUrl":"https://doi.org/10.1002/cns3.70010","url":null,"abstract":"<p>This previously healthy and vaccinated (except for the seasonal influenza vaccine) 12-year-old boy developed acute neurological symptoms following 3 days of fever and gastrointestinal distress. His symptoms progressed from headache and transient left-arm paresthesias to expressive aphasia, prompting emergency evaluation. He was febrile, tachycardic, and hypertensive on arrival, with fluctuating neurological deficits. Serum investigations, including blood counts, glucose, metabolic panel, urine toxicology, and anti-MOG, were normal. Influenza B was detected via nasopharyngeal swab. Magnetic resonance imaging/magnetic resonance angiography revealed confluent white matter signal changes with restricted diffusion (Figure 1) with normal vessels, consistent with an infection-triggered encephalopathy syndrome, specifically mild encephalopathy with a reversible splenial lesion (MERS) [<span>2</span>]. The patient's rapid clinical improvement within 24 h without treatment supported a diagnosis of influenza-associated encephalopathy (IAE), for which neuroimaging is paramount. Diffusion restriction was thought to be related to intramyelinic edema and/or inflammatory infiltrate, comparable to prior reports [<span>1, 3</span>]. At 3-month follow-up, he remained neurologically intact, had returned to age-appropriate schooling, and had normal repeat imaging. IAE is a rare but severe complication of influenza; the pathogenesis is not fully understood but is believed to involve dysregulated host inflammatory response to influenza, leading to varying degrees of brain dysfunction and inflammation [<span>4, 5</span>]. This patient with MERS with focal neurological deficits and extensive white matter involvement illustrates the variable presentation and rapid reversibility of IAE in some individuals. In contrast, more severe types of IAE require immediate neuroprotective measures in intensive care and prompt immunotherapy (namely, acute necrotizing encephalopathy) [<span>2, 6</span>]. Given the significant proportion of pediatric influenza-associated deaths involving IAE in the 2024-25 influenza season, prevention strategies, including seasonal influenza vaccination, remain critical [<span>7, 8</span>].</p><p><b>Andrew Silverman:</b> conceptualization, investigation, visualization, writing – review and editing, writing – original draft. <b>Chrisoula Cheronis:</b> conceptualization, visualization, writing – review and editing, writing – original draft, investigation.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 3","pages":"247-248"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom Onset in Classic Rett Syndrome: Analysis of Initial Clinical Severity Scale Entries","authors":"Alan K. Percy,&nbsp;Jeffrey L. Neul,&nbsp;Amitha Ananth,&nbsp;Timothy A. Benke,&nbsp;Eric D. Marsh","doi":"10.1002/cns3.70017","DOIUrl":"10.1002/cns3.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aim to assess the clinical features of Rett syndrome (RTT) at registration into the National Institutes of Health–sponsored natural history study (NHS) using the Clinical Severity Scale (CSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The CSS was established in 2000 to assess characteristics of individuals with RTT and related disorders. We analyzed the CSS at enrollment into the NHS of all individuals with classic RTT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The CSS of 1258 individuals was used to examine three historical items (age at regression, age at onset of hand stereotypies, and head growth) and 10 clinical features at initial enrollment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among historical items, age at regression was most prominent after age 12 months with 8% regressing before this, hand stereotypies were most common after 18 months with 30% occurring before, and head growth was substantially lower overall. Hand use, ambulation, and communication skills were reduced in most individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>These findings reflect core clinical criteria for classic RTT and mirror the top concerns registered independently by parents or caregivers. The CSS is an important analytic tool for the association of relative differences in clinical outcome with specific <i>MECP2</i> variant groups and has been important in establishing entrance criteria in RTT clinical trials. The range of age-specific CSS features will continue to inform the RTT natural natural history as well as provide stratification and selection in future clinical trials, especially those involving younger participants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 3","pages":"152-157"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manganese Neurotoxicity and Familial Disorders of Manganese Transport","authors":"Sidney M. Gospe Jr.","doi":"10.1002/cns3.70015","DOIUrl":"https://doi.org/10.1002/cns3.70015","url":null,"abstract":"<p>Manganese is the 12th most common element in the Earth's crust and is an essential industrial component. Biologically, this metal plays an important role as a constituent of numerous enzymes. While manganese is required for normal biochemical and physiological processes, manganese excess can lead to significant toxicity, particularly to the central nervous system. Over the past 25 years, three inherited disorders of manganese transport have been described, leading to a model of how this essential metal is absorbed, distributed to tissues, and eliminated. The first part of this review describes the clinical features and cellular mechanisms of manganese toxicity due to occupational and environmental exposure. The remainder of the review discusses the familial disorder associated with hypomagnesemia, SLC39A8 deficiency, and the two genetic diseases resulting in hypermanganesemia, SLC30A10 deficiency and SLC39A14 deficiency. These latter two disorders are treatable, and the early recognition and institution of chelation therapy and iron supplementation can improve neurological disability. Ongoing research regarding the tissue-specific role of each transporter and their regulatory interplay, the varied mechanisms of manganese toxicity, and its treatment are also described.</p>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 3","pages":"135-144"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy of Infancy With Migrating Focal Seizures","authors":"Samuel Kamoroff,&nbsp;Harry Abram,&nbsp;Fernando Galan","doi":"10.1002/cns3.70014","DOIUrl":"https://doi.org/10.1002/cns3.70014","url":null,"abstract":"<p>This 3-month-old boy had frequent recurrent events of right-arm stiffening and right head turn suggestive of focal seizures. Continuous electroencephalogram (EEG) showed subclinical focal seizures arising independently from the right occipital and left posterior head regions. These events persisted despite escalating use of lacosamide, levetiracetam, and phenobarbital. Given the patient's age, epilepsy of infancy with migrating focal seizures (EIMFS) was suspected. Early investigation with whole-exome sequencing revealed homozygous pathogenic variants in <i>SLC12A5</i> (c.986C &gt; A, p.Ala329Asp). Early recognition is vital in this epilepsy syndrome due to the difficulty in treating and subsequent prognosis. Given the expected drug resistance, early or urgent initiation of the ketogenic diet should be considered. The overall prognosis is not favorable, as poor developmental outcomes are expected.</p><p>EIMFS is a severe infantile-onset epilepsy syndrome characterized by refractory seizures, developmental delay, and migrating focal discharges [<span>1</span>]. <i>SLC12A5</i> mutations have been identified as a cause of EIMFS, with nine patients reported to date, but <i>KCNT1</i> remains responsible for about 50% of cases [<span>2</span>] (Figure 1). <i>SLC12A5</i> encodes the potassium-chloride cotransporter KCC2, which is crucial for maintaining synaptic inhibition [<span>3</span>]. Mutations in <i>SLC12A5</i> lead to decreased KCC2 surface expression, impaired chloride extrusion, and reduced protein glycosylation, resulting in neuronal hyperexcitability [<span>3</span>]. EIMFS typically presents before 6 months of age with focal motor seizures that become multifocal and intractable [<span>2</span>]. Treatment options are limited, but the ketogenic diet and potassium bromide have shown potential efficacy [<span>2</span>]. <i>SLC12A5</i>-related EIMFS is inherited in an autosomal recessive manner, with both de novo and inherited mutations reported [<span>4</span>].</p><p><b>Samuel Kamoroff:</b> conceptualization, writing – original draft, writing – review and editing, data curation. <b>Harry Abram:</b> writing – review and editing, data curation, supervision. <b>Fernando Galan:</b> conceptualization, writing – review and editing, data curation, supervision.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":"125-126"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child Neurology Workforce Shortage: Challenges and Recommendations for Researching and Recruiting the Next Generation of Child Neurologists","authors":"Sara A. Rubin,&nbsp;Peter E. Davis,&nbsp;Miya E. Bernson-Leung","doi":"10.1002/cns3.70011","DOIUrl":"https://doi.org/10.1002/cns3.70011","url":null,"abstract":"<p>For subspecialities like child neurology in which demand is predicted to increase and further exceed supply, understanding what attracts individuals to the field and deters individuals from it is particularly valuable. To explore this, we recently surveyed medical students and residents who had completed child neurology clerkships at US medical schools within the last approximately 7 years to investigate the antecedent factors that led to interest in these clerkships and the factors that subsequently impacted residency choice, child neurology or otherwise. Current child neurology and neurodevelopmental disabilities residents (postgraduate years [PGY] 1 through 5) and current medical students who completed at least one child neurology clerkship at a US medical institution were invited to complete an online survey through their residency program coordinators/directors or clerkship coordinators/directors. While our 38 respondents gave us useful insights, our difficulty reaching a larger sample of the population of interest (likely ~1000−5000 individuals) highlights several barriers to conducting workforce research. Here, we share relevant literature and our observations on the pipeline for careers in child neurology, current research challenges, and potential paths forward.</p><p>Early exposure to child neurology is critical for sparking interest in the field. Although studies have used different definitions of “early,” frequently referring to college and medical school [<span>1</span>], it is becoming more apparent that no exposure is too early for igniting interest. In our study, the most common timeframe for initial exposure to neurology was during college at 39%; however, exposure in high school or earlier was almost equally as common (37%). Popular media such as books by Oliver Sacks and fictional characters like Sherlock Holmes have been cited in residency personal statements as motivating interest in neurology [<span>2</span>]. These exposures along with chance encounters with neurologists through personal or family experience with neurological conditions, pediatric or otherwise, appear to be relevant when medical students are planning their career paths. It remains to be explored whether the specific exposure (pediatric, e.g., a sibling with autism, or adult, e.g., a grandparent with Alzheimer's disease) influences whether one decides to go into child neurology or adult neurology, especially given the lack of awareness among premedical and medical students that child neurology is its own specialty. Studying these types of “early” exposures could be fruitful for understanding how early lifeexperiences influence motivation to enter medicine and eventual specialty choice.</p><p>Undergraduate neuroscience courses are another crucial early exposure to the field. At present, there are inequities in access to such courses, which has implications for recruiting a diverse workforce [<span>3</span>]. In our survey, 24% of participants indicated tha","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":"68-70"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fenfluramine: An Uncommon Cause of False Positive Urine Drug Testing: A Case Report","authors":"Maria Ghawji,&nbsp;Meagan Hainlen,&nbsp;Charuta Joshi","doi":"10.1002/cns3.70012","DOIUrl":"https://doi.org/10.1002/cns3.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fenfluramine is an antiseizure medication approved by the Food and Drug Administration for the treatment of Dravet syndrome in patients older than 2 years. Fenfluramine is an amphetamine derivative. It cross-reacts with amphetamines in urine drug screen immunoassays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient Presentation</h3>\u0000 \u0000 <p>A 2-year-old patient with Dravet syndrome had a cardiorespiratory arrest and tested positive for amphetamines in a urine drug screen, raising concerns of child abuse. Liquid chromatography–mass spectrometry confirmed the presence of fenfluramine but did not detect amphetamines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fenfluramine can result in a false-positive amphetamine urine drug screen at the recommended dose for Dravet syndrome. Awareness of this potential cross-reactivity can prevent undue child protective services reports, especially in patients at high risk for sudden death.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":"121-124"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing FIRES Treatment: The Potential of Intrathecal Dexamethasone","authors":"Carol Park,&nbsp;Douglas R. Nordli III,&nbsp;Mohamed Taha,&nbsp;Henry David,&nbsp;Shawn Kacker,&nbsp;Tareq Kass-Hout,&nbsp;Sonam Thind,&nbsp;Aurelie Hanin,&nbsp;Sana Said,&nbsp;Hiba A. Haider,&nbsp;Douglas R. Nordli Jr.","doi":"10.1002/cns3.70008","DOIUrl":"https://doi.org/10.1002/cns3.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Febrile infection-related epilepsy syndrome (FIRES) is a rare, devastating epilepsy syndrome characterized by refractory status epilepticus following a febrile illness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient Description</h3>\u0000 \u0000 <p>We describe a 12-year-old girl with FIRES who exhibited a remarkable clinical and electrographic response to intrathecal dexamethasone (IT-DEX) after failing multiple antiseizure and immunomodulatory therapies. Despite persistent neuroinflammation, IT-DEX led to rapid seizure control and significant neurological recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This report supports IT-DEX as a promising intervention in FIRES and underscores the need for further research into its mechanisms and long-term efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":"115-120"},"PeriodicalIF":0.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144299750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Rett Syndrome: The Natural History Study Journey”","authors":"","doi":"10.1002/cns3.70004","DOIUrl":"https://doi.org/10.1002/cns3.70004","url":null,"abstract":"<p>Percy AK, Benke TA, Marsh ED, Neul JL. Rett syndrome: The Natural History Study Journey. <i>Ann Child Neurol Soc</i>. 2024;2(3):189–205. doi: 10.1002/cns3.20086.</p><p>We apologize for this error.</p>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Ears of the Lynx” Sign on Brain MRI in Siblings With Spastic Paraplegia: A Case Report","authors":"Qingqing Wang,&nbsp;Manikum Moodley","doi":"10.1002/cns3.20105","DOIUrl":"https://doi.org/10.1002/cns3.20105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hereditary spastic paraplegia (HSP) is a rare, clinically and genetically heterogenous condition that selectively affects the terminal segment of the descending corticospinal tract of the lumbar spine area, causing lower extremity spastic weakness with or without associated complex neurological symptoms. HSP type 11 is the most common form of autosomal recessive HSP and has unique clinical and neuroimaging features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We describe the clinical manifestations and imaging features of siblings with childhood-onset autosomal recessive HSP. Genetic testing confirmed compound heterozygous spastic paraplegia gene (SPG) 11 mutations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The older brother developed poor balance and progressive difficulty with walking starting in childhood. He also experienced poor memory and urinary incontinence. He was born preterm at 30 weeks and was developmentally delayed and cognitivly impaired. His examination revealed length-dependent corticospinal tract signs. Magnetic resonance imaging (MRI) showed thinning of the corpus callosum and periventricular signal changes. His earlier cerebral palsy (CP) diagnosis was based on the history and imaging findings, but rcognition of the “ears of the lynx” MRI sign led to the correct diagnosis of HSP 11 with the Invitae HSP gene panel. The younger sister has similar but milder manifestations and, has the same mutation as her brother.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Although the manifestations of HSP in children often mimic those of CP, the management and progression of HSP differ substantially.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":"105-109"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synergy in Child Neurology: Science, Collaboration, and Leadership – The 2024 Hower Award Lecture","authors":"Renée A. Shellhaas","doi":"10.1002/cns3.70005","DOIUrl":"https://doi.org/10.1002/cns3.70005","url":null,"abstract":"&lt;p&gt;This is an exciting era in child neurology! The scientific state of the art is accelerating rapidly. New diagnostics and treatments are here – or are coming quickly. And our community of researchers, clinicians, and educators is becoming more diverse and increasingly representative of the children and families we serve.&lt;/p&gt;&lt;p&gt;Of course, we have our challenges. What does it take to be a successful researcher in the current climate? How do we best take care of the many patients who need us? How do we recruit new colleagues and retain them in the field? Who will be the next wave of child neurology leaders? None of these questions have easy answers, but the solutions come down to three fundamental values: great science, effective and consistent collaboration, and excellent leadership.&lt;/p&gt;&lt;p&gt;Since the state of the art is advancing so quickly, this is a crucial time to mindfully evaluate how the new data can be incorporated into clinical practice. Apart from our need for rigorous training in implementation science and quality improvement methodology, one of our field's main challenges is the limited number of clinicians available to care for children with neurologic disease.&lt;/p&gt;&lt;p&gt;In 2024, 177 medical students matched into US child neurology residency programs [&lt;span&gt;47&lt;/span&gt;]. We do not currently have a systematic approach to quantifying the number of nurse practitioners or physician assistants in child neurology (personal communication, Mona Jacobson, president, ACNN), but such advanced practice providers are clearly a key element of expanded access to clinical care. To enable continued advances in the state of the art, it is crucial that every single one of these individuals succeeds and is retained in child neurology. And we need to recruit far more.&lt;/p&gt;&lt;p&gt;Early exposure to child neurology is an essential long-term strategy. From effective pipeline programs for school-aged children, to exposure to neurosciences in the undergraduate years, and learning from outstanding and inspirational clinicians in the early months of medical and nursing school, educators matter.&lt;/p&gt;&lt;p&gt;It is clear that we need to develop excellent leaders in child neurology. There are countless open positions for division chiefs, section heads, and program leaders – not to mention department chairs in Pediatrics and Neurology. The &lt;i&gt;CNS&lt;/i&gt; now has a committee on Leadership, Diversity, Equity, and Inclusion. This team is working to develop appropriate programming, but it is clear that support for emerging leaders must come from a range of sources – from national organizations to medical school offices of faculty development, to individuals who are willing to advise, mentor, and sponsor.&lt;/p&gt;&lt;p&gt;For senior child neurologists, this is a critical time to actively identify and develop emerging leaders. Challenging high-performers so they are constantly learning and performing at their highest potential is key for retention and career satisfaction – with benefit to the entire field ","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"3 2","pages":"71-77"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}