Annals of the Child Neurology Society最新文献

{"title":"Impact of infections on the incidence of acute inflammatory demyelinating polyneuropathy in children","authors":"Hannah Gilbert,&nbsp;Nicholas S. Abend,&nbsp;Melissa Hutchinson,&nbsp;Ricka Messer,&nbsp;Mahendranath Moharir,&nbsp;Kendall Nash,&nbsp;Jamie Palaganas,&nbsp;Juan Piantino,&nbsp;Samir S. Shah,&nbsp;Matt Hall,&nbsp;Elizabeth Wells,&nbsp;Craig A. Press,&nbsp;Pediatric Neurohospitalist Work Group","doi":"10.1002/cns3.20022","DOIUrl":"10.1002/cns3.20022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Acute inflammatory demyelinating polyneuropathy (AIDP) is the leading cause of acute flaccid paralysis in children and hypothesized to be triggered by antecedent infection. We sought to determine the association between AIDP and commonly acquired community infections in children. We utilized the reduction in these infections due to measures during coronavirus disease 2019 (COVID-19) to serve as a natural experiment and determine their contribution to AIDP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used administrative and billing data from children's hospitals contributing to the Pediatric Health Information System. We included hospitalizations of children with a diagnosis of AIDP from (January 2017 through February 2021). Encounters for infection- (including respiratory, gastrointestinal, and COVID-19) related diagnoses were measured as a marker of community incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1111 index encounters for AIDP were included. Pre-COVID-19, AIDP was not associated with respiratory or gastrointestinal infections, specifically, influenza or campylobacter. During the COVID-19 period from March 2020 to February 2021, respiratory, gastrointestinal, and influenza infections decreased compared to expected (for the same time of year pre-COVID-19) by 59.6%–90.1%, 51.5%–68.9%, and 54.5%–97.9%, respectively. In contrast, AIDP hospitalizations and all hospitalizations only decreased by 11.5%–39.3% and 14.2%–25%, respectively. COVID-19 was not positively associated with AIDP overall or at individual hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Common community-acquired infections including COVID-19 were not strongly associated with hospitalizations for AIDP in children. AIDP persisted despite the dramatic reduction in infection-related encounters during the pandemic. These results suggest that recent antecedent community-acquired infections were not the primary driver of AIDP and that alternative triggers should be explored.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 2","pages":"129-136"},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44606739","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":"Vitamin D status and latitude predict brain lesions in adrenoleukodystrophy","authors":"Keith P. van Haren,&nbsp;Jacob Wilkes,&nbsp;Ann B. Moser,&nbsp;Gerald V. Raymond,&nbsp;Troy Richardson,&nbsp;Patrick Aubourg,&nbsp;Timothy W. Collins,&nbsp;Ellen M. Mowry,&nbsp;Joshua L. Bonkowsky","doi":"10.1002/cns3.4","DOIUrl":"10.1002/cns3.4","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Approximately 40% of boys with X-linked adrenoleukodystrophy (ALD) develop inflammatory demyelinating brain lesions (cerebral ALD, cALD) and are at risk for death or severe disability. Risk factors for cALD are poorly understood. Our objective was to evaluate whether vitamin D status, which influences immune function, is associated with risk for cALD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used two independent cohorts to assess whether low vitamin D status is correlated with cALD. We used complementary proxies for vitamin D status: plasma 25-hydroxyvitamin D levels and latitude. In our first cohort, we measured 25-hydroxyvitamin D in biobanked plasma samples from ALD boys with initially normal brain MRIs followed at two expert centers. In a second cohort, we measured latitude (using home ZIP code) among ALD boys identified in a national administrative database (PHIS) covering 51 US pediatric hospitals. We used logistic regression models to estimate the odds of developing cALD in each cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the first cohort, we identified 20 ALD boys with a total of 53 plasma sample timepoints who met inclusion criteria; 50% (<i>n</i> = 10) subsequently developed cALD. Average 25-hydroxyvitamin D levels were lower among boys who developed cALD than those who did not (median 28.9 vs 36.6 ng/ml); <i>p</i> = 0.019. For each 10 ng/mL decrease in 25-hydroxyvitamin D, the odds ratio for developing cALD was 6.94; <i>p</i> = 0.044. In the second cohort, we identified 230 ALD boys across 28 states; 57% of boys (<i>n</i> = 132) developed cALD. Each 2° increase in latitude conferred an odds ratio of 1.17 (95% confidence interval, 1.01, 1.35); <i>p</i> = 0.036 for developing cALD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using independent cohorts, we found that ALD boys with lower pre-morbid plasma levels of 25-hydroxyvitamin D, or more northerly latitude of residence, were more likely to develop cALD. These findings offer complementary lines of evidence that vitamin D and/or ultraviolet light exposure influence cALD risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 2","pages":"155-161"},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43772446","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":"Under-recognition of leg dystonia in people with cerebral palsy","authors":"Bhooma Aravamuthan,&nbsp;Toni S. Pearson,&nbsp;Keerthana Chintalapati,&nbsp;Keisuke Ueda","doi":"10.1002/cns3.20018","DOIUrl":"10.1002/cns3.20018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the rates of clinical under-documentation of leg dystonia in people with cerebral palsy (CP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, we identified independently ambulatory people age 10–20 years with CP-associated spasticity seen in a tertiary care CP center between 1/1/20 and 11/4/21. Three pediatric movement disorders specialists assessed gait videos from these visits for leg dystonia using the Global Dystonia Rating Scale. We compared the gold standard expert consensus assessment for each patient with the clinical documentation of dystonia during a contemporaneous CP center clinic visit and also with dystonia documentation longitudinally in their medical record.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 116 people with CP-associated spasticity assessed in this study, 70 were found to have leg dystonia in their gait videos. Only 13% of these 70 individuals (<i>n</i> = 9/70) had leg dystonia documented in their contemporaneous CP center clinic visit, even though they were assessed during this visit by clinicians well trained in CP and dystonia assessment. Even with repeated assessment, only 54% (<i>n</i> = 38/70) of these individuals had leg dystonia documented in their medical record.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Leg dystonia is clinically under-documented in people with CP-associated spasticity, even when these people are evaluated by well-trained clinicians. Longitudinal evaluation and vigilance for leg dystonia is critical to address this diagnostic gap.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 2","pages":"162-167"},"PeriodicalIF":0.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46079015","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":"SIGnature Libraries: A roadmap for the formation of special interest group libraries","authors":"Young-Min Kim,&nbsp;Eric M. Chin,&nbsp;Michael Fahey,&nbsp;Rose Gelineau-Morel,&nbsp;Kate Himmelmann,&nbsp;Jennifer O'Malley,&nbsp;Maryam Oskoui,&nbsp;Bruce Shapiro,&nbsp;Michael Shevell,&nbsp;Jenny L. Wilson,&nbsp;Max Wiznitzer,&nbsp;the Child Neurology Society Cerebral Palsy Special Interest Group Consortium,&nbsp;Bhooma Aravamuthan","doi":"10.1002/cns3.20021","DOIUrl":"10.1002/cns3.20021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>“SIGnature Libraries” channel the dynamism of academic society-based special interest groups (SIG) to systematically identify and provide user-oriented access to essential literature for a subspecialty field in a manner that keeps pace with the field's continuing evolution. The libraries include literature beyond clinical trial data to encompass historical context, diagnostic conceptualization, and community organization materials to foster a holistic understanding of how neurologic conditions affect individuals, their community, and their lived experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Utilizing a modified-Delphi approach, Child Neurology Society's Cerebral Palsy (CP) SIG (<i>n</i> = 75) administered two rounds of literature submissions and ratings. A final review by an 11-member international advisory group determined threshold ratings for resource inclusion and the library's final structure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-nine articles were submitted for the first Delphi round and 22 articles for the second Delphi round. Survey response rates among SIG members were 29/75 for the first round and 24/75 for the second round. The advisory board added additional articles in the final review process in view of the overall project goal. A total of 60 articles were included in the final library, and articles were divided into seven sections and stratified by rating scores. A process for ongoing revisions of the library was determined. The library will be published on the Child Neurology Society website and made publicly accessible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CP SIGnature Library offers learners an unprecedented resource that provides equitable access to latest consensus guidelines, existing seminal datasets, up-to-date review articles, and other patient care tools. A distinctive feature of the library is its intentional large scope and depth, presented in a stratified fashion relative to the consensus-determined importance of each article. Learners can efficiently navigate the library based on individual interests and goals, and the library can be used as core curriculum for CP education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 3","pages":"218-227"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/48/nihms-1902114.PMC10550070.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164632","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":"Meningitis caused by the varicella vaccine virus in 17 immunized children and adolescents from the United States, Europe, and Japan","authors":"Charles Grose,&nbsp;Daniel J. Bonthius","doi":"10.1002/cns3.20020","DOIUrl":"10.1002/cns3.20020","url":null,"abstract":"<p>The varicella vaccination program has an excellent safety record. The vaccine virus, like its wild-type counterpart, can enter latency and later reactivate as herpes zoster. A lesser known but serious adverse event following reactivation is varicella vaccine meningitis. We investigate that adverse event. We performed a literature search using the PubMed and Google Scholar search engines to locate all published cases of varicella vaccine meningitis. We continued the search through January 2023. We found 17 cases of varicella vaccine meningitis. The first case was published in 2003, and the last case was published in 2023. The children lived in the United States, Greece, Germany, Switzerland, and Japan. Among the 17 cases, 14 were immunocompetent; nine of the 17 were adolescents. One potential risk factor was the administration of corticosteroids three to four weeks before the onset of meningitis. Varicella vaccine meningitis is a rare but one of the more serious adverse events that occurs several years following varicella vaccination. In immunocompetent children, this complication is treatable with a single course of intravenous acyclovir after hospitalization.</p>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 2","pages":"96-101"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45953653","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":"Pyridoxine-dependent epilepsy: Current perspectives and questions for future research","authors":"Curtis R. Coughlin  II,&nbsp;Sidney M. Gospe  Jr.","doi":"10.1002/cns3.20016","DOIUrl":"https://doi.org/10.1002/cns3.20016","url":null,"abstract":"Pyridoxine‐dependent epilepsy (PDE) was historically defined by a dramatic clinical response to a trial of pyridoxine and the re‐emergence of seizures after withdrawal of pyridoxine. Research conducted over the last seven decades has revealed that the phenotype of PDE results from multiple genetic disorders, and the most common disorder, PDE‐ALDH7A1, is caused by a deficiency of an enzyme involved in lysine metabolism. PDE‐ALDH7A1 is characterized by more than epilepsy, as many patients have abnormalities of brain development, and most patients have intellectual and developmental disability. Treatment aimed at the underlying metabolic defect, in addition to pyridoxine supplementation, has improved clinical outcomes. Recently discovered biomarkers and genetic testing allow for the diagnosis of PDE‐ALDH7A1 without the need of a pyridoxine trial and hold the promise for newborn screening. Despite these many advances, PDE‐ALDH7A1 remains a clinical and biochemical conundrum. The increasing use of model systems and an international collaboration of clinician‐scientists are among the reasons to be optimistic that these questions will be answered in the near future and that the clinical outcomes and quality of life will continue to improve for patients with PDE‐ALDH7A1.","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 1","pages":"24-37"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50137413","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":"Neuroradiological findings in children with subdural hematoma and suspected abusive head trauma","authors":"Sverre Morten Zahl,&nbsp;Jacob Andersson,&nbsp;Knut Wester,&nbsp;Johan Wikström","doi":"10.1002/cns3.3","DOIUrl":"10.1002/cns3.3","url":null,"abstract":"Abusive head trauma (AHT) is often suspected in infants with subdural hematoma (SDH). Other neuroradiological findings have also been reported in assumed AHT, such as hypoxic–ischemic injury (HII), cortical vein thrombosis, and subarachnoid hemorrhage. The purpose of this study was to investigate neuroradiological and clinical findings in cases of suspected AHT.","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 1","pages":"44-52"},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42870960","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":"Burden of illness in aromatic l-amino acid decarboxylase deficiency","authors":"Melissa L. DiBacco,&nbsp;Jordan Hinahara,&nbsp;Thomas F. Goss,&nbsp;Phillip L. Pearl","doi":"10.1002/cns3.20010","DOIUrl":"10.1002/cns3.20010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Deficiency of aromatic <span>l</span>-amino acid decarboxylase (AADC), a key enzyme in monoamine synthesis, is an ultrarare disorder of monoamine synthesis estimated to affect fewer than 50 patients in the United States, although rates of misdiagnosis may be high. In its severe form, this congenital hypodopaminergic state results in profound hypotonia, developmental impairment, oculogyric crises, dystonia, dysautonomia, hypoglycemia, and premature death. The present study assesses the burden of illness for patients and caregivers by assessment of medical resource utilization (MRU) and quality of life (QOL) measures to enable future health technology assessment activities for emerging therapeutic options.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from patients’ medical records from the prior two years were examined to estimate burden in terms of direct costs; indirect care burden (including caregiver impact on sleep, health, and vocational opportunities) and QOL were also assessed using the BURQOL-RD, AQoL-6, and Visual Analogue Scale questionnaires.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data were available for five US cases (three males, two females; age, 2–24 years, median, 5 years). MRU ranged from $6162.73 to $49 043.94 annually per patient. Although the proportion of costs (inpatient and outpatient visits, labs/tests, drugs, devices/durable medical equipment, and speech/physical therapy) varied greatly, the average annual direct cost of healthcare was approximately $25 000. Caregivers described profound care burden and QOL effects, with an average indirect care burden cost assessment of nearly $43 000 yearly. The mean economic burden of AADC deficiency per year was estimated at $68 000.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MRU and QOL varied considerably by patient. This is attributable to the disease's variable phenotypic severity and differing patient needs. Frequent contact with the healthcare system, however, is a constant for patients with AADC deficiency and their caregivers. Quantifying MRU and QOL for rare genetic diseases is critical for assessing the value of emerging targeted therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 1","pages":"75-81"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48055200","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":"A half-century check-up for child neurology training","authors":"E. Steve Roach","doi":"10.1002/cns3.20015","DOIUrl":"10.1002/cns3.20015","url":null,"abstract":"<p>The ideal approach for child neurology training has become a topic of controversy in recent years, with strong opinions from both sides of the discussion often generating more heat than light. What follows is a dispassionate analysis of our child neurology training requirements. My intent is to facilitate constructive discussion and reframe the questions, not to take sides. We owe it to our trainees and to the children entrusted to us to create the best possible child neurology training.</p><p>As a neurologist who still sees adult patients, I am not opposed to adult neurology training for child neurologists. The question is not whether a year of adult neurology training still has value for child neurologists, but whether requiring a full year continues to represent the best use of the residents' time given the major changes in the field in the half century since the basic training requirements were initially established. Similarly, it may be appropriate to discuss the optimal amount of preliminary pediatric training for child neurologists.</p><p>The American Board of Psychiatry and Neurology (ABPN) was founded in 1934, and separate training and certification programs for neurologists and psychiatrists began in 1946. In 1959, Sidney Carter became the first child neurologist to serve as an ABPN director. That same year, the ABPN began to include child neurology topics in its certification examination, which at the time consisted of an eight-hour oral examination.<span>²</span> During the next eight years, a written examination with child neurology topics was introduced, and in 1967, the oral examination was scaled back to four hours, one of which focused on child neurology. In 1969, the ABPN created its “Special Qualification in Child Neurology” category, awarding 106 “grandfather” certificates to individuals who were already focusing on child neurology.<span>²</span></p><p>There have been a number of modifications to the child neurology certification process since it began. The oral examination was eventually reduced to three hours and later replaced entirely with an expanded written examination. Time-limited certification was introduced. The option of dual certification in pediatrics and in neurology remains, although fewer and fewer trainees opt to pursue certification in pediatrics.<span>³</span> Two infrequently used alternate certification pathways allowing one year of general pediatrics training to be replaced by either internal medicine or pre-approved neuroscience research were approved, of course without the option of certification in general pediatrics. The six-year neurodevelopmental pediatrics track was approved as a separate pathway. Thus, the certification process has not been stagnant, but the requirement for 12 months of clinical adult neurology training has remained intact.</p><p>A decade or so ago, the Child Neurology Society's (CNS) leadership and the society's representatives on the Neurology","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43470625","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":"The NIH Intramural Research Program: Opportunities for training and career development in neuroscience and beyond","authors":"Nina F. Schor","doi":"10.1002/cns3.20012","DOIUrl":"10.1002/cns3.20012","url":null,"abstract":"<p>The National Institutes of Health is renowned for being the largest funder of biomedical research in the world. Although it also houses unique research laboratories and clinics on its campuses around the United States, the National Institutes of Health Intramural Research Program is much less well-known than its extramural enterprise. The Intramural Research Program provides many outstanding opportunities for research-intensive careers and training and includes a vibrant and diverse community of developmental neurobiology and child neurology investigators.</p>","PeriodicalId":72232,"journal":{"name":"Annals of the Child Neurology Society","volume":"1 1","pages":"38-43"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cns3.20012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43708101","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}