EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY

Advancing understanding and treatment of YWHAG-related developmental and epileptic encephalopathy
Tabarki B
A life course perspective on mental disorders and psychopharmacologic drug use among persons living with cerebral palsy
Linder A, Jarl J and Tedroff K
In this study, we investigated the prevalence of mental disorders and the use of psychopharmacologic drugs among individuals with cerebral palsy (CP). We studied how the association between CP and mental illness develops over the life course (between ages 5 and 65 years), and how it varies across disability specific factors (intellectual disability, gross motor function and communicative ability). We used logistic regression models on a longitudinal matched case-control data material on all persons with CP in Sweden linked to several administrative registers including, the national patient registers and the pharmaceutical registers. Our results showed that the probability of being diagnosed with mental disorders and being dispensed psychopharmacologic drug was significantly higher among persons with CP compared to persons without CP across the different outcomes [OR = 1.52-4.7]. For some mental and neurodevelopmental disorders including sleep disorders, autism, and ADHD, and for the use of anxiolytics and sedatives, there was a sizeable gap already in childhood. However, the excess burden of mental illness appeared to grow over the life course, indicating that adults with CP may be a particularly disadvantaged group. Diagnosis for mental disorders and dispensation for psychopharmacologic drugs were not consistent with respect to disability specific factors, especially communicative and intellectual function, which indicates the need for systematic approaches in the mental health care of individuals with CP.
Diagnosis of fetal alcohol spectrum disorders: German guideline version 2024
Landgraf MN, Schmucker C, Heinen F, Ziegler A, Kopp I and Strieker S
Integrated hip surveillance pathways for pain, function and quality of life in children with Cerebral Palsy: A systematic literature review
McGrath TM and Palmer ST
To determine the effectiveness of integrated hip surveillance pathways on pain, function and quality of life (QOL) in children with Cerebral Palsy (CP).
IL-17 in serum and cerebrospinal fluid of pediatric patients with acute neuropsychiatric disorders: Implications for PANDAS and PANS
Thomas F, Nicolò L, Lucia S, Santi V, Giulia D, Spreafico E, Alessandro O, Alessandro F, Mara A, Giorgia T, Luigi MG and Salvatore S
Acute neuropsychiatric disorders are heterogeneous conditions resulting from interaction between genetic and environmental features. Among these, post infectious forms like Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are common. Preclinical studies suggest a role of CNS T-helper-17/interleukin-17 (IL-17) inflammatory mediated response in the pathogenesis of these disorders. We analyze serum and cerebral-spinal fluid (CSF)-IL-17 concentrations in a cohort of patients with acute neuropsychiatric disease.
Is CSF hypocretin level useful for differentiating narcolepsy type 1 and 2?
Bruni O
Ketogenic diet registry for epilepsy: A cross-sectional feasibility study
Neal EG, Whiteley VJ, van der Louw E, Devlin AM, Eltze C, Pujar S, Simpson Z, Hardy I, Palmer A, Szmurlo A, Parker AP, Mills N, Ord R, Lagae L, Kerckhove KV, van den Berg S, Cross JH and Schoeler NE
We aimed to develop a registry ('Keto-Reg') for individuals with epilepsy referred for ketogenic dietary therapy (KDT) and to test feasibility of its implementation. The purpose of the registry is to provide a platform for collaborative research to answer specific research questions regarding long-term clinical and safety outcomes and to identify the most suitable candidates for KDT. Registry data items were determined via an international Delphi survey of KDT healthcare professionals, and then entered into an electronic platform. Three UK and two other European KDT centres entered data for 10 'patients' and reported on its acceptability and feasibility of use via questionnaire. 25 % of data was validated against medical records. A national survey was distributed and 19 parents and four young people were interviewed about a potential future patient/family section to the registry. Healthcare professionals from six continents responded to the Delphi (n = 153 round 1, n = 79 round 2); 70 items reached the agreement threshold. Registry data entry was accurate (0.3 % errors identified) and reported to be feasible and acceptable in the short-term. Lack of time was identified as the main barrier to longer-term implementation, with funded hours required. 87 % of the 53 survey responders and all interviewees viewed a patient/family section to be positive and feasible. We have shown healthcare professional involvement in Keto-Reg to be feasible in the short-term, and have identified what is necessary for the next stage: prospective longitudinal data entry from a larger number of international centres.
Caregiver burden and therapeutic needs in dravet syndrome - A national UK cross-sectional questionnaire study
Freeman-Jones E, Wilson G, Eldred C, Mercier A, Hendry K, Swindler A, Symonds JD, Zuberi SM, Dorris L and Brunklaus A
Dravet Syndrome is a severe developmental and epileptic encephalopathy with significant care needs for affected individuals and families. Our objective was to characterise the caregiver burden and therapeutic needs of families caring for an individual with Dravet Syndrome from child to adulthood, to examine age related differences in co-morbidities, and identify current gaps in health and social care.
Immune-mediated neurological syndromes associated with childhood cancers
Rossor T, Tewari S, Gadian J, Kaliakatsos M, Angelini P and Lim M
The association of recognisable neurological conditions with an underlying malignancy is well described. In this review we explore the complex interplay of genetic, environmental and tumour factors which contribute to autoimmunity and paraneoplastic conditions. We review the current understanding of the pathogenesis of well recognised paraneoplastic conditions in children including Opsoclonus myoclonus ataxia syndrome, N-Methyl-D Aspartate receptor encephalitis and limbic encephalitis, and the broad approaches to treatment. Rapid advances in oncological treatment has expanded the arsenal of therapeutic modalities. We explore the broad spectrum of immune therapies in childhood cancer, and the potential neurological complications of these novel therapies, and discuss the fine balance of risk and benefit that these bring.
Similar disease progression in nonsense Duchenne muscular dystrophy boys as general natural history: Single Brazilian center 15 years registry view
Nardes F, Araújo APQC, Russi S and Henriques SFB
Duchenne muscular dystrophy is a progressive and fatal X-linked neuromuscular disease. Emergent disease-modifying therapy (DMT) in nonsense Duchenne muscular dystrophy (nmDMD) has brought new perspectives to slow down functional decline in this fatal disease. To investigate if there are differences in natural history between nmDMD and other genotypes, we described a retrospective cohort analysis of 25 nonsense mutation DMD (nmDMD) boys without disease-modifying therapy, aged between 1 and 22 years, over the last 15 years (2007-2022) in a single neuromuscular center in Rio de Janeiro and use published data on DMD natural history for comparison. Regarding prognostic factors, there were remarkable and statistically significant early loss of ambulation (at 9.1y ±2.1) and shortening of life expectancy (17.6y ±2.1) in our nmDMD group. Late acquisition of neurodevelopmental milestones and annual rates of decline in respiratory, cardiac, and timed motor function tests are the same between nmDMD patients with standard care and other DMD genotypes as described in the literature. Our data indicates the similarity of natural history and disease progression among DMD boys with nmDMD mutations compared to different mutations.
Developmental and epileptic encephalopathy 56 due to YWHAG variants: 12 new cases and review of the literature
Amato ME, Balsells S, Martorell L, Alcalá San Martín A, Ansell K, Børresen ML, Johnson H, Korff C, Garcia-Tarodo S, Lefranc J, Denommé-Pichon AS, Sarrazin E, Szabo NZ, Saraiva JM, Wicher D, Goverde A, Bindels-de Heus KGCB, Barakat TS and Ortigoza-Escobar JD
Developmental and epileptic encephalopathy 56 (DEE-56) is caused by pathogenic variants in YWHAG and is characterized by early-onset epilepsy and neurodevelopmental delay. This study reports on a cohort of DEE-56 individuals, correlating antiseizure medication usage and comorbidities, to aid in understanding disease evolution.
Cost-effective diagnosis for children with developmental and epileptic encephalopathy phenotype
Panda PK and Sharawat IK
Spatiotemporal coordination in children with unilateral cerebral palsy: Insights from a bimanual goal-directed task
Mailleux L, Decraene L, Kalkantzi A, Kleeren L, Crotti M, Campenhout AV, Verheyden G, Ortibus E, Green D, Klingels K and Feys H
In children with unilateral cerebral palsy (uCP), bimanual assessments mostly focus on qualitative assessments of the impaired upper limb during bimanual tasks, which do not capture the spatiotemporal coordination between both hands. Hence, we aimed to advance our understandings in spatiotemporal coordination in children with uCP compared to typically developing children (TDC) using a bimanual, asymmetrical, goal-directed task.
Reassuring neuropsychological outcome data in myelin oligodendrocyte glycoprotein antibody-associated disease
Rudebeck SR and Eyre M
The development of checklists and reference charts for activities of daily living of normal developing children
Suppiej A, Tessari L, Fasolo A, Casarotto M, Borghini C, Gregori D and Mercuriali E
To measure the performance in activities of daily living and obtain reference charts in normal developing children.
Multicentric Pediatric Stroke Code: Insight to the first years after implementation
Jové-Blanco A, Ruiz Domínguez JA, González-Posada Flores AF, Barón González de Suso L, de Ceano-Vivas la Calle M, Verdú Sánchez C, Tirado Requero P, Fuentes Gimeno B, Utrilla Contreras C, Oviedo-Melgares L, Núñez Enamorado N, Martínez de Aragón A, Sanz Álvarez D, Ruiz Martín Y, Gil Nuñez AC, de Castro de Castro P and Vázquez-López M
The development of unicentric pediatric acute stroke protocols has improved stroke diagnosis and treatment. The impact of the implementation of a multicentric Pediatric Stroke Code (PSC) remains unknown.
Report from the child neurology education and training workshop at the International Child Neurology Congress 2024: Expert'saddressing the training gap
Wilmshurst JM, Albert DV, Doja A, Carrizosa J, Saini AG, Gupta J, Gwer S, Hammond C, Ishihara N, Joshi C, Kija E, Rafay MF, Sebunya R, Serdaroglu E, Vidaurre J, Wanigasinghe J and Patel AA
This report summarizes the key findings of a workshop undertaken at the International Child Neurology Congress in 2024 by child neurologists with expertise in training education and invested colleagues. The workshop aimed to explore global issues which have impact on access to child neurology training. The major findings supported a great need for more training programs globally, that consensus is needed for the minimum standards of training, and that training programs can be strengthened via global health partnerships especially with collaborations from regions with more available resources. The group concurred that the phenomena of 'neurophobia' amongst general paediatricians and medical trainees, was a reality, and creates barriers both working with paediatric colleagues, as well as recruiting specialists to the field. Optimal teaching practices for child neurology should include the expansion of learning through global partnerships and virtual educational resources. Measures must be put into place for fledgling training programs, to support colleagues in less resourced settings and to avoid their burn-out. Collegial and collaborative work is essential to support the future of child neurology across the globe, both to reach the current capacity needs but also to meet the necessary growth in the field.
Type 1 spinal muscular atrophy treated with nusinersen in Norway, a five-year follow-up
Wik-Klokk M, Rasmussen M, Ørstavik K, Zetterberg H, Hagen M, Holtebekk ME, Ramm-Pettersen A and Wallace S
New treatments for 5q spinal muscular atrophy (SMA) have led to changes in the disease phenotype. Questions about long-term efficacy, however, persist. We present the results from five-year follow-up of the first ten Norwegian patients with SMA type1 treated with nusinersen.
Predictive value of brain MRI for neurodevelopmental outcome in infants with severe unconjugated hyperbilirubinemia: A systematic review
van der Meulen NM, Meijers KL, Dudink J and van de Pol LA
Debate exists regarding predictive value of brain MRI for long-term neurodevelopmental outcome (NDO) in infants with severe unconjugated hyperbilirubinemia (above exchange transfusion levels).
Understanding North Star Ambulatory Assessment total scores and their implications for standards of care using observational data
Stimpson G, James MK, Guglieri M, Wolfe A, Manzur A, Sarkozy A, Baranello G, Muntoni F, Mayhew A and
NorthStar Ambulatory Assessment (NSAA) total score (TS) is an ordinal scale to evaluate disease progression and treatment response in ambulatory Duchenne Muscular Dystrophy individuals. Clinical management according to standard of care could be enhanced by understanding how changes in the TS could inform standards of care. Here we describe the associated item performance patterns in the NorthStar Database for ranges of NSAA TS and its timed tests (10 m walk/run and rise from floor). We then compare these patterns depending on whether a participant is on an improving/stable (≤2-point loss in the prior year) or declining (>2-point loss in the prior year) trend. These TS and trends are subsequently linked and referenced to therapy standards of care. We included 761 participants from the UK NorthStar observational clinical database between 5 and 16 years, who were on steroids. Differences and trends in item ability, compensations, and times can suggest specific disease complications and lead towards anticipatory therapy recommendations. Families and therapists can benefit from using the TS and trend to guide therapy management.
Understanding the scale of the problem: How to standardise the measurement of childhood movement disorders?
Lumsden DE