Image from Reynolds et al (pp 703–709).
Researchers examined the association between physical activity after a sport-related concussion and a set of multimodal, clinically oriented outcomes. Patients who reported engaging in early physical activity reported less symptom frequency and had a lower incidence of persistent postconcussion symptoms compared with patients who reported no early physical activity. These findings were in agreement with prior observations related to the potential benefit of activity after concussion, but further investigation is required to identify casual effects.
The aim of this study was to describe the age-related signs, symptoms, and epidemiology of concussion presentations to the emergency department in children by using a large multicenter prospective observational data set. Signs and symptoms of concussion varied by age, with higher levels of vomiting in younger children and higher levels of loss of consciousness and amnesia in older children. Concussions were increasingly sports related as age increased. The study illuminates age-related signs and symptoms of concussion and the epidemiology of concussion based on patient age.
This single-center case series has illustrated the use of MR-guided laser interstitial thermal therapy for the treatment of periventricular nodular heterotopia (PVNH)–related epilepsy in a pediatric population. The minimally invasive technique has met the need for deep treatment of the occasionally deep-seated seizure onset zones found in PVNH and avoids transventricular resection. Palliative outcomes were achieved in 4 of the 5 patients studied, without unexpected complications and with short hospital stays.
Children with arteriovenous malformations (AVMs) usually present with either seizures or hemorrhage. The factors that lead to seizures are not well understood. Based on univariate analysis, frontal lobe location, larger AVM size, higher Supplemental Spetzler-Martin grade, and older age correlated with seizure presentation. Children with AVMs with these features should be considered at higher risk for seizures.
The authors sought to evaluate the combined early experience of multiple pediatric stereoelectroencephalography (SEEG) centers. On average, patients received 11 electrodes and 7 days of monitoring. Subsequent therapeutic intervention occurred in 82% of procedures with approximately half of patients achieving seizure freedom. The majority of literature surrounding pediatric SEEG has been based on single-center, large-volume case series. This study has provided a more generalizable perspective in the learning curve and early implementation of pediatric SEEG.
调查人员进行了回顾性队列斯图dy and meta-analysis of angiographically cured pediatric arteriovenous malformations (AVMs) to quantify the risk of recurrence and identify risk factors influencing the rate of recurrence. Recurrence rates of 10.4% and 4.8% were identified in an institutional cohort and meta-analysis, respectively. Younger patient age was associated with higher rate of recurrence, while radiosurgical treatment was associated with lower rate of recurrence. These findings may inform angiographic follow-up of pediatric AVMs.
Researchers summarized their experience over 30 years treating pediatric cerebral aneurysms. Of 4500 total patients with 5150 intracranial aneurysms, 47 children presented with 53 aneurysms. Pediatric aneurysms were more likely giant, in males, and within the MCA. The mortality rate was 10.6%. Of treated aneurysms, 6.7% recurred in the endovascular group, while none recurred in the microsurgical group. Treatment of pediatric aneurysms should be definitive, as the risk for recurrence will be managed over a lifetime.
An estimated 10%–20% of all pediatric shunt malfunctions are associated with no radiographic findings and are often a diagnostic dilemma. In this large multicenter case-control study, the authors sought to identify risk factors for patients with shunted hydrocephalus who present without evidence of radiographic failure. Those children with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than other children with hydrocephalus to have unchanged ventricles at shunt failure.
In this study the authors sought to discover variables that could aid in predicting outcomes in patients with Dandy-Walker malformation (DWM). The data show that the presence of other anomalies of the CNS and larger cyst size predicted worse outcomes. These results are simultaneously in contrast to some previous research and further develop ideas revealed in other studies. This research was conducted in the hopes of better advising parents of children with DWM.
Researchers measured intracranial pressure in subjects undergoing treatment of craniosynostosis, and created a multivariate model to assess factors that are associated with elevated intracranial pressure. Increased age, increased number of involved sutures, and an associated craniofacial syndrome were each independently linked to risk of elevated intracranial pressure. These findings may have implications for risk factors and optimal treatment strategies for craniosynostosis.
The authors evaluated the efficacy of TG02, a novel multi–CDK inhibitor, in atypical teratoid rhabdoid tumors (ATRTs), a group of aggressive pediatric CNS malignancies. TG02 was found to inhibit proliferation and induce apoptosis in multiple ATRT cell lines, while also potentiating the antitumor effects of radiation and cisplatin. These findings have positioned TG02 as a promising adjuvant therapeutic that can decrease the necessary dose of chemoradiation in patients with ATRTs, thereby mitigating systemic side effects associated with treatment.