A Review of the Selected and Newer Antiseizure Medications Used in Childhood Epilepsies.

There have been additions of newer antiseizure medications in the armamentarium of clinicians for the management of epilepsy. The newer antiseizure medications have advantages of better tolerability, lesser adverse effects, and minimal drug interactions in comparison with conventional antiseizure medications. However, high cost and availability are concerns. There are also peculiar pharmacokinetic and pharmacodynamic considerations for the pediatric age, particularly in the context of age-dependent electroclinical syndromes and precision-based medicine. This review attempts to provide a comprehensive and pragmatic update on newer antiseizure medications.

Diagnosing and managing childhood absence epilepsy by telemedicine.

The diagnosis of childhood absence epilepsy (CAE) is typically based on history and description of spells, supported by an office-based positive hyperventilation test and confirmed by routine electroencephalography (EEG). In the current coronavirus disease 2019 (COVID-19) pandemic, many pediatric neurologists have switched to telemedicine visits for nonemergent outpatient evaluations. We present a series of children diagnosed as having CAE on the basis of a positive hyperventilation test performed during remote televisits. Several of these children were begun on treatment for CAE prior to obtaining an EEG, with significant seizure reduction. Our series documents the feasibility of CAE diagnosis and management by telemedicine.

Recent advances in perinatal neuroprotection.

Perinatal brain injury is a major cause of neurological disability in both premature and term infants. In this review, we summarize the evidence behind some established neuroprotective practices such as administration of antenatal steroids, intrapartum magnesium for preterm delivery, and therapeutic hypothermia. In addition, we examine emerging practices such as delayed cord clamping, postnatal magnesium administration, recombinant erythropoietin, and non-steroidal anti-inflammatory agents and finally inform the reader about novel interventions, some of which are currently in trials, such as xenon, melatonin, topiramate, allopurinol, creatine, and autologous cord cell therapy.

Vitamin B12 Deficiency Presenting with Neurological Dysfunction in an Adolescent.

BACKGROUND: Vitamin B12 deficiency is classically encountered in the adult Caucasian population and manifests as a subacute combined degeneration in the presence or absence of macrocytic anemia. However, B12 deficiency is extremely rare in children in developed countries, and pernicious anemia is even rarer etiology of this deficiency. The clinical presentation of B12 deficiency in children is not as easily recognizable or well-characterized and may result in missed or delayed diagnosis. PATIENT DESCRIPTION: We describe a previously healthy adolescent girl who presented with emotional lability, mental status changes, hyperreflexia, and ataxia. She was found to have megaloblastic anemia and subacute combined degeneration secondary to B12 deficiency caused by pernicious anemia. CONCLUSION: Though B12 deficiency is uncommon in pediatrics, it is important to maintain a high index of suspicion because early recognition and treatment of B12 deficiency are key to preventing long-term neurological sequelae.

Medical Comorbidities in Pediatric Headache.

Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities.

Pediatric headache: where have we been and where do we need to be.

In this article, we hope to summarize current understanding of pediatric headache. We discuss epidemiology, genetics, classification, diagnosis, outpatient, emergency and inpatient treatment options, prevention strategies, and behavioral approaches. For each section, we end with a series of questions for future research and consideration.

Diffusion tensor imaging of the maturing paediatric cervical spinal cord: from the neonate to the young adult.

OBJECTIVE: Normative apparent diffusion coefficient (ADC) and fractional anisotropy (FA) metrics of the brain have been published previously. However, no larger studies evaluated the normal evolution of ADC/FA metrics of the maturing paediatric spinal cord. Goal of this study is to evaluate the age-dependent evolution of the ADC/FA values of the developing/maturing normal cervical spinal cord (CSC). PATIENTS AND METHODS: Forty-one subjects, aged less than 18 years with a negative spinal MRI study and no systemic central nervous disease, underwent diffusion tensor imaging (DTI) of the CSC. DTI metrics were measured in the centre of the CSC. Regression and ANCOVA analyses were performed to evaluate the association between ADC/FA values and age and its potential modification by sex. RESULTS: A linear model emerged as the best fit for our data. ADC showed a continuous decrease with age; FA showed a continuous increase with age. CONCLUSION: The simultaneous age-related ADC decrease and FA increase likely reflect progressive maturation, myelination and fibre packing within the CSC similar to that observed in the brain. Collection of age-dependent normative DTI metrics may be helpful in the early identification and quantification of altered water diffusion in a variety of pathologies affecting the developing paediatric spinal cord.

Non-invasive imaging of intracranial pediatric vascular lesions.

OBJECTIVES: The goal of this review is to discuss the different non-invasive imaging techniques as well as the age-specific pediatric vascular pathologies and their imaging features. MATERIAL AND METHODS: Ultrasound, computed tomography, and magnetic resonance imaging features of pediatric ischemic stroke, intracranial hemorrhage, aneurysms, cavernomas, developmental venous anomalies, and arteriovenous malformations are presented. In addition, multiple non-invasive angiographic techniques (CT and MR angiography) and functional MRI sequences (diffusion, perfusion, and susceptibility-weighted imaging) are discussed. CONCLUSION: Neurovascular imaging plays a central role in the early, sensitive, and specific diagnosis of pediatric intracranial vascular disorders. A detailed knowledge of the quality and exact angioarchitecture of pediatric vascular pathologies as well as their impact on the cerebral hemo-dynamics is essential to guide and monitor treatment options and to predict functional outcome.