Neurology

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Review Article
Neurology
Rotavirus infection-associated central nervous system complications: clinicoradiological features and potential mechanisms
Kyung Yeon Lee
Clin Exp Pediatr. 2022;65(10):483-493.   Published online February 7, 2022
∙ Rotavirus infection-associated central nervous system (CNS) complications are fairly common in children.
∙ Common clinicoradiological features include benign convulsions with mild gastroenteritis, acute encephalopathies/encephalitis, cerebellitis, and neonatal rotavirus-associated leukoencephalopathy.
∙ Possible mechanisms for CNS complications include direct viral invasion into the brain via several potential routes such as the blood-brain barrier and vagus nerve, and entry of various brain-damaging mediators and activated immune cells into the brain.
Update on benign convulsions with mild gastroenteritis
Yeong Seok Lee, Ga Hee Lee, Young Se Kwon
Clin Exp Pediatr. 2022;65(10):469-475.   Published online December 27, 2021
∙ The main pathogen for benign convulsions with mild gastroenteritis (CwG) was previously rotavirus; however, cases associated with norovirus are increasing.
∙ CwG is characterized by clustered generalized seizures. Electroencephalography and magnetic resonance imaging show transiently abnormal findings in the acute phase that eventually normalize with progression. Its prognosis is good, and long-term treatment is unnecessary.
∙ There are many reports on the pathophysiological mechanism of CwG, which remains unclear.
Neonatal seizures: diagnostic updates based on new definition and classification
Eun-Hee Kim, Jeongmin Shin, Byoung Kook Lee
Clin Exp Pediatr. 2022;65(8):387-397.   Published online April 4, 2022
· Neonatal seizures are often electrographic-only seizures without clinical signs; therefore, the identification of electrical seizure activity on electroencephalography is the gold standard for diagnosis.
· Clinical signs of neonatal seizures are divided into motor or nonmotor seizures, and motor seizures are mostly focal or multifocal.
· Most neonatal seizures are caused by acute symptomatic etiologies, but in cases of intractable seizures, structural, genetic, or metabolic etiologies should be investigated.
Original Article
Neurology
Neurodevelopmental outcomes and comorbidities of children with congenital muscular torticollis: evaluation using the National Health Screening Program for Infants and Children database
Og Hyang Kim, Seung Won Lee, Eun Kyo Ha, Ju Hee Kim, Yun Hye Jo, Seongyeong Rhie, Man Yong Han, Kyu Young Chae
Clin Exp Pediatr. 2022;65(6):312-319.   Published online December 9, 2021
Question: What comorbidities are increased in children with congenital muscular torticollis (CMT)? Are there differences in the neurodevelopmental outcomes of children with CMT who received physical therapy versus those who did not?
Finding: The risk of congenital musculoskeletal deformities is increased in CMT. Children who did not receive physical therapy were at greater risk of neurodevelopmental delay.
Meaning: In CMT, musculoskeletal comorbidities should be identified and active early treatment provided.
Review Article
Neurology
Recent trends of healthcare information and communication technologies in pediatrics: a systematic review
Se young Jung, Keehyuck Lee, Hee Hwang
Clin Exp Pediatr. 2022;65(6):291-299.   Published online December 15, 2021
· The innovation of healthcare information communication technology (ICT) was accelerated with the adoption of electronic health records (EHRs).
· Telemedicine currently has no technical barriers.
· EHRs and personal health records are being connected, and mobile/wearable technologies are being integrated into them.
· Conventional rule-based clinical decision support systems have already been implemented and used in EHRs and PHRs. Artificial intelligence/machine learning improves precision and accuracy.
Big data analysis and artificial intelligence in epilepsy – common data model analysis and machine learning-based seizure detection and forecasting
Yoon Gi Chung, Yonghoon Jeon, Sooyoung Yoo, Hunmin Kim, Hee Hwang
Clin Exp Pediatr. 2022;65(6):272-282.   Published online November 26, 2021
· Big data analysis, such as common data model and artificial intelligence, can solve relevant questions and improve clinical care.
· Recent deep learning studies achieved 0.887–0.996 areas under the receiver operating characteristic curve for automated interictal epileptiform discharge detection.
· Recent deep learning studies achieved 62.3%–99.0% accuracy for interictal-ictal classification in seizure detection and 75.0%– 87.8% sensitivity with a 0.06–0.21/hr false positive rate in seizure forecasting.
Editorial
Neurology
Cerebrospinal fluid biomarkers in various pediatric neurologic diseases
Jeongho Lee
Clin Exp Pediatr. 2022;65(2):81-82.   Published online January 6, 2022
Cerebrospinal fluid (CSF) has many important biomarkers that are commonly analyzed in pediatric neurologic diseases, including central nervous system infection and inflammation. Neurologic disease in pediatrics is difficult to diagnosis, there are challenges in developing CSF profiles. Some biomarkers are expected to help differential diagnosis.
Review Article
Neurology
Promising candidate cerebrospinal fluid biomarkers of seizure disorder, infection, inflammation, tumor, and traumatic brain injury in pediatric patients
Seh Hyun Kim, Soo Ahn Chae
Clin Exp Pediatr. 2022;65(2):56-64.   Published online August 23, 2021
· Pediatric cerebrospinal fluid (CSF) components have been extensively evaluated as biomarkers of various neurologic diseases.
· Several promising candidate CSF biomarkers, including Tau, glial fibrillary acidic protein, neuron-specific enolase, S100β, and interleukins, have been studied in pediatric patients with seizure disorders, central nervous system infections, inflammation, tumors, hypoxic-ischemic encephalopathy, traumatic brain injuries, intraventricular hemorrhage, and congenital hydrocephalus.
· Circulating microRNAs in the CSF are a promising class of biomarkers for various neurological diseases.
Worldwide national intervention of developmental screening programs in infant and early childhood
Seunghyo Kim
Clin Exp Pediatr. 2022;65(1):10-20.   Published online September 30, 2021
∙ Prevalence rate of developmental disabilities has been reported from 8% to 15% and its rate is increasing worldwide.
∙ The critical period of intervention for developmental delay is before the child reaches 3 years of age.
∙ All primary care pediatricians should conduct developmental surveillance and screening tests to infants and children at scheduled visits. Through this, they are liable for providing early identification and timely intervention.
Editorial
Neurology
Recent studies are focus on the new treatments for hypoxicischemic encephalopathy (HIE) and long-term outcomes in later childhood and adolescence in children with a history on HIE
Eun Sook Suh
Clin Exp Pediatr. 2021;64(12):628-629.   Published online September 30, 2021
Neonatal encephalopathy is the most important reason for morbidity and mortality. The early detection of neonate with high risk for hypoxic ischemic encephalopathy (HIE) and treatment are important for prevent long term complication. Hypothermia is currently standard treatment option for HIE. Several clinical studies have been performed due to improve the long term outcome. New therapeutic options including xenon, allopurinol, erythropoietin, topiramate will help to reduce neuropsychiatric disability.
Review Article
Neurology
Cognitive outcomes in late childhood and adolescence of neonatal hypoxic-ischemic encephalopathy
Bo Lyun Lee, Hannah C. Glass
Clin Exp Pediatr. 2021;64(12):608-618.   Published online May 24, 2021
∙ Cognitive impairments occur in children with hypoxic-ischemic encephalopathy (HIE) even without neuromotor deficits.
∙ Therapeutic hypothermia has improved neurodevelopmental outcomes of children with HIE; however, 40% of children remain at risk of death/disability or cognitive impairments necessitating the development of adjunctive neuroprotective therapies.
∙ Long-term follow-up until adolescence is required to identify cognitive dysfunction.
∙ A pattern of watershed injury on brain imaging is associated with poor cognitive outcomes.
Recent update on reading disability (dyslexia) focused on neurobiology
Sung Koo Kim
Clin Exp Pediatr. 2021;64(10):497-503.   Published online March 2, 2021
·Neurobiological studies using functional brain imaging have uncovered the reading pathways, brain regions involved in reading, and neurobiological abnormalities of dyslexia.
·An accurate diagnosis and timely specialized intervention are important in children with dyslexia. When national infant development screening tests have been conducted as in Korea, if a language developmental delay and early predictors of dyslexia are detected, the progression to dyslexia should be carefully observed and early intervention provided.
Is it really a seizure? The challenge of paroxysmal nonepileptic events in young infants
Seung Yeon Jung, Joon Won Kang
Clin Exp Pediatr. 2021;64(8):384-392.   Published online September 18, 2020
Paroxysmal nonepileptic events (PNE) comprise of a variety of nonepileptic behaviors and are divided into various types. A more accurate diagnosis is possible by examining the video clip provided by the caregiver. In infants, physiologic PNE accounts for the majority of the PNE. It is important to exclude epilepsy, for which blood tests, electroencephalography, and imaging tests can facilitate differential...
Editorial
Neurology
Recent trends in autism spectrum disorder research using text mining of PubMed: importance of early detection
Seung Soo Kim
Clin Exp Pediatr. 2021;64(7):339-340.   Published online November 9, 2020
Behavioral therapy, the most widely proven intervention for the core symptoms of autism spectrum disorder (ASD), is required for life for individuals with ASD. Parent involvement, early detection, and early therapy play important roles. We must organize the risk factors for ASD and develop a screening tool that can be easily applied in the clinical, daycare, or school setting.
Clinical note
Neurology
Myelin oligodendrocyte glycoprotein antibody encephalitis following severe acute respiratory syndrome coronavirus 2 in a pediatric patient
Nusrat Ahsan, Saba Jafarpour, Jonathan D. Santoro
Clin Exp Pediatr. 2021;64(6):310-312.   Published online February 1, 2021
Question: Although neurologic complications have been reported during the acute phase of infection in children, less is known about the postinfectious phenomenon associated with the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) virus.
Finding: We present a case of a 7-year-old female with a prior asymptomatic infection with SARS-CoV-2 who subsequently developed encephalopathy and status epilepticus in association with myelin oligodendrocyte glycoprotein (MOG) antibody positivity.
Meaning: Here we present the first case of postinfectious of a MOG spectrum disorder associated with prior SARS-CoV-2 infection in a pediatric patient.
Editorial
Neurology
Psychogenic nonepileptic seizures; beyond differentiating from epileptic seizures
Sang Ook Nam
Clin Exp Pediatr. 2021;64(6):282-283.   Published online November 12, 2020
Review Article
Neurology
Myths and truths about pediatric psychogenic nonepileptic seizures
Jung Sook Yeom, Heather Bernard, Sookyong Koh
Clin Exp Pediatr. 2021;64(6):251-259.   Published online October 17, 2020
• Psychogenic non-epileptic seizures (PNES) are events that look like epileptic seizures but are not caused by abnormal electrical discharges.
• PNES are a manifestation of psychological and emotional distress.
• Treatment for PNES does not begin with the psychological intervention but starts with the diagnosis and how the diagnosis is delivered.
• A multifactorial biopsychosocial process and a neurobiological review are both essential components when treating PNES
Myelin oligodendrocyte glycoprotein antibody-associated disorders: clinical spectrum, diagnostic evaluation, and treatment options
Yun-Jin Lee, Sang Ook Nam, Ara Ko, JuHyun Kong, Shin Yun Byun
Clin Exp Pediatr. 2021;64(3):103-110.   Published online May 14, 2020
MOG antibody-associated disorder exhibits different pathophysiological and phenotypic findings than both aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder and typical MS. MOG-antibody is of particular interest in pediatric patients with clinical or radiological non-MS typical findings. MOG-antibody was included in a diagnostic algorithm for children recommending for the first time a standardized use in clinical practice except in cases of typical MS.
Perspective
Neurology
How can pediatricians treat neurodevelopmental disorders
Young-Hoon Kim
Clin Exp Pediatr. 2021;64(1):1-2.   Published online July 27, 2020
∙ Recently neurodevelopmental therapy for preschool-aged children with neurodevelopmental disorders is paid for by health insurance in Korea.
∙ There are good evidences that parenting programs and neurodevelopmental therapy can work in attention deficit hyperactivity disorder and autism spectrum disorder.
∙ Pediatricians must be able to pass away important information to parents.
Review Article
Neurology
Health effects of electromagnetic fields on children
Jin-Hwa Moon
Clin Exp Pediatr. 2020;63(11):422-428.   Published online May 26, 2020
· The nervous systems of children are more vulnerable to the effects of electromagnetic waves than adults.
· The exposure to electromagnetic fields (EMFs) among children should be minimized.
· According to International Agency for Research on Cancer EMFs are possibly carcinogenic, it should not be overlooked or interpreted with bias.
Editorial
Neurology
Commentary on "Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum"
Jieun Choi
Clin Exp Pediatr. 2020;63(8):310-311.   Published online August 15, 2020
Review Article
Neurology
Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum
Joo Hee Seo, Yun-Jin Lee, Ki Hyeong Lee, Elakkat Gireesh, Holly Skinner, Michael Westerveld
Clin Exp Pediatr. 2020;63(8):291-300.   Published online August 16, 2019
Advances in autoimmune encephalitis studies in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to the disorder. The disorder or syndrome has been linked to a wide variety of pathologic processes associated with the neuron-specific autoantibodies targeting intracellular and plasma membrane antigens. However, current criteria for autoimmune encephalitis...
Review Article
Neurology
Genetic tests by next-generation sequencing in children with developmental delay and/or intellectual disability
Ji Yoon Han, In Goo Lee
Clin Exp Pediatr. 2020;63(6):195-202.   Published online November 4, 2019
Developments in next-generation sequencing (NGS) techogies have assisted in clarifying the diagnosis and treatment of developmental delay/intellectual disability (DD/ID) via molecular genetic testing. Advances in DNA sequencing technology have not only allowed the evolution of targeted panels but also, and more currently enabled genome-wide analyses to progress from research era to clinical practice. Broad acceptance of accuracy- guided targeted gene...
Editorial
Neurology
Targeted temperature management and neuroprotective outcomes of pediatric patients after cardiac arrest
Yun-Jin Lee
Clin Exp Pediatr. 2020;63(5):180-181.   Published online April 14, 2020
Review Article
Neurology
Factors associated with seizure and cognitive outcomes after epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumors in children
Ara Ko, Joon Soo Lee
Clin Exp Pediatr. 2020;63(5):171-177.   Published online November 13, 2019
Low-grade epilepsy-associated neuroepithelial tumors (LEATs) are responsible for drug-resistant chronic focal epilepsy, and are the second-most common reason for epilepsy surgery in children. LEATs are extremely responsive to surgical treatment, and therefore epilepsy surgery should be considered as a treatment option for LEATs. However, the optimal time for surgery remains controversial, and surgeries are often delayed. In this review, we...
How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?
Hyo Jeong Kim
Clin Exp Pediatr. 2020;63(5):164-170.   Published online October 10, 2019
The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and counseling. A neurological examination is an important factor for prognostication, but widely used sedatives alter the neurological examination and delay the response recovery. Additional studies including electroencephalography, somatosensory-evoked potentials, brain imaging, and blood biomarkers are useful for...
Editorial
Neurology
Guideline for advanced neuroimaging in pediatric epilepsy
Yun Jung Hur
Clin Exp Pediatr. 2020;63(3):100-101.   Published online March 6, 2020
Review Article
Neurology
Advanced neuroimaging techniques for evaluating pediatric epilepsy
Yun Jeong Lee
Clin Exp Pediatr. 2020;63(3):88-95.   Published online February 6, 2020
Accurate localization of the seizure onset zone is important for better seizure outcomes and preventing deficits following epilepsy surgery. Recent advances in neuroimaging techniques have increased our understanding of the underlying etiology and improved our ability to noninvasively identify the seizure onset zone. Using epilepsy-specific magnetic resonance imaging (MRI) protocols, structural MRI allows better detection of the seizure onset zone,...
Original Article
Neurology
Evaluation of hematologic profile may be needed for patients treated with oxcarbazepine
Gu Hyun Jung, Su Jeong You
Clin Exp Pediatr. 2019;62(8):312-316.   Published online April 11, 2019

Purpose: The major side effects of treatment with oxcarbazepine (OXC) are skin rash and hyponatremia. Hematologic side effects are reported rarely. The aim of this study was to investigate the rate and types of the hematologic side effects of OXC. Methods: The medical records of 184 patients diagnosed with epilepsy or movement disorder and on OXC monotherapy, at the Department of...
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