Cyclic Vomiting
We have all had the experience of arriving late at a diagnosis that may have been revealed earlier if we had been more alert. Not only do Rosman and colleagues describe an interesting case with an extended diagnostic saga, a lesson in itself, but there are also other lessons to be learned here. Contained in the report is a very useful discussion of the migraine equivalent conditions. This alone would be reason enough to include the case in this issue, but there is also a caveat to the clinician to rethink the diagnostic evaluation when the patient does not follow the expected course during the medical management of the pro...
Source: Seminars in Pediatric Neurology - April 4, 2014 Category: Neurology Authors: John B. Bodensteiner Source Type: research

A Curable and Probably Often-Overlooked Cause of Cyclic Vomiting Syndrome
Cyclic vomiting syndrome is a disorder of many causes. The major challenge is to label the disorder as idiopathic or primary only when all possible etiologies, particularly those that can be specifically treated, have been ruled out. In retrospect, our patient had subtle prenatal and early postnatal radiological findings supportive of a urological cause for his symptoms, the importance of which was initially missed. It would probably be wise to include an abdominal ultrasound examination (looking for hydronephrosis) in the “must-do” battery of tests for the investigation of all cases of recurrent cyclic vomitin...
Source: Seminars in Pediatric Neurology - April 4, 2014 Category: Neurology Authors: Norman Paul Rosman, Monideep Dutt, Hiep T. Nguyen Source Type: research

Overview of the Effect and Epidemiology of Parasitic Central Nervous System Infections in African Children
This article reviews the current understandings of these parasitic and other rarer infections, highlighting the specific challenges in relation to prevention, diagnosis, treatment, and the complications of coinfection. (Source: Seminars in Pediatric Neurology)
Source: Seminars in Pediatric Neurology - February 10, 2014 Category: Neurology Authors: Macpherson Mallewa, Jo M. Wilmshurst Source Type: research

An Overview of the Effect and Epidemiology of Viral Central Nervous System Infections in African Children
Viral infections in Africa are common. Polio still persists in the continent despite vaccination campaigns. Many of the common viral infections, such as by the nonpolio enteroviruses, lack effective therapies and leave devastating sequelae to infected neonates and infants. Rarer conditions, such as by West Nile virus, have generated a fascinating conundrum as to how the virus spread to other parts of the world, such as the United States of America. This infection illustrates that these conditions should not be considered isolated to Africa alone but that they represent examples of potentially lethal infections which, altho...
Source: Seminars in Pediatric Neurology - February 7, 2014 Category: Neurology Authors: Eben Badoe, Jo M. Wilmshurst Source Type: research

Child Neurology in Africa
The World Health Organization estimates that children in low-income countries are 16 times more likely to die before approximately 5 years of age than children in high-income countries (http://apps.who.int/iris/bitstream/10665/82058/1/WHO_HIS_HSI_13.1_eng.pdf). Almost 75% of childhood deaths are caused by just 6 conditions: neonatal causes (preterm birth, asphyxia, and infections), pneumonia, diarrhea, malaria, human immunodeficiency virus (HIV) infection, and measles. Amongst resource-limited nations, the burden is heavily skewed toward Africa, where almost half of these childhood deaths occur. Of the survivors of these c...
Source: Seminars in Pediatric Neurology - February 7, 2014 Category: Neurology Authors: Jo M. Wilmshurst Source Type: research

Update on the Diagnosis and Management of Tuberculous Meningitis in Children
Tuberculous meningitis (TBM), the most devastating manifestation of tuberculosis, is often missed or overlooked because of nonspecific symptoms and difficulties in diagnosis. It continues to be an important cause of neurologic handicap in resource-poor countries. Owing to the suboptimal performance of diagnostic tests of TBM, diagnosis relies on thorough history, clinical examination, and relevant investigations. The development of affordable, accurate diagnostic tests for TBM in resource-poor settings remains a priority. Short intensified treatment is safe and effective in both human immunodeficiency virus (HIV)-infected ...
Source: Seminars in Pediatric Neurology - February 3, 2014 Category: Neurology Authors: Ronald van Toorn, Regan Solomons Source Type: research

Assessment of Neurodisability and Malnutrition in Children in Africa
Abstract: Neurodevelopmental delay, neurodisability, and malnutrition interact to contribute a significant burden of disease in global settings. Assessments which are well integrated with plans of management or advice are most likely to improve outcomes. Assessment tools used in clinical research and programming to evaluate outcomes include developmental and cognitive tools that vary in complexity, sensitivity, and validity as well as the target age of assessment. Few tools have been used to measure socioemotional outcomes and fewer to assess the disabled child with malnutrition. There is a paucity of tools used clinically...
Source: Seminars in Pediatric Neurology - January 15, 2014 Category: Neurology Authors: Melissa Gladstone, Mac Mallewa, Alhaji Alusine Jalloh, Wieger Voskuijl, Douglas Postels, Nora Groce, Marko Kerac, Elizabeth Molyneux Source Type: research

The Challenges of Managing Children With Epilepsy in Africa
Children with epilepsy who reside in the African continent are faced with some of the greatest challenges of receiving adequate care. The burden of disease is exacerbated by the high incidence of acquired causes and the large treatment gap. Skilled teams to identify and care for children with epilepsy are lacking. Many patients are managed through psychiatric services, thus potentially compounding the stigma associated with the condition. Little data exist to assess the true proportion of comorbidities suffered by children with epilepsy, the assumption is that this is high, further aggravated by delayed interventions and a...
Source: Seminars in Pediatric Neurology - January 15, 2014 Category: Neurology Authors: Jo M. Wilmshurst, Angelina Kakooza-Mwesige, Charles R. Newton Source Type: research

Neurologic Complications of Pediatric Human Immunodeficiency Virus: Implications for Clinical Practice and Management Challenges in the African Setting
This article summarizes the spectrum of neuro-HIV in children, focuses on the neurocognitive and behavioral sequelae, reviews the effects of treatment on the primary neurologic effects of the disease, and discusses the specific challenges of identifying and managing these problems in resource-limited contexts, such as those found on the African continent. (Source: Seminars in Pediatric Neurology)
Source: Seminars in Pediatric Neurology - January 13, 2014 Category: Neurology Authors: Kirsten Ann Donald, Jackie Hoare, Brian Eley, Jo M. Wilmshurst Source Type: research

Pediatric Cerebral Palsy in Africa: A Systematic Review
Cerebral palsy is a common neurologic problem in children and is reported as occurring in approximately 2-2.5 of 1000 live births globally. As is the case with many pediatric neurologic conditions, very little has been reported on this condition in the African context. Resource-limited settings such as those found across the continent are likely to result in a different spectrum of etiologies, prevalence, severity as well as management approaches. This review aims to establish what has been reported on this condition from the African continent so as to better define key clinical and research questions. (Source: Seminars in...
Source: Seminars in Pediatric Neurology - January 10, 2014 Category: Neurology Authors: Kirsten A. Donald, Pauline Samia, Angelina Kakooza-Mwesige, David Bearden Source Type: research

The Interaction of Malnutrition and Neurologic Disability in Africa
Malnutrition and neurodisability are both major public health problems in Africa. This review highlights key areas where they interact. This happens throughout life and starts with maternal malnutrition affecting fetal neurodevelopment with both immediate (eg, folate deficiency causing neural tube defects) and lifelong implications (eg, impaired cognitive function). Maternal malnutrition can also increase the risk of perinatal problems, including birth asphyxia, a major cause of neurologic damage and cerebral palsy. Macronutrient malnutrition can both cause and be caused by neurodisability. Mechanisms include decreased foo...
Source: Seminars in Pediatric Neurology - January 6, 2014 Category: Neurology Authors: Marko Kerac, Douglas G. Postels, Mac Mallewa, Alhaji Alusine Jalloh, Wieger P. Voskuijl, Nora Groce, Melissa Gladstone, Elizabeth Molyneux Source Type: research

Author Index
(Source: Seminars in Pediatric Neurology)
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Source Type: research

Notes From Clinical Practice: An MD’s Perspective on 9 Years of Neurofeedback Practice
Neurofeedback is a form of biofeedback in which electroencephalogram (EEG) activity is made apparent to a patient, who is “persuaded” to alter that activity via rewards and inhibitions that are manipulated by the EEG feedback therapist. The most popular forms of feedback presentation to a patient are via videos or simple video games. The operating parameters of the chosen feedback are altered according to selected EEG frequencies. The closer the EEG activity comes to optimal, the more the patient is rewarded by feedback that runs well. When the EEG deviates from the desired objectives, the feedback runs poorly ...
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Authors: Doreen E. McMahon Source Type: research

Endogenous Neuromodulation at Infralow Frequencies
Neuromodulation in the bioelectrical domain is an attractive option for the remediation of functionally based deficits. Most of the interest to date has focused on exogenous methods, such as repetitive transcranial magnetic stimulation, transient direct current stimulation, vagus nerve stimulation, and deep brain stimulation. Much less attention has been given to endogenous methods of exploiting latent brain plasticity. These have reached a level of sophistication and maturity that invites attention. Over the last 7 years, the domain of infralow frequencies has been exploited productively for the enhancement of neuroregula...
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Authors: Siegfried Othmer, Susan F. Othmer, David A. Kaiser, John Putman Source Type: research

Infralow Frequencies and Ultradian Rhythms
Our brain activity demonstrates amazing stability across multiple time frames ranging from a few milliseconds to several hours. The longer cycles are commonly called ultradian rhythms and they correspond to infralow frequencies (ILFs) in the milli-Hz range (0.001Hz). Ultradian rhythms between 90 minutes and 2 hours or longer are readily observed in our electroencephalogram, and they reflect periods of activity and rest, cycles of cortical excitability and plasticity followed by relative inactivity. Our nightly sleep is organized into similar stages (rapid eye movement and non–rapid eye movement sleep) as is our daily...
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Authors: David Kaiser Source Type: research

Astrocytes: The Missing Link in Neurologic Disease?
The central nervous system is comprised of numerous cell types that work in concert to facilitate proper function and homeostasis. Disruption of these carefully orchestrated networks results in neuronal dysfunction, manifesting itself in a variety of neurologic disorders. Although neuronal dysregulation is causative of symptoms that manifest in the clinic, the etiology of these disorders is often more complex than simply a loss of neurons or intrinsic dysregulation of their function. In the adult brain, astrocytes comprise the most abundant cell type and play key roles in central nervous system physiology; therefore, it st...
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Authors: Chia-Ching John Lin, Benjamin Deneen Source Type: research

Astrocyte Form and Function in the Developing Central Nervous System
Astrocytes have long been forgotten entities in our quest to understand brain function. Over the last few decades, there has been an exponential increase in our knowledge of central nervous system (CNS) function, and, consequently, astrocytes have emerged as key figures in CNS physiology and disease. Indeed, several pediatric neurologic disorders have recently been linked to astrocyte dysregulation, including leukodystrophies, autism spectrum disorders, and epilepsy. Given that pediatric disorders are rooted in developmental processes, the goal of this review is to catalog what we know about astrocyte development and funct...
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Authors: Lesley S. Chaboub, Benjamin Deneen Source Type: research

Developing Neural Networks and Plasticity
There is mounting evidence that the role of astrocytes in central nervous system development, networking, and plasticity is more than significant. Once regarded as mostly supportive and protective of neuronal function—the neuron traditionally considered the more evolved brain cell—recent neuroscientific advances from functional magnetic resonance imaging (fMRI) and other interface technologies force us to reconsider the hierarchy of brain control. Pereira and Furlan propose an astrocentric theory for the role of astrocytes in cognition and behavior. In this theory, the neuronal pool functions to provide an unco...
Source: Seminars in Pediatric Neurology - December 1, 2013 Category: Neurology Authors: Stella B. Legarda Source Type: research

Mitochondrial Dysfunction in Neuromuscular Disorders
This review deciphers aspects of mitochondrial (mt) dysfunction among nosologically, pathologically, and genetically diverse diseases of the skeletal muscle, lower motor neuron, and peripheral nerve, which fall outside the traditional realm of mt cytopathies. Special emphasis is given to well-characterized mt abnormalities in collagen VI myopathies (Ullrich congenital muscular dystrophy and Bethlem myopathy), megaconial congenital muscular dystrophy, limb-girdle muscular dystrophy type 2 (calpainopathy), centronuclear myopathies, core myopathies, inflammatory myopathies, spinal muscular atrophy, Charcot-Marie-Tooth neuropa...
Source: Seminars in Pediatric Neurology - November 7, 2013 Category: Neurology Authors: Christos D. Katsetos, Sirma Koutzaki, Joseph J. Melvin Source Type: research

Mitochondrial Dysfunction in Gliomas
Mitochondrial (mt) dysfunction in gliomas has been linked to abnormalities of mt energy metabolism, marked by a metabolic shift from oxidative phosphorylation to glycolysis (“Warburg effect”), disturbances in mt membrane potential regulation and apoptotic signaling, as well as to somatic mutations involving the Krebs cycle enzyme isocitrate dehydrogenase. Evolving biological concepts with potential therapeutic implications include interaction between microtubule proteins and mitochondria (mt) in the control of closure of voltage-dependent anion channels and in the regulation of mt dynamics and the mt-endoplasmi...
Source: Seminars in Pediatric Neurology - September 1, 2013 Category: Neurology Authors: Christos D. Katsetos, Helen Anni, Pavel Dráber Source Type: research

Mitochondrial Dysfunction in Demyelinating Diseases
Dysfunction of the mitochondrial (mt) system is thought to play an important role in the mechanism of progression of various neurodegenerative disorders, including demyelinating disorders. They are characterized by neuroinflammation, ultimately leading to neurodegeneration. Mitochondria (mt) dysfunction is closely related to the mechanism of neuroinflammation, causing increased production of reactive oxygen species, which is detrimental to neurons and glia. Vice versa, neuroinflammation is increasingly recognized to produce mt failure, which then contributes to further neuronal injury and degeneration. Multiple sclerosis a...
Source: Seminars in Pediatric Neurology - September 1, 2013 Category: Neurology Authors: Karen S. Carvalho Source Type: research

Mitochondrial Dysfunction in Migraine
Migraine is the most frequent type of headache in children. In the 1980s, scientists first hypothesized a connection between migraine and mitochondrial (mt) disorders. More recent studies have suggested that at least some subtypes of migraine may be related to a mt defect. Different types of evidence support a relationship between mitochondria (mt) and migraine: (1) Biochemical evidence: Abnormal mt function translates into high intracellular penetration of Ca2+, excessive production of free radicals, and deficient oxidative phosphorylation, which ultimately causes energy failure in neurons and astrocytes, thus triggering ...
Source: Seminars in Pediatric Neurology - September 1, 2013 Category: Neurology Authors: William R. Yorns, H. Huntley Hardison Source Type: research

Mitochondrial Dysfunction in Epilepsy
Epilepsy is the most common neurologic disorder worldwide and is characterized by recurrent unprovoked seizures. The mitochondrial (mt) respiratory chain is the final common pathway for cellular energy production through the process of oxidative phosphorylation. As neurons are terminally differentiated cells that lack significant regenerative capacity and have a high energy demand, they are more vulnerable to mt dysfunction. Therefore, epileptic seizures have been well described in several diseases such as mt encephalomyopathy, lactic acidosis, and stroke-like episodes and myoclonic epilepsy and ragged red fibers, which ar...
Source: Seminars in Pediatric Neurology - September 1, 2013 Category: Neurology Authors: Divya S. Khurana, Ignacio Valencia, Michael J. Goldenthal, Agustín Legido Source Type: research

Mitochondrial Dysfunction in Autism
Using data of the current prevalence of autism as 200:10,000 and a 1:2000 incidence of definite mitochondrial (mt) disease, if there was no linkage of autism spectrum disorder (ASD) and mt disease, it would be expected that 1 in 110 subjects with mt disease would have ASD and 1 in 2000 individuals with ASD would have mt disease. The co-occurrence of autism and mt disease is much higher than these figures, suggesting a possible pathogenetic relationship. Such hypothesis was initially suggested by the presence of biochemical markers of abnormal mt metabolic function in patients with ASD, including elevation of lactate, pyruv...
Source: Seminars in Pediatric Neurology - September 1, 2013 Category: Neurology Authors: Agustín Legido, Reena Jethva, Michael J. Goldenthal Source Type: research

Introduction
The first clinical and biochemical description of mitochondrial (mt) disease was reported by Luft et al. Only 2 patients with Luft disease have been described to date. Both were interesting examples of intellectually normal adult women with a rare form of mt hyperfunction associated with high oxygen consumption rates, hypermetabolism, heat intolerance, resting tachycardia, hyperhidrosis, and death in middle age from respiratory muscle failure. Although mitochondria (mt) were first reported to contain their own DNA in 1963 by Nass and Nass, it was another 25 years before the first DNA mutations were found that caused mt dis...
Source: Seminars in Pediatric Neurology - September 1, 2013 Category: Neurology Authors: Agustín Legido Source Type: research

Perspectives of Young Adults With Cerebral Palsy on Transitioning From Pediatric to Adult Healthcare Systems
Transition from pediatric to adult healthcare is a well-established challenge for individuals with neurodevelopmental disorders like cerebral palsy. With regard to ethics, some of the key aspects to explore include the following: if and how individuals feel respected during the transition process; if and how their values and preferences are developed and integrated within transition; and if and how young patients are prepared to participate in decision making (to be autonomous) within the transition. We carried out a qualitative study on 14 young adults with cerebral palsy. Some participants reported positive experiences. ...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Danaë Larivière-Bastien, Emily Bell, Annette Majnemer, Michael Shevell, Eric Racine Source Type: research

The Potential for Stem Cells in Cerebral Palsy—Piecing Together the Puzzle
The substantial socioeconomic burden of a diagnosis of cerebral palsy, coupled with a positive anecdotal and media spin on stem cell treatments, drives many affected families to seek information and treatment outside of the current clinical and scientific realm. Preclinical studies using several types of stem and adult cells—including mesenchymal stem cells, neural precursor cells, olfactory ensheathing glia and Schwann cells—have demonstrated some regenerative and functional efficacy in neurologic paradigms. This paper describes the most common cell types investigated for transplant in vivo and summarizes the ...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Stuart D. Faulkner, Crystal A. Ruff, Michael G. Fehlings Source Type: research

Robot-Assisted and Computer-Enhanced Therapies for Children with Cerebral Palsy: Current State and Clinical Implementation
The field of pediatric neurorehabilitation has rapidly evolved with the introduction of technological advancements over recent years. Rehabilitation robotics and computer-assisted systems can complement conventional physiotherapeutics or occupational therapies. These systems appear promising, especially in children, where exciting and challenging virtual reality scenarios could increase motivation to train intensely in a playful therapeutic environment. Despite promising experience and a large acceptance by the patients and parents, so far, only a few therapy systems have been evaluated in children, and well-designed rando...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Andreas Meyer-Heim, Hubertus J.A. van Hedel Source Type: research

Interactive Computer Play as “Motor Therapy” for Individuals With Cerebral Palsy
The aim of the study was to evaluate the quality of evidence for interactive computer play (ICP) to improve motor performance (including motor control, strength, or cardiovascular [CVS] fitness) in individuals with cerebral palsy. A computer-assisted literature search was completed, focusing on ICP as a therapeutic modality to improve motor outcomes in individuals of all ages with cerebral palsy with a specific focus on upper and lower extremity motor outcomes and promotion of CVS fitness. Articles were classified according to American Academy of Neurology guidelines and recommendation classifications were given based on t...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Darcy Fehlings, Lauren Switzer, Briar Findlay, Shannon Knights Source Type: research

Can Noninvasive Brain Stimulation Measure and Modulate Developmental Plasticity to Improve Function in Stroke-Induced Cerebral Palsy?
The permanent nature of motor deficits is a consistent cornerstone of cerebral palsy definitions. Such pessimism is disheartening to children, families, and researchers alike and may no longer be appropriate for it ignores the fantastic plastic potential of the developing brain. Perinatal stroke is presented as the ideal human model of developmental neuroplasticity following distinct, well-defined, focal perinatal brain injury. Elegant animal models are merging with human applied technology methods, including noninvasive brain stimulation for increasingly sophisticated models of plastic motor development following perinata...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Adam Kirton Source Type: research

Training to Enhance Walking in Children With Cerebral Palsy: Are We Missing the Window of Opportunity?
The objective of this paper is to (1) identify from the literature a potential critical period for the maturation of the corticospinal tract (CST) and (2) report pilot data on an intensive, activity-based therapy applied during this period, in children with lesions to the CST. The best estimate of the CST critical period for the legs is when the child is younger than 2 years of age. Previous interventions for walking in children with CST damage were mainly applied after this age. Our preliminary results with training children younger than 2 years showed improvements in walking that exceeded all previous reports. Further, w...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Jaynie F. Yang, Donna Livingstone, Kelly Brunton, Dasom Kim, Barbara Lopetinsky, Francois Roy, Ephrem Zewdie, Susan K. Patrick, John Andersen, Adam Kirton, Joe-Man Watt, Jerome Yager, Monica Gorassini Source Type: research

Intensive Upper Extremity Training for Children with Hemiplegia: From Science to Practice
This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upper extremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation,...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: John C. Andersen, Annette Majnemer, Kathleen O'Grady, Andrew M. Gordon Source Type: research

Motor Measures: A Moving Target?
Outcome measures may be used for a variety of reasons by clinicians and researchers. This paper provides an overview on motor measures that can be used in research or practice and are classified within the International Classification of Functioning, Disability and Health or ICF. Specifically, body function measures of neuromusculoskeletal and movement-related functions are presented, as are mobility measures within the activity and participation domain of the ICF. Descriptions of measures within these categories and their psychometric properties are provided. Current challenges and future directions for motor measurement ...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Virginia Wright, Annette Majnemer, Désirée B. Maltais, Patricia A. Burtner, Heidi Sanders Source Type: research

Evidence for Therapeutic Intervention in the Prevention of Cerebral Palsy: Hope from Animal Model Research
Knowledge translation, as defined by the Canadian Institute of Health Research, is defined as the exchange, synthesis, and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research through improved health, more effective services and products, and a strengthened healthcare system. The requirement for this to occur lies in the ability to continue to determine mechanistic actions at the molecular level, to understand how they fit at the in vitro and in vivo levels, and for disease states, to determine their sa...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Antoinette Nguyen, Edward A. Armstrong, Jerome Y. Yager Source Type: research

Brain Development in Infants Born Preterm: Looking Beyond Injury
Infants born very preterm are high risk for acquired brain injury and disturbances in brain maturation. Although survival rates for preterm infants have increased in the last decades owing to improved neonatal intensive care, motor disabilities including cerebral palsy persist, and impairments in cognitive, language, social, and executive functions have not decreased. Evidence from neuroimaging studies exploring brain structure, function, and metabolism has indicated abnormalities in the brain development trajectory of very preterm-born infants that persist through to adulthood. In this chapter, we review neuroimaging appr...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Emma G. Duerden, Margot J. Taylor, Steven P. Miller Source Type: research

The Epidemiology of Cerebral Palsy: New Perspectives From a Canadian Registry
Cerebral palsy (CP) was first recognized as a distinct clinical entity in the mid-19th century. Since then, our conceptualization of this neurodevelopmental disability has evolved with reification of its case definition. Presently, the most widely accepted consensus definition utilized for both clinical and research purposes is the one put forward by Rosenbaum et al in 2007, “cerebral palsy describes a group of permanent disorders of movement and posture, causing activity limitations, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cere...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Michael Shevell, Lynn Dagenais, Maryam Oskoui Source Type: research

Prologue
This supplement to Seminars in Pediatric Neurology is a compilation of papers that were given at the third Annual Cerebral Palsy in Motion Conference and Workshop, held in Edmonton, Alberta, Canada, in May 2012. The conference is an excellent reflection of the work being done in the area of cerebral palsy (CP) research, by the members of the NeuroDevNet Cerebral Palsy Demonstration Project. (Source: Seminars in Pediatric Neurology)
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Jerome Y. Yager, Michael Shevell Source Type: research

Perspectives of Young Adults With Cerebral Palsy on Transitioning From Pediatric to Adult Healthcare Systems
Transition from pediatric to adult healthcare is a well-established challenge for individuals with neurodevelopmental disorders like cerebral palsy. With regard to ethics, some of the key aspects to explore include the following: if and how individuals feel respected during the transition process; if and how their values and preferences are developed and integrated within transition; and if and how young patients are prepared to participate in decision making (to be autonomous) within the transition. We carried out a qualitative study on 14 young adults with cerebral palsy. Some participants reported positive experiences. ...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Danaë Larivière-Bastien, Emily Bell, Annette Majnemer, Michael Shevell, Eric Racine Source Type: research

The Potential for Stem Cells in Cerebral Palsy—Piecing Together the Puzzle
The substantial socioeconomic burden of a diagnosis of cerebral palsy, coupled with a positive anecdotal and media spin on stem cell treatments, drives many affected families to seek information and treatment outside of the current clinical and scientific realm. Preclinical studies using several types of stem and adult cells—including mesenchymal stem cells, neural precursor cells, olfactory ensheathing glia and Schwann cells—have demonstrated some regenerative and functional efficacy in neurologic paradigms. This paper describes the most common cell types investigated for transplant in vivo and summarizes the ...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Stuart D. Faulkner, Crystal A. Ruff, Michael G. Fehlings Source Type: research

Robot-Assisted and Computer-Enhanced Therapies for Children with Cerebral Palsy: Current State and Clinical Implementation
The field of pediatric neurorehabilitation has rapidly evolved with the introduction of technological advancements over recent years. Rehabilitation robotics and computer-assisted systems can complement conventional physiotherapeutics or occupational therapies. These systems appear promising, especially in children, where exciting and challenging virtual reality scenarios could increase motivation to train intensely in a playful therapeutic environment. Despite promising experience and a large acceptance by the patients and parents, so far, only a few therapy systems have been evaluated in children, and well-designed rando...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Andreas Meyer-Heim, Hubertus J.A. van Hedel Source Type: research

Interactive Computer Play as “Motor Therapy” for Individuals With Cerebral Palsy
The aim of the study was to evaluate the quality of evidence for interactive computer play (ICP) to improve motor performance (including motor control, strength, or cardiovascular [CVS] fitness) in individuals with cerebral palsy. A computer-assisted literature search was completed, focusing on ICP as a therapeutic modality to improve motor outcomes in individuals of all ages with cerebral palsy with a specific focus on upper and lower extremity motor outcomes and promotion of CVS fitness. Articles were classified according to American Academy of Neurology guidelines and recommendation classifications were given based on t...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Darcy Fehlings, Lauren Switzer, Briar Findlay, Shannon Knights Source Type: research

Can Noninvasive Brain Stimulation Measure and Modulate Developmental Plasticity to Improve Function in Stroke-Induced Cerebral Palsy?
The permanent nature of motor deficits is a consistent cornerstone of cerebral palsy definitions. Such pessimism is disheartening to children, families, and researchers alike and may no longer be appropriate for it ignores the fantastic plastic potential of the developing brain. Perinatal stroke is presented as the ideal human model of developmental neuroplasticity following distinct, well-defined, focal perinatal brain injury. Elegant animal models are merging with human applied technology methods, including noninvasive brain stimulation for increasingly sophisticated models of plastic motor development following perinata...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Adam Kirton Source Type: research

Training to Enhance Walking in Children With Cerebral Palsy: Are We Missing the Window of Opportunity?
The objective of this paper is to (1) identify from the literature a potential critical period for the maturation of the corticospinal tract (CST) and (2) report pilot data on an intensive, activity-based therapy applied during this period, in children with lesions to the CST. The best estimate of the CST critical period for the legs is when the child is younger than 2 years of age. Previous interventions for walking in children with CST damage were mainly applied after this age. Our preliminary results with training children younger than 2 years showed improvements in walking that exceeded all previous reports. Further, w...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Jaynie F. Yang, Donna Livingstone, Kelly Brunton, Dasom Kim, Barbara Lopetinsky, Francois Roy, Ephrem Zewdie, Susan K. Patrick, John Andersen, Adam Kirton, Joe-Man Watt, Jerome Yager, Monica Gorassini Source Type: research

Intensive Upper Extremity Training for Children with Hemiplegia: From Science to Practice
This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upper extremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation,...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: John C. Andersen, Annette Majnemer, Kathleen O'Grady, Andrew M. Gordon Source Type: research

Motor Measures: A Moving Target?
Outcome measures may be used for a variety of reasons by clinicians and researchers. This paper provides an overview on motor measures that can be used in research or practice and are classified within the International Classification of Functioning, Disability and Health or ICF. Specifically, body function measures of neuromusculoskeletal and movement-related functions are presented, as are mobility measures within the activity and participation domain of the ICF. Descriptions of measures within these categories and their psychometric properties are provided. Current challenges and future directions for motor measurement ...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Virginia Wright, Annette Majnemer, Désirée B. Maltais, Patricia A. Burtner, Heidi Sanders Source Type: research

Evidence for Therapeutic Intervention in the Prevention of Cerebral Palsy: Hope from Animal Model Research
Knowledge translation, as defined by the Canadian Institute of Health Research, is defined as the exchange, synthesis, and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research through improved health, more effective services and products, and a strengthened healthcare system. The requirement for this to occur lies in the ability to continue to determine mechanistic actions at the molecular level, to understand how they fit at the in vitro and in vivo levels, and for disease states, to determine their sa...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Antoinette Nguyen, Edward A. Armstrong, Jerome Y. Yager Source Type: research

Brain Development in Infants Born Preterm: Looking Beyond Injury
Infants born very preterm are high risk for acquired brain injury and disturbances in brain maturation. Although survival rates for preterm infants have increased in the last decades owing to improved neonatal intensive care, motor disabilities including cerebral palsy persist, and impairments in cognitive, language, social, and executive functions have not decreased. Evidence from neuroimaging studies exploring brain structure, function, and metabolism has indicated abnormalities in the brain development trajectory of very preterm-born infants that persist through to adulthood. In this chapter, we review neuroimaging appr...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Emma G. Duerden, Margot J. Taylor, Steven P. Miller Source Type: research

The Epidemiology of Cerebral Palsy: New Perspectives From a Canadian Registry
Cerebral palsy (CP) was first recognized as a distinct clinical entity in the mid-19th century. Since then, our conceptualization of this neurodevelopmental disability has evolved with reification of its case definition. Presently, the most widely accepted consensus definition utilized for both clinical and research purposes is the one put forward by Rosenbaum et al in 2007, “cerebral palsy describes a group of permanent disorders of movement and posture, causing activity limitations, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cere...
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Michael Shevell, Lynn Dagenais, Maryam Oskoui Source Type: research

Prologue
This supplement to Seminars in Pediatric Neurology is a compilation of papers that were given at the third Annual Cerebral Palsy in Motion Conference and Workshop, held in Edmonton, Alberta, Canada, in May 2012. The conference is an excellent reflection of the work being done in the area of cerebral palsy (CP) research, by the members of the NeuroDevNet Cerebral Palsy Demonstration Project. (Source: Seminars in Pediatric Neurology)
Source: Seminars in Pediatric Neurology - June 1, 2013 Category: Neurology Authors: Jerome Y. Yager, Michael Shevell Source Type: research

Corrigendum to “The NeuroDevNet autism spectrum disorders demonstration project” [Semin. Pediatr. Neurol. 18(1) (2011) 40–48]
The authors regret that in the above-named article one of the authors name was incorrect. The correct name is Evdokia Anagnostou, and not Evdokia Anognostou. (Source: Seminars in Pediatric Neurology)
Source: Seminars in Pediatric Neurology - March 1, 2013 Category: Neurology Source Type: research