Clinical profile and multidisciplinary needs of patients with neuromuscular disorders transitioning from paediatric to adult care.

Transition in paediatric health care refers to the planned process of shifting to an adult model of care and is highly individualised, patient focussed and requires a coordinated effort from different health care professionals. Through this retrospective study, we describe the spectrum of neuromuscular diseases evaluated through a paediatric to adult neuromuscular transition program in a tertiary academic centre in Canada, and also the speciality supports needed for these patients. 126 patients were transitioned during the study period. The most common clinical diagnosis was muscle disease (44.4%), followed by neuropathy (27.8%), neuromuscular junction disorders (15.9%) and motor neuron disease (MND) (10.3%). The majority of cases were inherited neuromuscular disorders (66.6%); 58.3% had a genetically confirmed diagnosis. Cardiac and respiratory abnormalities were encountered in 8.7% and 27.7% and transitioning was required for 39.8% and 35.7% respectively. Scoliosis was seen in 30.2% of patients; 9.5% underwent spine surgery. Patients with MND had maximum requirements for self-care (46.2% of MND) and a mobility device for ambulation was required in 69.2% of MND. We observed a wide range of systemic issues requiring the services of endocrinology, gastroenterology, speech and language pathology and psychiatry. A multidisciplinary clinical care model may provide optimal care for patients transitioning from paediatric to adult care health systems.

Post-Traumatic Headache in Children and Adolescents: a Narrative Review with a Focus on Management.

PURPOSE OF REVIEW: Although common, post-traumatic headache (PTH) in the pediatric population is a niche group with a paucity of published evidence on the diagnosis, most appropriate acute and preventative management, and prognosis. This article aims to review pediatric PTH, its epidemiology and pathophysiology with a focus on management and future directions. RECENT FINDINGS: Using MEDLINE, EMBASE, 52 articles on PTH in children and adolescents from 2016 to 2020 were identified. Over the last 4 years, our understanding of traumatic brain injury pathophysiology has grown, expanding the potential for more therapeutic targets. Despite this achievement, and recently published consensus guidelines, the review demonstrated a lack of published controlled trials to help guide management of pediatric PTH. The last 4 years have provided new insights into the potential pathophysiological mechanisms through laboratory research and advanced MR imaging; however, there continues to be a translational gap to clinical practice.

Management of Menstrual Migraine.

PURPOSE OF REVIEW: Migraine disease is a neurological brain disorder that has been associated with significant disability and socioeconomic burden affecting women three times more commonly than men. Menstrual migraine is a subclass of migraine disease affecting 42-61% of females living with migraine disease. Menstrual migraine is often far more disabling, of longer duration, and more resistant to treatment. It is crucial to gain a deeper understanding of the ongoing biological changes and have a current awareness of the management of this debilitating form of migraine disease to improve the quality of life of these females living with migraine disease. RECENT FINDINGS: In new treatment options such as devices and with large-scale genome-wide association studies in migraine, genes related to migraine are being identified. This article will review the current literature regarding the pathophysiology, epidemiology, and treatment of menstrual migraine.