Considerations in Children and Adolescents Related to Coronavirus Disease 2019 (COVID-19).

Pediatric post-acute sequelae of SARS-CoV-2 (PASC) or "long COVID" are a complex multisystemic disease that affects children's physical, social, and mental health. PASC has a variable presentation, time course, and severity and can affect children even with mild or asymptomatic acute COVID-19 symptoms. Screening for PASC in children with a history of SARS-CoV-2 infection is important for early detection and intervention. A multifaceted treatment approach and utilization of multidisciplinary care, if available, are beneficial in managing the complexities of PASC. Lifestyle interventions, physical rehabilitation, and mental health management are important treatment approaches to improve pediatric PASC patients' quality of life.

Spina Bifida Management.

Myelomeningocele, commonly known as spina bifida, is a birth defect in which the spinal cord does not develop properly due to incomplete closure of the neural tube at 28 days of gestation. With advances in treatment modalities, technologies, and medical knowledge, people with spina bifida in the United States are living well into adulthood. Myelomeningocele management includes life-long comprehensive neurologic, urologic, musculoskeletal, skin, and habilitation management. We describe approaches to the same, with an emphasis on the signs and symptoms of medical urgencies and emergencies of which every pediatrician must be aware.

Calming the Storm: Dysautonomia for the Pediatrician.

Dysautonomia is a potentially life-threatening syndrome seen in many different types of brain injuries. It involves paroxysmal sympathetic hyperactivity and typically includes a constellation of symptoms, including: tachycardia, tachypnea, hyperthermia, hypertension, diaphoresis, hypertonia, and/or decerebrate or decorticate posturing. It is a clinical diagnosis of exclusion. A multimodal treatment approach is necessary including environmental modifications along with pharmacotherapy. Early management can help prevent comorbidities including secondary brain injury while also improving patient outcomes. This discussion serves as an overview of dysautonomia with a focus on management in the pediatric population including an example of a clinical algorithm and a review of the commonly used medications.

Transcortical cooling inhibits hippocampal-kindled seizures in the rat.

PURPOSE: When epileptogenic regions encroach on eloquent brain, surgery may incur unacceptable deficits. Reversible cooling may control seizures while preserving function. We describe the effects of cooling kindled seizures in awake, freely moving rats. METHODS: We kindled rats after placement of a bipolar electrode and a copper cooling coil in dorsal hippocampus. Fully kindled animals (three consecutive grade 5 seizures) were cooled to one of two target temperatures (24 degrees or 27 degrees C) for 3 min preceding a kindling stimulation and 2 minutes after. We compared seizure score (0-5) and afterdischarge duration (ADD) with and without cooling. Target temperatures were confirmed in identical animals by using a needle thermocouple advanced to the kindling target while circulating coolant. RESULTS: Circulation of 16 degrees C and 8 degrees C coolant reliably achieved transcortical cooling of the hippocampal target to 27.0 +/- 1.2 degrees C and 23.8 +/- 2.0 degrees C, respectively, by 180 s. Cooling with 16 degrees C coolant (n = 5) significantly reduced seizure scores from 5 to 2.57 +/- 1.56, and ADD from 142 +/- 94.5 s to 45.7 +/- 20.5 s. Cooling with 8 degrees C coolant (n = 5) reduced seizure scores from 5 to 2.0 +/- 0.42, and ADD from 132.3 +/- 29.6 s to 55.5 +/- 25.9 s. In 33.3% of all cooled stimulations, grade 0 seizures resulted; grade 5 seizures recurred during subsequent stimulations when cooling was withheld. CONCLUSIONS: Fully kindled, tonic-clonic seizures can be suppressed or aborted with periictal cooling of the kindling target. Anticonvulsant activity occurred at temperatures well above those known to result in tissue injury or inhibition of normal neurologic function. These findings have important implications for the potential use of implantable cooling devices in humans with refractory epilepsies in or near eloquent cortex or dominant hippocampal formations.