Evidence about the use of pharmacologic agents in the treatment of Anorexia Nervosa (AN) is lacking, especially in childhood and adolescence. A systematic scoping review was conducted to outline current literature evidence about the use of antipsychotics in this population. A total of 499 studies were identified with the initial search, and 28 of these studies were selected regarding the use of olanzapine (n = 13), risperidone (n = 4), aripiprazole (n = 3), chlorpromazine (n = 3), pimozide (n = 1) clotiapine (n = 1) and multiple antipsychotics (n = 3) in these patients. Overall, major side effects were reported infrequently; improvements in psychopathology and weight measures have been suggested in the majority of the considered studies. Nonetheless, the lack of RCT or good-quality studies strongly limits the generalizability of results in clinical practice.

Febrile infection‐related epilepsy syndrome (FIRES) is a prolonged refractory status epilepticus (SE) that develops among healthy individuals after a febrile infection. FIRES treatment is challenging due to its poor response to antiseizure medications (ASMs) and anesthetic drugs. The use of cannabidiol (CBD) as an adjunctive treatment has been suggested, albeit data about its role in the acute phase is lacking. This report describes the use of purified CBD in the acute phase of two pediatric cases of FIRES and their long‐term outcome. Both children were treated with several ASMs, immunomodulators, anesthetics, and nonpharmacological treatment (ketogenic diet). CBD was administered, as an adjunctive treatment, through nasogastric tube about 30 days after onset. SE resolved within 3 days of reaching the target dose and both were seizure‐free for 1 year after. Although it is difficult to define the extent to which each previous therapy contributed to recovery, in both cases CBD therapy was a turning point, reinforcing its potential role as add‐on treatment in the acute phase of FIRES.

Recessive variants in the TK2 gene cause thymidine kinase 2 deficiency (TK2d) presenting with infantile, childhood, or adult-onset myopathy. CNS involvement is reported in only 25% of the infantile form. Compassionate use of deoxynucleoside substrate enhancement therapy (dC/dT) has been demonstrated safe and effective in TK2d myopathy, but no data are available on the potential efficacy on the human brain disease. Here, we report for the first time a patient with infantile TK2d epileptic encephalomyopathy enrolled in an early access program with dC/dT treatment (MT1621). At age 3 months, he presented progressive hypotonia, motor regression, failure to thrive, and respiratory failure. At age 8 months, he developed drug-resistant epilepsy with migrating focal seizures. Brain MRI showed progressive atrophy and bilateral subcortical lesions with lactate peak. Exome sequencing revealed 2 novel biallelic heterozygous variants in the TK2 gene (c.182G>A, p.Ser61Asn, c.704 T>C, p.Ile235Thr) whose pathogenicity was confirmed with in vitro studies. Early access compassionate use of dC/dT at 400 mg/kg prolonged the survival and stabilized the muscle disease but was not effective on the brain. Our report highlights the importance of deep-phenotyping infantile TK2d before dC/dT supplementation to stratify disease severity further and suggests a limited tissue-specific brain efficacy.

Objective: Status epilepticus (SE) is a neurological emergency in childhood, often leading to neuronal damage and long‐term outcomes. The study aims to identify barriers in the pre‐hospital and in‐hospital management of community‐onset pediatric SE and to evaluate the effectiveness of pediatric scores on outcomes prediction. Methods: This monocentric observational retrospective cohort study included patients treated for community‐onset pediatric SE in a tertiary care hospital between 2010 and 2021. Data were extracted following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inclusion criteria were community‐onset SE (according to the International League Against Epilepsy [ILAE] Task Force on SE Classification), admission to the pediatric emergency department (PED), age: 1 month to 18 years. Pre‐hospital, in‐hospital management and outcomes were analyzed. Pediatric scores for prediction of clinical worsening (Pediatric Early Warning Score ‐ PEWS) and SE outcome (Status Epilepticus in Pediatric patients Severity Score ‐ STEPSS; Pre‐status Epilepticus PCPCS, background Electroencephalographic abnormalities, Drug refractoriness, Semiology and critical Sickness Score ‐ PEDSS) were retrospectively assessed for their accuracy in predicting short‐term and long‐term outcomes. Results: A total of 103 consecutive episodes of SE were included. Out‐of‐hospital rescue medications administration occurred in 54.4% of cases and was associated with higher SE resolution rate before PED admission (48.2% vs 27.6%, p = .033). Longer in‐PED time to treatment was observed in case of delay to PED referral ( r = 0.268, p = .048) or non‐red triage labels (12 vs 5 min, p = 0.032), and was associated with longer in‐PED duration of SE ( r = 0.645, p < .001). Longer SE duration was observed in episodes leading to hospitalization compared to those discharged (50 vs 16 min, p < .001). In‐PED electroencephalography (EEG) recordings were available in 39.8% of events. Predictive scores varied in accuracy, with PEWS ≥5 showing high sensitivity for intensive care unit (ICU) admission but low specificity. No patients died, 6.3% of SE was refractory. Significance: Effective pre‐hospital administration of rescue medications and prompt PED management are crucial to reduce SE duration and improve outcomes. Predictive scores can aid in assessment of the severity and prognosis of SE; their utility is still not defined. Identifying and addressing actionable care barriers in SE management pathways is essential to enhance patient outcomes in pediatric SE.

The International Classification of Headache Disorders, 3rd edition (ICHD3) defines Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) as attacks of moderate or severe, strictly unilateral head pain lasting from seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye. Two subtypes of SUNHA are identified: Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) and Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms (SUNA). These pathologies are infrequent in children and difficult to diagnose. The authors reviewed the existing literature on SUNCT and SUNA, especially in the developmental age, which describes the pathophysiology in detail and focuses on the therapeutic options available to date. SUNHA-type headaches must be considered on the one hand, for the possibility of the onset of forms secondary to underlying pathologies even of a neoplastic nature, and on the other hand, for the negative impact they can have on an individual’s quality of life, particularly in young patients. Until now, published cases suggest that no chronic variants occur in childhood and adolescents. In light of this evidence, the authors offer a review that may serve as a source to be drawn upon in the implementation of suitable treatments in children and adolescents suffering from these headaches, focusing on therapies that are non-invasive and as risk-free as possible for pediatric patients.