Background: Status epilepticus (SE) is a neurological emergency with high morbidity and mortality in childhood, where rapid and effective intervention is essential to prevent neuronal injury. Experimental studies suggest that time-dependent loss of GABAergic responsiveness creates an early therapeutic window during which benzodiazepines are most effective for acute seizure suppression. Methods: This retrospective study analyzed 63 pediatric patients (mean age 46.5 ± 4.9 months) with first-episode SE treated between 2008 and 2022. Patients were categorized according to the timing of continuous midazolam infusion as early (≤15 min from seizure onset) or late (>15 min). Primary outcome was time to seizure control; secondary outcomes included infusion duration and epilepsy development during two-year follow-up. Results: Early infusion significantly shortened time to seizure control (21.8 ± 1.5 min vs. 29.3 ± 2.8 min, p = 0.029) and reduced infusion duration (18.4 ± 2.5 h vs. 32.7 ± 7.5 h, p = 0.049) compared with later initiation. Epilepsy developed in 74.6% of patients over two years, with no significant difference between early and late infusion groups (p = 0.079). Conclusions: Initiating continuous midazolam infusion within 15 min of seizure onset defines a clinically relevant early therapeutic window for pediatric SE. While infusion timing did not significantly alter long-term epileptogenesis, early initiation was associated with improved acute seizure control and shorter treatment duration, underscoring the importance of time-sensitive intervention in pediatric neuroemergencies.

Background: This study aimed to evaluate the comparative effectiveness of propranolol therapy and structured behavioral interventions in reducing headache severity in pediatric patients and to identify predictors of treatment response. Methods: In this prospective, single-center study, 178 pediatric patients diagnosed with migraine based on the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were enrolled. Participants were allocated into two groups according to baseline Pediatric Migraine Disability Assessment Scale (PedMIDAS) scores: Group 1 (PedMIDAS <15, n = 88) received standardized behavioral therapy, while Group 2 (PedMIDAS ≥15, n = 90) received propranolol (1–3 mg/kg/day) for 12 weeks. Primary outcomes were predefined as changes in monthly migraine attack frequency, PedMIDAS scores, and Visual Analog Scale (VAS)-measured headache intensity. Vitamin D deficiency and vitamin B12 deficiency were evaluated as biochemical predictors, and adherence was monitored bi-weekly. Results: Both groups showed significant improvement at week 12. Monthly migraine attacks declined from 3.5± 1.6 to 2.1 ± 1.2 in Group 1 and from 6.4 ± 2.1 to 3.1 ± 1.7 in Group 2. PedMIDAS scores decreased from 8.60 ± 3.25 to 5.75 ± 2.52 and 24.40 ± 9.65 to 16.11 ± 7.72, respectively (p < 0.001 both). VAS scores also improved in both groups with no significant between-group difference in percentage reduction. A ≥50%reduction in attack frequency plus ≥1-grade PedMIDAS improvement defined treatment response. In the propranolol group, response was independently associated with benign paroxysmal vertigo and essential tremor, while vitamin D and vitamin B12 deficiency predicted poorer outcomes. Conclusions: Both propranolol and structured behavioral therapy effectively reduce migraine-related disability and pain in pediatric patients, yielding comparable proportional improvements. The identification of key clinical and biochemical predictors supports a personalized treatment approach, integrating comorbidity screening and nutritional assessment to optimize outcomes. Clinical Trial Registration: ClinicalTrials.gov/NCT07180043, retrospectively registered.

This study examined the validity, test-retest reliability, and clinical feasibility of the 1-minute sit-to-stand test (1MSTS) as a practical alternative to the 6-minute walk test (6MWT) for assessing functional exercise capacity in children with cerebral palsy (CP). Seventy-eight children aged 5-18 years with spastic hemiplegic CP (Gross Motor Function Classification System I-II) completed the 1MSTS and 6MWT in random order on the same day. Test-retest reliability of the 1MSTS was evaluated using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Construct validity was assessed using correlation and linear regression analyses. The 1MSTS demonstrated good test-retest reliability (ICC = 0.78), with an SEM of 1.49 repetitions and an MDC₉₅ of 4.12 repetitions. A very strong association was observed between 1MSTS and 6MWT performances (ρ = 0.886, p < .001). Linear regression analysis further demonstrated that 6MWT distance explained approximately 80% of the variance in 1MSTS repetitions (R² = 0.799). These findings indicate that the 1MSTS captures functional exercise capacity assessed by the 6MWT. The 1MSTS is a valid, reliable, and clinically feasible alternative to the 6MWT for evaluating functional exercise capacity in children with spastic hemiplegic CP. ClinicalTrials.gov (NCT07136129).

Purpose Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent episodes of fever and serositis, caused by mutations in the MEFV gene. Inflammatory pathways associated with FMF are linked to increased proinflammatory cytokines, which may be related to primary headaches, including migraine. The aim of this study was to evaluate the frequency of migraine and other primary headaches in FMF patients. Methods In this retrospective study, the medical records of FMF patients were analyzed. Demographic data, MEFV gene mutations, and headache histories were collected. The frequency of migraine was compared among patients with these mutations, and statistical analyses were conducted. Results The study included 148 FMF patients, comprising 56.1% females and 43.9% males, with a mean age of 11.3 ± 3.7 years. A family history of FMF was reported in 77.7% of patients, and 35.8% had a family history of migraine. Headaches were reported in 52.7% of patients: 24.3% non-specific, 15.5% tension-type, and 12.8% migraine. Of those with migraine, 8.1% had migraine with aura, and 4.7% without aura. Headaches were more frequently frontal in patients under 12 years of age and temporal in those aged ≥12 years (p = 0.011). The most common genetic mutations were M694V heterozygous and homozygous, with M694V and E148Q mutations linked to more frequent migraines, although not statistically significant. Conclusion FMF patients should be screened for primary headaches, particularly migraine. The high frequency of migraine observed in this study suggests that clinicians should particularly consider migraine as a diagnosis in headache episodes experienced by FMF patients.

Objectives: Drug-resistant epilepsy (DRE) remains a major challenge in pediatric neurology, as many children fail to achieve seizure control despite appropriate medications. Vagus nerve stimulation (VNS) offers an effective adjunctive treatment; however, optimal stimulation parameters for children are not well defined and are often extrapolated from adult protocols. This retrospective two-center cohort study aimed to evaluate the clinical effectiveness of VNS in pediatric DRE and to determine stimulation thresholds—particularly output current and duty cycle—most strongly associated with seizure reduction. Methods: Fifty-two pediatric patients (aged 0–18 years) with DRE who underwent VNS implantation and were followed for at least 12 months were retrospectively analyzed. Stimulation frequency and pulse width were fixed at 30 Hz and 250 µs, while output current and duty cycle were titrated based on clinical response. Seizure outcomes were derived from caregiver-maintained seizure diaries and confirmed during structured follow-up visits. Treatment response was defined as a ≥50% reduction in seizure frequency compared to baseline. Results: At 12 months post-implantation, 76.9% of patients achieved ≥ 50% seizure reduction, 32.7% experienced ≥ 90% reduction, and 11.5% attained complete seizure freedom. Optimal outcomes were associated with output currents of approximately 1.5 mA and duty cycles of 10%. Conclusions: VNS is a highly effective and well-tolerated treatment for pediatric DRE. Stabilization at an output current of 1.5 mA and a 10% duty cycle may serve as a clinically useful programming target. These findings support the use of individualized, age-specific stimulation strategies to optimize outcomes in pediatric VNS therapy.