Sunday, June 7, 2026

SPG50 treatment

A rare disease called SPG50 affects fewer than 100 people in the world — and one of them is Naomi Lockard, a 3-year-old in Colorado.

An experimental genetic therapy has shown promise in stopping the disease’s progression — but it is far too expensive for most families to afford.

Rebekah Lockard, the girl’s mother, is on a mission to raise the funds needed to save her daughter’s life.

Spastic paraplegia 50 (SPG50) is a neurological disorder that affects a child’s development, gradually leading to cognitive impairment, muscle weakness, speech impairment and paralysis, according to the National Organization for Rare Disorders.

The disease typically has a life expectancy of 20 to 30 years if left untreated.

When Naomi Lockard was born in 2021, her parents immediately noticed some developmental delays.

By around six months, when she still "wasn't really moving," Lockard said, they started the baby in physical therapy, which didn’t help.

Eventually, an MRI and full genetic testing panel revealed the shocking diagnosis of SPG50.

At the time, Lockard was just a month away from giving birth to her second child — which added another element of fear given that the condition is genetic.

"My husband and I each have one healthy copy of this gene, but we each have one mutated copy," she told Fox News Digital in a phone interview. 

"Naomi got both mutated copies, and there was a 25% chance that Jack (the second baby) would also get both mutated copies."

"It was a lot of panic at first, a lot of tears, because it's a horrible condition," Lockard said.

A few weeks later, after Lockard gave birth, another round of genetic testing revealed the family’s worst fear: Baby Jack also had SPG50.

"Naomi just turned 3, and she only learned to crawl about six months ago. She can't walk or talk, and her cognitive level is probably that of a 9-month-old," her mother told Fox News Digital. (Rebekah Lockard)

"Children with SPG50 may experience early developmental delays, muscle weakness, and spasticity, but they continue to strive and adapt," Dr. Eve Elizabeth Penney, an epidemiologist at the Texas Department of State Health Services and medical contributor for Drugwatch, told Fox News Digital. 

Fewer than 100 people in the world are known to have SPG50.

"Over time, these symptoms can worsen, making it hard for affected individuals to walk and perform daily activities," added Penney, who was not involved in the Lockard children's care.

"The prognosis varies from person to person, but it’s generally a progressive condition, meaning symptoms can become more severe over time."

A glimmer of hope

There is currently no FDA-approved treatment for SPG50, but the Lockards found hope when they enrolled in a clinical trial for an experimental gene therapy that was started by another parent, Terry Pirovolakis.

"It’s kind of like a transplant for genes," Lockard told Fox News Digital. "It functions like a treatment, or maybe even a cure."

The procedure, which involves injecting cerebral spinal fluid through a lumbar puncture, does come with risks.

"But it's worth the risk, because it's the only thing that could possibly help prevent the condition from getting worse," Lockard said.

Her newly diagnosed baby — who was just shy of six months old — received the gene therapy treatment first, as there was a better chance of stopping the disease at a younger age.

He was the youngest child ever to receive an intrathecal (spinal) gene therapy treatment.

"Jack has thrived since then," Lockard said. "He is sitting independently, banging toys together, drinking from a straw cup, and working really hard on crawling."

She added, "Doctors and therapists share the same sentiment: The treatment works!"

Other children who participated in the trial have experienced similar results, Lockard said.

"They've all shown that their disease has stopped progressing and their cognition has improved," she said.

Lockard’s daughter, Naomi, has not yet received the therapy.

"We can’t help but compare Jack and Naomi, and we see how he's meeting these milestones. He's caught up to her developmentally, and he’ll probably surpass her within the next few months, even though they're two years apart," Lockard said.

"Naomi just turned 3, and she only learned to crawl about six months ago. She can't walk or talk, and her cognitive level is probably that of a 9-month-old."

Although her daughter will likely always have deficiencies, as she’s missed the "critical window" of development, the gene therapy could still stop further progression.

"If they can treat her before she gets the paralysis, the hope is that she'll never develop that," Lockard said.

If her daughter doesn’t receive the therapy, she will likely experience the typical trajectory of the disease, Lockard said.

"Kids develop paralysis in elementary school, become quadriplegic in high school and pass away in their 20s — never learning to talk, and losing any ability to move over the course of their short lives."

The problem is that the clinical trial has run out of funding.

Dr. Penney noted that treatment for SPG50 is challenging and expensive to develop — "mainly because it’s a sporadic disease."

The doctor told Fox News Digital, "Pharmaceutical companies often prioritize conditions that affect larger populations, with a more significant potential for recouping research and development costs."

"The market is much smaller for rare diseases like SPG50, making it financially less viable for companies to invest in creating a treatment."

Developing treatments for genetic disorders requires significant research, time and specialized technology, Penney added, all of which add to the cost and complexity.

In the absence of a cure, most families can only manage symptoms through physical therapy, occupational therapy, speech therapy and medications to help control spasticity or seizures, Penney said. 

"Managing SPG50 requires a comprehensive, multidisciplinary approach to address its various symptoms and challenges," Penney said.

Fighting to keep hope alive

The experimental trial that potentially saved Jack Lockard’s life was started by another parent, Terry Pirovolakis.

Pirovolakis, based in Canada, found out in 2017 that his youngest son, Michael, had SPG50.

"They told us he would be paralyzed from the waist down by the age of 10, and a quadriplegic by the age of 20," Pirovolakis told Fox News Digital in an interview. "They said he would need support for the rest of his life."

Pirovolakis refused to accept that. He immediately started doing research and traveling around the world to gene therapy conferences, speaking with medical experts about his son’s disease.

Eventually, he liquidated his life savings, refinanced his home and paid a team of scientists at the University of Texas Southwester Medical Center to create a "proof of concept" for a genetic treatment for his son."

After seeing positive results in mice studies, as well as in cells from his son and a few other children with SPG50, Pirovolakis partnered with a small company in Spain to manufacture the drug. 

In Dec. 2021, Health Canada granted Pirovolakis permission to move forward with the gene therapy for his son.

"After that, we had three more doses, and we decided that we had to help other kids," Pirovolakis said.

He opened a Phase 2 study in the U.S., in which three more children with SPG50 were treated — including Jack Lockard.

"I tried to give the therapy to pharmaceutical companies, but no one wanted to make it, so I quit my job and started a nonprofit, Elpida Therapeutics, in California," Pirovolakis said.

"We now have five employees and 20 consultants, and our goal is to save kids with five diseases, almost all of them fatal."

Next, Pirovolakis will start a Phase 3 study at the National Institute of Health for SPG50, with future trials planned for other diseases.

"Doctors are ready. There just isn't enough money to make it happen."

The problem is that without the backing of major drug companies, there isn’t funding available to dose the therapies to the children who need it.

"They have eight doses that were produced in Spain and have been flown to the U.S.," Lockard said. 

"It’s here, just literally sitting in a refrigerator, ready to go. Doctors are ready. There just isn't enough money to make it happen."

It costs about $1 million to make the drug for each child, Pirovolakis said, and another $300,000 or so to treat each patient in the U.S. at the hospital. 

While Pirovolakis and his team are actively working to secure grants and investors, it’s largely up to the parents to raise funds for the next phase of the clinical trial.

So far, Lockard has raised $50,000 via a GoFundMe fundraiser (called "Naomi and Jack Battle SPG50"), but that is only a fraction of what is needed to get her daughter treated.

"Right now, there are four families in the U.S. who are trying really hard to fundraise the money that's needed, because time is of the essence," he said.

"We want to make sure the trial moves on and these kids get treated."

The end goal

Looking ahead to the Phase 3 clinical trial at the NIH, Pirovolakis’ goal is to treat eight children with SPG50.

"If we can show that it works in all eight children — and we can prove to the FDA that it is making a difference — then the drug will get approved and every child can get it," he said.

"I get calls at least five times a week from families around the world, asking to help me save their kids."

Ideally, after the drug is approved — which could take three to five years, Pirovolakis estimates — SPG50 will be added to hospitals’ newborn screening programs and every child with the disease will be able to get the therapy.

"I get calls at least five times a week from families around the world, asking to help me save their kids," he said.

"It’s tough — there's only so much you can do, and unfortunately, this is a money problem. It's just heartbreaking."

Melissa Rudy 

https://www.foxnews.com/health/mother-frantic-save-clinical-trial-could-cure-daughter-treatment-sitting-fridge

See: https://childnervoussystem.blogspot.com/2024/09/a-treatment-for-spg50.html

Abortion for trisomy 21

YouTuber Jesse Ridgway and his wife revealed this week they terminated a pregnancy after learning their unborn child had Down syndrome, sharing an emotional account of what they described as one of the most difficult decisions of their lives.

Ridgway announced the diagnosis and their decision in a Wednesday post on X, saying they wrestled with the choice after doctors informed them their baby was likely to be born with the genetic condition. 

"This week, my wife and I made the very difficult decision to terminate the pregnancy due to Trisomy 21," Ridgway wrote. "The choice was not made lightly. We really appreciate all of the personal stories that you guys shared with us, especially the unconditional support we received from fans with no matter what we decided." 

Ridgway, whose YouTube channel McJuggerNuggets has more than 4 million followers, had kept followers in the loop during his wife Ashley's pregnancy. He posted a video to his personal channel where they read the confirmation of the Trisomy 21 diagnosis, and his wife wept over the news.

He acknowledged that some fans might be disappointed to hear that his wife had an abortion and thanked others for their support.

"I know some of you may be very disappointed to hear this news," Ridgway wrote. "We are devastated. This has been extremely traumatic for both of us, especially Ashley. She underwent the procedure earlier this week and is on the mend. Thankfully, everything went smoothly, but emotionally we are drained." 

He listed Down syndrome statistics, saying that half of babies with the condition have heart defects, 75% have hearing issues and that half will also have eyesight challenges, adding that "impaired immune function, developmental disabilities, learning disabilities, delayed physical development, poor muscle tone, structural issues with face, decreased lifespan," are also challenges. 

"Sadly, the list is long, feel free to look it up… Down Syndome [sic] isn’t a ‘blessing,’ it is objectively s---ty from a health perspective," Ridgway wrote.

The announcement went viral on X, formerly Twitter, prompting an onslaught of concern and pushback. 

In a Friday post on X, House Speaker Mike Johnson wrote, "In 29 days, we will celebrate the 250th birthday of our exceptional nation, which became the greatest of all because we were the first to declare the self-evident truth that all people are created equal by God. Not ‘born equal.’ We are ‘CREATED equal.’ Because God made us all in His image, it means EVERY SINGLE PERSON has inestimable DIGNITY and VALUE—and our value is not related in any way to the color of our skin, what zip code we live in, what our talents are, our health condition, or any other factor." 

Johnson added, "Our value is inherent, because it is given to us by our loving Heavenly Father. When a culture devolves to the point of depravity where ‘influencers’ can go online and so casually dismiss the deliberate murder of their own precious child, the survival of that culture itself is at risk."

Former Planned Parenthood clinic director Abby Johnson shared her dismay in a Thursday reply on X.

"Holy crap. Just out here boasting about murdering a beautiful child with no remorse," Johnson said.

"Your baby was brutally and torturously murdered in his mother’s womb… the place that should have been the safest," she added. "I hope you think about his fear as he was torn apart. I hope you think about his pain. Meanwhile, you’re saving your dog with cancer. What a monster of a man you are."

The Babylon Bee's Kyle Mann called him "evil."

Mollie Hemingway, editor-in-chief of The Federalist, replied to Ridgway’s post where someone responded, "Who are you to judge?" and Hemingway replied, "Just a human who cares about human rights."

Wrote another user: "My son has Down syndrome and he's one of the best things that ever happened to me. The list of conditions sounds terrifying at first, but modern medicine can do so much for them. If you ever get a positive screening, I promise you won't regret welcoming your child."

While some responses expressed sympathy for the Ridgways, the overwhelming amount of comments on YouTube and X to Ridgway appeared to show anger and grief.

In a post responding to critics, Ridgway wrote in part, "I’ve never seen such hate and vitriol for two people grieving the loss of their unborn child and making an impossible decision. The last 24 hours have exposed a side of humanity that is deeply disturbing. Being called 'murderous pieces of s---, evil, compared to Hitler' and receiving NON-STOP DEATH THREATS."

He added, "The reason this blew up is quite simple: IT’S BECAUSE NOBODY TALKS ABOUT IT. I can’t blame people for not talking about these vulnerable experiences publicly because you see the disgusting backlash that ensues. It’s very divisive. Luckily, after 20 years on the Internet, this is par the course for me taking on the crazies, so I’m glad I can help further the conversation."

Fox News Digital reached out to Ridgway for additional comment.

Rachel del Guidice 

https://www.foxnews.com/media/youtuber-sparks-outrage-after-announcing-he-wife-terminated-pregnancy-over-down-syndrome-diagnosis

Florida-based entrepreneur and father Aric Berquist shares his reaction to the news that he and his wife would have a child with Down syndrome — and how their son would bring him life-changing lessons.

"I literally felt like I'd lost the air in my chest. I couldn't speak."

That was the immediate reaction of a Florida dad and entrepreneur when he learned during an urgent phone call from his wife — who was pregnant with their fourth child and had just finished talking with a doctor — that their new baby might be born with Down syndrome.

"I was sad. I was angry. I was frustrated," said Aric Berquist, who shared his thoughts in a video (see the video at the top of this article) and in an interview with Fox News Digital. 

Berquist said that on the phone call, he "wanted to stay calm" for the sake of his wife, Gretchen, "who was teary" as the couple talked over the news. 

After they hung up, as he struggled with his emotions, he said, "I just felt this, heard this voice say, ‘Who are you to tell me what a blessing is?’"

The deeply faithful Christian parent said the voice "wasn't angry. It felt strong, and it felt safe — and it was so shocking that all of my arm hairs were raised to the point that it hurt."

And he found himself "just bursting into tears."

A subsequent ultrasound confirmed the diagnosis of Down syndrome for their new baby — and the couple did all they could to prepare themselves, and their older children, for the baby's arrival. 

"He continues to teach me more about life and myself than I could ever dream of articulating."

That year, the dad said, "Asher was born. And I really do feel that on that day, treasure was put in my hands."

Berquist described the joy he believes their youngest has brought the entire family — both from the time he was born and up to the present day, including at the recent wedding of their daughter, the oldest of their four children. 

"That kid has literally changed my life in an amazing way," he said. 

The couple's youngest is 13 years old today and in sixth grade.

"And he continues to teach me more about life and myself than I could ever dream of articulating."

He "loves sports," added Berquist. "He'll play flag football and he's done soccer. He loves to play sports with his two older brothers, Andrew and Adam."

"He is available to everyone he engages with."

He said his son Asher's bond with brother Adam — the sibling closest to him in age — "is one of the richest and most beautiful things I've ever seen." 

Their youngest "occupies the current moment like nobody I have ever met," Berquist also said. "He is present. And he is available to everyone he engages with."

He makes others feel "acknowledged. And I'm starting to think that we, as the ‘typical people,’ have the disabilities — not him."

Today, Berquist also told Fox News Digital, "he's doing so well. It's been really wonderful to see how he's developed — just his growth within each phase. But more than that, it's been really touching as a parent to see how he's connected with so many people in his life. It's been beautiful to watch."

The Berquist family at the recent wedding of daughter Abby, center. Youngest child Asher is shown at right, front.  (Berquist family)

Heart problems are a concern for children with Down syndrome — and young Asher had bypass surgery within the first three months of his life, his family said. After a week in the hospital, he returned home to his parents and siblings. 

Down syndrome is a condition in which a baby is born with an extra chromosome. 

Chromosomes determine how the body forms and functions. Those born with an extra one experience changes in the way the body and 

A baby is typically born with 46 chromosomes. A baby with Down syndrome has a full or partial copy of chromosome 21.

About 5,700 babies are born with Down syndrome each year in the U.S., and over 400,000 people in the country currently live with it, according to the Centers for Disease Control and Prevention (CDC).

The life expectancy of those with the condition has increased dramatically over the years. 

In 1983, it was just 25 years old — but today it's 60 years old, per the Global Down Syndrome Foundation, a nonprofit based in Denver, Colorado. 

The most common type of Down syndrome is trisomy 21, which accounts for 95% of all cases. Less common types of Down syndrome are translocation (caused by rearranged chromosome material) and mosaicism (when there is a mixture of two types of cells). 

There are no known ways to prevent the condition during pregnancy and no known root causes, experts say. 

One risk factor associated with Down syndrome is the age of the mother. For a 25-year-old pregnant woman, the odds are about 1 in 1,250. At age 40, those odds are 1 in 100, statistics show.

There are both physical and developmental symptoms of Down syndrome. 

Physical symptoms may include a flattened face; shorter height; short neck; small ears, hands and feet; and decreased muscle tone, according to the CDC. 

Developmental symptoms, meanwhile, may include a short attention span, impulsive behavior, slow learning and delayed speech development. 

Not every child with Down syndrome will display each of these traits.

A key life lesson for Berquist through his experiences has been about being present.

Know that "your feet are on the ground today," he said. 

"Walk through that day."

When there are life challenges, he said, "when we walk through things that are tough, we're being cleaned. We're being made into something beautiful if we allow it and if we walk through it."

Berquist also said, "Breathe that air. Engage with that beauty. Because that is your life."

Maureen Mackey. Angelica Stabile and Ashlyn Messier,contributed reporting. 

https://www.foxnews.com/health/family-down-syndrome-son-went-shock-gratitude-lost-air-chest



Wednesday, June 3, 2026

The clinical features and initial pharmacotherapeutic options of children with tic disorders

Xiang Y, Tong C, Sun D and Liu Z (2025) The clinical features and initial pharmacotherapeutic options of children with Tic disorders. Front. Pediatr. 13:1636110. doi: 10.3389/fped.2025.1636110

Abstract

Purpose:

Tic disorders (TD) are common childhood neurodevelopmental conditions, characterized by diverse manifestations, leading to misdiagnosis and delayed therapy. Timely identification of TD and access to care can improve clinical outcomes. This retrospective study characterizes clinical features and initial pharmacotherapy in newly diagnosed pediatric TD.

Method:

This retrospective cohort study included 805 newly diagnosed pediatric TD patients. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), with patients stratified into mild (YGTSS scores < 25), moderate (25–50), and severe (>50) groups. Chi-square tests/Fisher-exact tests and Wilcoxon rank—sum tests compared group differences in baseline characteristics. Multivariate analyses identified factors associated with tic severity, and logistic regression analyses identified predictors of pharmacotherapy initiation.

Results:

In 805 subjects, 73.43%, 11.18% and 15.39% were classified into provisional tic disorder, chronic tic disorder, and Tourette syndrome (TS). The prevalence of comorbid attention-deficit/hyperactivity disorder (ADHD) was higher in moderate (21.45%) and severe (36.36%) groups than in the mild group (15.60%). The diagnosis of Tourette syndrome (aOR = 1.40, 95% CI: 1.23–160.31), age at onset (aOR = 1.63, 95% CI: 1.22–2.18), and age at diagnosis (aOR = 1.63, 95% CI: 1.22–2.17), comorbid ADHD (aOR = 7.12, 95% CI: 1.39–36.43) were positively associated with greater tic severity. Clonidine patch (CAP) and traditional Chinese medicine (TCM) were the most common choices initial pharmacotherapy in newly diagnosed pediatric TD. Scores of YGTSS, comorbid ADHD predicted treatment initiation.

Conclusions:

This study contributed insights into the clinical profiles across tic severity and pharmacotherapeutic approaches in newly diagnosed pediatric TD. The findings highlighted the independent associations between baseline factors and tic severity, as well as the predictors of pharmacotherapy initiation. CAP and TCM served as the most common choices in newly diagnosed pediatric TD.

Magnetic resonance imaging and spectroscopy in neonatal encephalopathy

Laptook A, Garvey AA, Adams C, Grant PE, Molloy EJ, Groenendaal F, Weeke LC, Benders M, Hwang M, El-Dib M, Badawi N, Robertson NJ, Pang R, Thayyil S, Inder T, Andelius TCK, Kyng KJ; Neonatal MRI group; Brain, Development, and Imaging section of the European Society of Pediatric Research (ESPR). Magnetic resonance imaging and spectroscopy in neonatal encephalopathy: current consensus position and future opportunities. Pediatr Res. 2025 Oct 3. doi: 10.1038/s41390-025-04448-5. Epub ahead of print. PMID: 41044228.

Abstract

Neonatal encephalopathy (NE) is a significant global health concern. It is a leading cause of long-term neurodevelopmental impairment, with hypoxic-ischaemic perinatal brain injury being the most common underlying contributor. Although therapeutic hypothermia has reduced mortality and improved outcomes for some affected infants, many survivors experience neurodevelopmental disability, including cerebral palsy and/or deficits in cognition, behaviour, and executive functioning. Early and accurate prognostication and identification of injury severity remain a challenge due to evolving clinical signs and multiple etiologies. Magnetic resonance imaging (MRI) is the gold standard for characterizing NE-related brain injury. Diffusion-weighted imaging (DWI) enables early detection of injury, and proton magnetic resonance spectroscopy (1H-MRS), specifically the Lac/NAA peak area ratio from basal ganglia and thalamus, provides robust prognostic indicators of two-year neurodevelopmental outcomes. MRI scoring systems incorporating multiple modalities correlate well with later neurodevelopmental outcomes. Advanced imaging modalities, such as diffusion tensor imaging (DTI), arterial spin labelling (ASL), and blood oxygen level-dependent (BOLD) imaging, offer further insights into microstructural integrity, perfusion, and functional connectivity. By standardizing acquisition protocols and post-processing, MRI biomarkers can serve as reliable, early surrogate endpoints in neuroprotection trials, allowing smaller sample sizes and accelerating clinical translation. MRI and 1H-MRS integration enhances prognostication, guides clinical management, and supports informed decision-making in NE care. IMPACT: This article highlights the importance of state-of-the-art MRI and MRS techniques for assessing neonatal encephalopathy (NE), emphasizing optimized protocols, accurate interpretation, and the use of MRI scoring systems to enhance clinical decision-making. It provides a comprehensive guide to advanced MRI/MRS acquisition and interpretation in neonates with NE, addressing current limitations and future directions. By optimizing neonatal MRI/MRS practices, this work aims to improve early diagnosis and prognostication, guide treatment strategies, and ultimately improve the management of neonates with NE.

Mohammad K, Reddy Gurram Venkata SK, Wintermark P, Farooqui M, Beltempo M, Hicks M, Zein H, Shah PS, Garfinkle J, Sandesh S, Cizmeci MN, Fajardo C, Guillot M, de Vries LS, Pinchefsky E, Shroff M, Scott JN; Newborn Brain Health Working Group of the Canadian Neonatal Network. Consensus Approach for Standardization of the Timing of Brain Magnetic Resonance Imaging and Classification of Brain Injury in Neonates With Neonatal Encephalopathy/Hypoxic-Ischemic Encephalopathy: A Canadian Perspective. Pediatr Neurol. 2025 May;166:16-31. doi: 10.1016/j.pediatrneurol.2025.01.021. Epub 2025 Feb 12. PMID: 40048833.

Abstract

Neonatal encephalopathy (NE) is a significant global health concern. It is a leading cause of long-term neurodevelopmental impairment, with hypoxic-ischaemic perinatal brain injury being the most common underlying contributor. Although therapeutic hypothermia has reduced mortality and improved outcomes for some affected infants, many survivors experience neurodevelopmental disability, including cerebral palsy and/or deficits in cognition, behaviour, and executive functioning. Early and accurate prognostication and identification of injury severity remain a challenge due to evolving clinical signs and multiple etiologies. Magnetic resonance imaging (MRI) is the gold standard for characterizing NE-related brain injury. Diffusion-weighted imaging (DWI) enables early detection of injury, and proton magnetic resonance spectroscopy (1H-MRS), specifically the Lac/NAA peak area ratio from basal ganglia and thalamus, provides robust prognostic indicators of two-year neurodevelopmental outcomes. MRI scoring systems incorporating multiple modalities correlate well with later neurodevelopmental outcomes. Advanced imaging modalities, such as diffusion tensor imaging (DTI), arterial spin labelling (ASL), and blood oxygen level-dependent (BOLD) imaging, offer further insights into microstructural integrity, perfusion, and functional connectivity. By standardizing acquisition protocols and post-processing, MRI biomarkers can serve as reliable, early surrogate endpoints in neuroprotection trials, allowing smaller sample sizes and accelerating clinical translation. MRI and 1H-MRS integration enhances prognostication, guides clinical management, and supports informed decision-making in NE care.

Impact

This article highlights the importance of state-of-the-art MRI and MRS techniques for assessing neonatal encephalopathy (NE), emphasizing optimized protocols, accurate interpretation, and the use of MRI scoring systems to enhance clinical decision-making. It provides a comprehensive guide to advanced MRI/MRS acquisition and interpretation in neonates with NE, addressing current limitations and future directions. By optimizing neonatal MRI/MRS practices, this work aims to improve early diagnosis and prognostication, guide treatment strategies, and ultimately improve the management of neonates with NE.

Hung SC, Tu YF, Hunter SE, Guimaraes C. MRI predictors of long-term outcomes of neonatal hypoxic ischaemic encephalopathy: a primer for radiologists. Br J Radiol. 2024 May 29;97(1158):1067-1077. doi: 10.1093/bjr/tqae048. PMID: 38407350; PMCID: PMC11654721.

Abstract

This review aims to serve as a foundational resource for general radiologists, enhancing their understanding of the role of Magnetic Resonance Imaging (MRI) in early prognostication for newborns diagnosed with hypoxic ischaemic encephalopathy (HIE). The article explores the application of MRI as a predictive instrument for determining long-term outcomes in newborns affected by HIE. With HIE constituting a leading cause of neonatal mortality and severe long-term neurodevelopmental impairments, early identification of prognostic indicators is crucial for timely intervention and optimal clinical management. We examine current literature and recent advancements to provide an in-depth overview of MRI predictors, encompassing brain injury patterns, injury scoring systems, spectroscopy, and diffusion imaging. The potential of these MRI biomarkers in predicting long-term neurodevelopmental outcomes and the probability of epilepsy is also discussed.

Tuesday, June 2, 2026

Child Neurology Society statement on leucovorin use in autism and related disorders

 Child Neurology Society Statement on Leucovorin Use in Autism and Related Disorders

Background

In response to recent statements from the U.S. Department of Health and Human Services and the Food and Drug Administration regarding leucovorin use in children with autism spectrum disorder (ASD), the Child Neurology Society (CNS) provides thefollowing guidance to assist clinicians in evidence-based decision-making.

Leucovorin, also known as folinic acid or leucovorin calcium, is a reduced form of folate. It is distinct from the unmetabolized folic acid found in supplements and fortified foods. 

Summary of Evidence

• Existing studies examining leucovorin in individuals with ASD are small, methodologically heterogeneous, and in several cases have significant data integrity concerns.

• There is no adequately powered, placebo-controlled, pre-registered clinical trial establishing efficacy of leucovorin for core autism symptoms [1]. 

• The only clearly supported indication for leucovorin for neurodevelopmental disorders is for conditions in which folate metabolism is impacted, such as folinic acid-dependent epilepsy, and specific genetic causes of cerebral folate deficiency (CFD) which sometimes manifest as ASD along with other neurological symptoms. In these cases, leucovorin is indicated to address the underlying metabolic problem, rather than the ASD itself.

• Other reported associations, such as folate receptor autoantibody positivity or presumed functional folate deficiency, have not been validated.

Clinical Recommendations

1. Indication

• Leucovorin is primarily indicated for people receiving chemotherapy.

• Leucovorin may also be used for certain ultra-rare genetically confirmed disorders which are associated with aberrant cerebrospinal fluid (CSF) folate metabolism or transport, such as cerebral folate deficiency or folinic acid dependent epilepsy.

• It is not indicated for routine use in individuals with autism or other neurodevelopmental disorders.

2. Testing and Diagnostic Workup

• Genetic testing (e.g., exome or genome sequencing) is first-line testing for individuals with autism and would determine if there is a genetically based disorder of cerebral folate metabolism.

• Folate receptor autoantibody testing (FRAT) is not recommended as a basis for clinical decision-making at this time [2].

• Lumbar puncture should not be performed routinely in individuals with autism.

3. Use and Monitoring

• Leucovorin should not be prescribed as standard of care for individuals with autism.

• An ethical framework for considering leucovorin prescriptions in autism outside of CFD should consider both legal guardian discretion, which supports parents/caregivers to request treatment that is not clearly beneficial if it is not clearly harmful, alongside clinician professional judgment which allows medical professionals to prescribe or decline to prescribe medications for which there is no compelling evidence. [3]

• Optimal dosing and duration of treatment depend on the specific neurological disorder being addressed. There is no established optimal dosing regimen for autism without genetically documented CFD. • If leucovorin is prescribed for ASD, discuss uncertainties, risks, and ethical considerations, and monitor for both potential benefits and adverse effects with pre-determined metrics. Counsel parents/caregivers about the potential for a high placebo response. Normal developmental maturation may be mistaken for treatment response. 

4. Research Priorities

• Support development of well-designed trials, culminating in a multicenter randomized controlled trial with preregistered outcome measures.

• Develop validated cell-based assays for folate receptor autoantibodies.

5. Public Health Considerations

• Recognize potential supply limitations and prioritize established indications during shortages and supply chain limitations.

Summary Position

Leucovorin is not a standard or evidence-based therapy for individuals with autism.

Supplement

[1] Major methodological issues include small sample sizes, lack of blinding, post hoc

outcome selection, unverified dosing or formulation errors, and data integrity concerns

in key trials. These limitations preclude firm efficacy conclusions. Specifically, there are

three small randomized controlled trials (RCT) investigating leucovorin monotherapy as

treatment for idiopathic autism. The first showed a large effect size in language

improvement.1 However, as per clinicaltrials.gov, “The study sponsor (UAMS) was

unable to completely monitor the study or resolve outstanding queries. The study data

cannot be fully validated by the sponsor. The study was placed on Full Clinical Hold by

the FDA and terminated by the sponsor as a result of investigator non-compliance.” 2

The second study reported a significant improvement in Autism Diagnostic Observation

Schedule (ADOS) scores.3 However, this study was small (n=19) and did not adhere to

the pre-registered analysis plan. The largest and most recent RCT was retracted due to

errors in reported results and concerns about data validity.4

[2] The currently available FRAT uses a radioligand assay, a method that may produce

a high false-positive rate through nonspecific binding. The gold standard method in

neuroimmunology consists of cell-based assays that present the antigen (in this case,

the folate receptor) in its membrane-bound conformationally correct format (i.e., how

this receptor would appear to immune cells and antibodies that encounter the folate

receptor in the brain).5 Demonstration of antibodies in serum that bind to antigen

presented in a cell-based method is more likely to represent antibody-antigen binding as

would be seen in the human condition as compared to the radioligand assay.

[3] The President’s Commission on Bioethics (1983) emphasized deference to

parent/caregiver preferences around treatments with ambiguous benefits,6 laying a

foundation for the modern ethical framework of the zone of parental discretion, in which

parent/caregiver decision-making authority and clinician professional judgment operate

within boundaries set by a threshold of harm.7,8 For practicing child neurologists, this

framework emphasizes that clinicians exercise professional judgment to determine if

interventions requested by a parent or caregiver meet a threshold of plausibility and

safety.

References

1. Frye, R. E. et al. Folinic acid improves verbal communication in children with

autism and language impairment: a randomized double-blind placebo-controlled

trial. Mol. Psychiatry 23, 247–256 (2018).

2. https://clinicaltrials.gov/study/NCT01602016?tab=history&a=17 Accessed 19

February 2026

3. Renard, E. et al. Folinic acid improves the score of Autism in the EFFET placebocontrolled

randomized trial. Biochimie 173, 57–61 (2020).

4. Panda, P. K. et al. Retraction Note: Efficacy of oral folinic acid supplementation

in children with autism spectrum disorder: a randomized double-blind, placebocontrolled

trial. Eur. J. Pediatr. 185(2):109 (2026).

5. Sinmaz N, Amatoury M, Merheb V, Ramanathan S, Dale RC, Brilot F.

Autoantibodies in movement and psychiatric disorders: updated concepts in

detection methods, pathogenicity, and CNS entry. Ann N Y Acad Sci. 2015

Sep;1351:22-38. doi: 10.1111/nyas.12764. Epub 2015 Jun 17. PMID: 26083906.

6. President's Commission for the Study of Ethical Problems in Medicine and

Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining

Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment

Decisions. Washington, DC: U.S. Government Printing Office, March 1983.

Pages 197-229 (Chapter on Seriously Ill Newborns), especially pp. 217-223.

7. McDougall RJ, Notini L. Overriding parents’ medical decisions for their children: a

systematic review of normative literature. J Med Ethics 40:448–452 (2014).

8. Gillam L. The zone of parental discretion: An ethical tool for dealing with

disagreement between parents and doctors about medical treatment for a child.

Clinical Ethics. 11(1):1-8 (2016).

Monday, June 1, 2026

Mowat-Wilson syndrome

Inspired by a patient

Adam MP, Conta J, Bean LJH. Classic Mowat-Wilson Syndrome. 2007 Mar 28 [updated 2026 Apr 23]. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2026. PMID: 20301585.

Excerpt

Clinical characteristics: Classic Mowat-Wilson syndrome (MWS) is characterized by distinctive facial features (widely spaced eyes, broad eyebrows with a medial flare, low-hanging columella, prominent or pointed chin, open-mouth expression, and uplifted earlobes with a central depression), congenital heart defects with predilection for abnormalities of the pulmonary arteries and/or valves, Hirschsprung disease and/or chronic constipation, genitourinary anomalies (particularly hypospadias in males), and hypogenesis or agenesis of the corpus callosum. Most affected individuals have moderate-to-severe intellectual disability. Speech is typically limited to a few words or is absent, with relative preservation of receptive language skills. Growth restriction with microcephaly and epilepsy are also common. Most affected people have a happy demeanor and a wide-based gait that can sometimes be confused with Angelman syndrome.

Diagnosis/testing: The diagnosis of classic MWS is established in a proband with the typical recognizable dysmorphic facial features and developmental delay / intellectual disability and/or a heterozygous pathogenic variant in ZEB2 (most classic MWS-related ZEB2 pathogenic variants lead to predicted haploinsufficiency for the functional components of the ZEB2 protein) identified by molecular genetic testing.

Management: Treatment of manifestations: Care by the appropriate specialist for dental anomalies, seizures, ocular abnormalities, congenital heart defects, chronic constipation, Hirschsprung disease, genitourinary abnormalities, and pectus anomalies of the chest and/or foot/ankle anomalies; educational intervention and speech therapy beginning in infancy.

Surveillance: Annual eye examination in childhood to monitor for strabismus and refractive errors; monitoring for otitis media; regular developmental assessments to plan/refine educational interventions; periodic reevaluation by a clinical geneticist.

Genetic counseling: Classic MWS is an autosomal dominant disorder caused by a pathogenic variant in ZEB2, a heterozygous deletion of 2q22.3 involving ZEB2, or (rarely) a chromosome rearrangement that disrupts ZEB2. Almost all individuals reported to date have been simplex cases (i.e., a single occurrence in a family) resulting from a de novo genetic alteration; rarely, recurrence in a family has been reported when a parent has a low level of somatic or presumed gonadal mosaicism for a classic MWS-causing pathogenic variant. Individuals with classic MWS are not known to reproduce. Once the causative genetic alteration has been identified in the proband, prenatal testing may be offered to parents of a child with classic MWS because of the recurrence risk associated with the possibility of parental mosaicism or a balanced chromosome rearrangement.

Adam MP, Schelley S, Gallagher R, Brady AN, Barr K, Blumberg B, Shieh JT, Graham J, Slavotinek A, Martin M, Keppler-Noreuil K, Storm AL, Hudgins L. Clinical features and management issues in Mowat-Wilson syndrome. Am J Med Genet A. 2006 Dec 15;140(24):2730-41. doi: 10.1002/ajmg.a.31530. PMID: 17103451.

Abstract

Mowat-Wilson syndrome (MWS) is a relatively newly described multiple congenital anomaly/mental retardation syndrome. Haploinsufficiency of a gene termed ZFHX1B (also known as SIP1) on chromosome 2 is responsible for this condition, and clinical genetic testing for MWS recently became available. The majority of reports in the literature originate from Northern Europe and Australia. Here we report our clinical experience with 12 patients diagnosed with MWS within a 2-year period of time in the United States, with particular emphasis on clinical characteristics and management strategies. Individuals with this condition have characteristic facial features, including microcephaly, hypertelorism, medially flared and broad eyebrows, prominent columella, pointed chin, and uplifted earlobes, which typically prompt the clinician to consider the diagnosis. Medical issues in our cohort of patients included seizures (75%) with no predeliction for any particular seizure type; agenesis of the corpus callosum (60% of our patients studied); congenital heart defects (75%), particularly involving the pulmonary arteries and/or valves; hypospadias (55% of males); severely impaired or absent speech (100% of individuals over 1 year of age) with relatively spared receptive language; and Hirschsprung disease (50%) or chronic constipation (25%). The incidence of MWS is unknown, but based on the number of patients identified in a short period of time within the US, it is likely greatly under recognized. MWS should be considered in any individual with severely impaired or absent speech, especially in the presence of seizures and anomalies involving the pulmonary arteries (particularly pulmonary artery sling) or pulmonary valves.

Ju Y, Ji TY. Electro-clinical features of Mowat-Wilson syndrome: A retrospective study of 31 children in mainland China. Epileptic Disord. 2026 Apr;28(2):344-358. doi: 10.1002/epd2.70149. Epub 2025 Dec 27. PMID: 41454799; PMCID: PMC13084205.

Abstract

Objective: To summarize the electro-clinical and genetic characteristics of children with Mowat-Wilson syndrome (MWS).

Methods: This study is a hospital-based case series analyzing clinical data from 31 pediatric patients with MWS and epilepsy treated at Peking University First Hospital between June 2020 and December 2024. Information on seizures, electroencephalographic features, genetic characteristics, treatment, and prognosis was summarized and analyzed using descriptive statistics.

Results: Among the 31 children (16 males and 15 females), seizure onset occurred at a median age of 25.5 months (range: 1-113 months). Eighteen cases (58.1%, 18/31) began with fever-induced seizures; all 31 children experienced focal seizures, and 16 (51.6%, 16/31) exhibited atypical seizure presentations. Twelve (38.7%, 12/31) experienced seizures accompanied by gastrointestinal (GI) symptoms. Two children had myoclonic seizures, one had epileptic spasms, and another had atypical absence seizures. Ten (32.3%, 10/31) experienced convulsive status epilepticus. Electroencephalographic findings evolved from posterior head-dominant discharges to multifocal or anterior head-dominant discharges, with a significant increase in discharges during sleep. All 31 children had de novo ZEB2 variants, including 27 with single-nucleotide variants (SNVs) or insertions/deletions (indels) and four with copy number variants. Among the SNVs/indels, nonsense (13) and frameshift (12) variants predominated. One patient with rare seizures did not receive anti-seizure medication (ASM). Thirty received ASMs; both levetiracetam and valproic acid, used as monotherapy or in combination, proved effective. Sixteen children achieved seizure control for more than 6 months, and seven maintained seizure control for over 1 year.

Significance: Our findings reveal the electro-clinical characteristics, genetic variants, and effective treatments associated with MWS, providing an important basis for clinical diagnosis and management.

Wednesday, May 27, 2026

Circulatory determination of death and consciousness

Need for Reliable Assessments

In an accompanying editorial, Michael J. Young, MD, MPhil, director of neuroethics at the Massachusetts General Hospital Center for Neurotechnology and Neurorecovery, and Christof Koch, PhD, an investigator at the research organization the Allen Institute who specializes in consciousness, wrote that decisions to withdraw life-sustaining treatment in cases of DCD (aka “controlled donation”) need to be made with an appreciation of the “limits of reliably assessing consciousness in critically ill, behaviorally unresponsive patients.”
“Controlled donation has expanded, now approaching nearly half of deceased donors, underscoring its clinical importance and the obligation to implement it in step with contemporary knowledge of the neural substrate of consciousness and methods of neuroprognostication,” they wrote.

Donating organs after circulatory death—after the heart and lungs stop functioning irreversibly, as distinct from donation after brain death—has become an important way of getting organs to those who need them. Outcomes for DCD have been found to be similar in the short and long term to organ donation after brain death.

When it comes to heart donation, though, there are special complexities because a period of warm ischemia always occurs after doctors withdraw life-sustaining therapy. So, historically, they restart, or reanimate, the heart to evaluate its function. But these methods can be costly, result in considerable organ discard rates, or raise concerns about reperfusing the brain and spinal cord.

In their editorial, Drs. Young and Koch pointed to near-misses in recent years when patients scheduled for organ recovery showed unexpected signs of consciousness that were recognized just moments before surgery, prompting the U.S. Health Resources and Services Administration (HRSA) to call for more safeguards.

“The ethical structure of controlled donation rests on several key premises: first, that decisions to limit or withdraw treatment are consistent with a patient's values, preferences, and goals and are made independent of considerations related to organ donation, and second, that the patient is unconscious when peridonation procedures begin,” the editorialists said.
The risk of mismanagement is heightened by the close proximity of withdrawal of treatment and organ donation, both in time and in space, they added.

“Reliance on early or single neurological assessment risks self-fulfilling prophecy and premature decision-making,” Drs. Young and Koch wrote. “Such bias can shape goals-of-care discussions toward viewing continued treatment as futile, even when a patient remains conscious or retains a meaningful chance of recovering awareness and function.”

They also cautioned about the possibility of “covert consciousness,” or the possibility of someone having subjective experience even when their behavior reveals no sign of it. Studies have documented this phenomenon, including one from 2024 that found “covert command-following” was discovered through functional MRI (fMRI) and electroencephalography (EEG) in a quarter of behaviorally unresponsive patients. An HRSA review of 351 cases in which organ donation was attempted but not performed found that 29 percent exhibited “concerning features” and 21 percent involved “neurological findings [that] were inconsistent with current standards for eligibility for controlled donation, yet procurement preparations nonetheless proceeded.”

Unlike cases of death by neurologic criteria, the role of neurologic assessment in controlled donation is “upstream of determination of death,” the editorialists wrote. But as this type of donation has spread into community settings, advanced neurologic testing and prognostic expertise “remain specialized and scarce,” they added.

Drs. Young and Koch pointed to opportunities to reinforce controlled donations with standardized, serial neurologic assessments on evolving neurobehavioral findings, pharmacological exposure, and neurophysiology and neuroimaging data, emphasizing “repeated, confounder-aware assessments.” This, they said, could avoid transplant teams being mobilized unnecessarily and reduce potential distress regarding warm ischemia times and halted procurement.

They also called for clearer procedures for identifying and addressing pharmacological and metabolic confounders, with standardized holding periods and pharmacokinetic modeling for sedatives and neuromuscular blockers “along with expended access and validation of covert consciousness testing.”

“Efforts to develop scalable approaches for guideline-directed detection of consciousness are accelerating and warrant sustained institutional and policy support,” the editorialists said.

Additionally, they suggested formalizing and studying “time-out mechanisms” allowing for interdisciplinary review of neurologic status, risk of pain and discomfort, or “persistence of consciousness at the threshold of death”; any member of the care or procurement team, along with family representatives and surrogates, would be empowered to call for a temporary suspension of the proceedings if appropriate.

Aligning controlled donation with what contemporary neuroscience reveals about “the presence of awareness and its absence will help sustain compassion and humility at the center of medicine's most consequential decisions, grounded in recognition that even at life's edge and before death occurs, consciousness may persist, however faintly,” Drs. Young and Koch said.

Neuroethicists Weigh In

The fiduciary duty of the neurologist and intensivist is always to the patient being cared for and not the prospective transplant recipient, and “every reasonable effort” should be made to understand the patient's prospect for awareness and potential recovery, said Michael Rubin, MD, MA, associate professor of neurology and neurological surgery at the University of Texas Southwestern. Clinicians should communicate this clearly to the patient's family and have appropriate palliative medications available if signs of distress arise after life-sustaining treatment stops.

“The choice of medications should not be influenced by the donation process but rather follow the same protocol that would be used if the patient were to undergo limitations of life-sustaining therapy in the intensive care unit,” Dr. Rubin said.

Clinicians should tell families about the intentional separation between patient care and organ procurement, he said, noting that he is an advocate for informed authorization, potentially involving a third party, such as an ethics consultant.

Overall, Dr. Rubin said, the safeguards typically in place work well.

“The bottom line to me is that transparency and trust are in the interests of all concerned parties,” he said. “Like any complex process with lives on the line and profound ethical questions, we need to be able to continuously assess the foundational principles guiding our work as well as the practical consequences and notable exceptions.”

Benjamin Tolchin, MD, MS, associate professor of neurology at the Yale School of Medicine and director of the Center for Clinical Ethics at Yale New Haven Health, said neurologists have a key role in helping patients and families make such high-stakes decisions.
“Frequently, families' decisions about withdrawing life-sustaining treatment and pursuing organ donation depend significantly on their understanding of the patient's neurologic injuries and prognosis,” he said, and families making these decisions need to understand the possibility of covert consciousness.

“They don't necessarily need a guarantee that there is no covert consciousness,” he added. “Indeed, it is often impossible for us to offer this assurance in the absence of experimental advanced fMRI and/or EEG modalities, which are not available at most hospitals and medical centers. Rather, the family needs to know that neurologists and other clinicians have thoroughly assessed the patient's level of consciousness and neurologic prognosis given all available and feasible technologies.” Neurologists should help families understand the best possible, worst possible, and most likely outcomes for the patient.

Validating and disseminating use of fMRI and EEG for revealing covert consciousness is important for the future, Dr. Tolchin said, but “this will necessarily be a slow process,” precluding wide availability in the near future.

“In the meantime, serial standardized neurological examinations are a valuable tool to assess the trajectory of neurological function and assess for subtle and fluctuating responsiveness to external stimuli,” Dr. Tolchin said. “These are particularly valuable in combination with serial neuroimaging and clinical neurophysiologic testing. Teleneurology consultation can be valuable in areas where serial examinations by neurology experts are not feasible.”

https://neurologytoday.aan.com/doi/full/10.1097/01.wnt.0001193556.00933.bd

Young MJ, Koch C. Consciousness and Controlled Donation After Circulatory Determination of Death. JAMA. 2026 Mar 10;335(10):850-853. doi: 10.1001/jama.2025.27045. PMID: 41587025.

Plain language summary

This Perspective discusses the limitations of reliable assessment of consciousness in critically ill, behaviorally unresponsive patients in light of recent situations in which such patients exhibited signs of consciousness moments before initiation of organ recovery surgery.

Weiss MJ, Hornby L, Rochwerg B, van Manen M, Dhanani S, Sivarajan VB, Appleby A, Bennett M, Buchman D, Farrell C, Goldberg A, Greenberg R, Singh R, Nakagawa TA, Witteman W, Barter J, Beck A, Coughlin K, Conradi A, Cupido C, Dawson R, Dipchand A, Freed D, Hornby K, Langlois V, Mack C, Mahoney M, Manhas D, Tomlinson C, Zavalkoff S, Shemie SD. Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report. Pediatr Crit Care Med. 2017 Nov;18(11):1035-1046. doi: 10.1097/PCC.0000000000001320. Erratum in: Pediatr Crit Care Med. 2018 Feb;19(2):178. doi: 10.1097/PCC.0000000000001415. PMID: 28925929; PMCID: PMC5671796.

Abstract

Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada.

Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners.

Results: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report.

Conclusions: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.

Weiss MJ, Hornby L, Witteman W, Shemie SD. Pediatric Donation After Circulatory Determination of Death: A Scoping Review. Pediatr Crit Care Med. 2016 Mar;17(3):e87-e108. doi: 10.1097/PCC.0000000000000602. PMID: 26727103.

Abstract

Objective: Although pediatric donation after circulatory determination of death is increasing in frequency, there are no national or international donation after circulatory determination of death guidelines specific to pediatrics. This scoping review was performed to map the pediatric donation after circulatory determination of death literature, identify pediatric donation after circulatory determination of death knowledge gaps, and inform the development of national or regional pediatric donation after circulatory determination of death guidelines.

Data sources: Terms related to pediatric donation after circulatory determination of death were searched in Embase and MEDLINE, as well as the non-MEDLINE sources in PubMed from 1980 to May 2014.

Study selection: Seven thousand five hundred ninety-seven references were discovered and 85 retained for analysis. All references addressing pediatric donation after circulatory determination of death were considered. Exclusion criteria were articles that did not address pediatric patients, animal or laboratory studies, surgical techniques, and local pediatric donation after circulatory determination of death protocols. Narrative reviews and opinion articles were the most frequently discovered reference (25/85) and the few discovered studies were observational or qualitative and almost exclusively retrospective.

Data extraction: Retained references were divided into themes and analyzed using qualitative methodology.

Data synthesis: The main discovered themes were 1) studies estimating the number of potential pediatric donation after circulatory determination of death donors and their impact on donation; 2) ethical issues in pediatric donation after circulatory determination of death; 3) physiology of the dying process after withdrawal of life-sustaining therapy; 4) cardiac pediatric donation after circulatory determination of death; and 5) neonatal pediatric donation after circulatory determination of death. Donor estimates suggest that pediatric donation after circulatory determination of death will remain an event less common than brain death, albeit with the potential to substantially expand the existing organ donation pool. Limited data suggest outcomes comparable with organs donated after neurologic determination of death. Although there is continued debate around ethical aspects of pediatric donation after circulatory determination of death, all pediatric donation after circulatory determination of death publications from professional societies contend that pediatric donation after circulatory determination of death can be practiced ethically.

Conclusions: This review provides a comprehensive overview of the published literature related to pediatric donation after circulatory determination of death. In addition to informing the development of pediatric-specific guidelines, this review serves to highlight several important knowledge gaps in this topic.