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Moore L, Pakalnis A. Calcitonin Gene-Related Peptide Inhibitors in the Treatment of Migraine in the Pediatric and Adolescent Populations: A Review. Pediatr Neurol 2024; 157:87-95. [PMID: 38905744 DOI: 10.1016/j.pediatrneurol.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 06/23/2024]
Abstract
There are limited well-studied treatments for migraine in the pediatric population. Calcitonin gene-related peptide (CGRP) inhibitors are an established safe and effective treatment in adults, and use may be appropriate for pediatric patients in certain clinical situations. We describe migraine pathophysiology as it relates to CGRP, provide an overview of available medications, and discuss clinical usage in this population.
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Affiliation(s)
- Lisa Moore
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio; Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Ann Pakalnis
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio; Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
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2
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Triadou D, Bar-Shalom Y, Pollak M, Gal S, Nathan K, Yakovlev M, Genizi J. Weekend Headaches in School-Age Children. Healthcare (Basel) 2023; 12:60. [PMID: 38200966 PMCID: PMC10778602 DOI: 10.3390/healthcare12010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Children commonly encounter primary headaches, with various factors playing a role in their onset. The daily routine notably contributes to the occurrence of primary headaches in children. This study aims to profile children experiencing headaches on weekends (WH) in comparison to those primarily having headaches midweek (MWH). Out of 109 children visiting a pediatric headache clinic, 60 prospectively filled out questionnaires regarding their headaches. The average age was 11.8 years, and 63% were of female sex. Most of the children suffered from migraine headaches (60%), while the rest suffered from tension-type headaches (TTH, 15%), mixed headaches (17%), or undetermined headaches (8%). None of the children suffered from a headache only on the weekend. In contrast, 14 (23%) children suffered from a headache exclusively in midweek. Children with learning difficulties were similarly distributed between the WH and the MWH groups (48% and 52%, respectively). Children without learning difficulties suffered significantly more from MWH compared to WH (79% vs. 21%, respectively). In conclusion, children did not suffer from WH alone. Self-reported triggers were not significantly different in WH and MWH patients. Proper profiling of headache types and triggers may lead to more accurate management of these patients.
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Affiliation(s)
- Daniel Triadou
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
| | - Yoel Bar-Shalom
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
| | - Mordechai Pollak
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
| | - Shoshana Gal
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
| | - Keren Nathan
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
| | - Megi Yakovlev
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
| | - Jacob Genizi
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
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3
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Amer F, López T, Gil-Conesa M, Carlos S, Ariño AH, Carmona-Torre F, Martínez-González MA, Fernandez-Montero A. Association between COVID-19 and outstanding academic performance at a Spanish university. Arch Public Health 2023; 81:213. [PMID: 38093341 PMCID: PMC10717459 DOI: 10.1186/s13690-023-01225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND SARS-CoV-2 is the causative agent of COVID-19 identified in December 2019, an acute infectious respiratory disease that can cause persistent neurological and musculoskeletal symptoms such as headache, fatigue, myalgias difficulty concentrating, among others including acute cerebrovascular disease with a prevalence of 1-35%. The aim of this study is to evaluate the impact of COVID-19 in undergraduate students on their academic performance as an indicator of their intellectual ability and performance in a university that maintained 100% face-to-face teaching during the 2020-2021 academic year. METHODS A total of 7,039 undergraduate students were analyzed in a prospective cohort study at the University of Navarra. A questionnaire including sociodemographic and behavioral questions was sent. PCRs were performed throughout the academic year for the diagnosis of SARS-CoV-2 infection and students' academic results were provided by the academic center, adjusted descriptive and multivariate models were performed to assess the association. RESULTS A total of 658 (9.3%) participants were diagnosed with COVID-19, almost 4.0% of them achieved outstanding academic results, while uninfected students did so in 7.3%. SARS-CoV-2 infection was associated with a significant decrease in having outstanding academic results (OR = 0.57; 95% CI: 0.38-0.86). CONCLUSION Having COVID-19 disease, decreased academic performance in undergraduate students. Therefore, it is necessary to prevent infection even in the youngest sections of the population.
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Affiliation(s)
- Fares Amer
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
| | - Tamara López
- Department of Occupational Medicine, University of Navarra Clinic, Av. Pio XII, 36. 31008, Pamplona, Navarra, Spain
| | - Mario Gil-Conesa
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
| | - Arturo H Ariño
- Department of Environmental Biology, University of Navarra, Pamplona, Navarra, Spain
- Institute for Data Science and Artificial Intelligence (DATAI), University of Navarra, Pamplona, Navarra, Spain
| | - Francisco Carmona-Torre
- Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
- COVID-19 Department, University Clinic of Navarra, Pamplona, Navarra, Spain
- Infectious Diseases Service, University Clinic of Navarra, Pamplona, Navarra, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
- Department of Nutrition, Harvard T.H Chan School, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain.
- Department of Occupational Medicine, University of Navarra Clinic, Av. Pio XII, 36. 31008, Pamplona, Navarra, Spain.
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4
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Morse BL, Karian V. Supporting the Young Adulthood Transitions in Women With Migraine. Nurs Womens Health 2023; 27:457-466. [PMID: 37804861 DOI: 10.1016/j.nwh.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 10/09/2023]
Abstract
Migraine is a painful neurological disorder that disproportionately affects women and has a significant impact on quality of life. This article summarizes the critical role of women's health nurses in supporting young adult women with migraine during major life transitions. Nurses can advocate for workplace or school disability accommodations for women with migraine. Nurses can also support young adult women with migraine by providing education about available treatment that becomes available after an individual's 18th birthday. Women's health nurses can also provide counseling on healthy lifestyle habits to sustain through life transitions, such as guidance on safe alcohol consumption and wellness approaches to migraine management. Through these interventions, women's health nurses can help women with migraine to succeed personally, professionally, and academically while effectively managing migraine symptoms.
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DiSabella M, Pierce E, McCracken E, Ratnaseelan A, Vilardo L, Borner K, Langdon R, Fletcher AA. Pediatric Headache Experience During the COVID-19 Pandemic. J Child Neurol 2022; 37:871-881. [PMID: 36000303 PMCID: PMC9412153 DOI: 10.1177/08830738221114240] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Headache disorders are exceedingly common in children and adolescents. The association between headaches, emotional stress, and disruptions in daily routines are well established. The goal of this study is to compare the experiences of patients with a preexisting diagnosis of a primary headache disorder in terms of headache frequency and severity, lifestyle techniques for headache prevention, screen use, and mood from before and after the onset of the COVID-19 pandemic. METHODS Patients evaluated by the Headache Clinic at Children's National Hospital between Summer 2020 and Winter 2021 were enrolled in a patient registry. Patients completed a questionnaire examining changes in headache characteristics and lifestyle factors since the onset of the COVID-19 pandemic. RESULTS A total of 107 patients completed the survey. Since the pandemic's onset, patients reported decreased physical activity (n = 59, 55%), increased frequency of chronic headaches from 40% (N = 42) to 50% (N = 54), and increased constant daily headaches from 22% (n = 24) to 36% (n = 38). Patients reported worsened anxiety (n = 58, 54%), mood (n = 50, 47%), and workload (n = 49, 46%). Sixty-one percent (n = 65) of patients reported using screens for school for more than 6 hours per day. The majority (n = 67, 63%) of patients indicated that they would prefer attending in-person school, with 14% (n = 15) responding that they preferred online school. CONCLUSION Since the COVID-19 pandemic's onset, pediatric headache patients have experienced increasing headache frequency, worsening anxiety and mood, decreased physical activity, and increased screen usage. Although this study is limited by sample size and observational design, future population-based studies will further elucidate the impact of this pandemic on pediatric headache.
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Affiliation(s)
- Marc DiSabella
- George Washington University School of
Medicine, Children’s National Hospital, Washington, DC, USA,Children’s National Hospital,
Washington, DC, USA
| | - Emily Pierce
- Children’s National Hospital,
Washington, DC, USA
| | - Emily McCracken
- Children’s National Hospital,
Washington, DC, USA,Emily McCracken, BA, Children’s National
Hospital, 111 Michigan Ave, NW, Washington, DC 20010, USA.
| | - Aarane Ratnaseelan
- George Washington University School of
Medicine, Children’s National Hospital, Washington, DC, USA
| | | | - Kelsey Borner
- Warren Alpert Medical School of Brown
University, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI,
USA
| | - Raquel Langdon
- George Washington University School of
Medicine, Children’s National Hospital, Washington, DC, USA,Children’s National Hospital,
Washington, DC, USA
| | - Angela A. Fletcher
- George Washington University School of
Medicine, Children’s National Hospital, Washington, DC, USA,Children’s National Hospital,
Washington, DC, USA
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Tarantino S, Proietti Checchi M, Papetti L, Ursitti F, Sforza G, Ferilli MAN, Moavero R, Monte G, Capitello TG, Vigevano F, Valeriani M. Interictal Cognitive Performance in Children and Adolescents With Primary Headache: A Narrative Review. Front Neurol 2022; 13:898626. [PMID: 35911918 PMCID: PMC9326001 DOI: 10.3389/fneur.2022.898626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Primary headache is a very common and disabling disease. The burden of pain and recurrent attacks may lead to a poor quality of life, anxiety and depression. An increased risk of low functioning and curricular performances in young patients with primary headache has been described. The mechanisms underlying the relationship between migraine and poor school achievement may be various and could be a reflection of weak cognitive skills. Data concerning the cognitive functioning in the free pain interval in pediatric age are under-investigated and results are far from conclusive. The present review article suggests that, though considered a benign disease, pediatric migraine may be associated to altered neuropsychological functioning in the interictal phase. Although children and adolescents with migraine generally have a normal intelligence, they may show a not homogeneous cognitive profile, characterized by possible difficulties in verbal skills, in particular comprehension abilities. Pediatric primary headache may present altered neuropsychological functioning involving attentional resources, processing speed and memory, particularly verbal memory. Given the impact that this disease can have on school performance and the tendency to persist from childhood to adulthood, a cognitive screening in young patients affected by primary headache is pivotal. Additional neuropsychological research using more homogenous methods is needed.
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Affiliation(s)
- Samuela Tarantino
- Unit of Clinical Psychology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Samuela Tarantino
| | - Martina Proietti Checchi
- Unit of Clinical Psychology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgia Sforza
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Romina Moavero
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Gabriele Monte
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Teresa Grimaldi Capitello
- Unit of Clinical Psychology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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7
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Hamamci M, Songur MS, Aslan Bayhan S, Bayhan HA. Is ocular vascularity affected in young migraine patients? A pilot study. J Clin Neurosci 2021; 91:144-151. [PMID: 34373020 DOI: 10.1016/j.jocn.2021.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate ocular vascularity in young adult migraine patients with visual aura and without visual aura. MATERIAL AND METHODS The study included 30 patients with migraine with visual aura (MWVA), 30 patients with migraine without visual aura (MWOVA), and 30 healthy control subjects, all between ages ≥18 and <45. Migraine patients were applied Headache Impact Test (HIT) and Migraine Disability Assessment Scale (MIDAS). Retinal nerve fiber layer thickness and ocular vascularity of all participants were evaluated with optical coherence tomography (OCT) and OCT angiography (OCTA). RESULTS The MWVA group had significantly lower superficial and deep foveal vascular density values compared to the control group (p = 0.039, p = 0.028, respectively). The foveal avascular zone was significantly enlarged in the MWVA group compared to the control group (p = 0.033). MWVA patients had significantly lower whole optic disc, optic disc inside, peripapillary, superior hemisphere, inferior hemisphere, superior quadrant, and temporal quadrant vascular density values compared to the control group (p < 0.05 all), while there was no significant difference in the nasal quadrant (p = 0.083). Migraine attack frequency, MIDAS, and HIT were negatively correlated with ocular vascular density values. CONCLUSION The results of our study indicate that young adult patients with MWVA are at risk of decreased ocular vascularity and that this risk may increase with frequency and severity of migraine attacks.
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Affiliation(s)
- Mehmet Hamamci
- Department of Neurology, Yozgat Bozok University Medical School, Yozgat, Turkey.
| | - Murat Serkan Songur
- Department of Ophthalmology, Yozgat Bozok University Medical School, Yozgat, Turkey
| | - Seray Aslan Bayhan
- Department of Ophthalmology, Yozgat Bozok University Medical School, Yozgat, Turkey
| | - Hasan Ali Bayhan
- Department of Ophthalmology, Yozgat Bozok University Medical School, Yozgat, Turkey
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8
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Gazerani P. Migraine and Mood in Children. Behav Sci (Basel) 2021; 11:bs11040052. [PMID: 33919881 PMCID: PMC8070834 DOI: 10.3390/bs11040052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Migraine is one of the most prevalent headache disorders in children and negatively influences their quality of life. Physical, social, and school functioning are negatively affected. Mood changes are common in migraineurs and may happen before, during, or after a migraine headache. Children with migraine are not exempt from mood swings. The majority of mood changes occur during the prodromal phase, manifesting as a psychobiological response, e.g., difficulty thinking, trouble concentrating, irritability, higher or lower energy, confusion, and depression. A bi-directional relationship between migraine and mood has been proposed, but mechanisms are not clear. Collectively, a maladaptive stress response has been suggested to explain the inability to balance homoeostatic changes when facing various stressors. Recognizing mood changes and monitoring mood patterns in children with migraine, for example, by various apps and so-called mood monitors, is valuable for better management. A multidisciplinary intervention has been recommended to reduce migraine disability, improve coping strategies, and reduce chronification risks in children with migraine. Pharmacological and non-pharmacological strategies are both available and effective. Biofeedback, relaxation, and cognitive-behavioral therapy yield positive outcomes in pediatric migraine. Developing healthy lifestyle habits (diet, exercise, sleep) also seems to improve migraine in this population.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway;
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9229 Aalborg E, Denmark;
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9
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Karvounides D, Marzouk M, Ross AC, VanderPluym JH, Pettet C, Ladak A, Ziplow J, Patterson Gentile C, Turner S, Anto M, Barmherzig R, Chadehumbe M, Kalkbrenner J, Malavolta CP, Clementi MA, Gerson T, Szperka CL. The intersection of COVID-19, school, and headaches: Problems and solutions. Headache 2021; 61:190-201. [PMID: 33382459 PMCID: PMC8086994 DOI: 10.1111/head.14038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/12/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID-19), which impact the physical, emotional, and social health of youth with headache disorders. BACKGROUND COVID-19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020-2021 school year, whether classes are conducted in-person or virtually. METHODS Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue. RESULTS We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020. CONCLUSION Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine.
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Affiliation(s)
- Dina Karvounides
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maya Marzouk
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Alexandra C Ross
- UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | | | | | - Ali Ladak
- Penn Therapy & Fitness, University City, Philadelphia, PA, USA
| | - Jason Ziplow
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carlyn Patterson Gentile
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott Turner
- Department of Neurology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Marissa Anto
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Barmherzig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Madeline Chadehumbe
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jocelyn Kalkbrenner
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carrie P Malavolta
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle A Clementi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Trevor Gerson
- Division of Child Neurology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Christina L Szperka
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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