Aim:Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention (IA), hyperactivity, and impulsivity. In 2022, the Japanese version of the ADHD Rating Scale-5 (ADHD-RS-5) was released based on DSM-5. Although there are several changes compared to the previous version, few clinical studies have been conducted using the ADHD-RS-5. This study aimed to re-evaluate ADHD-related characteristics by age group in pediatric psychiatric outpatients, using the ADHD-RS-5 regardless of diagnosis, and compare these findings with previous research. Methods:Participants were all patients aged 5-17 years who visited the Psychiatry Clinic of Tokiwa Hospital or the Tokiwa Child Development Center (Child Psychiatry Clinic) during the study period. Of 503 children, 452 met the inclusion criteria. Primary caregivers completed the ADHD-RS-5. Symptom and functional impairment scores were compared by ADHD diagnosis and age group. In the ADHD group, scores were also compared based on pharmacological treatment. Results:IA and hyperactivity-impulsivity (HI) scores were significantly higher in the ADHD group. Functional impairment scores did not differ significantly in some age groups. HI scores were lower in older age bands, whereas IA scores did not differ significantly across age groups; the cross-sectional patterns are compatible with relative stability of inattentive symptoms but do not establish longitudinal persistence. Pharmacological treatment was not linked to symptom scores but was associated with higher impairment scores. Conclusion:Our findings using the ADHD-RS-5 showed results consistent with previous reports regarding age-specific symptom characteristics of ADHD, while also providing new insights into treatment options for ADHD. Clinicians may consider both symptom severity and functional impact when initiating pharmacotherapy. Given medication approval from age 6 in Japan, accurate assessment and diagnosis remain essential, and the ADHD-RS-5 may support decision-making when interpreted alongside clinical judgment and multi-informant input.
Background:Pulmonary arterial hypertension (PAH) is characterized by a progressive increase in pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR), imposing an increased workload on the right ventricle and ultimately leading to right heart failure. Macitentan is a potent dual endothelin receptor antagonist that blocks both endothelin receptor subtypes A and B, and is approved for adult patients with PAH, but evidence in pediatric PAH patients is limited. Methods and Results:This was an open-label, multicenter, Phase III study enrolling Japanese pediatric PAH patients aged ≥3 months to <15 years. A total of 7 patients were enrolled. Efficacy was evaluated by assessing pulmonary hemodynamics after 24 weeks of treatment, and safety was assessed over a 52-week period. The geometric mean fold change in PVR index (PVRI) at Week 24 was 59.43%, which met the prespecified success criterion of ≤81.6% (primary endpoint). Other pulmonary hemodynamic parameters, including mean PAP, mean right atrial pressure, and total pulmonary resistance, also showed improvement. Additionally, at Week 52, functional outcomes such as 6-minute walk test performance and quality-of-life reports, demonstrated a trend toward improvement. Safety findings were favorable, with no unexpected concerns among the 7 treated participants. Most adverse events were mild to moderate in severity, and none were considered related to macitentan. Conclusions:Macitentan showed clinically meaningful reduction in PVRI and improved pulmonary hemodynamics in Japanese pediatric patients with PAH, with a favorable safety profile over 52 weeks of treatment.
OBJECTIVE:Intracranial electroencephalography (iEEG) monitoring presents additional challenges in pediatric patients compared to adults due to factors such as smaller body size, increased surgical invasiveness, difficulty maintaining rest, higher sensitivity to pain, and a greater risk of electrode self-removal. However, long-term outcomes and complications following resective surgery after iEEG evaluation in children remain underreported. This study aimed to evaluate the long-term outcomes and safety of surgical treatment following iEEG monitoring in pediatric patients. METHODS:We retrospectively analyzed 24 pediatric patients (aged ≤15 years) who underwent surgical treatment after iEEG implantation between 1994 and 2024, with a minimum follow-up period of 5 years. Clinical characteristics, neuroimaging findings, details of iEEG monitoring, surgical procedures, epilepsy etiology, and seizure outcomes were reviewed. RESULTS:The mean age at epilepsy onset was 4.5 years (range, 0.0-12.0), and the mean age at surgery was 10.4 years (range, 1.8-14.0). The average interval from seizure onset to surgery was 6.0 years (range, 0.9-14.8). The iEEG modalities included subdural grid electrodes alone (15 patients), a combination of subdural and depth electrodes (eight patients), and depth electrodes alone (one patient). The mean duration of iEEG monitoring was 9.1 days (range, 2-14). Surgical procedures included focal cortical resection and/or lesionectomy in 18 patients (75.0%), anterior temporal lobectomy in five (20.8%), and multiple subpial transections (MST) alone in one (4.2%). MST, in addition to resection, was performed in six patients (25.0%). Thirteen patients (54.2%) achieved Engel class I or II outcomes. No perioperative complications related to iEEG implantation occurred, and no patients experienced permanent neurological deterioration. Blood transfusion was not required in any case. MEG-MRI (magnetoencephalography-magnetic resonance imaging) concordance was significantly associated with favorable seizure outcomes. CONCLUSION:This study demonstrated a good seizure outcome rate of 54.2% in pediatric patients who underwent surgical treatment following iEEG monitoring. No major perioperative complications related to iEEG implantation were observed, and no patients experienced permanent neurological deterioration in this cohort. These findings suggest that with careful electrode selection, precise placement and fixation, and vigilant perioperative management, iEEG can be safely performed even in very young children. Furthermore, the presence of MEG clusters concordant with MRI lesions tended to be associated with better seizure outcomes after resection, suggesting a possible role of multimodal imaging data in individualized treatment planning.
