Spinal muscular atrophy (SMA) Type 1 in infants with two SMN2 copies is characterised by rapid motor neuron loss and a historically fatal course if untreated; however, nationwide real-world comparative data evaluating screening efficacy remain scarce. This nationwide retrospective, multicentre study evaluated the real-world impact of Turkey's national newborn screening (NBS) program on clinical outcomes in a high-risk population-of infants with genetically confirmed SMA and two SMN2 copies-treated with nusinersen. Patients were classified into a historical symptomatic cohort diagnosed before NBS implementation (pre-NBS, n = 162) and an NBS cohort identified through screening (n = 96); all received nusinersen. Outcomes included survival, respiratory and nutritional independence, and acquisition of WHO-defined motor milestones. Motor function was evaluated using the Children's Hospital of Philadelphia-Infant Test of Neuromuscular Disorders (CHOP-INTEND) scale. The NBS program markedly reduced the mean age at diagnosis and treatment initiation. Mortality was 6.3% in the NBS cohort compared with 30.9% in the pre-NBS group (p < 0.001). CHOP-INTEND scores at baseline were higher in the NBS cohort. Sustained motor gains were confirmed in both cohorts, though the NBS cohort maintained superior function throughout follow-up; 48.3% of NBS-identified infants achieved independent walking, compared with only 8.6% in the pre-NBS group. Preservation of bulbar and respiratory function was superior in the NBS cohort, whereas the pre-NBS group demonstrated progressive decline. NBS program fundamentally altered the clinical trajectory of SMA Type 1 in infants with two SMN2 copies in the present cohort. Pre-symptomatic treatment in the NBS cohort supports sustained motor development and preserves bulbar and respiratory functions, underscoring the importance of minimising delays between birth, diagnosis, and treatment initiation.
BACKGROUND:Epilepsy is frequently associated with psychological and social challenges for both children and adults including social isolation, fear of seizures, and difficulties forming close relationships. These issues often come from a lack of understanding of this disease in the general population. Educational programs may help improve public knowledge of epilepsy and potentially contribute to stigma reduction. MATERIALS & METHODS:This study evaluated the impact of a targeted educational intervention on epilepsy awareness among high school students. A structured, three-phase protocol was implemented, comprising a demographic survey, a pre-lesson knowledge test, a dedicated epilepsy education session, and a post-lesson test. The questionnaire addressed topics such as epilepsy epidemiology, seizure types, appropriate first aid responses and challenges in daily life faced by individuals with epilepsy. RESULTS:After excluding incomplete responses, data from 550 students were analyzed. The intervention resulted in a significant increase in knowledge, with mean results rising from 9.26/15 correct answers (61.7%) in the pre-lesson test to 12.97/15 (86.5%) in the post-lesson test (p < 0.001). While baseline knowledge did not differ by gender, female students exhibited greater post-lesson improvement (p < 0.05). Younger participants tended to score lower at baseline (p = 0.07), but all age groups showed similar results in the post-lesson test. Students in biology-focused academic tracks demonstrated higher baseline understanding (p = 0.02). CONCLUSIONS:These findings highlight the effectiveness of targeted educational programs in enhancing epilepsy and seizure first aid short-term knowledge among adolescents.
Background and objectives Primary headache is the most frequent neurological symptom in childhood and often coexists with psychosomatic risk factors. This study investigated functional (psychosomatic) features and anxiety in children and adolescents with primary headache, testing the hypothesis that a subgroup with high Children's Somatic Symptoms Inventory (CSSI-24) scores may present characteristics consistent with a functional disorder. Methods In this prospective observational cohort study, 148 patients aged >6 years with primary headache, diagnosed according to ICHD-3 criteria by child neurologists at a tertiary hospital, were enrolled. Demographic and clinical data, psychosomatic risk factors, and anxiety were collected through interviews and validated questionnaires. Patients were stratified using the CSSI-24 into Group 1 (<19: low psychosomatic score) and Group 2 (≥19: high psychosomatic score). Associations between functional symptoms , anxiety, and headache characteristics were analysed. Results Overall, 42.6% of participants had CSSI-24 ≥ 19. Compared with Group 1, Group 2 included more females (p = 0.046), were older (p = 0.013), and reported greater pain intensity (p = 0.02), higher monthly headache frequency (p = 0.04), and more frequent chronic analgesic use (p = 0.012). They also showed multiple psychosomatic risk factors (p = 0.04), severe somatic symptoms across several systems (p < 0.001), and higher anxiety levels (p < 0.001). Conclusions The identification of high CSSI-24 scores in a subgroup of children with primary headache could have implications for the conceptual model of pediatric headache and supports integrating neurodevelopmental and biopsychosocial perspectives. Early recognition of a “functional” phenotype may guide personalized, multidisciplinary interventions addressing stress, anxiety, and maladaptive behaviour.
INTRODUCTION:Children with cerebral palsy exhibit impaired gross motor function, particularly in standing and walking abilities. Robot-assisted gait training using the Lokomat device has emerged as an established intervention for improving gross motor function in this population. This study aimed to analyze the effects of two distinct training protocols in children who participated in Lokomat training programs and physiotherapy over a ten-year period. METHODS:We conducted a retrospective analysis of 114 children with cerebral palsy (35 female, mean age 11.2 ± 3.6 years, GMFCS levels I-V) who participated in Lokomat gait training and physiotherapy between November 2011 and November 2021. Participants were assigned to either an intensive program (n = 88; 4-5 sessions on Lokomat/week for 4 weeks) or an moderate intensity program (n = 26; 2 sessions on Lokomat/week for 8 weeks). Assessments included passive range of motion, Timed Up and Go test, 10-m walking test, and 6-min walking test, all conducted pre- and post-training. RESULTS:Both groups demonstrated significant within-group improvements in passive range of motion at the knee (popliteal angles) and ankle joints (p < 0.001). The proportion of children with hip and knee contractures decreased following training, with hip joint improvements significantly correlated with GMFCS level (p = 0.019). Walking outcomes generally showed no significant differences between the two training protocols, except for the Timed Up and Go test, where the moderate intensity group exhibited significantly greater improvement (p = 0.021). Significant within-group improvements were predominantly observed in the intensive training program. CONCLUSION:Both training protocols produced statistically significant within-group improvements in passive range of motion, though no significant between-group differences were detected post-training. The intensive program group demonstrated significant improvements across multiple walking tests, while the moderate intensity group showed significant improvement only in the Timed Up and Go test-the sole measure revealing significant between-group differences.
BACKGROUND:Cerebral palsy (CP) is a group of permanent central motor and postural development disorders caused by non-progressive damage to the developing brain. Spastic cerebral palsy, the most common type, often results in increased gastrocnemius muscle tone, limiting gait and activity. This study investigates the impact of extracorporeal shock wave therapy (ESWT) on gross motor capacity assessed by the Gross Motor Function Measure (GMFM), muscle tone, and muscle properties in children with spastic cerebral palsy. METHODS:Thirty-six patients (mean age 3.58 ± 0.96) years with spastic cerebral palsy were recruited and randomly assigned to an ESWT group (N = 18) or a control group (N = 18). The ESWT group received ESWT three times per week in addition to standard daily physical and occupational therapy for 12 weeks, while the control group received only conventional treatment. Baseline and post-intervention measurements included Gross Motor Function Measure (GMFM), Modified Ashworth Scale (MAS), muscle thickness (MT), pinnate angle (PA), fascicle length (FL), and shear wave velocity (SWV). RESULTS:The ESWT group showed significant improvements in GMFM scores, reduced MAS ratings, increased MT and FL, and decreased PA compared to the control group. SWV was significantly correlated with MAS ratings in both groups. However, no significant correlations were found between GMFM and other muscle parameters in the ESWT group. CONCLUSIONS:ESWT, combined with conventional treatment, was associated with greater short-term post-intervention GMFM scores, reduced gastrocnemius muscle tone, and improved selected sonographic muscle properties in children with spastic cerebral palsy. These findings suggest that ESWT may be a useful adjunct therapy, but longer-term follow-up is required to determine whether these changes are sustained and translate into real-world mobility benefits.
OBJECTIVE:Paradoxical reactions (PR) in pediatric HIV-negative CNS tuberculosis remain underexplored. This study prospectively analyzes incidence and pattern of PR and its impact on functional outcome. METHODS:Children (6 months-14 years) with newly diagnosed CNS Tuberculosis using the Lancet Consensus Scoring System, were enrolled. All participants received standard anti-tubercular therapy (ATT). Clinical evaluation, CSF analysis and neuroimaging were performed at baseline, during clinical worsening, or at 8 weeks. PR patterns defined as worsening or new tuberculosis lesions or symptoms following initial improvement after ≥10 days of ATT, were documented. Functional outcomes were assessed at 6-months using the Pediatric Cerebral Performance Category (PCPC) scale. RESULTS:Of the 57 participants enrolled [04 with rifampicin resistance were excluded; 24/53 had deterioration within initial 12-weeks of which 17 children qualified for PR (32%; median onset-3.5 weeks; range: 2-7 weeks). Two children developed late-onset PR beyond 12 weeks. [Total PR = 19 (Early-17; Late-2)] Common clinical features included focal neurological deficits (47%) and fever (42%). Prominent radiological patterns were infarction (47%), new or enlarging tuberculomas (37%) and spinal arachnoiditis (37%). Thirteen of 19 cases required additional anti-inflammatory treatment. BMRC Stage 2 and 3 independently predicted PR. PR was associated with unfavourable outcome on PCPC scale (adjusted OR = 34.3; 95% CI: 3.42-343.71; p = 0.001). CONCLUSION:PR occurs in approximately one-third of pediatric HIV-negative CNS tuberculosis cases, typically early in treatment. Early recognition is essential to distinguish PR from disease progression or drug resistance and to avoid inappropriate treatment modifications.
OBJECTIVE:To describe the clinical, genetic, treatment, and EEG features of patients with SCN1A-related epilepsy who showed spike-wave activation in sleep (SWAS), and to highlight the need for serial sleep EEG follow-up in this population. METHODS:We retrospectively included 19 patients with SCN1A-related epilepsy and SWAS (17 from our cohort, 2 from literature review), collecting clinical data, genotypes (categorized as loss-of-function [LOF], gain-of-function [GOF], or unclear), and EEG data (including power spectral density [PSD] and aperiodic exponent analysis) from 14 patients within our cohort. RESULTS:The cohort exhibited early seizure onset (median 10 months), whereas SWAS was identified later during the disease course (median 59 months), with a high prevalence of intellectual disability (13/19, 68.42%) and developmental delay (15/19, 78.95%). Genetic analysis revealed diverse SCN1A variants, predominantly de novo, with 10/19 (52.63%) mapping to the pore loop and intracellular linker regions. Quantitative EEG analysis showed higher PSD and aperiodic exponent values in patients with SCN1A-related epilepsy and SWAS than in the comparison groups. In descriptive subgroup analyses, the LOF group showed a higher numerical burden of early seizure onset, higher seizure frequency, drug-resistant epilepsy (DRE), and motor abnormalities, whereas neurodevelopmental and behavioral abnormalities were also observed in the Unclear group. At last follow-up, 7/19 (36.84%) patients achieved seizure control, while 10/19 (52.63%) developed DRE. CONCLUSIONS:SWAS may occur during the disease course of SCN1A-related epilepsy, often several years after seizure onset. These findings support serial sleep EEG follow-up and careful monitoring for developmental or behavioral changes in children with SCN1A-related epilepsy.
OBJECTIVE:Febrile infection-related epilepsy syndrome (FIRES) is associated with high mortality and poor neurological outcomes, yet reliable prognostic indicators are lacking. This study aimed to evaluate the prognostic value of inflammatory indexes in FIRES and to explore their potential role in guiding clinical management. METHODS:Children with FIRES hospitalized at the Children's Hospital affiliated to Chongqing Medical University between November 2015 and April 2024 and followed for more than 6 months were retrospectively included. Inflammatory indexes were analyzed at admission and after immunotherapy. Patients were categorized into death, KD, and non-KD survival groups according to clinical course and treatment pathway. Multivariate logistic and sequential logistic regression analyses were performed to identify prognostic factors. Receiver operating characteristic (ROC) curves and Gordon's coefficient were used to determine cut-off values. Sankey diagrams and nomograms were applied to validate prognostic stratification. RESULTS:Thirty-six children with FIRES were included (22 males; mean age 6.67 ± 3 years). Nine patients died, none of whom received KD. The KD group had significantly higher 6-month Glasgow Outcome Scale (GOS) scores than the non-KD survival and death groups (4 ± 1 vs. 3 ± 1 vs. 1 ± 0, p < 0.001). Multivariate analyses showed that total bilirubin-to-albumin ratio (TAR) at admission (18.48, 95% CI 6.86∼30.09, p = 0.002) and systemic immune inflammation index (SII) after immunotherapy (-0.001, 95% CI -0.001-0, p = 0.003) were independently associated with prognosis. Cut-off values of 0.145 and 0.195 for TAR and 1292 and 1892 for SII stratified patients into distinct severity groups. Higher TAR values and lower SII values were associated with milder disease and better outcomes. Sankey diagrams and nomograms further illustrated the prognostic stratification based on TAR and SII. CONCLUSION:TAR at admission and SII after immunotherapy are practical inflammatory indexes associated with disease severity and prognosis in FIRES. These findings support further investigation of early KD initiation, particularly in patients with low TAR at admission or persistently elevated SII after immunotherapy.
PURPOSE:Advances in medical engineering have increased survival among children requiring long-term mechanical ventilation (LMV), leading to a growing population of adolescents and young adults (AYA) transitioning to adult care. However, little is known about system-level barriers to this transition, particularly for technology-dependent populations. This study aimed to identify barriers to transition for AYA requiring LMV in Japan and to examine gaps between provider- and patient-reported perspectives. METHODS:We conducted a nationwide cross-sectional survey of paediatric neurologists in Japan, to assess current transition practices, perceived barriers to adult care, and referral patterns for patients requiring LMV. In addition, we conducted a supplementary exploratory questionnaire survey of a small, single-center sample of AYA patients receiving LMV and their families to contextualize physician-reported findings. Descriptive analyses were performed. RESULTS:A total of 325 paediatric neurologists responded to the nationwide survey, with a vast majority (87.5%) identifying the lack of adult providers willing or able to accept patients requiring LMV as the primary barrier to transition. Consequently, transition commonly occurred later than recommended, often after age 20 years (mean age 23 ± 5 years). In contrast, the supplementary, single-center exploratory survey of patients and families revealed that they primarily focused on securing specialized respiratory expertise and emergency care readiness. This mismatch highlights a substantial gap between structural health system limitations and patient-centred clinical needs. CONCLUSIONS:Our results suggest that structural limitations in adult-care capacity are the major barriers to timely transition for technology-dependent AYA, while patient/family data preliminarily highlight the importance of maintaining specialized respiratory expertise during the transition.
AIM:To characterise the clinical features in children with paediatric acute-onset neuropsychiatric syndrome (PANS), and compare these features to non-PANS neurodevelopmental disorders (NDDs). METHOD:Using a standardised tool (NDD-ECHO), clinical data was prospectively captured from 162 patients referred with tics and/or OCD, some of whom were referred due to a suspicion of PANS, before clinical assessment. The Strengths and Difficulties Questionnaire (SDQ) compared behaviour in all children, and 58 healthy controls were used for reference. At clinical review, the patients were classified into PANS (n = 56, median age 12 years, [range 4-21], 59% male) and non-PANS NDDs (n = 106, median age 10 years, [range 4-18], 72% male). RESULTS:The median age at first neuropsychiatric flare in PANS was 5 years, with males presenting earlier (4 years vs 6.5 years, p < 0.05). In addition to core symptoms of obsessive-compulsive disorder (OCD, 98%) and eating restriction (62%), younger children with PANS were more likely to have new onset speech dysfunction during flares whereas older children had depression. OCD symptoms were present in 98% of children with PANS and 27% of children with non-PANS NDDs, tics were less common in PANS compared to non-PANS NDDs (66% vs 84%, p < 0.05), whereas autism (43% vs 31%, ns) and attention deficit hyperactivity disorder (57% vs 58%, ns) did not differ. Severe fluctuations and relapsing-remitting course were more common in PANS than non-PANS NDDs (54.3% vs 28.7%, and 11% vs 1%, both p < 0.05, respectively). However, symptom fluctuations of any kind were common in both PANS and non-PANS NDDs (73.8% and 88.2%, ns, respectively), with stress reported as an exacerbating factor in both groups (84.4% vs 87.2%, p = 0.795), whereas infection was a reported exacerbating factor more frequently in PANS (80.0% vs 50.5%, p = 0.003). Maternal autoimmune disease was more common in PANS than non-PANS NDDs (49% vs 17%, p < 0.001), particularly autoimmune thyroid disease (26% vs 2%, p < 0.0001). SDQ scores were significantly higher in PANS compared to non-PANS NDDs in emotional, internalising, and impact domains (all p < 0.01). INTERPRETATION:PANS demonstrates age-related symptomatology, familial autoimmunity, and significant behavioural impact in emotional domains. Clinical fluctuations provoked by environmental factors are common to both PANS and non-PANS NDDs, suggesting that gene-environment interactions are common to many NDDs, with PANS being a severe phenotype.
BACKGROUND:Hereditary spastic paraplegia (HSP) comprises a heterogeneous group of inherited neurodegenerative disorders characterized by progressive spasticity and weakness primarily of the lower extremities. Data describing pediatric HSP from the Levant region remain limited. OBJECTIVE:This study characterizes the clinical and genetic spectrum of pediatric HSP patients with an identified variant in an HSP-associated gene evaluated at a tertiary referral center serving the Eastern Levant. METHODS:A retrospective descriptive review of pediatric and adolescent patients with a clinical diagnosis of HSP and an identified variant in an HSP-associated gene, evaluated between 2010 and 2024 was conducted. Demographic, clinical, neuroimaging and genetic data were extracted from medical records. Genetic diagnoses were established using next-generation sequencing-based approaches and interpreted according to American College of Medical Genetics and Genomics guidelines. Data were summarized descriptively. RESULTS:A total of 21 pediatric patients were included. Nineteen patients (90.5%) had an autosomal recessive inheritance, 71.4% were progeny from consanguineous families. Clinically relevant variants were identified across 11 HSP-associated genes, including CYP2U1, SPG11, ARL6IP1, B4GALNT1, DDHD2, RNF170, AMPD2, as well as variants in AP-4 complex genes (AP4B1, AP4M1, AP4S1). Additionally, the autosomal dominant SPAST gene was also featured. Age at symptom onset ranged from infancy to late childhood. Ambulatory status at last follow-up ranged from independent ambulation to dependence on assistive devices or caregiver support. Clinical presentations spanned pure spastic paraplegia and complex phenotypes, the latter being associated with variable combinations of features such as intellectual disability, ataxia or seizures. Brain magnetic resonance imaging findings were variable and encompassed thinning of the corpus callosum and nonspecific white matter abnormalities. CONCLUSION:The cases discussed provide a descriptive overview of the clinical and genetic characteristics of pediatric HSP in Lebanon, Syria and Iraq. The relatively high number of CYP2U1 and AP-4 complex variants observed in this referral cohort, together with the predominance of autosomal recessive and complex forms, highlight the value of broad molecular testing in populations with high rates of consanguinity, such as the Eastern Levant.
Congenital myasthenic syndromes (CMS) are inherited disorders caused by defects of the neuromuscular junction. Both the definitive diagnosis and the treatment are structured in accordance with genetic analysis. We aimed to investigate the clinical and genetic characteristics of CMS in a pediatric cohort from Southeastern Türkiye, a region with high rates of consanguineous marriage. The clinical features and demographic data of fifteen patients (9 girls, 6 boys) with CMS were evaluated. Genetic analysis was performed using clinical exome sequencing. The mean age of patients was 7.4 ± 4.1 years, and the mean age at diagnosis was 5.8 ± 4 years. Symptoms were present from birth in most patients. The latest age at symptom onset was 11 years. The patients presented with ptosis, ophthalmoplegia, muscle weakness, frequent falls, collapse, respiratory distress, dysphagia, and laryngomalacia. Homozygous variants in COLQ (11/15, 73%), CHAT (1), DOK7 (1), RAPSN (1), and a compound heterozygous variant in MYO9A (1) were identified. The same variant, c.444G > A, was detected in all patients with COLQ variants except one, in whom the c.706C > T variant was identified. Epilepsy was observed in three patients (two with COLQ and one with CHAT variants). CMS in Southeastern Türkiye is predominantly caused by COLQ variants, particularly the recurrent c.444G > A nonsense variant, likely reflecting a founder effect in this region with a consanguineous marriage rate of 43%.
OBJECTIVES:Up to 30% of adults with peripheral facial palsy (FP) develop synkinesis, but it's incidence in children remains unclear due to limited long-term data. METHODS:Children (<18 years) treated for acute peripheral FP at Jena University Hospital between 2009 and 2021 were screened in this cross-sectional study. Bell's palsy and infection-associated FP (e.g., Lyme disease, Zoster) were included, while secondary causes such as tumors, trauma, CNS disorders, and conditions like Guillain-Barré syndrome or Chiari malformation were excluded. Video follow-ups collected clinicodemographic information and PROMs including Facial Clinimetric Evaluation Scale (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Facial movements were video-recorded and assessed using Sunnybrook and eFACE. RESULTS:Of 85 eligible patients, 26 participated (46% female; response rate 30.6%). Mean age at onset was 8.5 years (range: 0.2-16); 54% had idiopathic FP (IFP) and 46% Lyme-associated FP (LFP). Median follow-up was 7.56 years (range: 2.5-13). All LFP participants and 11 out of 14 IFP participants achieved complete or near-complete recovery (eFACE and Sunnybrook scores 90-100). Four participants (28.6%), exclusively from the IFP group, developed synkinesis, three with functional impairments in PROMs and video-based assessment. Seven participants (five (35.7%) from the IFP group and two (16.7%) from the LFP group) reported that they still experience mental health-related effects of FP today. CONCLUSION:The data indicate that a relevant proportion (around 21.4%) of children with Bell's palsy develop moderate to severe synkinesis. Long-term follow-up and further research on corticosteroids use in pediatric FP are warranted.
BACKGROUND:Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by progressive muscle weakness and atrophy, often leading to severe disability or early mortality. This study aimed to estimate the prevalence of pediatric SMA in Kazakhstan and to evaluate outcomes of the national disease-modifying treatment program with nusinersen. METHODS:Data from all patients registered in the national SMA registry were analyzed. SMA prevalence was calculated per 100,000 pediatric population. Survival was assessed using Kaplan-Meier analysis stratified by SMA type, and treatment outcomes were evaluated in relation to clinical characteristics and timing of therapy initiation. RESULTS:The national SMA prevalence was 2.9 cases per 100,000 pediatric population. Survival differed significantly across SMA types, with all recorded deaths occurring in patients with SMA type 1, while near-complete survival was observed in types 2 and 3. Kaplan-Meier analysis demonstrated a significantly reduced survival probability in SMA type 1 compared to other types (log-rank p < 0.001). Substantial delays in diagnosis and treatment initiation were observed, with a mean delay of 18 months. Earlier initiation of therapy was associated with more favorable outcomes. CONCLUSION:SMA prevalence in Kazakhstan is likely underestimated due to the absence of a national screening program. Survival outcomes vary significantly by SMA type, highlighting the importance of early diagnosis and timely treatment initiation, particularly in severe phenotypes. These findings may inform optimization of national SMA care strategies.
Pediatric arterial ischemic stroke can have a significant impact on visuospatial processing, with patients exhibiting deficits in tasks such as copying and drawing, block construction, and spatial localization. However, given that these visuospatial tasks often also involve motor skills, it remains unclear to what extent patients' motor impairments may affect their performance. Therefore, this cross-sectional study aimed to examine the relationship between patients' motor-free visual perception and visuomotor integration, and to explore the impact of demographic and clinical characteristics on these skills. We investigated the visuospatial processing abilities of 16 pediatric stroke patients (M = 9.5 years, SD = 2.6 years) using the Rey-Osterrieth Complex Figure (ROCF) and Developmental Test of Visual Perception-3 (DTVP-3). Correlational analyses were conducted to examine associations between cognitive tests, as well as between age at stroke, socioeconomic status, modASPECTS, and test performance. The motor-free visual perception composite score of the DTVP-3 significantly correlated with the copy (rs = .65) and delayed recall condition of the ROCF (rs = .71). In contrast, the visuomotor integration composite score of the DTVP-3 did not correlate with any of the ROCF conditions (all p > .05). The modASPECTS was significantly related to the global visual perception (r = -.83), visuomotor integration (r = -.72), and motor-free visual perception (r = -.72) composite scores of the DTVP-3. These results suggest that the visuospatial processing deficits seen in pediatric stroke patients are independent of their visuomotor integration and that a larger initial lesion size negatively impacts their visuospatial abilities. Taken together, these findings contribute to our current understanding of the cognitive profile post stroke and to clinical predictors of visuospatial processing in pediatric stroke patients.
