Background: Schizencephaly is a congenital brain malformation involving a cleft in the cerebral hemisphere lined with abnormal gray matter with an estimated incidence of 1.5 per 100,000 live births. Methods: This study aims to characterize the radiological, etiological, and clinical features of schizencephaly, identifying factors predictive of patient outcomes. A retrospective cohort of 94 individuals, both adult and pediatric, was analyzed across four tertiary care centers. A neuroradiologist systematically reviewed imaging, while charts were reviewed for clinical features. Results: Several perinatal risk factors were identified, including young maternal age and prenatal infections. However, genetic testing yielded only one pathogenic COL4A1 mutation. MRI findings showed frequent additional malformations, including those in the pituitary, corpus callosum, and fornix. Clinical characteristics included neurodevelopmental delay (71.6%), seizures (50.0%), and motor impairments (53.3%). Outcomes were heterogeneous, with bilateral and open-lip clefts associated with more severe developmental delays, while seizure rates were comparable across subtypes. Conclusions: The complexity of schizencephaly is highlighted in the largest cohort reported with high rates of seizures, neurodevelopmental delays, and motor impairments, but outcomes varied widely based on imaging features, underscoring the importance of individualized management. The low yield of genetic findings emphasizes prenatal environmental risk factors as etiological contributors.

Pathogenic CACNA1A mutations can result in paroxysmal attacks of encephalopathy, hemiplegia and cerebral edema. We report two patients with CACNA1A-associated encephalopathy, hemiplegia and contralateral hemispheric cerebral edema treated successfully with intravenous magnesium sulfate and dexamethasone. One patient met the clinical criteria for familial hemiplegic migraine. There is a paucity of guidance in the literature on how to manage these patients. Despite some discrepancies in the treatment protocols in our two cases, they indicate that magnesium and dexamethasone could be part of the treatment algorithm for these patients. Further research to delineate appropriate dosing and duration of therapy is needed.

Wearable-based seizure detection devices hold promise in reducing seizure-related adverse events and relieving the daily stress experienced by people with epilepsy. In this work, we present the latest evidence regarding the performance of three seizure detection wearables (eight studies) commercially available in Canada to provide guidance to clinicians. Overall, their ability to detect focal-to-bilateral and/or generalized tonic-clonic seizures ranges between 21.0% and 98.15% in sensitivity, with the 24h false alarm rates ranging from 0 to 1.28. While performance in epilepsy monitoring units show promise, the lack of evidence in outpatient settings precludes strong recommendations for their use in daily life.

Background: Protein phosphorylation is critical in development and tumor progression, but kinase promiscuity limits selective regulation. Alternative transcription start sites (ATSS) and alternative splicing (AS) may generate isoforms with or without the phosphorylation sites, offering a mechanism of precise control. Sonic Hedgehog (Shh) medulloblastoma (MB), the most common pediatric cerebellar tumor, arises from granule neuron precursors (GNPs) via aberrant Shh signaling. Highly proliferative postnatal day 7 (P7) GNPs and MB share transcriptomic and molecular characteristics, acting as a model for further investigation. Here, we examined the regulation of phosphorylation sites in the mRNA level in P7 GNP and MB. Methods: Integrated phosphoproteomics, proteomics, and RNA-Seq datasets were analyzed to identify candidates producing alternative transcripts with phosphorylation changes in murine P7 GNPs and Ptch1+/- MB. Differential isoform expression was validated via RT-qPCR and RNA-FISH. Results: Rnf220 and Septin9 were identified as candidates that utilize ATSS to produce differential isoforms with or without the phosphorylation sites. RT-qPCR and RNA-FISH showed significant upregulation of their long isoforms in Shh MB compared to GNPs. Conclusions: Alternative transcript generation may act as a novel mechanism for regulating phosphorylation in Shh MB. Differential expression of Rnf220 and Septin9 phosphorylated isoforms suggests their involvement in MB development, warranting further functional investigations.

Bell’s palsy is acute facial palsy due to inflammation involving the facial nerve related to infections. Rates have not been noted to differ by ethnicity. We studied the lifetime prevalence in First Nations and all other Manitobans in people with type 2 diabetes mellitus aged 7 and older in 2013–2014 and 2016–2017. We found a crude lifetime prevalence of 9.9% [95% CI 9.4–10.4%] in the First Nations population versus 3.9% [95% CI 3.8–4.0%] in all other Manitobans. It is unknown if there were differences in glycemic control. The increased prevalence was found in all five provincial health regions. This study indicates that ethnicity may be an important risk factor for Bell’s palsy.

Background: Tuberous Sclerosis Complex (TSC) is a genetic condition marked by multisystem benign tumours. mTOR inhibitor (mTORi) therapy is indicated for subependymal giant cell astrocytomas (SEGA), renal angiomyolipomas (AML), and drug-resistant epilepsy. This study aimed to evaluate the efficacy and safety of mTORi in our paediatric TSC cohort. Methods: Data on patient demographics, clinical outcomes, and adverse events (AEs) were obtained from SickKids’ prospective observational TSC Database (n=107). Results: 19 children (median age at diagnosis 0.6 years, range 0-8.3; F:M 10:9) received mTORi. Indications were SEGA (n=6), AML (n=4), seizures (n=4), prophylactic (n=2), AML/SEGA (n=1), seizures/AML (n=1), and seizures/SEGA (n=1). Median age at mTORi initiation was 8.4 years (range 2.1-15.4). 68.4% (n=13/19) received sirolimus and 31.6% (n=6/19) received everolimus. 24 months post-mTORi initiation, 50% showed stable SEGA (n=4/8), 50% reduced SEGA (n=4/8), 66.7% stable AML (n=8/12), 25% reduced AML (n=3/12), and 8.3% larger AML (n=1/12). Variability in reporting seizure frequency rendered mTORi effects on epilepsy inconclusive. mTORi was overall well tolerated, yet 100% (n=19/19) reported AEs, majority Grade 1-2. Conclusions: This study describes the efficacy and tolerability of mTORi in a Canadian paediatric TSC cohort, which demonstrates beneficial effects on SEGA and AML, with mild to moderate AEs reported.

We evaluated stress and burden in epilepsy patient caregivers in a pediatric neurology clinic. Caregivers of 102 children with epilepsy completed the Caregivers’ Assessment of Difficulty Index and a questionnaire regarding caregiver sociocultural characteristics. A multiple linear regression statistical analysis found that caregiver burden was significantly increased for those who had a second child with a chronic disease, sole caregivers and for those with children with drug-resistant epilepsy. Caregiver stress was significantly increased for caregivers with a native language other than English or French, caregivers who had a second child with a chronic disease and sole caregivers.

Increased rehabilitation intensity, the number of minutes of therapy per day, is associated with improved outcomes. However, it is unclear whether males and females receive the same inpatient stroke rehabilitation intensity. A sub-analysis of a retrospective population-based cohort study of adults (5877 females, 6893 males) with stroke discharged to inpatient rehabilitation between 2017 and 2021 was conducted. The mean rehabilitation intensity was 75.86 min/day for males and 73.33 min/day for females (p < .0001). Males <80 years of age were more likely to receive higher rehabilitation intensity than females. Future research should explore what factors account for this sex difference.