Botulinum toxin has been used in medicine for the past 30 years. However, there continues to be controversy about the appropriate uses and dosing, especially in the pediatric population. A panel of nine pediatric physiatrists from different regions and previous training programs in the United States were nominated based on institutional reputation and botulinum toxin (BoNT) experience. Based on a review of the current literature, the goal was to provide the rationale for recommendations on the administration of BoNT in the pediatric population. The goal was not only to review safety, dosing, and injection techniques but also to develop a consensus on the appropriate uses in the pediatric population. In addition to upper and lower limb spasticity, the consensus also provides recommendations for congenital muscular torticollis, cervical dystonia, sialorrhea, and brachial plexus palsies.

Objective The aims of the current study were to characterize the demographic and clinical presentation of pediatric patients diagnosed with anti–N-methyl-d-aspartate receptor encephalitis who require inpatient rehabilitation, to examine early functional outcomes, and to investigate predictors of early recovery. Design A retrospective chart review was conducted for 27 pediatric patients diagnosed with anti–N-methyl-d-aspartate receptor encephalitis who received intensive inpatient neurorehabilitation. Results On average, patients were 10.6 yrs of age (range, 2–18 yrs) at the time of symptom onset. Average time to treatment from symptom onset was 27.2 days (range, 5–91 days). Patients displayed significant improvements between admission and discharge Functional Independence Measure for Children (WeeFIM) Developmental Functional Quotient (DFQ) scores across patients (P < 0.01). Mean Functional Independence Measure for Children Total Developmental Functional Quotient score at admission was 28.6 (range, 15.0–62.6) and at discharge was 54.3 (range, 14.2–91.9). Younger age at onset, seizures, and number of treatments received were associated with worse functional outcomes at discharge. Time to initiate treatment was not found to be associated with early functional outcomes. Conclusion Pediatric patients diagnosed with anti–N-methyl-d-aspartate receptor encephalitis displayed significant functional gains during inpatient rehabilitation, despite persistent functional deficits at discharge, suggesting the need for ongoing monitoring and intervention. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to (1) Recognize the clinical presentation of anti–N-methyl-d-aspartate receptor encephalitis in pediatric patients, (2) Appreciate the role of rehabilitation in the care of the pediatric patient with anti–N-methyl-d-aspartate receptor encephalitis, and (3) Identify demographic and clinical variables that predict poor functional outcomes after rehabilitation in pediatric patients with anti–N-methyl-d-aspartate receptor encephalitis. Level Advanced. Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Amantadine is commonly prescribed as a neurostimulant in patients with brain injuries. This is a case of a 14-year-old male with a history of brain tumor that developed corneal edema after initiation of amantadine, a rare but documented side effect of this medication. After discontinuation of amantadine, the corneal edema resolved within two months, but endothelial cells density remained low. LEVEL OF EVIDENCE: V.

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