Pediatric Neurocritical Care Shifts Focus to Individualized Patient Treatment
A new approach to pediatric neurocritical care emphasizes tailoring therapies to each child’s unique needs, moving beyond simply stopping seizures, according to discussions at the 2025 Child Neurology Society (CNS) Annual Meeting.
The landscape of pediatric neurocritical care is undergoing a significant transformation, driven by advancements in diagnostic tools and therapies. Clinicians are increasingly recognizing the need to move beyond standardized protocols and embrace individualized treatment plans that consider a child’s underlying condition, response to medication, and disease progression. This shift was a central theme at the CNS Annual Meeting, held October 8-11 in charlotte, North Carolina.
During a session titled “Optimizing neuroicu Care: Treating Patients Rather Than Seizures,” pediatric neurologist Craig Press, MD, an associate professor of clinical neurology at the University of Pennsylvania Perelman school of Medicine, highlighted the growing complexity of managing acute neurological conditions in children. He emphasized that a one-size-fits-all approach is often insufficient.
“The biggest goal was to get people thinking differently about how we approach pediatric neurocritical care,” Dr. Press stated. “The children we see in the ICU are incredibly diverse…We have to make sure every patient receives the right care at the right time.”
Addressing Complex Cases: FIRES, NORSE, and the Role of Immunotherapy
A key focus of the session was the management of acute-onset, highly refractory seizures, specifically Febrile Infections-Related Epileptic Syndrome (FIRES) and New-onset Refractory Status Epilepticus (NORSE). these conditions,characterized by sudden and
A significant challenge in pediatric neurocritical care is the translation of adult-focused research to pediatric populations. Often, drugs are initially developed and approved for adults with neurological conditions, but lack sufficient testing in children. Clinicians must then navigate the complexities of using these therapies “off-label,” weighing potential benefits against unknown risks.
To address this, collaborative networks like PedQuest are emerging. This national infrastructure aims to pool data from multiple pediatric centers, enabling more robust research and evidence-based care. “For common diseases,we can collect enough data to refine treatment targeting,and for rare conditions such as FIRES and NORSE,we can combine small patient numbers from many centers to generate meaningful evidence,” explained Dr. Press.
Overcoming Barriers to Progress
Beyond data sharing, several barriers hinder advancements in pediatric neurocritical care. access to rapid genetic testing remains a significant obstacle.Identifying the genetic cause of early-onset epilepsy can take weeks or months, delaying appropriate treatment. While rapid tests exist, they are not universally available.
another challenge is a shortage of expertise in interpreting advanced diagnostic tools, such as quantitative EEG, immunologic assays, and cytokine profiling. Building multidisciplinary teams comprising geneticists, immunologists, and data specialists is crucial, but requires considerable resources, education, and time.
Thankfully, organizations like the Child Neurology Society and the american Epilepsy Society are increasing educational content related to these emerging tools and techniques. However, sustained investment is needed to scale expertise nationally.
Dr. Press concluded with an optimistic outlook, emphasizing the potential for truly individualized care in pediatric neurology. “What excites me most is that we are getting closer to truly individualized care in pediatric neurology,” he said. “When we can match the right treatment to the right child, it shortens the diagnostic journey, helps families feel more confident in care decisions, and allows us to set realistic expectations.”
Ultimately, the goal is to integrate precision, compassion, and collaboration to improve outcomes and experiences for every child treated.
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