Acute Ataxia in Children

Based on observational studies and expert opinion, (3) for children 28 days to 18 years old with acute ischemic stroke presenting within the treatment window, tissue plasminogen activator should be considered. · Based on case series and retrospective reviews, (7)(8)(24) acute cerebellar ataxia is typically a benign, self-limited condition. With typical presentation, in the postvaccine era, varicella is an unlikely cause. Lumbar puncture and magnetic resonance imaging of the brain are typically unrevealing and are, therefore, generally not recommended. · Based on expert opinion, (11) acute disseminated encephalomyelitis should be treated with methylprednisolone, 10 to 30 mg/kg intravenously (IV) daily (maximum of 1 g IV daily), followed by a prednisone taper over 4 to 6 weeks. In severe or refractory cases, based on evidence from case series (12)(13), additional treatment with plasmapheresis or intravenous immunoglobulin (IVIg) should be considered. · Based on case series and expert opinion, (9)(10) evaluation for occult tumor and treatment with immune therapy is recommended for opsoclonus-myoclonus syndrome. · Retrospective evidence and expert opinion (19)(20) suggest that treatment of transverse myelitis with early corticosteroids improves outcome. When the diagnosis is being considered, early treatment with methylprednisolone, 30 mg/kg IV (maximum dose, 1 g IV), is recommended, even as other potential causes for acute myelopathy, such as epidural tumor and epidural hematoma, are being evaluated. · Based on expert opinion, (22) Guillain-Barre syndrome treatment is typically with IVIg, 0.4 g/kg IV daily for 5 days. A multicenter trial of 95 children suggested that treatment hastens recovery and decreases relapse but does not clearly affect overall outcome (23). · Based on multiple cohort studies (25)(26)(27) of acute flaccid paralysis due to enterovirus D68, empirical therapy with IVIg and/ or corticosteroids has been ineffective. · A randomized study of vestibular neuritis in adults found that vestibular function was improved in patients treated with methylprednisolone but not with valacyclovir (21). © 2019 American Academy of Pediatrics. All rights reserved.