Cerebral palsy (CP) is a neurodevelopmental disorder characterized by abnormalities of muscle tone, movement and motor skills, and is attributed to injury to the developing brain. The clinical features of this entity evolve over time and the specific CP syndrome may be recognizable only after 3-5 y of age; although suggestive signs and symptoms may be present at an earlier age. The management involves neurological rehabilitation (addressing muscle tonal abnormalities, and devising physical and occupational therapies) and diagnosis and management of co-morbidities (including epilepsy, impairment of cognition, vision, hearing, and disturbances of growth and gastrointestinal function). The management, therefore, is multidisciplinary involving the treating physician working with a team of rehabilitation-, orthopedic-, psychologic-, and social care- providers.

Cerebral Palsy: An Overview.

Monkeypox

for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.

Medication use in childhood dystonia

Monkeypox virus (MPXV) has spread globally. Emerging studies have now provided evidence regarding MPXV transmission, that can inform rational evidence‐based policies and reduce misinformation on this topic. We aimed to review the evidence on transmission of the virus. Real‐world studies have isolated viable viruses from high‐touch surfaces for as long as 15 days. Strong evidence suggests that the current circulating monkeypox (mpox) has evolved from previous outbreaks outside of Africa, but it is yet unknown whether these mutations may lead to an inherently increased infectivity of the virus. Strong evidence also suggests that the main route of current MPXV transmission is sexual; through either close contact or directly, with detection of culturable virus in saliva, nasopharynx, and sperm for prolonged periods and the presence of rashes mainly in genital areas. The milder clinical presentations and the potential presence of presymptomatic transmission in the current circulating variant compared to previous clades, as well as the dominance of spread amongst men who have sex with men (MSMs) suggests that mpox has a developed distinct clinical phenotype that has increased its transmissibility. Increased public awareness of MPXV transmission modalities may lead to earlier detection of the spillover of new cases into other groups.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jmv.28534

Transmission of monkeypox/mpox virus: A narrative review of environmental, viral, host, and population factors in relation to the 2022 international outbreak

Spasticity is defined clinically as ‘a motor disorder characterised by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon acts resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome’.1 Spasticity is a common feature of cerebral palsy (CP) as well as spinal cord and traumatic brain injury.

The most common cause of spasticity in childhood is CP which affects between 2 and 3 of every 1000 live births in industrialised countries.2 Other causes of spasticity include traumatic brain injury, spinal cord injury, central nervous system tumour or infarct, metabolic disorders and hydrocephalus.

Dystonia is defined as ‘a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures or both’.3 Dystonia may be either acute (eg, an oculogyric crisis secondary to drug administration) or chronic. Chronic dystonia can occur either locally (eg, writer's cramp, blepharospasm) or systemically as part of CP or other neurological syndromes.

The management of spasticity and chronic dystonia in children requires multidisciplinary management including neurologists, paediatricians, surgeons, GPs, physiotherapists, occupational therapists and pharmacists. Pharmacotherapy forms one aspect of this management and will be the focus of this review article, but other interventions, such as physical therapy, orthopaedic surgery and procedures, such as selective dorsal rhizotomy, play a major role too. Fundamental knowledge of pharmacologic properties and toxicities of these medications is required for safe and appropriate use, and should be part of an integrated therapeutic approach in which patients, carers, therapists, physicians and surgeons have open and clear communication about the overall rehabilitation process of the patient.

### Oral/enteral drugs

Oral, or enteral medication, can provide systemic treatment for the relief of generalised spasticity via different pharmacological mechanisms. These agents can be combined in cases difficult to treat, although the …

https://ep.bmj.com/content/edpract/97/6/230.full.pdf

An overview of drug therapies used in the treatment of dystonia and spasticity in children

Infant postnatal prophylaxis following maternal viraemia during breastfeeding.

INTRODUCTION
Timely diagnosis of HIV in children remains a challenge in all settings including low-prevalence, high-income countries (HIC). We aimed to characterize the prevalence of late diagnosis, and prior missed diagnostic opportunities among new presentations of paediatric HIV in HIC referred to an international Perinatal Virtual Clinic (PVC).


METHODS
Retrospective analysis of new paediatric diagnoses in HIC, referred to the PVC between January 2018 and April 2025. Data on demographics, clinical features and HIV virology/immunology were extracted from standardized referral templates. Cases were categorized as late or non-late diagnosis by age-related CD4 thresholds, and the two groups compared.


RESULTS
Among 45 new paediatric HIV diagnoses referred to the PVC from the European region (41), Australia (2) and Chile (2), the median age was 9 years (IQR 0.8-13); 66% (27/41) were migrants, predominantly from sub-Saharan Africa; 39% (16/41) were born in HIC. Most (27/45;60%) were tested due to symptoms; 21/45 (47%) were diagnosed with AIDS. The median CD4 count was 230 cells/mm3 (IQR 24.5-531), viral load (VL) 316 000 copies/mL (IQR 65 150-1 315  000) with 31/45 (69%) meeting criteria for late diagnosis. Late-diagnosed children had significantly higher VL (p = 0.02) and were more likely to have prior symptomatic healthcare encounters (p = 0.004).


CONCLUSIONS
Despite access to prevention and screening, late paediatric HIV diagnosis persists in HIC, with severe immunosuppression and missed opportunities for earlier recognition and treatment initiation. Improved implementation of family-based screening, particularly following parental/sibling diagnosis or migration from endemic areas, and education of healthcare providers regarding HIV indicator diseases in children are essential.

Late diagnosis of paediatric HIV infection in high-income countries: Lessons from the HIV Perinatal Virtual Clinic.

Neonatal Monkeypox Virus Infection.

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Papers

An overview of drug therapies used in the treatment of dystonia and spasticity in children

Infant postnatal prophylaxis following maternal viraemia during breastfeeding.

Late diagnosis of paediatric HIV infection in high-income countries: Lessons from the HIV Perinatal Virtual Clinic.

Neonatal Monkeypox Virus Infection.