Mercante Anna, Siden Harold, Baker Justin Nathaniel, Papadatou Danai, Abu-Saad Huijer Huda, Zernikow Boris, Hauer Julie, Benini Franca
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy.
Department of Pediatrics, Canuck Place Children's Hospice, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
Neurol Clin Pract. 2025 Oct;15(5):e200525. doi: 10.1212/CPJ.0000000000200525. Epub 2025 Aug 11.
Many children with severe neurologic impairment (SNI) have complex care coordination and management needs, making them eligible for pediatric palliative care (PPC). Indeed, SNI is associated with numerous, often simultaneous, distressing symptoms. Among these, neuro-irritability is particularly common and impactful. The limited understanding of this condition poses a challenge for clinicians in terms of recognition and management, constituting a significant barrier to adequate care. Given the lack of scientific evidence and clinical practice guidelines, we initiated an international and multidisciplinary project to obtain consensus-based guidance on pediatric neuro-irritability.
A panel of 66 experts from across the world was selected to participate in a 2-round Delphi method. The aim of this process was to gather their opinions and insights in the areas of Definition, Assessment, Monitoring, and Treatment of neuro-irritability as encountered in PPC. Panelists were asked to indicate their level of agreement with a series of statements through an online survey, using a 5-point Likert scale. Consensus on a particular item was defined as achieving ≥75% of (dis)agreement among participants.
A total of 55 statements were endorsed during the 2 voting sessions. In addition to defining the fundamental features of neuro-irritability, several core elements of the diagnostic process and follow-up protocol were developed. Recommendations on the pharmacological and nonpharmacological approaches are also provided.
This first international expert consensus aims to support physicians in identifying and addressing neuro-irritability in children with SNI. Our work provides a framework to enhance knowledge on neuro-irritability and advance clinical practice, identifying unmet needs and areas of uncertainty that warrant further research efforts.
许多患有严重神经功能障碍（SNI）的儿童有复杂的护理协调和管理需求，因此符合儿童姑息治疗（PPC）的条件。事实上，SNI与众多往往同时出现的痛苦症状相关。其中，神经易激惹尤为常见且影响较大。对这种情况的了解有限给临床医生在识别和管理方面带来了挑战，构成了充分护理的重大障碍。鉴于缺乏科学证据和临床实践指南，我们启动了一个国际多学科项目，以获得关于儿童神经易激惹的基于共识的指导意见。
挑选了来自世界各地的66名专家组成一个小组，参与两轮德尔菲法。这个过程的目的是收集他们在PPC中遇到的神经易激惹的定义、评估、监测和治疗等方面的意见和见解。要求小组成员通过在线调查，使用5点李克特量表表明他们对一系列陈述的同意程度。对某一特定项目的共识被定义为参与者中达成≥75%的（不）同意。
在两轮投票中总共认可了55项陈述。除了定义神经易激惹的基本特征外，还制定了诊断过程和随访方案的几个核心要素。还提供了关于药物和非药物方法的建议。
这第一个国际专家共识旨在支持医生识别和处理患有SNI的儿童的神经易激惹问题。我们的工作提供了一个框架，以增强对神经易激惹的认识并推进临床实践，确定未满足的需求和不确定领域，这些领域值得进一步研究。
