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Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is marked by symptoms such as inappropriate levels of inattention, hyperactivity, and impulsivity that can affect academic, social, and personal functioning in children and adolescents. This review summarizes clinical trials demonstrating the effectiveness of Alpha-2 agonists in reducing symptoms of inattention, hyperactivity, and impulsivity in children with ADHD. Studies were identified through a systematic search of PubMed and Cochrane databases. However, these medications’ long-term safety and efficacy remain uncertain, with a lack of data on their effects on growth, cardiovascular function, and other adverse events. Further studies are required to determine these medications’ optimal dose and treatment duration. Methods: Medications that target the noradrenergic system, such as Alpha-2 agonists, have been increasingly used as a treatment option for ADHD, with guanfacine and clonidine being two of the most commonly used medications. They function by selectively targeting Alpha-2 adrenergic receptors in the brain leading to improved attention and reduced hyperactivity and impulsivity symptoms in children with ADHD. Results: Clinical trials have demonstrated the effectiveness of Alpha-2 agonists in treating ADHD in children by reducing symptoms of inattention, hyperactivity, and impulsivity. However, these medications’ long-term safety and efficacy still need to be completely understood. Due to a lack of information on the effects of Alpha-2 agonists on growth, cardiovascular function, and other long-term adverse events, more studies must investigate the optimal dose and treatment duration for these medications. Conclusions: Despite these concerns, Alpha-2 agonists remain a valuable treatment option for ADHD in children, especially those unable to tolerate stimulant medications or who have coexisting conditions such as tic disorders. Future research should continue to explore the safety and efficacy of Alpha-2 agonists in the long term. In conclusion, Alpha-2 agonists show promise as a treatment for ADHD in children; however, the safety and efficacy of these drugs in the long term are not yet completely understood. Additional studies are required to investigate the optimal dose and treatment duration for these medications in their use as a treatment for this debilitating disease.

Introduction Mechanical thrombectomy (MT) has demonstrated a significant improvement in functional outcomes for patients with anterior circulation strokes and large‐vessel occlusion (LVO). However, despite successful recanalization, certain patients still experience large hemispheric ischemia (LHI), necessitating decompressive hemicraniectomy (DHC). This study aims to investigate the characteristics and predictive factors associated with LHI requiring DHC in patients with successfully recanalized anterior circulation LVO, shedding light on potential factors influencing patient outcomes in this context. Methods We retrospectively analyzed 117 patients with LHI admitted to OLSU from November 2015 to March 2023. These individuals were then matched into two groups: a study group who had undergone decompressive hemicraniectomy (38) and a control group of individuals who had not (79). Additionally, within the DHC recipients, these individuals were further subgrouped into those who had undergone MT. Information was collected on demographic variables, medical history and clinical parameters. Functional outcomes were assessed via binarization of the following variables: the modified Rankin scale score on discharge (0‐4: good outcome vs. 5‐6: poor outcome). Results Among the 38 patients with LHI who underwent DHC (mean age 52.47 + 12.27 years, 63.1% males), 16 (42.1%) patients received intravenous tPA administration, and 13 (34%) underwent mechanical thrombectomy (MT) with successful reperfusion (TICI ≥ 2b) achieved in 8 (61.5%) of these patients. The assessment of the modified Rankin Scale (mRS) at discharge (0‐4: good outcome, 5‐6: poor outcome) revealed that both intravenous tPA (p‐value ‐ 0.206) and MT (p‐value 0.50) were not significantly associated with a good clinical outcome at discharge. Conclusion In the overall analysis of all individuals with complete outcome data, none of the variables (DHC receipt, MT receipt, tPA receipt) were significantly associated with mRS at discharge. The study did not find significant associations between the examined variables and the outcome (mRS on discharge) in patients with LHI who underwent DHC, regardless of whether they underwent reperfusion therapy or not. Advancements in acute ischemic stroke therapies such as thrombolytics and thrombectomy may reduce the need for DHC.