Review Article

The effect of baby walker on child development: a systematic review

Shervin Badihian, Negin Badihian, Omid Yaghini

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 1-6


Baby walkers are used all around the world as a fun equipment without any dangers. In contrast with public beliefs, some researchers have claimed they can cause developmental delay. We aimed to investigate their effect on child development through a systematic review. We searched Pubmed, Google Scholar, Embase, and Scopus for related articles in English and included all study designs. Of 315 articles found in Pubmed, 1630 citations in Google Scholar, 18 articles in Embase, and 38 papers in Scopus, only 9 articles fulfilled the inclusion criteria. Among them, only a cohort and a cross-sectional study reported developmental delay caused by baby walker use. Based on the current data, evidence against baby walker is not enough regarding its negative effect on child development. This subject needs to be addressed more, considering the large number of baby walker users worldwide.

Research Article

Duchenne muscular dystrophy (DMD) protein- protein interaction mapping

Mostafa Rezaei-Tavirani, Farshad Okhovatian, Mona Zamanian Azodi, Majid Rezaei Tavirani

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 7-14


Duchenne muscular dystrophy as one of the mortal diseases is prominent to study in terms of molecular investigation. In this study, the protein interaction map of this muscle-wasting condition is generated to gain a better knowledge of interactome profile of DMD.

Materials & Methods

 Applying Cytoscape and String Database, the protein-protein interaction network was constructed and the gene ontology of the constructed network was analyzed for biological process, molecular function, and cell component annotations.


The results indicate that among 100 proteins that are related to DMD, Dystrophin, Utrophin, Caveolin 3, and Myogenic differentiation 1 play key roles in DMD network. In addition, the gene ontology analysis showed that regulation processes, kinase activity and sarcoplasmic reticulum are the highlighted biological processes, molecular function, and cell component enrichments respectively for the proteins related to DMD.  


In conclusion, the central proteins and the enriched ontologies can be suggested as possible prominent agents in DMD; however, the validation studies may be required.

Fordyce happiness program and performance in the mothers of children with cleft lip and palate referring healthcare team in Isfahan University of Medical Sciences in 2015

Dr zeinab hemati, Msc Samira Abasi, Dr Parastoo Oujian, Msc davood kiani

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 15-22



Giving birth to a child with cleft lip and palate, as a crisis, can jeopardize the physical and mental health of parents, especially mothers, and affect their function.Therefore, the present study was conducted to investigate the effect of happiness program on performance in the mothers of children with cleft lip and palate.

Methods: In this semi experimental study, 64 mothers of children with cleft lip and palate referring healthcare team in Isfahan University of Medical Sciences, were enrolled by simple random sampling, and the patients’ referring and assigned to two groups of control and intervention. Then, the program of happiness training was implemented within 10 sessions of two hours each and performance Questionnaire were filled out prior to and two months after the last session. The data were analyzed by descriptive and analytical statistics consisting of paired t test, independent t test, chi-square and Mann-Whitney in SPSS 20.

Findings: Mean age of the mothers in intervention and control groups was 33.3±6.3 and 33.5±5.8 years, respectively, and Mean age of the children in intervention and control groups was 6.34±3.37 and 5.03±3.36 years. No significant differences in demographic variables between the two groups (P > 0.05). No significant differences in mean score of performance domains in the two groups before training (P > 0.05). However after 2 months a significant difference in mean score of performance domains was observed between two groups (P < 0.05). Furthermore in intervention group showed significant differences in mean score of performance domains before and after intervention (P < 0.05). However in the control group had not any significant change.   

Conclusion: Given the effect of happiness program in promoting mothers performance for children with cleft lip and palate, this program can be used in healthcare centers to empower mothers and enhance performance in taking care of children.

Long term video-EEG monitoring findings in children and adolescents with intractable epilepsy

Yasaman Ghazavi, Ebrahim Asayesh zarchi, Taher Taheri, Mahdi Safiabadi, Elham Rahimian, Susan Amirsalari

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 23-31

Introduction:   In spite of appropriate management, seizures are not controlled in10 to 20 percent of epileptic children. If we can find the epileptogenic focus and resect it by surgery, patient may be cured from refractory seizures. Long Term Video-EEG Monitoring (LTM) may give us important information in the preoperative assessment of these patients. We performed this study for the first time in pediatric age group in Iran.

Materials and Methods: In this cross-sectional study, 43 children between 4 to 18 years, with intractable epilepsy who were Referred to Shefa Neuroscience Research Center between 1386_1391, were enrolled to study in order to evaluate their long-term video EEG findings.

Results: Forty-three children were enrolled to this study with mean age of 10.07 years, that 24(65.9%) were boys and 19(44.1%) were girls.

Seven patients with definite epileptogenic zone were advised to perform lesionectomy surgery, in 2 patients there was not any seizure onset focus but corpus callosotomy was advised to control their frequent falling.

 Eight cases were recommended to perform Electrocorticography or invasive EEG monitoring. Twenty-six cases were recommended to adjust medical treatment. In 3 cases there was not any electrical seizure activity during clinical attacks, so discontinuing anti-epileptic drugs were recommended with diagnosis of conditions that mimic epilepsy.

Conclusions:   It is necessary to perform LTM in patients with refractory epilepsy in order to determine their treatment strategy. If there is any doubt about pseudoseizure LTM can help to differentiate epilepsy from conditions that mimic epilepsy.

Assessment of Toxoplasma seropositivity in low Toxoplasma seroprevalence children suffering from anxiety disorders

Shahla Afsharpaiman, Mohammad Hossein Khosravi, Mojtaba Mahmoodinejad, Shahnaz Shirbazoo, Susan Amirsalari, Mohammad Torkaman, Shokoofeh Radfar

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 32-37


 To assess seroprevalence of Toxoplasma gondii in children with anxiety disorders

Materials & methods:

 This case-control study was conducted between September 2012 and May 2013 in pediatrics clinic of Baqiyatallah hospital. Children referred to child psychiatry clinic of our hospital were selected to be assessed clinically. Diagnosis of patients with anxiety disorders was based on DSM-4system, which is performed by child psychiatrist. Then they were referred to laboratory in order to have their anti-toxoplasma antibodies measured. A questionnaire was verbally administered to all individuals’ parents including demographic information and questions about life style, family history, medical history, economic situation, residence, nutritional patterns and contact with animals.


Ninety-six male and female cases with a mean age of 8.56±2.5 and 8.42±1.9 underwent   analysis. Anti-T.gondii IgG antibody was found in one case of each group There was no significant difference between case and control groups for serum Toxoplasma IgG antibody (p=0.14). No case individuals had Anti-T.gondii IgM antibody, while it was found in one control individual. No significant difference was seen between case and control groups for Toxoplasma IgM antibody (p=0.27).


In conclusion, our findings suggest that toxoplasmosis has no direct effect on the incidence of anxiety disorders. More studies are needed with a larger volume of individuals in future.

Quasi-experimental Effectiveness of Cognitive-Behavioral Therapy on Reliving Migraine Headaches in Migraine Sufferers

Hosein Ebrahimi Moghadam, Ahoo Karimi, Kimia Seifi

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 38-42


Objectives: This study aimed to investigate the effectiveness of cognitive-behavioral therapy on relieving migraine headaches in migraine sufferers.

Materials & Methods: The research was a quasi-experimental study with pre-test and post-test method. The samples were outpatients of Public hospitals in Ilam since May - July 2010. They were selected based on inclusion and exclusion criteria, and divided into experimental group and control group. The data were analyzed using SPSS 16. and via multivariate covariance method.


Results: The results showed that cognitive-behavioral therapy affected on reducing the duration of symptoms of migraine in sufferers (P<0.05).


Cognitive behavioral therapy effects on reducing the time duration of symptoms of migraine headaches. This therapeutic method increases the level of individual, familial, social and occupational activities by reducing the time duration of symptoms and this method helps the individuals to resume their activities and regain their previous control instead of founding themselves incapable and helpless due to the pain they suffer from. 

The effect of Kinesio Taping on hand grip and active range of motion of hand in children with Cerebral Palsy

Zabih Allah rasti, alireza shamsoddini, Hamid Dalvand, sina labaf

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 43-51


Objective: Kinesio taping is a relatively new technique which uses in rehabilitation of neurologic disease. The aim of this study was to investigate the effects of kinesio taping on hand grip and active range of motion of hand in children with Cerebral Palsy.

Materials and Methods: In experimental study with pre-test and three post-test, Thirty two children with cerebral palsy randomly were placed in experimental (n=17) and control group (n=15).  Kinesio taping was applied on dorsum of forearm and hand. Evaluation was performed initially, two days after taping and two days after tape removal. Goniometer was used to evaluate active range of motion of wrist extension. Also, vigorimeter was used to evaluate of grip strength.

Results: In all variable, data showed that in pre-test there is no difference between groups but in post-tests; initially after application of taping with p<0.05, two days after application of taping with p<0.05 and follow-up (two days after removed taping) with p<0.05 were significantly differences between trial and control group.

Conclusion: Kinesio taping in neurorehabilitation of children with cerebral palsy can be a useful option to promote power or grip strength and active range of motion of wrist and thumb. 

Does Parent report gross motor function level of Cerebral palsy children impact on the parent report quality of life in children with cerebral palsy?

marzieh pashmdarfard, malek amini, reza shervin badv, narges ghaffarzadeh namazi, mehdi rassafiani

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 52-57


The aim of this study was to assess the effect of parent report gross motor function level of Cerebral Palsy (CP) children on the parent report quality of life of CP children.

Material & Methods

This study was a cross - sectional study and sampling was done in occupational therapy clinics and CP children’s schools in Zanjan, Iran. In this study the samples size was 60 CP children aged 6-12 years and for sampling method a non-probability convenience sampling method was used. For assessing the quality of life of CP children the cerebral palsy quality of life (CP QOL) questionnaire and for assessing the level of gross motor function of CP children the   Gross Motor Function Classification System Family Report Questionnaire (GMFCSFRQ) were used.


The average age of children (22 male and 30 female) was 8.92 years old (minimum 6 years and maximum 12 years). The relationship between the level of gross motor function and participation and physical health was Direct and significant (r=0.65). The relationship between functioning, access to services and family health with the level of gross motor function were direct but were not significant (p >0.05) and the relationship between pain and impact of disability and emotional wellbeing with the level of gross motor function was significant (p<0.05).

Neurometabolic Disorder Articles

Glutaric aciduria type 1: clinical, biochemical, neuroimaging and molecular findings in Iranian patients

Zahra Pirzadeh, Seyed Hassan Tonekaboni, Massoud Houshmand, Jafar Nasiri, Mohsen Mollamohammadi, Mostafa Sedighi, Omid Aryani

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 58-65

Objective: Glutaric aciduria type 1 (GA1), is a rare, treatable neuro- metabolic disease, due to Glutaryl - CoA dehydrogenase (GCDH) gene mutation. More than 200 mutations in GCDH are reported. In regions without Neonatal blood screening (NBS), patients are diagnosed in symptomatic period. This study was the first report of clinical manifestation, neuroimaging and laboratory data including GCDH gene mutation in Iranian GA1 patients.

Materials and Methods: In this cross-sectional, descriptive study, clinical manifestation, neuroimaging and metabolic finding of eleven Iranian GA1 patients were evaluated. GCDH mutations of patients were studied, too.

Results: All of patients were diagnosed before 32 months old. Clinical presentation of GA1 includes acute encephalopathic crisis and / or developmental delay. Neuroimaging of patients were typical .We found three novel mutations in GCDH gene in Iranian GA1 patients. Two new mutations patients were low excretors of glutaric acid. There is no correlation of genotype and phenotype in our patients.

Conclusion: Physician must remember GA1 in differential diagnosis of macrocephaly, developmental delay, acute encephalopathy, dystonia and dyskinesia. Early detection, proper treatment and selective screening of patients’ siblings can prevent neurologic disabilities.

Neurological Crises after Discontinuation of Nitisinone (NTBC) Treatment in 3 Cases of Tyrosinemia

Naser Honar, Nader Shakibazad, Zahra Serati Shirazi, Seyed Mohsen Dehghani, Soroor Inaloo

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 66-70

Tyrosinemia Type 1 is a hereditary disorder with liver, kidney and nervous system involvement. We report 3 children developed diaphragmatic paralysis requiring mechanical ventilation after discontinuation of NTBC treatment. In patients with Tyrosinemia type 1, combined treatment with NTBC and a low-tyrosine diet have prevented neurological crises. Treatment with NTBC in the first months of life protects against hepatic and neurologic complications. Neurological crises can occur in tyrosinemia without treatment and also occur when treatment stops. We report three patients that developed diaphragmatic paralysis after interruption of NTBC treatment, which finally required mechanical ventilation. It should be emphasized that discontinuation of NTBC can induce diaphragmatic paralysis and respiratory failure. So we should advise patients to use NTBC for long term and not interrupted it.

Case Report

Another limping child: an interesting diagnosis journey

Mehrnoush Hassas Yeganeh, Khosro Rahmani, Shokuh Hashemi, Seyyed Hassan Tonekaboni, Reza Sinaei, Mohammad reza Fathi, Reza Shiari, Fatemeh Mehregan

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 71-76



Limp is described as any deviation from a normal gait pattern for the child’s age. Limping takes many forms and is one of the most enigmatic complaints in pediatric medicine. It is never normal, and both benign and life-threatening illnesses can present with limp. The provisional diagnosis can be a challenge to establish even after history, physical, and laboratory examinations.

Keywords: limping child; Weakness; Hypercalciuria

A highlighted case for emphasizing on clinical diagnosis for rare syndrome in third world

Fatemeh Owlia, Mohammad Hasan Akhavan karbassi, Roqayeh Hakimian, Mohammad-Sadegh Alemrajabi

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 77-80

Premature tooth loss is a disastrous situation may impact on deciduous or permanent teeth era with different cause. It is may be attributed to some disorders like papillon- lefevr syndrome or coffin-lowry  syndrome but because of ambiguous nature, precious diagnosis is not easily possible .having very low incidence and defined by few and limited case series ,with vague characters to some extent, confusion in detecting the right diagnosis is a common possibility. Then it's expectable to have a wrong diagnosis for this case. In this article, a 5 year old boy with chief complaint of early tooth loss despite having blindness in left eye and palmar keratosis is reported, although he had some other manifestation of ODDD like ataxia, dysartheria and nail deformity, ignoring other extra and intra oral finding, he was diagnosed as papillon- lefevr syndrome before, just because of early tooth loss and palmar keratosis.

Cerebral vasculitis in a case of meningitis

Devdeep Mukherjee, Agnisekhar Saha

Iranian Journal of Child Neurology, Vol. 11 No. 4 (2017), 13 September 2017, Page 81-84

Abstract: Cerebral vasculitis is a serious complication of meningitis with Streptocccus pneumoniae. We report a 5 years old girl who was diagnosed to have pneumococcal meningitis with vasculitis on DWMRI within a week of onset of fever. She was given high dose of Methyl-prednisolone simultaneously with antibiotics and successfully treated without any neuro- sequelae. Although vasculitis has been documented to develop as a sequelae to bacterial meningitis usually in the second week, our patient had an early presentation. Treatment with high dose steroid along with antibiotics resulted in dramatic improvement with no neurodeficit. DWMRI is an important investigation to pick up early, evidence of vasculitis in a patient with meningitis who is showing neurological deteriorations despite of improvement in blood parameters.