Iranian Journal of Child Neurology

Objective

In the majority of patients with intractable epilepsy, seizures can be well controlled with appropriate medication. However, current estimates indicate that some of patients with epilepsy are refractory to all forms of medical therapy. The surgical treatment of intractable epilepsy in children has  evolved with advances in technical innovations. These medically intractable patients are candidates for surgical treatment in an attempt to achieve better seizure control. The definitive successful outcome of epilepsy surgery is a seizure-free state without significant neurological impairments.

In this article, we will outline the essential elements of presurgical evaluation and describe a variety of therapeutic surgical options, and the related indications, techniques, results and complications of each procedure.

Objective

Absence status epilepticus (ASE) is a common form of nonconvulsive status epilepcticus. It is  characterized by loss of consciousness with spike and wave discharges in EEG simultaneously. The most effective treatment of ASE is diazepam, either infusion or in divided doses; the former is more expensive since patients must be admitted in an Intensive Care Unit. The aim of this study was to evaluate and compare the efficacy of diazepam infusion and parenteral diazepam in divided doses in the treatment of ASE.

Materials & Methods

This randomized controlled clinical trial, enrolled 20 patients with absence status epilepticus. Diagnosis was made based on the clinical manifestations and electroencephalogram (EEG). Prior to treatment, all patients underwent EEG and imaging. Patients were randomized to receive 0.2 mg/kg/h diazepam infusion or 0.2 mg/kg in six daily doses. Clinical and EEG improvements were considered to be optimal responses.

Results

Of the 20 patients studied, 13 (65%) were boys and the remaining 7(35%) were girls. There were no differences between the two groups regarding age and sex (non-significant). Following treatments after 48 hours, 1 week and 1 month respectively, clinical improvement in previous problems (loss of consciousness, ataxia, behavior and speech problems) and EEGs was similar in both groups (p=1). There were controlled seizures in 18 (90%), abnormal CT scans in 5 (25%), abnormal EEGs after treatments in 6 (30%) cases; however no significant differences were seen between the two groups.

Conclusion

This study demonstrates that there are no significant differences between treatments of ASE with diazepam infusion and parenteral diazepam in divided doses. Treatment of ASE, with divided doses of diazepam is easier, less expensive and patients do not require to be hospitalized in an Intensive Care unit.

Objective

This study aimed at investigating seasonal variation, clinical symptoms, and cerebrospinal fluid (CSF) changes in patients with aseptic meningitis admitted in Mofid hospital between 1995 and 1996.

Materials & Methods

A total of 63 children with aseptic meningitis were enrolled in the study. Their age, gender, season of the disease, etiology, clinical symptoms, CSF changes, and treatment were evaluated and  documented. Data were analyzed using SPSS 11.5.

Results

The male to female ratio of the patients was 2.5 to 1, mean age being 6.5 years. The disease occurrence was most common in spring and summer, and the most common symptoms observed were fever (92.6%), followed by nausea and vomiting (88.88% and 68.25%), neck stiffness, neck stiffness (54%), seizure (19%), kernig sign (14.28%), Brudzinski's sign (11.11%), and 1.58% of the patients had history of head injury. Mean white blood cell count for CSF was 165/mm3 (range, 6 to 850/mm3), the common cells being mononuclear cells; mean red blood cell count was 538 (range, 0 to 8100/mm3); protein and glucose levels were within the normal ranges. Blood and CSF culture and CSF smear were negative. Prognosis was excellent and mean duration of recovery was 5 days (range, 2 to 18 days).

Conclusion

Although the clinical symptoms of aseptic meningitis are similar to those of bacterial meningitis, its prognosis is excellent. The CSF features can be used to diagnose the disease.

Objective

Massage therapy is one of the most widely used complementary and alternative medicine therapies for children. This study was conducted to determine the effect of Swedish massage on the muscle tonicity of children with spastic cerebral palsy (CP).

Materials & Methods

This study was a single blind clinical trial conducted on forty children with spastic CP, recruited from clinics of the University of Social Welfare & Rehabilitation Sciences. They were randomly assigned to intervention and control groups. Routine occupational therapy techniques were performed during a 3 monthperiod in both groups, while the intervention group also received Swedish massage for 30 minutes before every rehabilitation session. Muscle tonicity was evaluated at the  beginning of the study and 3 months later using the Modified Ashworth Scale.

Results

The average ages of children in the intervention (n=13) and control (n=14) groups were 49.5 and 42.1 months respectively. Although after intervention, tonicity of upper and lower limbs, trunk and neck in the intervention group in comparison with controls had no significant differences, there were statistically significant differences in reduction rate of tonicity in upper limbs and trunk between the two groups (P <0.05).

Conclusion

Massage therapy is not a panacea for improvement of spasticity in children with CP but the encouraging results of other studies on children with CP indicate that further studies are needed for more definite results.

Objective

Simple febrile seizures are the most common form of childhood seizures,often recurring within the first twenty-four hours. This study was conducted to determine the probable role of low serum  sodium levels in predicting seizure recurrence in febrile children.

Materials & Methods

For the study, 226 patients with seizures, aged between 6 months to 5 years, were divided into 3 groups of simple febrile seizure, simple febrile seizure with recurrence, and the control group of afebrile patients with seizures. For all groups, serum sodium levels were evaluated.

Results

The mean age of our cases, predominantly male, was 22 months. No significant difference was observed in the serum sodium levels between the simple febrile seizure and the simple febrile seizure with recurrence groups (P value 0.465); however a significant relative hyponatremia was observed in the simple febrile seizure group as compared to the afebrile seizure control group (P value: 0.016).

Conclusion

Based on the findings, although serum sodium levels cannot assist in prediction of recurrence of simple febrile seizures in children, relative hyponatremia may predispose the febrile child to occurrence of simple febrile seizure.

Objective

This study was conducted to evaluate the preventive effect of lamotringine on migraine aura and migraine attacks in children, afflicted with classic migraine.

Material & Methods

Conducted between October 2005 and April 2008 in the neurology clinic of Kashani hospital,  Shahrekord, this study was a clinical trial, aimed at evaluating the prophylactic effects of Lamotringine administered to 21 children suffering from migraine with aura.

Results

Of the subjects, 52.4% of patients were female. The most common type of aura was visual (42.9%). Following use of Lamotrigine, significant reductions were seen in the frequency (from 5 ± 0.83 to 3.04 ± 1.65) and in intensity (from 6. 33 ± 1.08 to 3.66 ± 1.1) of migraine aura (P= 0.002). After 6 months of drug usage 66.6% of patients were improved.

Conclusion

Lamotringine is effective in reducing the migraine aura and intensity of attacks in patients suffering from migraine with aura, and is hence beneficial for prophylactic therapy in children with classic migraine.

Objective

Concern for side-effects of therapy related to treatment of childhood malignancies is becoming an increasingly important topic. In this study, we evaluated extent of vincristine (VCR) induced neurotoxicity in a group of children who underwent chemotherapy, with VCR being part of the regimen.

Materials & Methods

In this investigation, for 75 children (54% boys, 46% girls), aged between 1 to 14 (mean 6.5±4.3) years, serial weekly neurological examinations were performed; of the 75, 70 had acute lymphoblastic leukemia and 5 Wilm's tumor. All patients were on a chemotherapy protocol of at least 4 consecutive VCR (1.5mg/m2) injections.

Results

Decreased deep tendons reflexes were seen in the Achilles reflex in 78%, and the patellar reflex in 53% of patients. Muscle weakness was found in 70% of patients, being mild in 76% of them. Four  percent of patients showed severe weakness. Petosis, jaw pain, hoarseness, abdominal pain and constipation were seen in 15%, 6%, 12%, 12% and 12% respectively. Paresthesia was observed in 32 of 52 patients, over 4 years old. No cases of foot drop, urinary retention or facial nerve palsy were seen in this patient group.

Conclusion

Children on usual doses of vincristine regimen may have neuropathic side effects but most of these side effects are mild and not troublesome.

Objective

Primary central nervous system lymphoma (PCNSL) is an extremely rare condition in childhood. We report the first case of PCNSL in a child in Iran.

Clinical presentation

A nine-year-old boy was referred to Mofid Hospital with the history of headache of four months and seizure of 2 months duration. Magnetic resonance imaging of the brain revealed a hyper-intense lesion in left fronto-parietal area with secondary satellite lesions. Biopsy of the brain mass was performed. Pathologic findings showed brain lymphoma and immunohistochemistry confirmed this diagnosis. The treatment started with intrathecal and systemic chemotherapy in combination with radiotherapy.