Iranian Journal of Child Neurology

Objectives
There has been increased interest in using telepractice in clinical services during COVID-19. Using telepractice is little known in speech and language therapy. However, the parents and speech therapists were satisfied with this method. Therefore, this scoping review aims to compare tele speech therapy and face-to-face speech therapy during the COVID-19 pandemic and determine the efficacy of available telepractices in speech therapy.
Materials & Methods
This scoping review was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guideline. The authors systematically searched Web of Science, PubMed, and Scopus databases with specific eligibility criteria. The eligibility criteria were studies published from 1 January 2020 to 10 May 2023 from a peer-reviewed journal and written in English. In addition, the articles were about speech therapy in children during COVID-19.
Results
Fifteen articles were included in this scoping review. Results showed that approximately all speech therapists used tele practice during the pandemic. Parents and students are satisfied with this method but have problems with it. On the other hand, some parents and SLPs preferred tele practice accompanied by face-to-face intervention. Furthermore, few studies determined the efficacy of tele practice with clear structural methods in specific populations.

Conclusion
Although tele speech therapy is acceptable for providing speech and language therapy services to children with swallowing and communication disorder, speech-language therapists should increase their information and technology to achieve successful

results
Moreover, parents must play an essential role in telepractice services to facilitate effective communication between clinicians and families.

Objectives
This study aimed to evaluate patients with focal seizures, their clinical manifestations, and their response to treatment, then compared the accuracy of electroencephalography and Magnetic Resonance Imaging (MRI) to assess the cost-effectiveness of the latter.
Materials & Methods
After selecting the appropriate individuals, the authors obtained the data by clinically evaluating the cases and interviewing them or their caretaker(s) on admission and the six-month follow-up visit. The researchers then analyzed the obtained data.
Results
Most cases (88.4%) had idiopathic seizures. A positive family history of seizures was observed in eight cases (5.4%). Respectively, theoccipital, frontal, and temporal lobes showed the highest frequencyo normalities on electroencephalography, while periventricular leukomalacia was the highest abnormal MRI finding (4.1%).
However, in 87.8% of cases, this modality’s results were normal. No recurrence of seizures was observed in 116 cases (78.9%) on the sixmonth follow-up visit, pointing towards an appropriate response to treatment.
Conclusion
While this study revealed that most had normal MRI, reporting an abnormality in electroencephalography was a more prevalent occurrence. This finding undermines the cost-effectiveness of the former modality, even though its importance in diagnosing the underlying abnormalities necessitates further studies regarding the
subject at hand. Furthermore, the study of age groups showed that treatment response is less desirable in children under two years of age, suggesting more intense workups.

Objectives
The present investigation has been done to study the behavioral
effects of donepezil in autistic children, given that not much research
has been carried out concerning using this drug for treating autism.

Materials & Methods
A cross-sectional and analytic-descriptive study was done on twentypatients with autism, aged 4-17, who visited the neurology clinic of Gorgan’s Taleghani Pediatric Hospital and Yasha Pediatric Autism Clinic, Iran from 2019 to 2020. Demographic information, including sex, age, father’s education, mother’s education ,patient’s education, family status, other problems, and ethnicity, were documented using a checklist, having been filled in during interviews with the parents. Before the trial, ABC cognitive and behavioral tests were taken to determine the children’s current status. After the tests, these children received a daily dose of donepezil (10mg) before sleep for three months. At the end of the three months, the cognitive and behavioral tests were taken from the children once again. In order to analyze the effects of different factors on the studied variables, including irritability, lethargy, stereotypic behavior, hyperactivity, and inappropriate speech before and after the administration of donepezil in patients, a generalized linear model and to test the effects of donepezil on the studied variables, paired t-test was used.

Results
In this study, twenty patients were registered for the investigation, 12 (60%) male and eight (40%) female. Age groups 5-6 had the highest frequency, and age group 17 had the lowest. Regardingthe parents’ education, the highest frequency was for bachelor’s degrees, and the lowest was for less-than-high school education and master’s degree. The highest frequency for the patients’ education was kindergarten (60%), and then groups without education (20%) and elementary school-level education (15%). Most of the studied patients (80%) did not have other problems besides autism, and only 20% had other problems besides autism. The family status of 15% of the families was ‘separated,’ and ethnically, most patients (80%) were Fars, while the rest (20%) were Turkmen. None of the analyzed factors (age, sex, father’s education, mother’s education, patient’s education, other problems, family status, and ethnicity) had a significant effect on the studied variables after the administration of donepezil. Among the studied variables prior to the administration of donepezil and among the analyzed factors, the father’s education, the patient’s education, other problems, and family status had only a significant effect on stereotypic behavior. The present research findings of the present research indicated that all the studied variables, including irritability, lethargy, stereotypic behavior, hyperactivity, and inappropriate speech, were significantly decreased toward the desired goal. The decreased amounts in irritability, lethargy, stereotypic behavior, hyperactivity, and inappropriate speech after the administration of donepezil were, respectively, 38%, 44%, 54%, 41%, and 54% and on average, these behaviors were reduced by 46%.

Conclusion
The present investigation has shown that all the studied variables, including irritability, lethargy, stereotypic behavior, hyperactivity, and inappropriate speech, were significantly decreased towards the desired goal by 46%. This significant decrease is indicative of the effectiveness of the treatment of autism patients with donepezil, and therefore, this drug can be placed as a prominent and essential part of the medical therapy of autism.

Objectives
The SARS-CoV-2 pandemic is the most challenging crisis in the contemporary world. Besides severe pulmonary involvement, the disease also has several extrapulmonary manifestations, and new signs and symptoms are associated with it every dayThe present study aimed to inquire about the frequency of neurological manifestations and risk factors of COVID-19.

Materials & Methods
This retrospective, descriptive study included patients with neurological involvement admitted to the Alborz University of Medical Sciences academic hospitals from March 2020 to July 2020 with confirmed COVID-19 infection. The data included in the analysis were the patient’s demographic information, underlying diseases, neurological manifestations, and laboratory findings.

Results
The study included ninety-five patients with a mean age of fiftynine. Neurological symptoms and signs were observed in 91.6% and 10.5% of the patients, respectively. The most frequently associated neurological symptoms of COVID-19 were fatigue (49.5%), headache (47.4%), and dizziness (45.3%). Furthermore, the most common neurological involvements included gait disorders (6.3%), cerebellar dysfunction (4.2%), and cerebrovascular accidents (3.15%). Positive troponin was shown to be the strongest predictor of neurological signs (OR=21, P=0.017), followed by WBC≥15,000 (OR = 20.75, P=0.018) and a history of respiratory disease (OR=7.42, P=0.007).

Objectives
This study aimed to investigate the risk factors of bruxism in children and adolescents under 15 years old in Iran.

Materials & Methods
This case-control study was conducted in day clinics of Shahid
Beheshti Hospital in 2020. Fifty children with bruxism in the case
group and 50 without in the control group were compared to five
risk factors, including intestinal parasites, sucking the fingers, biting
objects, a family history of bruxism, and secondhand smoking (SHS).
The statistical tests of smoking, odds ratio, and logistic regression
were used for data analysis.

Result:

The mean age of the subjects was 10.6±3.2 and 10.8±2.9 years
in the case and control groups, respectively. The bruxism showed
significant relation with sucking the fingers, the family history
of bruxism, and intestinal parasites. The SHS and biting objects
showed no significant relation with bruxism. The logistic regression
indicated that the study variables could explain the 22.6 to 30.1% of
risk factors in bruxism.

Conclusion

Bruxism is a common disorder in children and adolescents. The
intestinal parasites might be associated with bruxism. These
infestations should be diagnosed and treated in children with
bruxism.

Objective

Epilepsy, defined as the tendency to have recurrent unprovoked seizures, is the most common and chronic neurological disorder worldwide. About 20% to 40% of children with epilepsy suffer from refractory seizures, causing several neurological, cognitive, and psychosocial impairments. Identifying the factors contributing to pediatric refractory seizures can help neurologists in effective prevention, diagnosis, and treatment of their patients.

Materials & Methods

In this cross-sectional study 2 to 16 years old children with refractory seizures (drug-resistant epilepsy), were assessed regarding their demographic and seizure-associated characteristics.

Results

Children with refractory seizures had a significantly higher rate of neonatal asphyxia, hospitalization after birth, neonatal seizures, seizure in the first year of life, history of infantile spasm and symptomatic epilepsy. Also, polymorphic seizures, brain MRI abnormalities were significantly more frequent among them. Several different mechanisms have been suggested for explaining intractability in epileptic patients. None of the mechanisms can explain all patients. The most common underlying etiologies for seizures in the intractable group were hypoxic-ischemic damage, cerebral dysgenesis, genetic disorders.

Conclusions

Seizure intractability is the result of a great deleterious change in the structure of the brain. Early identification of the risk factors and prediction of patients likely to have pharmaco-resistant epilepsy will allow more aggressive treatment and earlier specialized intervention.

Objectives
Sedation and stability during electroencephalography (EEG) in pediatrics have high clinical importance. This study compares the sedative properties of oral chloral hydrate (OCH) and intranasal
fentanyl (INF).

Materials & Methods

This study was a randomized clinical trial conducted in 2020 in Isfahan City on sixty-two pediatric candidates for EEG. Patients were randomized into two groups receiving 50 mg/kg OCH and 2 μg/kg INF thirty minutes before the process. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and oxygen saturation (O2 sat) of patients, sedation, and physician’s satisfaction were measured and compared between groups.

Results

The HR of patients decreased significantly in both groups (P< 0.001), and the patients that received INF had significantly lower HR 15, 30,45, and 60 minutes after drug administrations (P< 0.05). RR evaluation indicated significantly decreased RR in both groups (P< 0.001), and patients receiving INF had lower RR 30, 45, and 60 per minutes after drug administrations (P< 0.001). Both groups showed significantly increased sedation levels during the study (P< 0.001), and patients treated with INF had higher sedation levels 15, 30, and 45 minutes after drug administration. Satisfaction rates were higher among the group that received INF (P= 0.020).

Conclusion

use of intranasal fentanyl had significant analgesic and sedative effects on pediatrics undergoing EEG.

Objectives
Multiple sclerosis (MS) is among the most prevalent chronic immunemediated
inflammatory diseases. If MS onset is under 18, it is defined
as pediatric-onset MS (POMS). This study aimed to determine the
clinical and epidemiological aspects of POMS.
Materials & Methods
This population-based study was conducted in East-Azerbaijan (EA)
province and concerned POMS patients. The data concerning almost
all of the POMS patients of the province was gathered from the only
MS registry center in the university hospital of the Tabriz University
of Medical Sciences by the end of 2017. The diagnosis of patients was
based on McDonald’s criteria.

Results
Out of 2976 total cases of MS, eighty-five (2.85%) were POMS. The
overall regional prevalence of POMS was 11.67 per 100,000 (95%
CI:9.43-11.43). Sixty-seven cases were female (prevalence: 18.94 per
100,000 [95% CI:14.91-24.07], and eighteen were male (prevalence:
4.80 per 100,000 [95% CI:3.03-7.62]. The crude regional incidence
in 2017 was 1.37/100,000 (95% CI:0.74-2.55). The mean age of onset
was 15.81±1.33 years, with a minimum age of 12. 71.76% of the
patients were diagnosed in the 16- or 17-years old age group. 7.05%
had a positive family history, and 87.5% of the patients diagnosed the
disease promptly. The most common first clinical presentations were
blurred vision (43.75%), sensory (28.12%), cerebellar (15.62%), and
brainstem (9.37%) symptoms.

Conclusion
POMS is not a rare condition, and it mainly affects females. POMS
prevalence increases significantly after age 15 years old, and the first
manifestation of the disease is usually blurred vision.

Objectives:

Migraine is a common disorder in children that its prophylaxis with minimal side effects is momentous. This study aimed to compare the efficacy of Pregabalin and Sodium valproate in preventing migraine attacks.

Material & methods:

Sixty-four children (aged 6-18) with migraines were recruited, as
defined by Internation Headache Criteria (ICHD-III). They were
randomly assigned to two groups: Sodium Valproate (n=32) and
Pregabalin (n=32). The minimum dosage of drugs was prescribed
in both groups. The patients were followed for four months. The
parameters such as frequency, intensity, duration of migraine attacks,
and the number of painkillers that the patients used monthly were
recorded. The Spence Children’s anxiety scale was also used to
evaluate medications’ effect on patients’ anxiety levels.

Results
Two medications were equally effective in reducing the intensity and
duration of attacks. Additionally, their effect on reducing the anxiety
level of patients was equal. There was a significant difference between
the effect of drugs on the frequency of migraine attacks at the end of
the first and fourth months and the number of painkillers used at the
end of the fourth month. The frequency of attacks was decreased by
more than 50% in twenty-eight patients (90%) of Pregabalin recipients
and twenty-one patients (84%) of Sodium Valproate recipients.

Conclusion

considering the better effect of Pregabalin in the reduction of frequency of migraine attacks and pain-reducing medications consumption, Pregabalin could be a proper substitute to Sodium valproate for migraine prophylactic treatment in children.

Objectives
The present study aimed to evaluate the serum proteome of women with obsessive-compulsive disorder (OCD)/bipolar disorder (BP) compared to pure OCD subjects and healthy controls.
Materials & Methods
Serum proteome of women with OCD/BP, pure OCD individuals, and healthy controls were subjected to 2DE-based proteomics accompanied with MALDI-TOF-TOF mass spectrometry. Further evaluation of the identified protein spots with the significance of p<0.05 and fold≥1.5 was done by applying protein interaction mapping via Cytoscape v.5.3.1 and its plugins.
Results
The results indicate that vitamin D binding protein (GC) and haptoglobin spots (HP) significantly changed expression in OCD and OCD/BP with different expression patterns. These identified spots may contribute to OCD/BP and act as differentially recognized biomarkers comparing pure OCD and OCD/BP.
Conclusion
The Findings imply that these proteins in the serum of the patients could be potential distinguishable biomarkers in clinical usage after related validation experiments. Therefore, this study provides a preliminary evaluation to understand OCD/BP proteome behavior better.

Objectives
Given that deficiency in B vitamins can lead to the accumulation of homocysteine (Hcy), and hyperhomocysteinemia may have a role in migraine pathogenesis, the present prospective randomized doubleblinded placebo-controlled trial aimed to evaluate the effect of vitamin B-complex supplementation on the alleviation of migraine in children through a possible reduction in Hcy levels.
Materials & Methods
Ninety children under 15 years of age suffering from typical migraine were included in the present trial. They were randomly assigned into two groups (forty-five patients in each group) to receive either vitamin B-complex or a matching placebo for six months. Serum Homocysteine levels and headache characteristics were evaluated and compared before and after administering vitamin B-complex or placebo.

Results
Unlike the placebo group, the monthly headache frequency, severity of headache, headache disability, and serum Hcy levels were significantly decreased after the vitamin administration. The headache duration was not significantly different before and after the treatment. In the vitamin group, there were significant positive correlations between the frequency and severity, frequency and disability, and severity and disability of headaches. Hcy also had significant positive correlations with the frequency and disability of headaches. In the placebo group, the only found significant correlation was between headache frequency and disability

Conclusion
The administration of vitamin B-complex might effectively relieve migraine severity in children by reducing serum Hcy. However, further studies are needed to confirm the results.

Cavernous hemangiomas (CHs) are vascular structures comprising of clusters of abnormally dilated blood vessels. It is estimated to occur this anomaly in approximately one out of every 500-600 people,.  Individuals often show the first sign of cavernous hemangiomas in their second or third decade of life therefore, the presentation of this disorder is not common in children, here we presented a 5 year-old-girl who developed abruptly nearly fixed right sided eyes deviation and incoordination after a short course of viral infection. In physical examination, she had left peripheral facial palsy in addition to right eye oculomotor nerve and left abducens nerve palsy.  A computed tomography (CT) scan of her brain revealed hemorrhages in posterior aspect of the pons and some areas of hemispheres in different stages. Following brain magnetic resonance imaging, multiple popcorn ball low-signal T2* lesions with both supra- and infra tentorial location with marked peripheral hypo intensities were seen. These findings were in favor of multiple cavernous hemangiomas of the brain. The novelity of our case was due to observing cavernous angiomas in both supra and infra tentorial spaces in pediatric age.