Iranian Journal of Child Neurology

Several circumstances, including the etiology of epilepsy, its early onset, recurrent seizures, and the use of anti-seizure medications (ASMs), can lead to cognitive impairment in people with epilepsy. Studies indicate that the etiology of epilepsy may be more closely associated with cognitive problems than the ASMs. However, considering long-term treatment in pediatrics and their developing nervous systems, it is critical to understand the cognitive effects of each anti-seizure medication. Significant methodological challenges exist in studying the cognitive effects of ASMs. Accordingly, this review aims to give a broad overview of recent studies on cognitive impairment caused by first- and second-generation ASMs

Objectives
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by qualitative deficits in behavior and social interaction patterns. Recently, cognitive impairments commonly associated with ASD have been well-documented. Neurofeedback (NFB) has been proposed as a potential treatment for individuals with autism, but its effectiveness in improving cognitive issues remains uncertain despite multiple trials. This review aims to summarize the estate of documents regarding the cognitive efficacy of NFB for participants with ASD.
Materials & Methods
Conducting a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study scrutinized NFB studies specific to ASD treatment. Its inclusion criteria focused on studies involving individuals with ASD without comorbidities, employing JBI checklists to assess study quality. Utilizing PubMed, Embase, Web of Science, PsycINFO, and Scopus, supplemented by manual paper reviews, we initially identified 474 papers. After deduplication and full-text review, 12 studies were selected for analysis.
Results
Findings revealed that 83% of the chosen studies highlighted a positive impact of NFB on cognition in individuals with ASD. The findings suggest NFB as a promising alternative treatment, demonstrating efficacy in addressing attention, memory, executive function, and speech difficulties. Additionally, six studies indicated sustained long-term effectiveness of NFB in improving cognitive functioning among ASD patients.
Conclusion
This review supports the potential of NFB as a viable intervention for cognitive challenges in ASD. Furthermore, the results hint at broader applications of NFB beyond ASD, suggesting efficacy in addressing conditions like Attention Deficit/Hyperactivity Disorder (ADHD), sleep apnea, depression, and epilepsy.

Objectives
Maintaining and enhancing patients’ quality of life (QoL) are considered the most significant objectives in healthcare systems. These objectives are directly associated with the intervention of healthcare providers across the globe. This study aimed to evaluate the health-related quality of life (HRQoL) of toddlers who have undergone interventions for oral clefts and compare it with a healthy control group.
Materials & Methods
The present study is cross-sectional. Thirty-six toddlers aged 18 to 36 months with oral clefts undergoing team care were recruited from a pediatric hospital and matched with healthy peers based on inclusion criteria. Demographic characteristics were collected before the TNO-AZL preschool children’s quality of life (TAPQoL) questionnaire was completed.
Results
The QoL was compared to an overall score and the average score of items and domains on the TAPQoL questionnaire between the groups. The results showed a significant difference between the two groups in social functioning (t=2.96, p = 0.004), cognitive functioning (t=2.21, p = 0.03), emotional functioning (t=3.99, p<0.01), and the total score (p<0.001). However, no significant difference was observed in physical functioning (t= 0.78, p=0.43), and toddlers with oral clefts had more reasonable scores.
Conclusion
The QoL of toddlers with oral clefts who received care from a multidisciplinary team was slightly better than that of the healthy group. Therefore, participating in these teams could lead these children to a similar QoL as their peers. Medical systems can provide easy accessibility to cleft care teams for patients and their families

Objectives
This study aims to determine the concurrent validity of the Bayley-III and the Bayley screening in Persian-speaking children. Measuring child development with the Bayley-III can be time-consuming and expensive. Accordingly, this research seeks to assess the accuracy of the Bayley screening as a measure of developmental delay for high-risk infants by age group.
Materials & Methods
Concurrent validity between raw Bayley screening scores and Bayley-III scores was assessed by administering to 403 1-42 month-old children. The cut score of 1.0 standard deviation below the mean of two tests was calculated using the Bayley-III as the criterion measure. This study used 70% of the sensitivity and specificity cut scores to measure validity. In addition, the study calculated the Pearson and Cohen’s kappa correlation for the association between the two measures.
Results
The sensitivity of cognitive, receptive, and expressive communication, fine, and gross motor scales of Bayley screening were 70.7, 81.4, 67.7, 60.7, and 58.1, respectively. Specificity values varied narrower, from 87.8% to 100%. The Cohen’s kappa coefficient in all age groups was substantial. The Pearson correlation between two test scores is significant for all scales, although the coefficients are over 0.884. The sensitivity and specificity have no specific trends with children’s age, and the best sensitivity concurrence on the two tests was in the 1-12 months old age range.
Conclusion
The study supports the concurrent validity of the Bayley screening, showing an assertive and significant association between Bayley screening and Bayley-III in Persian-speaking children.

Objectives
This randomized clinical trial aims to evaluate and compare phenobarbital and levetiracetam effectiveness and safety in controlling neonatal seizures as first-line therapeutic options.
Materials & Methods
Neonates with seizure manifestations presenting to the Bahrami Hospital from March 2020 to March 2022 were enrolled in this study. Patients’ data were recorded, including demographic findings, anthropometric measurements, birth characteristics, and laboratory findings. Patients were randomly divided into the phenobarbital and levetiracetam treatment groups. Outcomes defined as adverse effects, response to medication, time to start enteral feeding, and length of hospital stay were compared between the two treatment groups.
Results
The current study comprises 44 neonates divided into phenobarbital and levetiracetam groups. Seizure control among the two groups was not significantly different, with levetiracetam and phenobarbital groups showing seizure control of 68.2% and 59.1%, respectively. Moreover, no significant difference was observed regarding the duration of hospitalization and time to initiate feeding. No adverse effect was reported in either group.
Conclusion
This study showed no significant difference between levetiracetam and phenobarbital for neonatal seizure control.

Objectives
Acute disseminated encephalomyelitis (ADEM) is a rapid-onset inflammatory central nervous system (CNS) disorder in children, causing demyelination, encephalopathy, and neurological deficits, often following infections.
Materials & Methods
This 10-year retrospective study evaluated pediatric patients with seronegative acute disseminated encephalomyelitis (ADEM), focusing on clinical, laboratory, and imaging profiles. The various profiles were assessed to determine age- and/or sex-based differences.
Results
The study reviewed 36 patients, with an average age of 6.08 years and predominantly male (61.1%). Clinical presentations included fever, nausea, vomiting, and seizures, with left facial hemiparesis being more common in girls (P-value = 0.023), while abnormal deep tendon reflexes (DTRs) and right-sided pathologies were more common in older patients (P-value < 0.05). Recent laboratory results have revealed differences between peripheral lymphocytes and polymorphonuclear (PMN) cells. Imaging revealed predominantly bilateral lesions, with older patients more likely to show lesions in the right parietal and occipital lobes (P-value = 0.01 and 0.04). Bilateral parietal lobe lesions were significantly correlated with several laboratory findings across the different subgroups. Multivariate logistic regression revealed that these findings were statistically significant in regards to peripheral PMN and lymphocytes in the age category and cerebrospinal fluid (CSF) protein in the gender category (P-value < 0.05). Additionally, girls, particularly those who were older, had significantly higher involvement of the cervical spine (P-value = 0.04 and 0.02).
Conclusion
This study reveals age and sex-related differences in the clinical presentation and imaging findings of seronegative pediatric ADEM, showcasing the various demographic factors in patient profiles.

Objectives
The increasing popularity of wireless smart devices among adolescents has raised concerns about their possible negative effects on academic performance, phone addiction, and sleep disorders. In particular, this issue is of special importance in Iran because some studies have shown that more than 50% of Iranian adolescents are addicted to mobile phones according to the criteria of the Smartphone Addiction Scale-Short Version (SAS-SV). This study aimed to investigate the relationship between daily use time and/or exposure to wireless smart devices and some educational and psychological factors in high school students.
Materials & Methods
This study was conducted on anonymous Iranian high school students using an online questionnaire. Only students aged 14 to 18 who owned personal smart devices were included in this study.
Results
Twenty-nine participants met the inclusion criteria. The results showed that female students used these devices more frequently than male students, and having multiple devices had negative effects on educational performance, phone addiction, and sleep disorders. Sleeping next to wireless devices also negatively impacts sleep quality.
Conclusion
This study highlights the need to promote healthy device usage habits among adolescents.

Objectives
One of the clinical presentations of COVID-19 infection in children is seizure. Furthermore, based on other studies during the epidemy of the Omicron variant in Iran and other parts of the world, the incidence of seizure in children increased. Moreover, the distribution of different seizure types remains to be discovered due to the newness of the Omicron variant epidemic and the lack of studies in this field. Understanding the connections between demographic factors and different seizure types is crucial, as managing this disorder varies based on the type of seizure and the individual characteristics of each patient. This study aims to investigate the relationship between age and gender with the type of seizures in children under 18 years of age with the Omicron type of COVID-19.
Materials & Methods
In this this analytical cross-sectional study included 45 children diagnosed with COVID-19 and having seizures. The required information, including demographic characteristics and clinical findings of seizures, was recorded in them.
Results
No statistically significant relationship was observed between demographic characteristics and the type of seizures.
Conclusion
Although this study contains significant clinical results, more studies are needed to clarify this issue due to its limitations.

Objectives
Binaural processing deficits are commonly observed in children with specific learning disabilities (SLD). These deficits can significantly hinder learning, specifically in noisy environments, making rehabilitating binaural processing crucial. This study aimed to implement an auditory training program based on binaural interaction tasks at the brainstem level in children with learning disabilities who exhibit binaural processing issues and to assess its effectiveness.
Materials & Methods
A sample of fourteen children diagnosed with SLD was randomly divided into intervention (n=7) and control groups (n=7). The intervention group participated in a 12-week auditory training program based on binaural interaction. The training exercises were designed with modifications to a test battery classified as assessments of binaural interaction at the brainstem level. Pre- and post-intervention assessments included masking level difference and Persian auditory recognition of words-in-noise tests.
Results
The Wilcoxon signed-rank test showed a statistically significant change in the masking level difference and Persian auditory recognition of words-in-noise results from pre- to post-intervention within the intervention group. Additionally, a nonparametric analysis of covariance indicated a significant difference in post-intervention outcomes between the two groups, with both assessments showing a meaningful effect from the rehabilitation (p < 0.05).
Conclusion
This study’s findings suggest that computerized auditory training focused on binaural interactions may effectively address binaural processing challenges in children with SLD. Further research is recommended to confirm these initial findings and explore the benefits of binaural auditory training for social communication in this population.

Cobalamin, commonly known as vitamin B12, is a crucial micronutrient synthesized predominantly by a few microorganisms. In the human body, Vitamin B12 (Cobalamin) is essential for DNA synthesis and is required as a cofactor for functioning two crucial enzymes, methylmalonyl-CoA mutase and methionine synthase. The deficiency in these cobalamin-derivated coenzymes leads to enzyme activity dysfunction and an accumulation of their respective substrates, methylmalonic acid, and homocysteine,harming the brain and many other organs. Furthermore, deficiency in this micronutrient can lead to a wide spectrum of hematologic and neuropsychiatric disorders. In addition to vitamin B12 deficiency, some genetic disorders block the intracellular processing of Cobalamin to its cofactors and lead to symptoms somewhat similar to vitamin B12 deficiency. These disorders are called Cobalamin metabolism disorders. Many of them are reversible when diagnosed early and treated promptly. This group’s most common and well-understood disease is Cobalamin C (CblC) metabolism disorder. This case series report aimed to provide a comprehensive overview of diverse clinical presentations within the spectrum of CblC metabolism disorder and the introduction of two cases of late-onset presentation with ataxia and repeated seizures as the first manifestation of the disorder. Few case reports are available, specifically in children, describing cerebellar ataxia and seizure as the first manifestations of late-onset CblC metabolism disorder. Additionally, this report sought to contribute to the existing literature by highlighting potential areas for timely recognition and targeted clinical and therapeutic interventions, thereby enhancing the comprehensive care and support for individuals affected by CblC metabolism disorder

Ataxiatelangiectasia (A-T) is an infrequent genetic neurodegenerative disorder inherited autosomal recessively. It is mainly characterized by early-onset progressive cerebellar ataxia and dilated capillaries in the oculocutaneous regions especially conjunctivae so-called telangiectasia. A-T is a multisystem disorder and requires multi-disciplinary approach to management. Diagnosis is difficult in some cases because presentation is not in the same manner and showing a phenotypic spectrum. In atypical cases serum immunoglobulins and alfa fetoprotein are normal and telangiectasia is absent. We present a 5.5-year-old boy with progressive cerebellar ataxia and history of repeated sino-pulmonary infections that was homozygote for ataxia-telangiectasia mutated gene and had a giant arachnoid cyst in left hemisphere. It is important to keep in mind those cases with ataxia and repeated sino-pulmonary infections may be ataxia telangectasia patients. Genetic study is helpful and confirms the diagnosis by showing ataxia-telangiectasia mutated gene

Neural tube defects (NTDs) are severe congenital anomalies resulting from improper neural tube closure. Craniorachischisis totalis, the most extreme form, involves failure of neural tube formation along the entire cranio-spinal axis. This rare condition is fatal, with limited reported cases globally.
We report a case of a 35-year-old G3P1L1A1 woman admitted at 20 weeks and 4 days gestation for medical termination of pregnancy following second-trimester ultrasound findings of anencephaly and spinal dysraphism. The patient began folic acid supplementation only after pregnancy confirmation. The fetus exhibited acrania, bifid vertebrae, exposed neural tissue, frog-eye deformity, and limb contractures. Butterfly vertebrae was observed in infantogram. Retrospective ultrasound review revealed an absent cranial vault, disorganized brain matter, and a large open spinal defect extending to the upper lumbar region. Genetic and infectious panels were largely unremarkable, except for reactive rubella IgG.
Craniorachischisis totalis arises from failure of neural tube closure, potentially linked to genetic mutations, folate deficiency, and multiple maternal risk factors. Here, we also revisit the various theories of neural tube closure. Early prenatal diagnosis and counseling are critical for managing craniorachischisis. Periconceptional folic acid supplementation remains the most effective preventive measure.

Horner syndrome, characterized by the triad of unilateral ptosis, miosis, and anhidrosis, typically arises following a stroke, surgical interventions in the neck and chest, or trauma. Horner syndrome is rare in children. This study presents the case of a 9-year-old girl with End-Stage Renal Disease (ESRD) caused by renal hypodysplasia. After permcath insertion, she developed a severe headache and anisocoria, followed by ptosis and a progressively expanding neck hematoma. Physical examination and MRI of the neck revealed that Horner syndrome, caused by hematoma formation following permcath placement, was the diagnosis. Supportive interventions were implemented, leading to significant improvement in Horner syndrome over a six-month period. Complications from permcath insertion can be a cause of Horner syndrome.