Iranian Journal of Child Neurology

Studies show that anxiety is one of the most common symptoms of mercury poisoning. The mechanism of mercury toxicity is not known in detail. This study aimed to broaden our understanding of mercury-induced anxiety and suggest potential protective agents. A list of genes associated with anxiety was extracted from the overlap between GeneCards, DisGeNET, and Diseases to decipher protein-protein interaction (PPI) and core sub-network. The comparative toxicogenomic database (CTD) helped to identify core mercury targets in anxiety disorders. Detailed interactions and relevant functions were obtained through GeneMANIA. Network pharmacology and molecular docking approaches identified potential protective agents-mercury target interactions. Among the eight proteins in the anxiety-related core sub-network (IL1B, IL6, TNF, IFNG, STAT3, TP53, EP300, and ESR1), the top-ranked proteins IL1B, IL6, TNF, and IFNG were revealed as core mercury targets with key interactions in disrupting the inflammatory responses and interfering with cellular processes. GeneMANIA highlighted the functions of CASP1, TNFAIP3, and SQSTM1 as first neighbors of the core mercury targets. Quercetin, selenium, curcumin, and glutathione were specified as factors that target the most mercury-responsive genes. Molecular docking revealed strong binding affinities between protective agents (quercetin and curcumin) and core target proteins. This study presented a network biology approach in toxicology and pharmacology to further understand the mechanism of mercury toxicity and its therapeutic solution for anxiety disorders.

Objectives:

Prior research investigating the variance in febrile seizure (FS) incidence between 6-month-old exclusively breastfed (EBF) and partially breastfed children has yielded inconsistent findings. To fill this void, this study conducted a systematic review and meta-analysis.

Materials & Methods:

This study performed a search across electronic databases, including PubMed, Scopus, the Cochrane Library, and Google Scholar without any restrictions, from the year 2000 up to January 2024.

Results:

Thirteen studies were reviewed. Regarding six articles (data number=1876753) used in the meta-analysis, EBF (OR=0.65, 95% CI: 0.50, 0.85) and partial breastfeeding (OR=0.92, 96% CI: 0.91, 94) were both significantly associated with lower risks of FS. However, the association in the EBF group was stronger.

Conclusion:

Breastfeeding positively affects lowering the risk of FS. Encouraging mothers to breastfeed and implementing preventive strategies can be beneficial for health policymakers in reducing the incidence of FS.

Objectives:

Epilepsy with eyelid myoclonia (EEM), with or without absence, also known as Jeavons Syndrome (JS), is a unique epileptic syndrome. This syndrome may be accompanied by other generalized seizures, such as generalized, tonic-clonic, myoclonic, and rarely atomic seizures. This study was conducted to determine the diversity of clinical and neurophysiological manifestations of JS in the pediatric population of Iran.

Materials & Methods:

This retrospective, cross-sectional study was conducted at the Children’s Medical Center of Tehran, Iran, from 2017 to 2023. Two clinical neurophysiologists reviewed long-term video electroencephalographic (EEG) monitoring to confirm the diagnosis. Patients’ demographic information was extracted from medical records or direct interviews based on clinical characteristics and history taking.

Results:

Among 1530 patients admitted during the study period, 12 out of 17 previously diagnosed patients confirmed their diagnosis. Among the group of confirmed patients, seven were boys and five were girls. The average age of seizure onset was 3.4±1.7 years. Except for absence seizures, five out of 12 had no other types of seizures. Two patients showed generalized tonic-clonic events as associated seizures. One patient had astatic seizures, in the form of head drop, one patient had myoclonic seizures, and three patients had focal seizures without persistency in the EEG. Eleven of the 12 patients had focal electrographic findings during recording, with eight having focal epileptiform discharges during the interictal period.

Conclusion:

JS is an under-recognized epileptic syndrome requiring accurate diagnosis through identifying seizure types and EEG features. Although it is classified as a generalized epilepsy, focal seizures have been reported in a few case reports and were observed in three patients during the ictal period in our study. Additionally, focal electrographic findings were prevalent during the interictal period. Further research is needed to better understand the clinical and neurophysiological aspects of this syndrome

Objectives:

Despite the significant frequency of sleep disorders in premature infants, the specific causes remain unclear. Thus, pediatricians and other caregivers may be able to prevent the onset of sleep disorders in children. Accordingly, the present study aimed to assess the predictors of sleep habits among preschoolers born preterm.

Materials & Methods:

This cross-sectional, retrospective study included 174 preterm infants from the Semnan clinic in Iran between 2019 and 2020. All children between the ages of four and seven years old who were born before 37 weeks were included. Information on demographic variables and the Children’s Sleep Habits Questionnaire (CSHQ) was collected from the participants. The Research Ethics Committee of the Semnan University of Medical Sciences, Semnan, Iran (IR. SEMUMS.REC.1396.235).

Results:

The average age of children and mothers were 5.7±0.96 and 32.14 ±2.02 years old, respectively. The probability of familial conflict (OR = 2.73, 95% CI = 0.97-7.71, and P = 0.041), sleepwalking (OR=2.56, 95% CI=1.30-5.06, and p=0.006) and seclusion increased (OR=2.68, 95% CI=0.91-5.13, and P=0.034) in CSHQ 1< to 2 compared with CSHQ >2 in adjusted model History of psychological disorder, sleep drugs use, withdrawn and previously diagnosed sleep disorders, depression, nightmares, and sleeping alone no had significant association with CSHQ score.

Conclusion:

The study concluded that stress factors, such as family conflicts, behavioral changes like increased seclusion, as well as internal issues like sleepwalking, should be regularly investigated in children referred to clinics for sleep problems. Healthcare professionals need to assess how these symptoms may worsen or impact the effectiveness of treatment.

Objectives:

Journal Club sessions are a staple in clinical training, widely implemented across various specialities. This study aims to compare the effectiveness if in-person and virtual Journal Club sessions .
Materials & Methods:

This compartive study involved pediatric neurology residents from two institutions: six residents from Children's Medical Centerattended in-person sessions, while seven residents from Mofid Children's Hospital participated in virtual sessions. Evaluations were based on an interaction and behavior checklist during the sessions, apost-test consisting of ten multiple-choice questions, and a student-satisfaction questionnaire .
Results:

A total of 13 pediatricneurology residents(12 women and 1 man) participated. The average knowledge score was higher in virtual sessions compared to the in-person sessions, though this difference was not statistically significant. High satisfaction(score of 4) for active participation was reported by 50% of in-person attendees and 57.1% of virtual attendees, with nosignificant difference. For analytic assessment of statistical tests in articles, high satisfaction was reported by 83.3% of in-person attendees and 100% of virtual attendees, also not significantly different .
Conclusion:

The findings suggest that virtual Journal Clubs can be effective and satisfactory as in-person sessions. Further studies with larger sample sizes are recommended to validate these results.

Objectives:

The clinical outcomes of pediatric stroke in patients can vary significantly depending on the affected brain region. Supratentorial and infratentorial strokes may present different clinical features and prognoses. Understanding these differences is crucial for developing targeted treatment strategies and improving patient care. Accordingly, this study aimed to compare the outcomes of patients under 18 years old with supratentorial and infratentorial strokes.

Materials & Methods:

This retrospective cohort study included 100 children under 18 years old hospitalized due to stroke at Ali Asghar and Rasoul Akram hospitals from 2011 to 2023 and followed for 24 months. The motor and cognitive impairments were assessed 24 months post-stroke using the Modified Rankin Scale (MRS), the Bayley-III Scale (for children under three years), and the Binet scale (for children over three years). Statistical analyses were performed using T-tests and Chi-square tests. The required data include age, gender, stroke type (ischemic or hemorrhagic), stroke location (supratentorial /infratentorial), and underlying conditions.

Results:

The mean age of the patients was 70.47 months. About 57% of the patients were older than two years, and 67% were male. Supratentorial stroke was observed in 78% of cases. No significant difference was observed in age or gender distribution between the supratentorial and infratentorial groups (P = 0.64 and P = 0.128, respectively). Outcome comparisons between the groups revealed no significant difference in Binet scores; however, children with supratentorial strokes had significantly lower Bayley scores and higher MRS scores compared to the infratentorial group (P = 0.023 and P = 0.002, respectively).

Conclusion:

The present findings indicate that children with supratentorial strokes may experience more severe long-term motor and cognitive impairments. Further research is needed to investigate long-term outcomes in pediatric stroke patients based on stroke location

Objectives:

Relations exist between autism spectrum disorder (ASD) and visual and hearing loss (VL/HL). This study evaluated the prenatal risk factors specific to ASD compared to VL/HL.

Materials & Methods:

This case-control study recruited individuals with ASD to compare with individuals with VL/HL as controls from special schools. Parents completed a questionnaire containing questions about demographic characteristics, socioeconomic status, family history of neurological or psychological disorders, and problems during the pregnancy.

Results:

Five hundred thirty-six participants were enrolled in the study, of which 238 (44.4%) had ASD, 198 individuals had HL (36.9%), and 100 had VL (18.7%). Seven (2.9%) participants in the ASD group were male, significantly (p<0.001) lower than the proportion of males in the HL/VL group (99, 33.2%). In the final regression model, higher educational levels of parents and gestational hypertension were associated with a higher risk of ASD (p<0.05). However, female gender, parents not living together, and cousin marriage were associated with a higher risk of HL/VL (p<0.05).

Conclusion:

This preliminary study determined the factors more associated with ASD than HL/VL. Believably, the study’s results could shed more light on the exclusive risk factors of ASD

Objectives:

Epileptic Spasm (ES) is a special type of convulsive disorder that primarily occurs in infants, typically within the first year of life. This disorder is usually resistant to routine anticonvulsant drugs. This study aims to evaluate the epidemiology and factors affecting one-year prognosis in patients with ES in Tabriz Children’s Hospital.

Materials & Methods:

This descriptive-analytical cross-sectional study focused on patients diagnosed with ES who were referred to the neurology department of Tabriz Children’s Hospital between 2015 and 2019. Data was collected using a census sampling method and a checklist that included demographic information and clinical and treatment histories. The results were then reported statistically.

Results:

Thirty-seven patients were studied, with 15 (40.5%) exhibiting flexor seizures, eight (21.7%) extensor seizures, and 14 (37.8%) mixed seizures. The most common causes were prenatal insult (10 cases, 27.0%), cryptogenic (9 cases, 24.3%), and Central Nervous System (CNS) malformations (6 cases, 16.2%). Electroencephalography findings included modified hypsarrhythmia in 12 cases (30.8%), hypsarrhythmia in 16 (41.0%), and frequent epileptiform discharge in nine (23.1%). MRI and CT scans showed abnormalities in three cases (8.1%) and 16 cases (43.2%), respectively. Treatment involved Phenobarbital in 35 patients (94.6%), Vigabatrin in 29 (78.4%), and ACTH in 11 (29.7%). The one-year prognosis indicated 25 patients (67.6%) experienced disease recurrence, seven (18.9%) recovered with complications, and two (5.4%) died.

Conclusion:

The most common causes of ES are prenatal insults, cryptogenic factors, and CNS malformations. The key one-year prognoses include disease recurrence and recovery with complications.

Objectives:

The focus on children with cerebral palsy (CP) has mostly been on its postural, balance, and movement constraints. However, another factor that affects children’s daily functioning the manifestation of sensory processing irregularities and disorders. A standard tool can provide in-depth insight into sensory processing in children with CP by appropriately addressing their sensory issues.

Materials & Methods:

In this cross-sectional study, 143 children with CP participated to measure the reliability and validity of the Persian version of the Child Sensory Profile-2 (CSP-2) in children with CP. Data were collected using the Persian version of CSP-2 (parent/caregiver form) and analyzed using SPSS-26 software.

Results:

The current study revealed that Persian version of CSP-2 has good divergent validity in children with CP (p<0.001) as children with CP showed significantly different sensory processing patterns compared to typically developing peers, with higher scores across most subscales including Sensitivity (r = –0.61), Avoiding (r = –0.33), Registration (r = –0.21), and Seeking (r = –0.42). Excellent internal consistency showed that all items are internally consistent and reliable (0.78≤α≤ 0.91). The Intraclass Correlation Coefficient (ICC) that was used to measure test-retest reliability also confirmed its test-retest reliability (0.84≤ICC≤0.96).

Conclusion:

The Persian version of the CSP-2 can efficiently differentiate sensory processing patterns, sensation, and behavioral areas between typically developing children and children with CP. The excellent internal consistency and reproducibility of results in test-retests indicate that the Persian version of the CSP-2 is a valid and reliable tool to assess sensory processing in children with CP.

Objectives:

Pediatric arterial ischemic stroke (AIS) is a rare but serious condition leading to significant neurological disability. AIS is classified into anterior circulation AIS (ACAIS) and posterior circulation AIS (PCAIS). Understanding the differences between these subtypes is essential for early diagnosis and effective management. This study aimed to evaluate the demographic, clinical, and laboratory characteristics of pediatric ACAIS and PCAIS, focusing on lipid profiles, prothrombotic factors, and SARS-CoV-2 prevalence.

Materials & Methods:

A descriptive-analytical cross-sectional study was conducted on 34 children diagnosed with AIS at the Tabriz Children’s Hospital from March 2020 to October 2021. Patients were categorized into ACAIS, PCAIS, and mixed, involving both anterior and posterior circulations based on neuroimaging findings. Demographic data, medical history, and laboratory parameters, including coagulation factors, lipid profiles, and SARS-CoV-2 antibodies, were analyzed. Statistical comparisons were performed using SPSS version 26, with a p-value of <0.05 considered statistically significant.

Results:

Among the 34 patients, 73.5% were diagnosed with ACAIS, 20.6% with PCAIS, and 5.9% with both. PCAIS patients were older (median age: 8.0 vs. 2.0 years), and sex distribution varied, although not significantly. No significant differences were found in lipid profiles, coagulation factors, or SARS-CoV-2 prevalence between ACAIS and PCAIS groups.

Conclusion:

No significant differences in demographic features, lipid profiles, or prothrombotic conditions were observed between ACAIS and PCAIS, suggesting that pediatric stroke mechanisms may differ from those in adults. Further large-scale studies are warranted to validate these findings and improve pediatric stroke management.

Objectives:

Despite the advancements in antiepileptic drugs over the past decades, drug-resistant epilepsy (DRE) remains a significant challenge, particularly in children. Familial Mediterranean fever (FMF), attributed to mutations in the Mediterranean fever (MEFV) gene, has been linked to various neurological disorders, including seizures. This study investigates the potential association between MEFV gene mutations and DRE and evaluates their impact on the disease course.

Materials & Methods:

A case-control study was conducted involving 22 children under 18 years of age with DRE, referred to the Pediatric Neurology Clinic of Children’s Medical Center, Tehran, Iran, between March 2021 and March 2022. The control group comprised 30 healthy individuals randomly selected from the FMF database of Ardabil University, Iran. Relevant information, including age, demographics, disease characteristics, and treatment details, was collected using a structured form. Blood samples were analyzed for 12 common MEFV gene mutations

Results:

Out of 52 subjects, the case group consisted of 22 children diagnosed with DRE, compared to 30 patients without FMF in the control group. The mean age of the case group was 9.2 ± 4.5 years, with a mean age at seizure onset of 38.13 ± 32.21 months. MEFV mutations were identified in eight patients (15.4%), with seven in the control group and one (4.5%) in the case group. However, the difference in MEFV gene mutations between the case and control groups did not reach statistical significance (P=0.13).

Conclusion:

The prevalence of MEFV gene mutations in children with DRE was 4.5%, suggesting that these mutations may not significantly influence the occurrence of DRE in this population.

Pyle’s disease (PD), also known as metaphyseal dysplasia, is a rare genetic skeletal disorder characterized by a specific radiologic feature known as the Erlenmeyer-flask deformity, the expansion of trabecular metaphyses, specifically in the distal aspects of long bones. The main pathophysiology of this disease is caused by mutations in the Secreted Frizzled-Related Protein 4 (SFRP4) gene. This case report aims to discuss the electrodiagnostic findings of an 8-year-old girl diagnosed with PD. This evaluation revealed normal sensory nerve action potentials (SNAP); however, compound muscle action potentials (CMAP) showed minimal amplitudes with increased latencies and profound reductions in nerve conduction velocities (NCVs), particularly in the lower limbs. These features are consistent with peripheral motor polyneuropathy with a mixed axonal and demyelinating pattern. This case is reported because PD is an uncommon disorder, and until now, there has been no literature describing the electrodiagnostic features of this disease.