Iranian Journal of Child Neurology

The occurrence of neonatal seizures may be the first and perhaps, the only clinical sign of a central nervous system (CNS) disorder in the newborn infant. Identifying the etiology for the neonatal seizures is/critical to prognosis and treatment. The most common etiology for neonatal seizures is hypoxic-ischemic encephalopathy. Seizures may indicate the presence of a potentially treatable etiology and should prompt an immediate evaluation to determine the precise cause and institute etiology-specific therapy.

In this review article, we will discuss the etiology, classification, clinical features, diagnosis and the approaches to treatment of neonatal seizures.

Key words: Neonate,Seizure,CNS, Anti-Epileptic drugs(AED'S)

Objective

Several investigations have demonstrated that Rosa damascena has an inhibitory effect on the hypothalamus and on pituitary system reactivity in the rat; it has also been shown that the essential oil of Rosa damascena has significant antiepileptic effects on pentylentetrazole (PTZ) induced seizures in rats. We aimed at assessing the effects of the essential oil of Rosa damascena when used as an adjunct treatment to treat children with refractory seizures

Materials and Methods

In this double-blind clinical trial, conducted as a pilot study between April 2004 and March 2005, we administered essential oil of Rosa damascena to sixteen children with refractory epilepsy as an adjunct therapy, and evaluated its effects.

Results

16 patients, age range 3-13 years, were enrolled; 56.3% (n=9) girls and 43.8% (n=7) boys.

 All has been under treatment for 3-6 weeks (baseline phase). They received either the essential oil or placebo for a period of 4 weeks and in between these periods, they took only their pre-existing antiepileptic drugs for two weeks (washout phase).

The mean frequency of seizures in those using essential oil, showed significant decrease as compared to the controls using placeboes (p=0.00).

Conclusion

It can be concluded that the essential oil of Rosa Damascena has beneficial antiepileptic effect in children with refractory seizures.

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Objective

Oxygen intoxication plays an important role in the pathogenesis of some fetal diseases such as encephalopathy, ischemia& hypoxia. Antioxidants can reduce oxidative damage in newborns. The object of this research was measuring total value of antioxidant and vitamin C in blood sample of pregnant women before delivery, and also in umbilical cord blood of their newborn, and repeating these measurements 48 hours after birth in newborns with hypoxia and controlling group.

Materials & Methods

The sample included 32 healthy pregnant women presented for delivery & also their newborns. The total values of antioxidant & vitamin C in plasma were measured by staining methods.

Results

There was no statistical meaningful difference in total values of antioxidants & vitamin C in women's blood & their newborn's cord blood. Also total

values of antioxidant & vitamin C meaningfully increased in newborns with hypoxia after 48 hours.

Conclusion

total values of antioxidant & vitamin C in blood plasma of newborn, increase in oxidative damage as a defense mechanism.

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Objective

Infantile spasms (IS) or West syndrome is a convulsive disease characterized by brief, symmetric axial muscle contractions (neck, trunk, and/or extremities).The therapy universally recognized as most effective in the treatment of IS, is treatment with the adrenocorticotropic hormone (ACTH) or oral corticosteroids. This therapy however has important side effects. Many studies have sought to find alternative therapies with fewer side effects. Nitrazepam, it has been proven, can be as effective as ACTH in controlling infantile spasms. The aim of this study was to evaluate and compare the efficacy of Nitrazepam and ACTH on the treatment of infantile spasms.

 Materials & Methods

This randomized controlled clinical trial, enrolled sixty patients with newly diagnosed and previously untreated IS; diagnosis was made based on the criteria of The International Classification of Epilepsies of the International League Against Epilepsy (ILAE). Prior to treatment, all patients underwent Electro encephalo graphs (EEGs) and CT scans. Patients were randomized to receive 0.5-1 mg/kg Nitrazpam (NZP) in three daily doses or 40 IU Depot ACTH in a single morning dose. Complete cessation of spasms was considered to be as optimal response.

Results

Of the sixty patients studied, 24 (40%) were girls and 36(60%) were boys. All patients in the both groups were matched for age and sex.There were no differences between the both groups regarding age and sex (non-significant). Following treatments, at the end of the 6-week duration therapy, optimal response (Cessation of spasms) was obtained in 19 (63%) patients of NZP group and 9 (30%) patients of ACTH group, (P<0.05). ACTH side effects were more pronounced than those of NZP; Most patients in ACTH group, developed cushingoid features (moon face 93%, weight gain 100%)(P<0.05); a few patients,all from the ACTH group, developed hypertension (P<0.05). The side effects of nitrazepam were drowsiness 33%, hypotonia 10%, infection 20%, and  hypersalivation 93%. EEG anomalies had disappeared in 47% of NZP patients and in 30% of ACTH patients (P>0.05).

Conclusion

This study supports the belief that NZP offers an effective and possibly safer therapy than ACTH, for the management of IS and that the therapeutic response, if imminent, can be detected within 4-6 weeks of treatment. Clinicians should consider using NZP as a first-line therapy for IS.

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Objective

Gastroenteritis has a diverse etiology; many pathogens can cause this condition. Of the extraintestinal manifestations, one is convulsions, which may be  attributable to fever, type of bacteria, or electrolyte imbalance. To assess the risk of occurrence of convulsions, in this study we investigated the association between the paraclinical and clinical findings of children with gastroenteritis and the risk of occurrence of convulsions.

Materials & Methods

In this prospective study, conducted between March 2004 and February 2005, we studied 50 patients admitted to the Mofid Childrens' Hospital, with gastroenteritis and convulsions.

Stool samples were obtained for investigations of electrolyte imbalances and type of gastroenteritis. A control group consisting of patients admitted

simultaneously with gastroenteritis but no convulsions was selected as well.They were matched with the case group in terms of age, sex, and month

of admission and number. Data was collected using a specific checklist.

Results

The stool exam (SE) showed 31 cases (62%) had inflammatory diarrhea and 19 (38%) had the non-inflammatory type. In the control group, 21 cases

(42%) had inflammatory and 29 (58%) had non-inflammatory diarrhea. Stool culture (SC) results showed 11 (22%) subjects had Shigella, 27 (54%) revealed

no organism, and 12 (24%) did not have SCs in their medical records. In the control group SC results revealed Shigella in 2 cases (4%), 38 patients

(76%) showed no organism, and 10(20%) did not have SCs. Six cases (12%) had hyponatremia ranging between 125-130meq/lit. In the control group,

4 (8%) had electrolyte imbalances, 3 had hyponatremia ranging between 125-130meq/lit, and 1 had hypokalemia.

Conclusion

No significant relation was found between inflammatory gastroenteritis and the incidence of convulsion (P value=0.0716) Although a significant relation

was found between Shigella and convulsion (P value=0.0113), no significant relation existed between electrolyte imbalance and the incidence of convulsion

( P value=0.7389 ).

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Objective

Bacterial meningitis is still a life threatening epidemiological problem especially in many developing countries; considering its dire consequences, its prompt and accurate diagnosis has become a priority for clinicians. Because of the various limitations of conventionally used laboratory techniques, we evaluated and compared the diagnostic utility of C-reactive protein(CRP) and lactate dehydrogenase (LDH)in serum and cerebrospinal fluid (CSF)in the diagnosis of bacterial meningitis and its effectivity in distinguishing it from aseptic meningitis (AP).

Material and Methods

A total of 125 pediatric cases, aged between 1 month and 12 years, including patients with bacterial meningitis (n=45), aseptic meningitis (n=42) and a control group (n=38), were retrospectively analyzed on the basis of data from the initial clinical examinations. Cultures, smears and other common serum and CSF indices were compared with serum and CSF CRP levels and LDH activity.

Results

Compared with each of the other variables, there were significant differences in the mean values of serum-CRP, CSF-glucose, CSF-LDH and CSF/serum LDH ratio between the bacterial and aseptic meningitis groups (p<0.001). Of all the tests applied, the highest sensitivity (95%) and negative predictive value (95%) belonged to CSF-LDH activity and the most specific (100%) test with the highest positive predictive value (100%) was CSF-CRP titration as well as smear and culture. Combination of CSF-CRP serum-CRP, and CSFLDH yielded the highest sensitivity (100%) and negative predictive value but the combined application of CSF-LDH and CSF-CRP proved to be the most specific and efficient.

Conclusion

In the presence of a normal CRP titration and low glucose level in CSF, bacterial meningitis is excluded, whereas elevated level of CSF-LDH activity is a valid confirmatory predictor of BM. In addition, combination of these three tests with serum CRP is far more effective than the separate determination of any of these parameters.

Objective

Refractory convulsive Status Epilepticus (SE) which does not respond to first line drugs (benzodiazepines, phenytoin and phenobarbital) heralds an emergency condition in pediatric neurology which can cause irreparable brain damage. There is no consensus on the choice of drug treatment for refractory generalized  convulsive status epilepticus in children. Lidocaine is a valuable forgotten antiepileptic agent with favorable properties which include prompt responses, less alteration of consciousness, and fewer adverse effects such as respiratory depression.

Materials & Methods

In a retrospective study conducted to investigate clinical efficacy and safety of intravenous lidocaine in treating refractory generalized convulsive SE of children, the medical records of 13 patients admitted to the Shaheed Sadoughi Hospital of Yazd between 2003 and 2005 and treated with intravenous lidocaine, were reviewed.

Results

13 patients, 7 girls and 6 boys (average age 3 years, SD=2.7years) were treated with lidocaine. Neurodevelopmental delay was seen in 38.5 %, and in 46.2% of them EEG and neuroimaging abnormalities were observed.

Seizures ceased in eight patients (61/5 %), without any undesirable side effects. Two patients had to be intubated because of non-responsiveness to lidocaine, and other treatments were begun .Mean duration of ICU stay was 4.77 days, SD=3days.

Conclusion

It is recommended that lidocaine be used as a second-line, anticonvulsive drug in the treatment of status epilepticus, especially when faced with unavailability of appropriate respiratory care and intubation equipment.

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Objective

Mercury poisoning is one of the important recent causes of mortality and mortality in children worldwide, particularly in industrial environments; mercury is a poisonous metal, especially harmful to the nervous and immune systems and the kidneys and can even be fatal. Elemental mercury is present in thermometers, barometer batteries, sphygmomanometers and latex paints.

Inorganic mercury salts are found in antiseptics, pesticides, pigments and explosives and are used as preservatives in medicine. Mercury was once used to stop fever, and this worked because the immune system was so weakened that it could no longer sustain the attack for which the fever was created. Some medical drugs still contain mercury chloride and mercurous chloride and certain forms of mercury are still used in some laxatives. Mercury toxicity of the nervous system causes anorexia, ataxia, lack of ability to coordinate voluntary muscle movements, dementia, depression, dizziness, emotional instability, erethism (abnormal irritability in response to stimulation), incoordination, insomnia, irritability, loss of ability to speak, memory impairment, numbness, saresthesias (sensation of prickling, tingling or creeping on the skin), psychosis, tremors, drowsiness, fatigue and weakness.

Other organ damages include kidney failure, headaches, hearing impairment, visual impairment, hypertension, dermatitis, digestive tract problems, colitis, diarrhea, stomatitis and excessive salivation, loss of teeth, metallic taste, chromosomal damage, birth defects and ensuing organ failure. Chronic mercury poisoning can cause Acrodynia (Pink disease). Mercury poisoning is a rare cause of hypertension in children. Herein we report 3 cases, the first a child with hypertensive encephalopathy due to severe mercury poisoning and his two siblings with moderate symptoms.

Case report

A 10 year old boy was admitted in psychiatric ward of Imam Hossein Hospital with behavioral disorder, irritability, mood change and convulsion. Because of his blood pressure which was 160/120 he was referred and admitted to the Pediatric Nephrology department. On arrival, for his hypotonia and the pink  discoloration of his fingers a diagnosis of Acrodynia (Pink disease) was considered; his history showed that he has played with a ball of mercury, taken from a laboratory. He and his 2 siblings received British Anti Lewisite(BAL) and D-penicillamin; at follow-up all symptoms had gradually disappeared and they are well now.

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