Iranian Journal of Child Neurology

How to Cite This Article: Fallah R, Ferdosian F, Shajari A. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative
Review Article. Iran J Child Neurol. Summer 2015;9(3):1-8.

Abstract

Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non- parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist.

How to Cite This Article: Keihanidoust Z, Shariat M, Rahimian E, Tehrani F, Saddighi Gh. Comparative Evaluation between Diameter Difference of the Thumb and Asymmetry of Lateral Cerebral Ventricles in Children with Developmental Delay: A  New Finding. Iran J Child Neurol. Summer 2015;9(3):9-12.

Abstract
Objective
Anthropometry (measurement of body dimensions) has been used for clinical diagnosis of growth and developmental disorders during pregnancy and after birth. Different brain volumes have also been shown in abnormal developmental disorders. This study compares the different horizontal diameters of the left- and right-hand thumbnails and asymmetry of lateral cerebral ventricles in children with developmental delays.
Materials & Methods
This retrospective case control study was carried out in the Pediatric Neurologic Outpatient of a university hospital in Tehran, Iran (2009–2011). Twenty-eight patients with motor developmental disorders (case) and 28 healthy individuals
(control) had brain MRIs and volume of lateral cerebral ventricles size had been studied. The maximum horizontal diameters of the left and right thumbnails were measured by calipers during physical and neurological exams by a pediatric neurologist. Finally, we compared and analyzed different horizontal diameters of the left and right hand thumbnails and asymmetry of lateral cerebral ventricles.
Results
There was a significant correlation between asymmetry of brain lateral ventricles size and mean difference of horizontal diameter of thumb nails (P = 0.0001). A meaningful relation between brain hemispheres asymmetry and developmental delay (P = 0.04) was seen.
Conclusion
The asymmetry of thumbnails can be a marker for asymmetry of lateral ventricles and child developmental delays.

How to Cite This Article: Assarzadegan F, Asadollahi M, Derakhshanfar H, Kashefizadeh A, Aryani O, Khorshidi M. Measuring Serum Level of Ionized Magnesium in Patients with Migraine. Iran J Child Neurol. Summer 2015;9(3):13-16.

Abstract

Objective

Migraine is known as one of the most disabling types of headache. Among the variety of theories to explain mechanism of migraine, role of serum magnesium is of great importance. Serum magnesium, as a pathogenesis factor, was considerably lower in patients with migraine. We established this study to see if serum ionized magnesium, not its total serum level, was different in migraineurs from normal individuals.

Materials & Methods

In this case control study, all participants were recruited from Neurology Clinic of Imam Hossein Hospital, Tehran, Iran. Ninety-six people were entered in the study, 48 for each of case and control groups. The two groups were matched by age and sex. Migrainous patients were selected according to the criteria of International Headache Society. Various characteristics of headache were recorded based on patients’ report. Controls had no history of migraine or any significant chronic headaches. Serum ionized magnesium level was measured in both of the case and control groups and the results were compared to each other. P value of <0.05 was considered as significant.

Results

Case group consisted of 13 males, 35 females, and control group included 14 males, as well as 34 females. Mean age was 33.47± 10.32 yr for case and 30.45 ±7.12 yr for control group. Twenty-eight patients described the intensity of their headaches as moderate; 15 patients had severe and the 5 remainders had only mild headaches. Mean serum level of ionized Mg was 1.16± 0.08 in case group and 1.13± 0.11 in control group of no significant difference (P >0.05).

Conclusion

Serum ionized magnesium, which is the active form of this ion, was not significantly different in migraineurs and those without migraine. This may propose a revision regarding pathogenesis of migraine and question the role of magnesium in this type of headache.

How to Cite This Article: Yaghini O, Kelishadi R, Keikha M, Niknam N, Sadeghi S, Najafpour E, Ghazavi MR. Prevalence of Developmental Delay in Apparently Normal Preschool Children in Isfahan, Central Iran. Iran J Child Neurol. Summer 2015;9(3):17-23.

Abstract

Objective

Developmental delay screening is essential in pediatric medicine. The purpose of this study was to estimate the developmental delay in apparently normal children at entry to kindergarten.

Materials & Methods

In this cross- sectional study conducted in 2013, the developmental status of a sample of children who entered to kindergarten at the age of 4-60 months were evaluated by the Persian version of ages and stages questionnaires (ASQ) in Isfahan county, central Iran.

Results

Totally 680 children were enrolled, 11.8% of them were suspected to delayed in at least one domain and 1.3% and 1.2% in two and three domains, respectively. Developmental delay was in the following items: 5% in problem solving; 4.9% in fine motor; 3.2% in gross motor, 2.2% and 1.2% in personal – social and communication domains, respectively.

Conclusion

Considerable proportions of apparently normal children who are entering kindergarten had developmental delay, which could be detected by evaluation with appropriate screening tools.

How to Cite This Article: Aghayan Golkashani H, Hatami H, Farzan A, Mohammadi HR, Nilipour Y, Khoddami M, Jadali F. Tumors of the Central Nervous System: An 18-Year Retrospective Review in a Tertiary Pediatric Referral Center. Iran J Child Neurol. Summer 2015;9(3):24-33.

Abstract
Objective
Few studies exist on the demographics and trends of pediatric central nervous system (CNS) tumors in Iran. In this study, we retrospectively reviewed all cases with confirmed CNS tumors admitted to Mofid Pediatric Hospital, Tehran, Iran during the last 18 years.

Materials & Methods
Data on gender, age of diagnosis, pathologic classification and tumor location were extracted from the available medical records. We used the last version of International Classification of Childhood Cancer.

Result
Overall, 258 (81.9%) brain tumors and 57 (18.1%) spinal tumors were identified.
Our subjects comprised of 147 (46.7%) female and 168 (53.3%) male children.
More male dominancy was observed in brain tumors with a male to female ratio of 1.2 compared with 1.03 of spinal tumors. Malignant CNS tumors were most common in 1-4 yr age group. The four most common brain tumors in our subjects were astrocytomas, medulloblastoma, ependymoma and craniopharyngioma.
Overall, 53.1% of the brain tumors were supratentorial. Gliomas, PNET and neuroblastma were the most frequent primary spinal tumors in our study. We observed an increasing trend for both brain and spinal tumors that was more remarkable in the last 5 years.

Conclusion
Our results are comparable with similar single center studies on CNS tumors during childhood. The observed disparities could be attributed to the single center nature of our study and geographical, environmental and racial variations in pediatric CNS tumors. The increasing trend of both brain and spinal tumors could warrant further investigations at provincial and national levels to investigate probable contributing environmental risk factors. 

How to Cite This Article: Afsharkhas L, Khalessi N, Karimi Panah M. Intraventricular Hemorrhage in Term Neonates: Sources, Severity and Outcome. Iran J Child Neurol. Summer 2015;9(3):34-39.

Abstract
Objective
Intraventricular hemorrhage (IVH) occurs in preterm infants; however, the
occurrence of this event is less frequent in term neonates. The present study
evaluated clinical characteristics, pathophysiological features, and early
outcome of term neonates with IVH in a referral neonatal center in Iran.

Materials & Methods
This study was performed on 30 full-term neonates admitted to the Neonatal
Intensive Care Unit (NICU) of Ali-Asghar Hospital, Tehran, Iran between
March 2005 and April 2011. IVH was diagnosed using cranial ultrasonography,
or brain magnetic resonance imaging (MRI).

Results
The mean age at onset of symptoms was 3.9 days. Seizure was the commonest
clinical symptoms followed by poor feeding and fever. The sources of
bleeding in the brain were choroid plexus (60%), germinal matrix (20%) and
parenchyma (6.7%). Severity of bleeding included 33.3% grade I, 30.0% grade
II, 36.7% grade III to IV. Fifteen (50%) cases had coagulopathy. Twenty-five
(83.3%) cases were discharged with a good condition, three (10%) cases were
referred to surgical ward and two cases (6.7%) died in NICU.

Conclusion
The main source of IVH in term neonates is choroid plexus; the most common
clinical symptoms include seizure and poor feeding, and one-third of IVH
events are graded as III to IV. Most affected neonates are discharged from
NICU without CNS complication, about 10% need to refer to surgical
interventions, and death was occurred in a few of neonates.

How to Cite This Article: Adibsereshki N, Nesayan A, Asadi Gandomani R, Karimlou M. The Effectiveness of Theory of Mind Training On the Social Skills of Children with High Functioning Autism Spectrum Disorders. Iran J Child Neurol. Summer 2015;9(3):40-49.

Abstract
Objective
Children with Autism Spectrum Disorders (ASD) tend to have problems in
establishing and maintaining their social relationships. Some professionals
believe this social impairment is the result of deficit in Theory of Mind (ToM).
This study was conducted to explore the effectiveness of ToM training on such
children.

Materials & Methods
A quasi-experimental method, pre- test, post-test with control group was used.
The sample included of 12 girls and 12 boys with High Functioning Autism
Spectrum Disorders (HFASD). Two instruments were used as follows: the
Theory of Mind test and the social skills questionnaire (1). The samples were
randomly placed in the experimental and control groups. The experimental
groups had 15 sessions of ToM training and the control groups had just regular
school program.

Results
The data were analyzed by Kolmogorov-Smirnov, independent t- and twoway-
variance tests. The scores for social skills in the experimental group were
significantly more than the control group.

Conclusion
ToM training might improve the social skills of children with autism spectrum
disorders.

How to Cite This Article: Talebian A, Soltani B, Sehat M, Zahedi A, Noorian A, Talebian M. Incidence and Risk Factors of Neural Tube Defects in Kashan, Central Iran. Iran J Child Neurol. Summer 2015;9(3):50-56.

Abstract
Objective
Neural tube defects (NTDs) are the most common congenital defects of central
nervous system due to neural tube closure deficit during the third and fourth
weeks of gestational age. Our study was performed to detect the incidence and
risk factors of NTDs in Kashan, center of Iran.

Material & Methods
This case-control study was done on all pregnancies with NTD affected
neonates (n=91) and 209 pregnancies with normal neonates from February
2007 to December 2012 in three hospitals in Kashan, center of Iran. Annual and
the mean incidence of NTDs were calculated. Risk factors including neonatal
gender, maternal age, gravidity, maternal abortion history, maternal gestational
diabetes (GDM), folic acid use, familial marriage, maternal body mass index
(BMI), birth season and family history of NTDs were evaluated by interview
with mothers. Univariate and multivariate logistic regression were used to
analyze the risk factors.

Results
The mean incidence of NTDs was 2.33 per 1000 births. The multivariate analysis
indicated that maternal history of abortion (OR: 4.9, CI: 1.9-12.8), and maternal obesity (OR: 5.4, CI: 1.3-21.8) were significantly associated with NTDs.

Conclusion
Maternal history of abortion and BMI were the major risk factors of NTDs.

How to Cite This Article: Jabbehdari S, Rahimian E, Jafari N, Sanii S, Khayatzadeh Kakhki S, Nejad Biglari H. The Clinical Features and Diagnosis of Metachromatic Leukodystrophy: A Case Series of Iranian Pediatric Patients. Iran J Child Neurol. Summer 2015;9(3):57-61.

Abstract
Objective
Metachromatic leukodystrophy disorder (MLD) is one of the rare neurometabolic
diseases caused due to lack of saposin B and arylsulfatase A enzyme deficiency.

Materials & Methods
Eighteen patients diagnosed as metachromatic leukodystrophy in the Neurology
Department of Mofid Children’s Hospital in Tehran, Iran between 2010 and
2014 were included in our study. The disorder was confirmed by clinical,
EMG-NCV, arylsulfatase A enzyme checking and neuroimaging findings along
with neurometabolic and genetic assessment from reference laboratory in Iran.
We assessed age, gender, past medical history, developmental status, clinical
manifestations, and neuroimaging findings of 18 patients with metachromatic
leukodystrophy.

Results
From 18 patients, 80% were offspring from consanguineous marriages. A family
history of metachromatic leukodystrophy disease was positive for four patients.
Twelve patients had late infantile form of this disorder and six patients had juvenile form. A history of tonic type seizure was positive in 20% of the patients and tonic spasm was confirmed with clinical information. Electromyographgraphy (EMG) in 96% of patients was abnormal with demyelinating sensorimotor neuropathy pattern. MRI in all patients showed the leukodystrophic pattern as arcuate fibers sparing and subcortical rim in white matter and periventricular involvement. Our diagnosis was confirmed by EMG-NCV findings with sensorimotor neuropathy pattern and the assessment of arylsulfatase A enzyme function. 

Conclusion
MLD is an inheritance metabolic disorder, which was confirmed by the
assessment of arylsulfatase A enzyme function, peripheral blood leukocyte that
assessed in a referral laboratory in Iran.

How to Cite This Article: Toopchizadeh V, Barzegar M, Habibzadeh A. Sciatic Nerve Injection Palsy in Children, Electrophysiologic Pattern and Outcome: A Case Series Study. Iran J Child Neurol. Summer 2015;9(3):69-72.

Abstract
Sciatic nerve injury is one of the frequent mononeuropathies in children that
occurs due to different causes such as nerve compression, trauma and stretch
during surgery. Gluteal injection is an uncommon cause of sciatic injury in
developed countries. Poor techniques and frequent injections are the common
cause of injection palsy. Proneal division of the sciatic nerve is more prone to
injury due to anatomic and structural characteristics. The diagnosis is based on
electrophysiological studies and the recovery rate is poor. In this study, in a
period of 2 years between 2012 and 2013, we report seven children under 6 years old (three females and four males) with abnormal gait and foot pain following gluteal injection in pediatric electrodiagnostic center. Five children had proneal component and two with tibial component injuries. Five children were followed for one year and only one showed good recovery.

How to Cite This Article: Allmendinger AM, Ricci JA, Desai NS, Viswanadhan N, Rodriguez D. Atypical Neuroimaging Manifestations of Linear Scleroderma “en coup de sabre”. Iran J Child Neurol. Summer 2015;9(3):62-68.

Abstract
Linear scleroderma “en coup de sabre” is a subset of localized scleroderma
with band-like sclerotic lesions typically involving the fronto-parietal regions
of the scalp. Patients often present with neurologic symptoms. On imaging,
patients may have lesions in the cerebrum ipsilateral to the scalp abnormality.
Infratentorial lesions and other lesions not closely associated with the overlying
scalp abnormality, such as those found in the cerebellum, have been reported,
but are extremely uncommon. We present a case of an 8-year-old boy with a left fronto-parietal “en coup de sabre” scalp lesion and describe the neuroimaging findings of a progressively enlarging left cerebellar lesion discovered incidentally on routine magnetic resonance imaging. Interestingly, the patient had no neurologic symptoms given the size of the mass identified.