Iranian Journal of Child Neurology

How to Cite This Article: Sayehmiri F, Babaknejad N, Bahrami S, Sayehmiri K, Darabi M, Rezaei-Tavirani M. Zn/Cu Levels in the Field of Autism Disorders: A Systematic Review and Meta-analysis. Iran J Child Neurol. Autumn 2015;9(4):1-9.

Abstract
Objective
There is probably a relationship between zinc/cupper concentration in individuals
with autism. The present review was written to estimate this probability by using meta-analysis method.

Martials & Methods
In this meta-analysis of Fixed Effect Model, by searching PubMed, Scopus
and Google scholar databases, 11 articles were selected and verified published
in 1978 to 2012. I² statistics were calculated to examine heterogeneity. The
information was analyzed by R and STATA Ver. 11.2.

Results
Due to non-uniform measurement methods of Zn/Cu concentrations, the
concentration of these elements was measured in various subgroups (plasma,
hair and general) in both study cases and controls. There was a significant
statistical difference between plasma OR=0.252 (95% CI: -0.001-0.504) and
hair OR=0.27(95% CI: 0.059-0.481, P=0.01) concentrations of Zn/Cu statuses
between controls and autistic patients. Using a Fixed Effects Model, the overall integration of data from the two groups was significant as risk factor
OR=0.31(95% CI:0.16-0.46, P=0.001).

Conclusion
Significant correlation existed between Zn/Cu levels and the development of
autistic disorders in general analysis. Therefore, Zn/Cu levels could be mentioned as a pathogenesis reason of autism spectrum disorders.

How to Cite This Article: Houshmandi MM, Moayedi AR, Rahmati MB, Nazemi A, Fakhrai D, Zare Sh. Human Herpes Virus Type 6 and Febrile Convulsion. Iran J Child Neurol. Autumn 2015;9(4):10-14.

Abstract

Objective

Febrile Convulsion (FC) is occurred in 6 months to 5 yr old children. The aim of this study was to investigate the prevalence of HHV-6 infection in FC admitted patients of Bandar Abbas Children Hospital, southern Iran.

 Materials & Methods

In a cross-sectional study, 118 children aged 6-60 months who had FC were selected by a simple random method in 2010-11. Demographic data, clinical manifestation and two blood samples gathered to assess the human herpes virus type 6 (HHV6). Blood sample obtained at the time of admission and 10 days

after the first examination. ELISA was used to detect HHV-6 IgG. The subjects were studied in two groups with and without infection of HHV-6. Two groups were compared by t-test and X2.

 Results

Fifty-three subjects completed the study, including 30 boys (56.6 %) and 23 girls (43.4%). The HHV-6 infection was detected in 23 patients out of 53 studied subjects. The mean of age for the groups with and without HHV-6 infection was 19.7±9.7 and 20.4±10.2 months old, respectively. The most common clinical presentation in both groups was rhinorrhea, diarrhea, vomiting and lethargy without any significant difference between two groups. Five patients (21.7%) in HHV-6 group and 1 patient (3.3%) in HHV-6 negative group had postictal phase more than 15 minutes (P<0.05). Convulsion within 1 hour from beginning of fever was more frequent in HHV-6 infection group than the other group (P<0.01).

Conclusion

There was not any difference in terms of age group, gender and clinical manifestation of infected and non-infected children with FC. Postictal phase and seizure during 1 hour after the fever were significantly different between two groups.

How to Cite This Article: Esmaeili Mo, Esmaeili Ma, Ghane Sharbaf F, Bokharaie Sh. Fontanel Size from Birth to 24 Months of Age in Iranian Children. Iran J Child Neurol. Autumn 2015;9(4):15-23.

Abstract

Objective

Diagnosis of abnormal fontanel size, a potential clue to recognition of different disorders, requires an understanding of the wide variation of normal fontanel size. The anterior fontanel is the largest, prominent and most important for clinical evaluation. The aim of this study was to establish and define normal range of fontanel size from birth to 24 months of age in healthy Iranian children that might be generalized to other populations.

Materials & Methods

Totally, 550 subjects enrolled randomly in this cross sectional study. They were apparently normal healthy children, from birth to 24 months of age, including 208-term newborn and 342 infant from birth to 2 yr old. Fontanel size was measured and recorded as the mean of the length (anterior- posterior dimension) and width (transverse dimension). Mean anterior fontanel sizes in our samples were classified for periods of 3 months. Nomograms and statistical analyses were performed and depicted by Excel Microsoft Office 2007 and two-tailed t-test respectively.

Results

The mean ±2SD of anterior fontanel size was 2.55±1.92 cm in newborns, 3.37±2.48 (largest size) in 3 months of age. It was closed in all cases in 15-18 months of age. The mean posterior fontanel size was 0.8 cm in newborns and closed in all infants in 2 months of age. There was no significant difference in anterior fontanel size between two genders except in newborn and 6-9 months old (P>0.05).

Conclusion

Abnormal fontanel can indicate a serious medical condition. Therefore, it is important to understand normal variations, to utilize standardized techniques for measurement and appropriate standards of normal range in different age groups and populations. This study provides a normal range of mean fontanel size in Iranian infants as a local reference. It might be generalized to other populations.

How to Cite This Article: Barzegar M, Mahdavi M, Zalegolab behbehani A, Tabrizi A. Refractory Convulsive Status Epilepticus in Children: Etiology, Associated Risk Factors and Outcome. Iran J Child Neurol. Autumn 2015;9(4): 24-31.

Abstract

Objective

Refractory status epilepticus (RSE) is a life-threatening disease in children wherein the patient’s convulsive seizures do not respond to adequate initial anticonvulsants. RSE is associated with high rate of mortality and morbidity.

This study was aimed to survey the risk factors leading status epilepticus (SE) to RSE in children, and their early outcome.

Materials & Methods

Patients with SE hospitalized in Tabriz Children’s Hospital, Iran were studied during the years 2007 and 2008 with regard to their clinical profile, etiology, the treatment methods available to them and their outcome upon release from the hospital.

Results

Among 132 patients with SE, 53 patients (40.15%) suffered from RSE. Acute symptomatic etiology was a risk factor responsible for developing RSE in the patient (P=0.004). Encephalitis was the most common etiology of acute symptomatic SE. There was no significant relationship observed between RSE and the patients’ age, gender, date of initial drug intake and type of seizure. The mortality rate was 8.3% and a new neurological deficit occurred in 25.7% of cases. None of RSE with encephalitis returned to the baseline status. Mortality and morbidity rates were significantly higher in children with RSE than in those

with SE (P=0.006).

Conclusion

Etiology of SE significantly influenced prognosis of it with significant incidence of RSE in acute symptomatic group. Because acute neurological insult such as encephalitis and meningitis are common causes of RSE in children, properly management of them is necessary to avoid permanent brain damage.

How to Cite This Article: Allahdin S, Khademvatan S, Rafiei A, Momen AA, Rafiei R. Frequency of Toxoplasma and Toxocara Sp. Antibodies in Epileptic Patients, in South Western Iran. Iran J Child Neurol. Autumn 2015;9(4):32-40.

Abstract

Objective

Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures. Infectious agents are mentioned in its etiology. With identifying and appropriate treatment of these infectious agents, preventing their secondary outcomes, including seizure is possible. This study was conducted to determine frequency of anti-Toxoplasma antibodies (IgG, IgM) and anti- Toxocara antibody (IgG) in epileptic patients.

Materials & Methods

Study sample consisted of 141 epileptic patients and 144 healthy people. After obtaining informed consents and completing demographic questionnaire, serum samples were taken from participants. The diagnostic test of Toxoplasma IgG & IgM and Toxocara antibodies was performed under the same conditions using ELISA method in a qualified private laboratory. Samples from patients and control groups with positive ELISA test in terms of anti-Toxocara antibody were also used for confirmatory Western blot test.

Result

According to ELISA results, 28 (19.85%) epileptic patients and 2(1.38%) of healthy people had anti-Toxocara antibodies (P<001), while 39 (30.46%) of the control group people and 14.18% of patients had anti-Toxoplsma antibodies (P=0.001).

Conclusion

Frequency of anti-Toxoplasma gondii is lower in epileptic than healthy individuals and this result is contrary to investigations that have reported higher levels of this antibody in such patient groups. ELISA results for Toxocara showed that the frequency of anti-Toxocara antibody in epileptic patients might empower the probability that this parasite may cause central nervous system damage. Western

blotting has high specificity and is a proper confirmative method for diagnosis of toxocariasis.

How to Cite This Article: Farhadi R, Alaee AR, Alipour Z, Abbaskhanian A, Nakhshab M, Derakhshanfar H. Prevalence of Stroke in Neonates
Who Admitted With Seizures in Neonatal Intensive Care Unit. Iran J Child Neurol. Autumn 2015;9(4):41-47.

Abstract

Objective

Prevalence of neonatal stroke has been reported 1/2300-1/4000 live births and accounts for 12-20% of the cases of neonatal seizures. Although stroke has been introduced as the second cause of the neonatal seizures in literatures, it may remain unclear in diagnostic evaluations of seizure in neonates. This study was performed to assess the prevalence of stroke in neonates with seizure.

Materials & Methods

In this cross-sectional study, all neonates ≥ 28 weeks of gestation with a diagnosis of seizures admitted to the NICU of Boo-Ali Sina Hospital in Sari, north of Iran, were enrolled. Brain CT scan and a Transcranial Doppler ultrasonography were performed for the all cases. In cases that stroke were reported in one or two above modalities, an MRI was also performed and prevalence of stroke was reported. Putative risk factors of stroke were analyzed with univariate and multivariate statistical methods.

Results

From 174 newborn infants, 75.3% of neonates were male. Prevalence of stroke was 8%, 2.3% and 3.4% in Doppler ultrasonography, CT scan and MRI reports respectively. Umbilical venous catheterization was the risk factor of stroke in the univariate and multivariate analysis (P= 0.001; OR, 10.39; 95% CI, 2.72-

39.77). The most common form of seizure was focal clonic seizures (78.6%) in neonates with stroke.

Conclusion

Investigation of stroke as an etiology of neonatal seizures is essential because seizure may be the only symptom of neonatal cerebral infarction. Doppler ultrasonography can be a valuable diagnostic tool at first in critically ill neonates or in situations that MRI is not available primarily. Further studies with notice to outcome assessment of these infants recommended.

How to Cite This Article: Sharif MR, Madani M, Tabatabaei F, Tabatabaee Z. The Relationship between Serum Vitamin D Levels and
Attention Deficit Hyperactivity Disorder. Iran J Child Neurol. Autumn 2015;9(4): 48-53.

Abstract

Objective

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent mental health disorders. In recent years, the impacts of various micronutrients on ADHD have been studied. However, vitamin D has received much less attention. This study was aimed at evaluating the association and level of serum vitamin D in children with ADHD.

Materials & Methods

This case-control study was carried out, in 2012, on 6 to 12 yr-old children.

Thirty-seven were children with ADHD in the cases group and another 37 healthy children were in the control group. Venous blood sample was drawn from each child to measure the serum level of vitamin D. Other variables were compared as well.

Results

The mean serum vitamin D level of children with ADHD (19.11±10.10 ng/ml) was significantly lower than that of the control group (28.67±13.76 ng/ml) (P<0.001).

Conclusion

Deficiency of vitamin D has been proved in various psychiatric diseases. This study evidenced a significantly low level of serum vitamin D in children with ADHD. This suggests the need for regularly monitoring of serum vitamin D levels and treatment of patients with vitamin D deficiencies.

How to Cite This Article: Ashrafi MR, Tavasoli AR, Katibeh P, Aryani O, Vafaee-Shahi M. A Novel Mutation In Aspartoacylase Gene; Canavan Disease. Iran J Child Neurol. Autumn 2015; 9(4): 54-57.

Abstract

Objective

Canavan disease (CD) is a type of vacuolating leukodystrophy with autosomal recessive inheritance. Aspartoacylase deficiency results in decrease of myelin biosynthesis, dysmyelination and brain edema. Although CD is a very common in Ashkenazi Jews patients, several cases have been reported from non- Jewish population. This report is based on a homozygous C.202G>A mutation in the ASPA gene identified from an Iranian patient. To our knowledge, this type of mutation has not been reported in non-Jewish population in the literature.

How to Cite This Article: Paul SP, Ahmed S, Painless Loss of Vision as The First Presentation of Undiagnosed Neurofibromatosis 1 in A Child. Iran J Child Neurol. Autumn 2015;9(4):58-60.

Abstract

Objective

A 10 year old presented with painless loss of vision as the first manifestation of neurofibromatosis 1 (NF1). Clinical assessment detected diagnostic features of NF1 and Magnetic Resonance Imaging (MRI) scan confirmed presence of plexiform neurofibroma and bilateral optic pathway glioma (OPG). The child was managed with chemotherapy which helped in improvement of vision. Review of current literature recommends vision testing in diagnosed cases of NP1 till 7 years of age; this is aimed at detecting visual impairments resulting from a symptomatic OPG.

How to Cite This Article: Hakim Shoushtari M, Ghalebandi MF, Tavasoli A, Pourshams M. Kleine-Levin Syndrome in an 8 Year Old Girl with Autistic Disorder Does Autism Account a Primary or Secondary Cause? Iran J Child Neurol. Autumn 2015;9(4):61-64.

Abstract

Objective

Kleine–Levin syndrome (KLS) is a rare disorder with an unknown etiology. Autism spectrum disorder is characterized by various degrees of impairment in social communication, repetitive behavior and restricted interests. Only four patients of KLS with autistic spectrum disorder (ASD) have been reported so far. This report presents an 8-year-old girl with history of autistic disorder and epilepsy that superimposed KLS. Because of the rarity of KLS and related studies did not address whether autism accounts for a primary or secondary cause, the area required attention further studies.

How to Cite This Article: Sanyal Sh, Duraisamy Sh, Garga ChU. MRI Brain in Evaluation of Floppy Children: A Case Series. Iran J Child Neurol. Autumn 2015; 9(4): 65-74.

Abstract

Objective

Hypotonia is a common clinical entity well recognized in pediatric age group, which demands experienced clinical assessment and an extensive array of investigations to establish the underlying disease process. Neuroimaging comes as great help in diagnosing the disease process in rare cases of central hypotonia due to structural malformations of brain and metabolic disorders and should always be included as an important investigation in the assessment of a floppy child. In this article, we discuss the MRI features of eight cases of central and two cases of combined hypotonia and the importance of neuroimaging in understanding the underlying disease in a hypotonic child.

Abstract

How to Cite This Article: Eryılmaz A, Başal Y, Günel C, Ozkul A, Tosun A. Successful Treatment of Essential Palatal Tremor Lasting
Over a Long Term with a Rare Application of Botulinum Toxin in a Child. Iran J Child Neurol. Autumn 2015;9(4): 75-77.

Abstract

Objective

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent mental health disorders. In recent years, the impacts of various micronutrients on ADHD have been studied. However, vitamin D has received much less attention. This study was aimed at evaluating the association and level of

serum vitamin D in children with ADHD.

Materials & Methods

This case-control study was carried out, in 2012, on 6 to 12 yr-old children. Thirty-seven were children with ADHD in the cases group and another 37 healthy children were in the control group. Venous blood sample was drawn from each child to measure the serum level of vitamin D. Other variables were compared as well.

Results

The mean serum vitamin D level of children with ADHD (19.11±10.10 ng/ml) was significantly lower than that of the control group (28.67±13.76 ng/ml) (P<0.001).

Conclusion

Deficiency of vitamin D has been proved in various psychiatric diseases. This study evidenced a significantly low level of serum vitamin D in children with ADHD. This suggests the need for regularly monitoring of serum vitamin D levels and treatment of patients with vitamin D deficiencies.