How to Cite This Article: Noohi S, Amirsalari S. History, Studies and Specific Uses of Repetitive Transcranial Magnetic Stimulation (rTMS) in Treating Epilepsy. Iran J Child Neurol. Winter 2016; 10(1):1-8.

 

Abstract

Objective

In this study, repetitive Transcranial Magnetic Stimulation (rTMS) and its specific use for treating epilepsy were carefully scrutinized.

 Materials & Methods

Target researches such as review articles, case reports, books and theses, which had to do with therapeutic method of rTMS were surveyed. It is worth mentioning that until the final stages, the search for records and documents related to rTMS went on and in the end, the collected data underwent a qualitative analysis.

 Results

As the literature review suggests, TMS principally applies electromagnetic induction to generate an electric current inside the brain without physical contact. The therapeutic uses of rTMS are for a wide range of mental disorders, namely epilepsy, chronic pains, motor disorders and so on.

 Conclusion

Despite safety concerns and possible side effects, many researchers subscribe to rTMS and see a bright future for it.

Omega 3 in Childhood Migraines: a Double Blind Randomized Clinical Trial

Afshin FAYYAZI, Ali KHAJEH, Ahad GHAZAVI, Mahsha SANGESTANI

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 9-13
https://doi.org/10.22037/ijcn.v10i1.6132

How to Cite This Article: Fayyazi A, Khajeh A, Ghazavi A, Sangestani M. Omega 3 in Childhood Migraines; A Double Blind Randomized Clinical Trial. Iran J Child Neurol. Winter 2016; 10(1):9-13.


Abstract

Objective

The effect of using omega-3 to prevent migraine attacks has been raised in recent studies. The majority of these studies have been conducted in adults.

Conversely, other studies have yet to confirm the effect of omega-3. The main purpose of this study was to assess the effects of omega-3 in the prevention of migraine attacks in children.

Materials & Methods

In this study, children aged 5–15 years with a diagnosis of migraine were randomly assigned to case and control groups. The case group was treated with sodium valproate and 1 g of omega-3; the control group was treated with sodium valproate and a placebo for 2 months. The severity of attacks was evaluated before and after the treatment using PedMIDAS and parental satisfaction (CGI) using a 7-point Likert scale.

Results

In this study, 12 cases and 13 controls were enrolled. The average number of headache attacks per month decreased significantly in both groups after starting the treatment but there was no significant difference between the two groups. The severity of attacks decreased significantly in both groups after

starting the treatment but it was not significant between them. Examination of the CGI average showed the average was 6.08 (SD = 0.52) in the case group and 6.07 (SD = 0.65) in the control group.

Conclusion

The present study indicated that omega-3 with a dose of 1 mg per day has no effect in reducing the severity and frequency of migraine attacks in children.

Sodium valproate was effective in reducing the frequency and severity of attacks.

Sleep Symptoms and Polysomnographic Patterns of Obstructive Sleep Apnea in Obese Children

Azita TAVASOLI, Shabnam JALILOLGHADR, Shiva LOTFI

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 14-20
https://doi.org/10.22037/ijcn.v10i1.7648

How to Cite This Article: Tavasoli A, Jalilolghadr Sh, Lotfi Sh. Sleep symptoms and polysomnographic patterns of obstructive sleep apnea in obese children. Iran J Child Neurol. Winter 2016; 10 (1):14-20.

Abstract

Objective

This study was conducted to investigate the sleep symptoms and polysomnographic patterns of obstructive sleep apnea in overweight and obese children.

Materials & Methods

Overweight or obese children aging 6-18 yr old referred during 2010 to Endocrinology Clinic of Ghods Hospital in Ghazvin, central Iran were enrolled in the study. Polysomnography was done for the diagnosis of obstructive sleep apnea and the BEARS and Children’s Sleep Habits questionnaires were used to survey sleep behaviors.

Results

We enrolled 30 children (14 males, 16 females). Twenty-one cases had body mass index (BMI) >95% and 9 had 85% <BMI<95%. Respiratory disturbance in polysomnography was seen in 90% of cases. Symptoms included snoring 18 (60%); frequent awakening 17 (56.6%); nocturnal sweating 15 (50%); daytime sleepiness 12 (40%); sleep talking 10 (33.3%); bedtime resistance 9 (30%); nightmares 8 (26.6%); waking up problems 6 (20%); sleep walking 6 (20%); difficult breathing 4 (13.3%); bedwetting 3 (10%) and sleep onset delay 2 (6.06%). Severe, moderate and mild apnea – hypopnea Index (AHI) were seen in 12, 9 and 6 subjects, respectively. A significant Pearson correlation was found between the BMI values and sleep latency.

Conclusion

Prevalence of obstructive sleep apnea is high among overweight and obese children. Physicians should be familiar with its manifestations and consider polysomnography as an invaluable diagnostic test. There was no relation between the degree of obesity and severity of obstructive sleep apnea.

Intermittent Diazepam versus Continuous Phenobarbital to Prevent Recurrence of Febrile Seizures: A Randomized Controlled Trial

Mohammad Reza SALEHIOMRAN, Seyed Mohammad HOSEINI, Ali GHABELI JUIBARY

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 21-24
https://doi.org/10.22037/ijcn.v10i1.6435

How to Cite This Article: Salehiomran MR, Hoseini SM, Ghabeli Juibary A. Intermittent Diazepam Versus Continuous Phenobarbital to Prevent Recurrence of Febrile Seizures: A Randomized Controlled Trial. Iran J Child Neurol. Winter 2016;10(1):21-24.

Abstract

Objective

Febrile seizure is the most common neurologic problem in children between 3 months to 5 years old. Two to five percent of children aged less than five yr old will experience it at least one time. This type of seizure is age dependent and its recurrence rate is about 33% overalls and 50% in children less than one yr old.

The prophylactic treatment is still controversial, so we conducted a randomized controlled clinical trial to find out the effectiveness of continuous phenobarbital versus intermittent diazepam for febrile seizure.

Materials & Methods

This clinical trial was conducted in the Department of Pediatric Neurology, Babol University of Medical Sciences, Babol, Iran between March 2008 and October 2010. All children from 6 month to 5 yr old referred to Amirkola Children’s Hospital, Babol, Iran were enrolled in the study. Children with febrile seizure that had indication for prophylaxis but did not receive any prophylaxis previously were enrolled in the study. For prophylactic anti convulsion therapy, patients were divided randomly in two groups. One group received continuous phenobarbital and another treated with intermittent diazepam whenever the children experienced an episode of febrile illness for up to one year after their last convulsion.

Results

Of all 145 studied cases, the recurrent rate in children under prophylaxis with diazepam was 11/71 and in phenobarbital group was 17/74. There was no significant difference in the recurrence rate in both groups.

Conclusion

There was no significant difference in the effectiveness of phenobarbital and diazepam in prevention of recurrent in febrile seizure and we think that in respect of lower complication rate in diazepam administration, it cloud be better choice than phenobarbital.

Evaluation of QT Dispersion in Children with Breath Holding Spells

Amir Hosein MOVAHEDIAN, Marzieh HEIDARZADEH ARANI, Davood MOTAHARIZAD, Gholam Abbas MOUSAVI, Ziba MOSAYEBI

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 25-30
https://doi.org/10.22037/ijcn.v10i1.7123

How to Cite This Article: Movahedian AH, Heidarzadeh Arani M, Motaharizad M, Mousavi GhA, Mosayebi Z. Evaluation of QT Dispersion in Children with Breath Holding Spells. Iran J Child Neurol. Winter 2016; 10(1):25-30.

Abstract

Objective

Breath holding spells (BHS) are common involuntary reflexes in infancy and early childhood. Differential diagnosis should embrace Long QT Syndrome (LQTS) and paroxysmal abnormalities of rhythm. The aim of this study was to compare QT dispersion (QTd) in children with breath holding spells and normal controls.

Materials & Methods

QT dispersion and Corrected QT(QTc) dispersion were measured in 12 lead surface electrocardiograms in 56 patients with BHS and compared with healthy children of the same age referred to the clinic for regular checkup visits.

Results

The most common type of BHS was cyanotic (83.9%). Seven patients (12.5%) had pallid and two patients (3.5%) had mixed spells. There was a history of breath holding spells in 33.9% of the children. QT dispersion was 61.6± 22.5 and 47.1±18.8 ms in patient and control groups, respectively. QTc dispersion (QTcd) was 104 ± 29.6 and 71.9 ±18.2 ms, respectively. There was a significant difference between patient and control groups in terms of QTd and QTcd (P<0.001).

Conclusion

QTd and QTcd were increased in children with BHS. Therefore, the evaluation of EKG for early diagnosis of rhythm abnormalities seems reasonable in these children.

Antioxidant Levels in Cord Blood of Term Neonates and Its Association with Birth Weight

Mehrdad MIRZARAHIMI, Adel AHADI, Shahab BOHLOOLI, Esmaeil NAMAKIKHALAJAN, Manouchehr BARAK

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 31-34
https://doi.org/10.22037/ijcn.v10i1.8081

How to Cite This Article: Mirzarahimi M, Ahadi A, Bohlooli SH, Namakikhalajan E, Barak M. Antioxidant Levels in Cord Blood of Term Neonates and Its Association with Birth Weight. Iran J Child Neurol. Winter 2016; 10(1):31-34.

 

Abstract

Objective

Due to excessive production of free radicals and antioxidants evolved mechanisms against oxidative stress, infants are very vulnerable. As there was a significant relation between antioxidant levels and birth weight, we aimed verify this relationship.

Materials & Methods

In this descriptive analytical study we evaluated the antioxidant status of 40 healthy term newborns (gestation age 38-42 wk) with weight >2500 g (AGA) and 40 healthy term newborns (gestation age 38-42 wk) with LBW babies (weight < 2500 g) (SGA) in Ardabil Buali Hospital, Ardabil, northwest Iran in 2014. About 15 Ml of cord blood was collected after the second stage of labor.

The levels of vitamin A, E, and C, catalase, glutathione peroxidase (GPX), bilirubin and serum uric acid were measured by standard methods. Informed consent was obtained from newborn mothers and study protocol was approved by university Ethics Committee. Data were analyzed using SPSS.19.

Results

The mean levels of bilirubin, vitamin C, E, catalase and GPX in AGA group were significantly higher than SGA group but the mean of serum uric acid in SGA group was more than AGA. In addition, the mean of vitamin A was similar in two groups.

There was a significant relation between antioxidant levels and birth weight in term newborns.

Conclusion

In line with other studies the amounts of antioxidant levels except serum uric acid in AGA group was significantly more than SGA group.

Cerebral Palsy in 1-12 Year Old Children in Southern Iran

Soroor INALOO, Pegah KATIBEH, Masroor GHASEMOF

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 35-41
https://doi.org/10.22037/ijcn.v10i1.8728

How to Cite This Article: Inaloo S, Katibeh P, Ghasemof M. Cerebral Palsy in 1-12 Year Old Children in Southern Iran. Iran J Child Neurol. Winter 2016; 10(1):35-41.

Abstract

Objective

Cerebral palsy (CP) is a non-progressive CNS disorder due to an insult to the growing brain, usually occurring in the first two years of life. During the recent years, its etiology has been changed; perinatal and postnatal insults are not considered as its main causes in developed countries any more. The aim of this study was to evaluate the causes of CP in children in southern Iran.

Materials & Methods

Overall, 200 children with CP aged 1-12 yr old referring to Pediatric Neurology Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran between 2012 and 2013 were enrolled. In addition, 200 healthy age and sex-matched children were considered as the control group. Exclusion criteria were isolated movement disorders with no other evidence of CP, progressive neurologic disorders, metabolic disorders, and incomplete or uncertain past history. After collecting the data on pregnancy period, prenatal history and past medical problems, they were analyzed with appropriate statistical methods.

Results

Maternal age, medical problems during pregnancy period, route of delivery, head circumference at birth, neonatal admission, neonatal jaundice, and prematurity were the main risk factors for CP.

Discussion

The distribution of risk factors of CP is different from that of developed countries in our region. Pre- and peri-natal etiologies are still among the common causes of CP in Iran.

Plasma Ammonia Levels in Newborns with Asphyxia

Nasrin KHALESSI, Nastaran KHOSRAVI, Maryam MIRJAFARI, Ladan AFSHARKHAS

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 42-46
https://doi.org/10.22037/ijcn.v10i1.6978

How to Cite This Article: Khalessi N, Khosravi N, Mirjafari M, Afsharkhas L. Plasma Ammonia Levels in Newborns with Asphyxia. Iran J Child Neurol. Winter 2016; 10(1):42-46.

Abstract

Objective

Perinatal asphyxia may result in hypoxic damage in various body organs, especially in the central nervous system. It could induce cascade of biochemical events leading to the cell death and metabolic changes, eventually may increase plasma ammonia levels. The purpose of this study was to determine the prevalence of hyperammonemia in neonates with asphyxia and to find the relationship between ammonia levels and severity of asphyxia.

Material & Methods

In this cross-sectional study, we included 100 neonates with perinatal asphyxia in the Neonatal Intensive Care Unit of Ali-Asghar Hospital, Iran University of Medical Science, Tehran, Iran in 2010-2011. All full term patients diagnosed of asphyxia were enrolled. The relationship between plasma ammonia levels and sex, gestational age, birth weight and severity of asphyxia were determined.

Data were analyzed using SPSS software.

Results

Fifty six percent of neonates were male. The mean gestational age was 38.0± 1.2 wk. Mean plasma ammonia level was 222 ± 100 μg/dl and 20% of the neonates had hyperammonemia. It was not associated with gender, gestational age, birth weight, and asphyxia severity. Six patients died and mean plasma ammonia levels was 206±122 μg/dl. In this group, there was no significant relation between plasma ammonia levels and severity of asphyxia. No significant different was seen between plasma ammonia in dead and lived neonates.

Conclusion

According to high prevalence of hyperammonemia in neonatal asphyxia, measurement of plasma ammonia levels, is suggested to improve management of asphyxia.

Anthropometric Indices in Children With Refractory Epilepsy

Vahid AMINZADEH, Setila DALILI, Yalda ASHOORIAN, Shahin KOHMANAEE, Afagh HASSANZADEH RAD

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 47-52
https://doi.org/10.22037/ijcn.v10i1.8892

How to Cite This Article: Aminzadeh V, Setila Dalili S, Ashoorian Y, Kohmanaee Sh, Hassanzadeh rad A. Anthropometric Indices in Children With Refractory Epilepsy. Iran J Child Neurol. Winter 2016; 10(1):47-52.

Abstract

Objective

We aimed to assess the effect of body mass index (BMI) on reducing the risk of refractory seizure due to lipoid tissue factors.

Materials & Methods

This matched case-control study, consisted of cases (Patients with refractory epilepsy) and controls (Healthy children) referred to 17 Shahrivar Hospital, Guilan University of Medical Sciences, Guilan, Iran during 2013-2014.

Data were gathered by a form including demographic characteristics, type of epilepsy, predominant time of epilepsy, therapeutic approach, frequency of epilepsy, time of disease onset and anthropometric indices. We measured anthropometric indices and transformed them into Z-scores. Data were reported by descriptive statistics (mean and standard deviation) and analyzed by Pearson correlation coefficient, paired t test and multinomial regression analysis test using SPSS 19.

Results

There was no significant difference between sex groups regarding anthropometric indices. Generalized and focal types of epilepsies were noted on 57.5% and 38.75% of patients, respectively. Daytime epilepsies happened in 46.25% of patients and 33.75% noted no predominant time for epilepsies.

Clinicians indicated poly-therapy for the majority of patients (92.5%). The most common onset times for epilepsies were 36-72 months for 32.5% of patients. Lower onset time indicated lower frequency of refractory epilepsies.

Although, there was significant difference between Zheight and predominant time of epilepsies but no significant relation was found between types of epilepsies and frequency of epilepsies with anthropometric indices. Using multivariate regression analysis by backward LR, Zweight and birth weight were noted as the predicting factors of refractory epilepsies.

Conclusion

This effect may be because of leptin. Therefore, researchers recommend further investigations regarding this issue in children with epilepsy.

Evaluation of Bax and Bcl-2 Proteins Expression in the Rat Hippocampus due to Childhood Febrile Seizure

Mohammad Javad SAEEDI BORUJENI, Javad HAMI, Hossein HAGHIR, Maryam RASTIN, Ghasem SAZEGAR

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 53-60
https://doi.org/10.22037/ijcn.v10i1.8202

How to Cite This Article: Saeedi Borujeni MJ, Hami J, Haghir H, Rastin M, SazegarGh. Evaluation of Bax and Bcl-2 Proteins Expression in the Rat Hippocampus due to childhood Febrile Seizure. Iran J Child Neurol. Winter 2016; 10(1):53-60.

Abstract

Objective

Simple Febrile Seizure (SFS) is the most common seizure disorder in childhood, and is frequently described as inoffensive disorder. Nevertheless, there is evidence suggesting the association between neonatal febrile seizures and hippocampal abnormalities in adulthood. This study was conducted at evaluating the hippocampal expression of pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins following SFS induction in rat neonates.

Materials & Methods

Febrile seizure was modeled by hyperthermia-induced seizure in 22-dayold male rats by a hot water bath. The animals were divided into two groups based on the presence or absence of seizure behaviors: Hyperthermia without seizure (n=10) and hyperthermia with seizure (n=10). To control the effects of environmental stress a sham-control group was also added (n=10). The rats’ hippocampi were dissected 2 or 15 days after hyperthermia. The expression of Bax and Bcl-2 proteins were measured using Western Blotting technique.

Results

The hippocampal expression of Bcl-2 protein was significantly lower in the hyperthermia with seizure animals than that of the sham-control and hyperthermia without seizure groups. The expression of pro-apoptotic Bax protein also significantly increased in the hippocampus of hyperthermia with seizure group rats compared to the sham-control and hyperthermia without seizure animals.

Conclusion

The simple febrile seizure markedly disturbed the hippocampal expression of both Bcl2 and Bax proteins, resulting in apoptosis promotion in hippocampi of juvenile rats, which were measurable for at least 15 days.

The Clinical Features and Diagnosis of Adrenoleukodystrophy: A Case Series of Iranian Family

Parvaneh KARIMZADEH, Narjes JAFARI, Habibe NEJAD BIGLARI, Sayena JABBEHDARI, Mehdi ALIZADEH, Ghazal ALIZADEH, Hamid NEJAD BIGLARI, Sara SANII

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 61-64
https://doi.org/10.22037/ijcn.v10i1.8884

How to Cite This Article: Karimzadeh P, Jafari N, Nejad Biglari Hb, Jabbehdari S, Alizadeh M, Alizadeh Gh, Nejad Biglari Hm, Sanii S. The Clinical Features and Diagnosis of Adrenoleukodystrophy: A Case Series of Iranian Family. Iran J Child Neurol. Winter 2016; 10(1):61-64.

Abstract

Objective

Adrenoleukodystrophy disorder is one of the x-linked genetic disorders caused by the myelin sheath breakdown in the brain. In this study, we present 4 yr experience on this disorder.

Materials & Methods

The patients diagnosed as adrenoleukodystrophy in the Neurology Department of Mofid Children’s Hospital in Tehran, Iran from 2010 to 2014 were enrolled into the study. The disorder was confirmed by neuroimaging and clinical findings along with genetic and neurometabolic assessment at Reference Laboratory in Germany. We assessed age, gender, past medical history, developmental status, clinical manifestations, and neuroimaging findings of populous family with adrenoleukodystrophy.

Results

All of the patients were one populous family with high rate of consanguineous marriages. This disorder was confirmed by genetic assessment, VLCFA and brain MRI.

c.253_254insC, p.R85Pfs112* was found in heterozygote state and the VLCFA assessment showed the typical pattern for adrenoleukodystrophy/ adrenomyeloneuropathy. This diagnosis was in agreement with the family history and the clinical history of the patient. Since there have been a number of cases in patient’s family in the past, so intensive follow-up on the family especially detection the female members of the family of childbearing age was recommended. The amount of C-26, C24/C22 and C26/C22 was elevated. All patients with the same genotype had wide ranges of clinical presentation.

Conclusion

Early diagnose of this disease might help us for early intervention and prenatal diagnosis for the disease in next siblings.

Acute Motor Axonal Neuropathy (Aman) With Motor Conduction Blocks In Childhood; Case Report

Serhan YILDIRIM, Rahşan Adviye İNAN, Hakan Levent GÜL, Ülkü TÜRK BÖRÜ

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 70-72
https://doi.org/10.22037/ijcn.v10i1.6973

How to Cite This Article: Yıldırım S. Inan AR, Gül LH, Türk Börü Ü. An Acute Motor Axonal Neuropathy (AMAN) Case With Motor Conductıon Blocks In Childhood. Iran J Child Neurol. Winter 2016; 10(1):65-69.

Abstract

Objective

characterized with decreased compound muscle action potentials (CMAP) and absence of demyelinating findings in electrophysiological studies, is a subtype of Guillain-Barre Syndrome (GBS). A 4 yr-old male patient presented with ascending weakness, dysarthria and dysphagia to İstanbul Dr. Lütfi Kırdar Kartal Training and Research Hospital Neurology outpatient for three days to in 2012. Dysphonia, restricted eye movements, flaccid tetraplegia and areflexia were found in neurological examination. There were motor conduction blocks in all peripheral nerves in electrophysiological studies.According to these findings the patient was diagnosed as Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP). Reduction of CMAP amplitudes in posterior tibial nerve, absence of CMAPs in median, ulnar and peroneal nerves and loss of motor conduction blocks were found in following electrophysiological studies. According to these findings, patient was diagnosed as AMAN. Motor conduction blocks may appear in early stage of AMAN and they disappear in later examinations.

That’s why electrophysiological studies must be repeated in patients with GBS.

Bilateral Ptosis as the First Presentation of Guillain-Barre Syndrome

Ahmad TALEBIAN, Babak SOLTANI, Motahhareh TALEBIAN

Iranian Journal of Child Neurology, Vol. 10 No. 1 (2016), 30 December 2015 , Page 65-69
https://doi.org/10.22037/ijcn.v10i1.6544

How to Cite This Article: Talebian A, Soltani B, Talebian M. Bilateral Ptosis as the First Presentation of Guillain-Barre Syndrome. Iran J Child Neurol. Winter 2016; 10(1):70-72.

Abstract

Objective

Guillain-Barre syndrome (GBS) is the most common cause of acute weakness in children. It has multiple variant forms with different presentations. A rare initial sign is ptosis. In this study, we present a 10-year-old girl with bilateral ptosis without opthalmoplegia followed by a weakness in extremities with a favourable response to intravenous immunoglobulin. Due to the patient’s initial eyelid levators, myasthenia gravis was ruled out by a Tensilon test and electrophysiological studies. Our report highlights the possibility of GBS as a cause of isolated ptosis, especially in cases without ophthalmoplegia.