Iranian Journal of Child Neurology

How to Cite This Article: Soltani D, Ghaffar pour M, Tafakhori A, Sarraf P, Bitarafan S. Nutritional Aspects of Treatment in Epileptic Patients. Iran J Child Neurol. Summer 2016; 10(3): 1-12.

Abstract
Epilepsy is a neurological disorder characterized by interruption of normal neuronal functions that is manifested by behavioral disorders, changing of awareness level, and presence of some sensory, autonomic and motor symptoms or signs. It is resulted from many different causes. Many antiepileptic drugs (AEDs) are considered to manage epileptic attacks. Some of them  hange
metabolism and absorption of many nutrients. Therefore, epileptic patients may be in higher risk of nutrient deficiency and its unwelcome effects. In the present paper, we intend to review the relationship between nutrition and epilepsy in two aspects. In one aspect we discuss the nutritional status in epileptic patients, the causes of nutritional deficiencies and the way of compensation of the nutrient deficiencies. It will guide these patients to have a healthy life. In another aspect we explain the role of some nutrients and specific diets in management of epileptic attacks. It can help to better control of epileptic attacks in these patients.

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151.Schoeler NE, Wood S, Aldridge V, Sander JW, Cross JH, Sisodiya SM. Ketogenic dietary therapies for adults with epilepsy: Feasibility and classification of response. Epilepsy Behav 2014; 37:77-81.

152.Kossoff EH, McGrogan JR, Bluml RM, Pillas DJ, Rubenstein JE, Vining EP. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia 2006; 47:421-4.

153.Pfeifer HH, Thiele EA. Low-glycemic-index treatment: a liberalized ketogenicdiet for treatment of intractable epilepsy. Neurology 2005; 65:1810-2.

154.Coppola G, D’Aniello A, Messana T, Di Pasquale F, della Corte R, Pascotto A, et al. Low glycemic index diet in children and young adults with refractory epilepsy: first Italian experience. Seizure 2011; 20:526-8.

155.Kossoff EH, Turner Z, Bluml RM, Pyzik PL, Vining EP. A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet. Epilepsy Behav 2007; 10:432-6.

156.Kossoff EH, Dorward JL. The modified Atkins diet. Epilepsia 2008; 49:37-41.

157.Sharma S, Sankhyan N, Gulati S, Agarwala A. Use of the modified Atkins diet in infantile spasms refractory to firstline treatment. Seizure 2012; 21:45-8.

158.Sharma S, Sankhyan N, Gulati S, Agarwala A. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia 2013; 54:481-6.

159.Karimzadeh P, Sedighi M, Beheshti M, Azargashb E, Ghofrani M, Abdollahe-Gorgi F. Low Glycemic Index Treatment in pediatric refractory epilepsy: The first Middle East report. Seizure 2014; 23:570-2.

How to Cite This Article: Najafi MR, Najafi MA, Nasr Z. Diagnosis and Management of Multiple Sclerosis in Children. Iran J Child Neurol. Summer 2016; 10(3): 13-23.

Abstract

Growing evidence indicates the safety and well toleration of treatment by Disease-modifying in children suffering multiple sclerosis (MS). The treatment is not straight forward in a great number of patients, thus patients with pediatric MS must be managed by experienced specialized centers. Common treatments of multiple sclerosis for adults are first-line therapies. These therapies (firstline) are safe for children. Failure in treatment that leads to therapy alteration is almost prevalent in pediatric MS. Toleration against current second-line therapies has been shown in multiple sclerosis children. Oral agents have not been assessed in children MS patients. Although clinical trials in children are insufficient, immunomodulating managed children, experience a side effect similar to the adult MS patients. However, further prospective clinical studies, with large sample size and long follow-up are needed to distinguish the benefits and probable side effects of pediatric MS therapies.

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How to Cite This Article: Dalirani R, Mahyar A, Ayazi P, Ahmadi Gh. Neurological Manifestations of Renal Diseases in

Children in Qazvin/ Iran. Iran J Child Neurol. Summer 2016; 10(3):24-27.

Abstract

Objective

Renal diseases are one of the most common causes of referrals and admissions of children, hence it is important to know their neurological presentations. This study aimed to determine neurological presentations of renal diseases in children.

Material & Methods

A total of 634 children with renal diseases, admitted to Qazvin Pediatric Hospital, Qazvin, central Iran from 2011 to 2013 were studied. Neurological presentations of patients were established and the results were analyzed using statistical tests.

Results

Neurological presentations were found in 18 (2.8%) out of 634 patients, of whom 15 had febrile seizures, two thromboembolism, and one encephalopathy. Among patients with urinary tract infection (UTI), 2.6% had febrile seizures, 11.1% of those with glomerulonephritis had encephalopathy, and 3.7% of those with nephrotic syndrome had cerebral thromboembolism.

Conclusion

Results showed neurological presentations in 2.8% of children with renal diseases, and febrile seizure as the most common presentation.

References

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2.      Bhoobun S, Jalloh AA, Jacobsen KH. Cerebral venous thrombosis in a child with nephrotic syndrome: case report. Pan Afr Med J 2012;13:57.

3.      Lee P, Verrier Jones K. Urinary tract infection in febrile convulsions. Arch Dis Child 1991; 66(11):1287-90.

4.      Bensman A, Dunand O, Ulinski T: Urinary tract infection. In: Avner ED, Harman WE, Niaudet P, Yoshikawa N, Pediatric Nephrology. Berlin, Springer. 2009:1007-1025.

5.      Anochie I, Eke F, Okpere A. Childhood nephrotic syndrome: change in pattern and response to steroids. J Natl Med Assoc 2006; 98(12):1977-81.

6.      Pan GC, Avner ED. Glomerulonephritis Associated with Infections. In: Kliegman RM, Stanton RE, Schor NF, Geme III JW St, Behrman RE. Nelson Textbook of Pediatrics. 19th ed. Phila, Saunders; 2011: 1783-6.

7.      Salvadori M, Bertoni E. Update on hemolytic uremic syndrome: Diagnostic and therapeutic recommendations. World J Nephrol 2013 6; 2(3): 56-7.

8.      Shinnar S. Febrile seizures. In: Swaiman KF, Ashwal S,Ferriero DM. Pediatric neurology: principles and practice. 4th ed. Philadelphia: Mosby, 2006:1079-86.

9.      Bryce A. Kerlin, Rose Ayoob, William E. Smoyer. Epidemiology and Pathophysiology of Nephrotic Syndrome–Associated Thromboembolic Disease. Clin J Am Soc Nephrol 2012 ; 7(3): 513–520.

10.  Faigle R, Sutter R, Kaplan PW. The electroencephalography of encephalopathy in patients with endocrine and metabolic disorders. J Clin Neurophysiol 2013;30(5):10.1097. doi:10.1097/WNP.0b013e3182a73db9.

11.  Momen AA, Monajemzadeh SM, Gholamian M. The Frequency of Urinary Tract Infection among Children with Febrile Convulsions. Iran J Child Neurol 2011; 5(3): 29-32.

12.  Burn D J, Bates D. Neurology and the kidney. J Neurol Neurosurg Psychiatr 1998;65:810–821.

13.  Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med 1998;338: 1202-11.

14.  Zaffanello M, Franchini M. Thromboembolism in childhood nephritic syndrome: a rare but serious complication. Hematology 2007; 12:69-73.

15.  Sébire G, Tabarki B, Saunders DE, et al. Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain 2005; 128 (3):477–89.

16.  Joel F, Denis G, deVeber Gabrielle D V. Cerebral sinovenous thrombosis and idiopathic nephrotic syndrome in childhood: report of four new cases and review of the literature. Eur J Pediatr 2006; 165(10):709–716.

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How to Cite This Article: Dadgar H, HadianMR, Lira OA. Effects of Abnormal Oral Reflexes on Speech Articulation in Persian Speaking Children with Spastic Cerebral Palsy. Iran J Child Neurol. Summer 2016; 10(3):28-34.

Abstract

Objective

The purpose of this study was to investigate the relationship between the presence of abnormal oral reflexes and speech sound production in children with severe cerebral palsy.

Materials&Methods

Seven oral reflexes such as, rooting, mouth-opening, biting, chewing, lip, tongue, and suckling were examined in 52Persian-speaking monolingual children with spastic cerebral palsy (ages 5-10 yr).Phonetic information tests were administered to investigate their ability for articulation of the speech sounds.

Results

A significant relationship between three (i.e. the chewing, lip, and biting reflexes) out of the seven abnormal oral reflexes and the speech articulation was noticed. The presence of the chewing reflex was associated with deficits in production of /s, z, š,č/ sounds. The lip reflex was associated with deficits in the production of /p, m, r, j, f, č/ sounds. The biting reflex was associated with deficits in the production of /z, l, y and š/ sounds. No significant relationship was found between the rooting, mouth-opening, tongue, and suckling reflexes and sound articulation.

Conclusion

The presence of abnormal reflexes in the children with spastic cerebral palsy would suggest a correlation between these reflexes and sound articulation in Iranian children with spastic cerebral palsy. Hence, these observations might suggest some disturbances in normal speech development. 

References

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How to Cite This Article: Shamsaei F, Cheraghi F, Zamani Ghr. Comparing Mental Health of School-Age Children with and without Epilepsy: A Case Control Study. Iran J Child Neurol. Summer 2016; 10(3):35-41.

Abstract

Objective

Mental health problems frequently occur in children with epilepsy but the diagnosis is frequently missed and therapeutic opportunities are often lost. The aim of this study was to compare mental health statues between school-aged children with epilepsy and the healthy group.

Materials & Methods

In this case, control study, 120 children aged 6 to 12 years with idiopathic epilepsy and 240 healthy control groups were followed up. Children with epilepsy were enrolled from Iranian Epilepsy Association in 2014. The parent version of Child Symptom Inventory-4 questionnaire was used. Mean comparisons were performed using Student’s t test while effect sizes were estimated by Cohen’s d coefficient. The Chi-Square test was used to assess the difference between frequency distribution of demographic variables in both groups. The significance level was considered less than 0.05.

Results

There were statistically significant differences between children with epilepsy and control group as for attention deficit hyperactivity disorder, generalized anxiety disorder, major depression, separation anxiety, social phobia, motor and vocal tics and oppositional defiant disorder.

Conclusion

The carefully evaluating and prospectively following the psychopathology symptom of children with epilepsy are critical for early identification, prevention and treatment.

References

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2. Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics 2002; 129(2):256-264.
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How to Cite This Article: Poor Zamany Nejat Kermany M, Modirian E, Soroush M, Masoumi M, Hosseini M. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) Among Young Landmine Amputees. Iran J Child Neurol. Summer 2016; 10(3):42-47.

Abstract

Objective

To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.

Materials & Methods

All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.

Results

There were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP.

Conclusion

Phantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation.

References

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How to Cite This Article: Poudel P, Chitlangia M, Pokharel R. Predictors of Poor Seizure Control in Children Managed at a Tertiary Care Hospital of Eastern Nepal Iran J Child Neurol. Summer 2016; 10(3):48-56.

Abstract

Objective

Various factors have been claimed to predict outcome of afebrile seizures in children. This study was aimed to find out the predictors of poor seizure control in children at a resource limited setting.

Materials & Methods

This prospective study was done from July 1st, 2009 to January 31st, 2012 at B.P. Koirala Institute of Health Sciences, Nepal. Children (1 month-20 yr of age) with afebrile seizures presenting to pediatric neurology clinic were studied.

Significant predictors on bivariate analysis were further analyzed with binary logistic model to find out the true predictors. Positive predictive values (PPVs) and negative predictive values (NPVs) for the true predictors were calculated.

Results

Out of 256 patients (male: female ratio 3:2) with afebrile seizures followed up for median duration of 27 (IQR 12-50) months, seizure was poorly controlled in 20% patients. Three factors predicted poor seizure control. They were frequent (≥1 per month) seizures at onset (OR 12.76, 95% CI 1.44-112.73, PPV 25%, NPV 98%); remote symptomatic etiology (OR 3.56, 95% CI 1.04-12.17, PPV 36%, NPV 92%); and need of more than one anticonvulsant drug (polytherapy) (OR 12.83, 95% CI 5.50-29.9, PPV 56%, NPV 96%). The strongest predictor was need of polytherapy. When all three factors were present, PPV and NPV for prediction of poor seizure control were 70% and 90% respectively.

Conclusion

Frequent seizures at onset, remote symptomatic etiology of seizure and need of polytherapy were associated with poor seizure control in children with afebrile seizures.

 References

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 How to Cite This Article: Namakin K, Zardast M, Sharifzadeh Gh, Bidar T, Zargarian S. Serum Trace Elements in Febrile Seizure: A Case-Control Study. Iran J Child Neurol. Summer 2016; 10(3):57-60.

Abstract

Objective

Febrile seizure (FS) is one of the most common neurological problems during childhood.Pathogenesis of febrile convulsion is unknown. This study investigated some trace elements among children admitted with FS compared with thoseof febrile without seizure attacks.

Materials & Methods

This case-control study was conducted on48 children (6 months to 5 yr old) diagnosed with febrile seizure as the cases and 48 age-matched febrile children as the control group. Serum levels of magnesium, calcium, sodium, potassium, and serum zinc were measured. Statistical analysis was performed with SPSS (version 15) using Student t-test.

Results

There were no significant differences between the cases and controls in terms of gender or age. The means of serum level of zinc, sodium, calcium and magnesium in the case group was lower than those of the control group. There was no significant difference onserum potassium mean level between the case and control groups.

Conclusion

Deficiency of trace elements was correlated significantly with febrile convulsion, while further investigations on trace elements are required.

References

References

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3. Akbayram S, Cemek M, Büyükben A, Aymelek F, Karaman S, Yilmaz F, Dogan M,Caksen H. Major and minor bio-element status in children with febrile seizure. Bratisl Lek Listy 2012; 113 (7)421 – 423.
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6. Nadkarni J, Binaykiya I, Sharma U, Dwivedi R. Role of serum sodium levels in prediction of seizure recurrence within the same febrile illness.Neurology Asia 2011; 16(3): 195–197.
7. Ganesh R, Janakiraman L. Serum zinc levels in children with simple febrile seizure. Clin Pediatr (Phila) 2008;47:164–166.
8. Waqar Rabbani M, Ali I, Zahid Latif H, Basit A, Rabbani MA. Serum zinc level in children presenting with febrile seizures. Pak J Med Sci 2013;29(4):1008-11.
9. Ehsanipour F, Talebi-Taher M, Harandi N, Kani K. Serumzinc level in children with febrile convulsion and itscomparison with that of control group. Iran J Pediatr2009;65-8.
10. Amiri M, Farzin L, Moassesi ME, Sajadi F. Serum trace element levels in febrile convulsion. Biol Trace Elem Res 2010;135(1-3):38-44.
11. Mohamed Aly IAR, Mohamed Kmal H, Soliman DR, Hassan Mohamed M. Iron profile parameters and serum zinc & copper levels in children with febrile convulsions in Banha. J Am Sci 2014;10(7): 1-4.
12. Gattoo I, Harish R, Quyoom Hussain S. Correlation of serum zinc level with simple febrile seizures: a hospital based prospective case control study. Int J Pediatr 2015;3(2):16-.19.
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How to Cite This Article: Firoozeh Sajedi F, Ahmadi Doulabi M, Vameghi R, Mazaheri MA, Akbarzadeh Baghban AR. Relationship of Mothers’ Psychological Status with Development of Kindergarten Children. Iran J Child Neurol. Summer 2016; 10(3):61-72.

Abstract

Objective

Given the importance of children’s development and the role of psychological status of mothers in this regard, this study investigated the relationship of mothers’ psychological status (stress, anxiety and depression) with the development of children aged 36-60 months.

Materials & Methods

This descriptive study was performed on 1036 mothers and their children, aged 36 to 60 months, in different kindergartens in Tehran City, Iran, in 2014-2015.

Participants were selected through multi-stage random sampling. The following instruments were used in this study: A demographic and obstetric specification questionnaire, children specification questionnaire, the Beck Depression Inventory, Spiel Berger Test, Perceived stress questionnaire and the Ages and Stages Questionnaire to determine the status of the children’s development.

Data were analyzed using SPSS20 software, Mann-Whitney; independent t-test and logistic-Regression model were used.

Results

The prevalence of developmental delay in children aged 36-60 months was 16.2%. The independent t-test showed a relationship between maternal stress and developmental delay in children. The Mann-Whitney test revealed a significant relation between mothers’ depression level and developmental delay in their children. There was a significant relation between trait anxiety and developmental delay in children. Moreover, a significant relation was found between maternal stress and developmental delay in fine motor skills.

The logistic regression model showed a significant relationship of child gender, economic and social states with developmental delay.

Conclusion

This study showed mothers’ psychological status probably is an effective factor in developmental delay. The assessment of mothers’ psychological status is suggested for early interventions.

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How to Cite This Article: Karimzadeh P, Jafari N, Nejad Biglari H, Jabbehdari J, Khayat Zadeh S, Ahmad Abadi F, Lotfi A. Neurometabolic Diagnosis in Children who referred as Neurodevelopmental Delay (A Practical Criteria, in Iranian Pediatric Patients). Iran J Child Neurol. Summer 2016; 10(3):73-81.

Objective

We aimed to investigate the clinical and para clinical manifestations of neuro metabolic disorders, in patients who presented by neuro developmental delay in their neuro developmental milestones.

Materials & Methods

The patients diagnosed as neuro developmental delay and regression with or without seizure at the Neurology Department of Mofid Children Hospital in Tehran, Iran between 2004 and 2014 were included in our study. These patients diagnosed as neuro developmental delay by pediatric neurologists in view of diagnostic /screening neuro developmental assessment tests. The patients who completed our inclusion criteria as neuro metabolic disorders were evaluated in terms of metabolic and genetic study in referral lab.

Results

Overall, 213 patients with neurometabolic disorders were diagnosed. 54.3% of patients were male. The average age of patients was 41 +-46.1 months. 71.4% of parent’s patients had consanguinity of marriages. Eighty seven percent of patients had developmental delay (or/and) regression. 55.5% of them had different type of seizures. Overall, 213 patients with 34 different neurometabolic disorders were diagnosed and classified in the 7 sub classes, consisting of:

1- organic acidemia and aminoacidopathy (122 patients), 2-storage disease (37 patients) 3- eukodystrophy (27 patients), other classes consisted: lipid oxidation disorders, urea cycle disorders, progressive myoclonic epilepsy; and peroxizomal disorders (27 patients).

Conclusion

In patients with developmental delay or regression, with or without seizure, abnormal neurologic exam along with positive family history of similar disorder or relative parents, abnormal brain imaging with specific patterns, neurometabolic disorders should be considered as one of the important treatable diseases.

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How to Cite This Article: Oz II, Bozay Oz E, Şerifoğlu I, Kaya N, Erdem O. Cerebellar Infarction in Childhood: Delayed-Onset Complication of Mild Head Trauma. Iran J Child Neurol. Summer 2016; 10(3):82-85.

Objective
Cerebellar ischemic infarction is a rare complication of minor head trauma. Vertebral artery dissection, vasospasm or systemic hypo perfusion can cause infarct. However, underlying causes of the ischemic infarct cannot be explained in nearly half of cases. The accurate diagnosis is essential to ensure appropriate treatment. Here we report a five yr old boy patient of cerebellar infraction after minor head trauma, admitted to emergency serves of Bulent Ecevit University, Turkey in 2013. We aimed to remind minor head trauma that causes cerebellar infarction during childhood, and to review the important points of the diagnosis, which should be keep in mind.

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How to Cite This Article: Gunawan PI, Lusiana L, Saharso D. Hemispherectomy Procedure in Proteus Syndrome. Iran J Child Neurol.Summer 2016; 10(3):86-90

Objective

Proteus syndrome is a rare overgrowth disorder including bone, soft tissue, and skin. Central nervous system manifestations were reported in about 40% of the patients including hemimegalencephaly and the resultant hemicranial hyperplasia, convulsions and mental deficiency. We report a 1-month-old male baby referred to Pediatric Neurology Clinic Soetomo Hospital, Surabaya, Indonesia in 2014 presented recurrent seizures since birth with asymmetric dysmorphic face with the right side larger than the left, subcutaneous mass and linear nevi. Craniocervical MRI revealed hemimegalencephaly right cerebral hemisphere. Triple antiepileptic drugs were already given as well as the ketogenic diet, but the seizures persisted. The seizure then was resolved after hemispherectomy procedure.

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