Effectiveness of Neurogenesis in treating Children with Cerebral Palsy

Susan AMIRSALARI, Leila DEHGHAN, Hamid DALVAND, Hojjat Allah HAGHGOO

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 1-8
https://doi.org/10.22037/ijcn.v6i2.3303

How to Cite this Article: Amirsalary S, Dehghan L, Dalvand H, Haghgoo H. Effectiveness of Neurogenesis in treating children with Cerebral Palsy. Iran J Child Neurol 2012;6(2):1-8.

 

objective

Tissue-specific stem cells divide to generate different cell types for the purpose oftissue repair in the adult. The aim of this study was to detect the significance ofneurogenesis in the central nervous system in patients with cerebral palsy (CP).

Materials & Methods

A search was made in Medline, CINAHL, PubMed, ISI Web of Science andGoogle Scholar from 1995 to February 2011. The outcomes measured in thereview were classified to origins, proliferation, and migration of new neurons,and neurogenesis in CP.

Results

According to the review of articles, neurogenesis persists in specific brainregions throughout lifetime and can be enhanced from endogenous progenitorcells residing in the subventricular zone by growth factors or neurotrophicfactors and rehabilitation program.

Conclusion

Most of the studies have been conducted in the laboratory and on animals,more work is required at the basic level of stem cell biology, in the developmentof human models, and finally in well-conceived clinical trials.

 

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Psychiatric Aspects of Childhood Epilepsy

Raman Deep PATTANAYAK, Rajesh SAGAR

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 9-18
https://doi.org/10.22037/ijcn.v6i2.3304

How to Cite this Article: Pattanayak RD, Sagar R. Psychiatric Aspects of Childhood Epilepsy. Iran J Child Neurol 2012;6(2):9-18.

Childhood epilepsy is a chronic, recurrent disorder of unprovoked seizures. Theonset of epilepsy in childhood has significant implications for brain growth anddevelopment. Seizures may impair the ongoing neurodevelopmental processes and compromise the child’s intellectual and cognitive functioning, leading totremendous cognitive, behavioral and psychosocial consequences. Children with epilepsy are at increased risk for emotional and behavioral problems. In addition to the direct effects of epilepsy, there are multiple contributory factors including the underlying neurological abnormalities and adverse effects of medication. This review discusses the current understanding of various psychiatric aspects of childhood epilepsy, including the neuropsychological, behavioral and psychosocial concomitants of childhood epilepsy.

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Posterior Fossa Tumor in Children

Seyed Mahmoud TABATABAEI, Afsoun SEDDIGHI, Amir Saied SEDDIGHI

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 19-24
https://doi.org/10.22037/ijcn.v6i2.3305

How to Cite this Article: Tabatabaei SM, Seddighi A, Seddighi AS. Posterior Fossa Tumor in Children. Iran. J. Child. Neurol 2012;6(2): 19-24.

 

Objective

Primary brain tumors are the most common solid neoplasms of childhood, representing 20% of all pediatric tumors. The best current estimates place the incidence between 2.76 and 4.28/100,000 children per year. Compared with brain tumors in adults, a much higher percentage of pediatric brain tumors arise in the posterior fossa. Infratentorial tumors comprise as many as two thirds of all pediatric brain tumors in some large series. Tumor types that most often occur in the posterior fossa include medulloblastoma, ependymoma, cerebellar astrocytoma and brainstem glioma.

Materials & Methods

All pediatric cases of posterior fossa tumor that were considered for surgery from 1981 to 2011 were selected and the demographic data including age, gender and tumor characteristics along with the location and pathological diagnosis were recorded. The surgical outcomes were assessed according to pathological diagnosis.

Results

Our series consisted of 84 patients (52 males, 32 females). Cerebellar symptoms were the most common cause of presentation (80.9%) followed by headache (73.8%) and vomiting (38.1%). The most common histology was medulloblastoma (42.8%) followed by cerebellar astrocytoma (28.6%), ependymoma (14.3%), brainstem glioma (7.2%) and miscellaneous pathologies (e.g., dermoid,  andtuberculoma) (7.2%).

Conclusion

The diagnosis of brain tumors in the general pediatric population remains challenging. Most symptomatic children require several visits to a physician before the correct diagnosis is made. These patients are often misdiagnosed for gastrointestinal disorders. Greater understanding of the clinical presentation of these tumors and judicious use of modern neuroimaging techniques should lead to more efficacious therapies.

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21. Griwan MS, Sharma BS, Mahajan RK, Kak VK. Value of precraniotomy shunts in children with posterior fossa tumours. Childs Nerv Syst 1993 Dec;9(8):462-5.

22. Raimondi AJ, Tomita T. Hydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment. J Neurosurg 1981 Aug;55(2):17482.

23. Jamjoom AB, Jamjoom ZA, al-Rayess M. Intraventricular and leptomeningeal dissemination of a pilocytic cerebellar astrocytoma in a child with a ventriculoperitoneal shunt: case report Br J Neurosurg. 1998 Feb;12(1):568.

24. Vaquero J, Cabezudo JM, de Sola RG, Nombela L. Intratumoral hemorrhage in posterior fossa tumors after ventricular drainage. Report of two cases. J Neurosurg 1981 Mar;54(3):406-8.

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26. Hirsch J, Renier D, Czernichow P, Benveniste L, PierreKahn A. Medulloblastoma in childhood: survival and functional results. Acta Neurochir 1979;48:1-15.

27. Abdollahzadeh-Hosseini SM, Rezaishiraz H, Allahdini F. Acta Medica Iranica 2006;44(2):89-94.

 

Is Interictal EEG Correlated with the Seizure Type in Idiopathic (Genetic) Generalized Epilepsies?

Ali Akbar ASADI-POOYA, Mehrdad EMAMI

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 25-28
https://doi.org/10.22037/ijcn.v6i2.3306

How to Cite this Article: Asadi-pooya AA, Emami M. Is Interictal EEG Correlated with the Seizure Type in Idiopathic (Genetic) Generalized Epilepsies? Iran J Child Neurol 2012;6(2): 25-28.

 

Objective

We investigated the correlation between different interictal EEG abnormalities observed in patients with idiopathic (genetic) generalized epilepsies (IGEs) and their seizure types.

Material & Methods

In this cross-sectional study, all patients with the diagnosis of IGE, were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 through 2010. Demographic variables and relevant clinical and EEG variables were summarized descriptively. Statistical analyses were performed using independent samples T-test, Chi square and Fisher's Exact tests to determine potentially significant differences.

Results

Three-hundred thirty-six patients were diagnosed ashaving IGE. Interictal EEG findings in patients with generalized tonic-clonic seizure (GTCS) compared to patients without GTCS were not different. Abnormal EEG findings in patients with myoclonic seizures compared to patients without these were not different either. However, normal EEGs were more frequently observed in patients with history of myoclonic seizures (P = 0.0001). EEG findings in patients with absences compared to patients without absences were not different.

Conclusion

Interictal EEG cannot differentiate the seizure types and therefore different syndromes of IGEs. Polyspikes, 3-Hz generalized spike-wave (GSW) complexes and 3.5 - 6 Hz GSW complexes, alone or in combinations, could be observed in various seizure types and syndromes of IGE. The key element in making the correct diagnosis is a detailed clinical history.

 

References

  1. Panayiotopoulos CP. Idiopathic generalized epilepsies. In: Panayiotopoulos CP, editor. The epilepsies: seizures, syndromes and management. Oxford: Bladon Medical Publishing 2005. p. 271-348.
  2. Lagerlund TD, Cascino GD, Cicora KM, Sharbrough FW. Long-term electroencephalographic monitoring for diagnosis and management of seizures. Mayo Clin Proc 1996 Oct;71(10):1000-6.
  3. Betting LE, Mory SB, Lopes-Cendes I, Li LM, Guerreiro MM, Guerreiro CA et al. EEG features in idiopathic generalized epilepsy: clues to diagnosis. Epilepsia 2006 Mar;47(3):523-8.
  4. Yenjun S, Harvey AS, Marini C, Newton MR, King MA, Berkovic SF. EEG in adult-onset idiopathic generalized epilepsy. Epilepsia 2003 Feb;44(2):252-6.
  5. Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001;42(9):1212-8.
  6. Engel J Jr. A proposed diagnostic scheme for people with epileptic seizures and epilepsy: report of the ILAE task force on classification and terminology. Epilepsia 2001 Jun;42(6):796-803.
  7. Engel J. Jr. Report of the ILAE Classification Core Group. Epilepsia 2006 Sep;47(9):1558-68.
  8. Asadi-Pooya AA, Emami M. Effects of antiepileptic drugs on electroencephalographic findings in patients with idiopathic generalized epilepsies. Iran J Child Neurol 2011;5(4):33-6.
  9. Asadi-Pooya AA, Emami M, Nikseresht A. Early-onset versus typical childhood absence epilepsy; clinical and electrographic characteristics. Seizure 2012;21:273-5.
  10. Nordi DR. Idiopathic generalized epilepsies recognized by the International League Against Epilepsy. Epilepsia 2005;46(Suppl. 9):48-56.
  11. Panayiotopoulos CP. Syndromes of idiopathic generalized epilepsies not recognized by the International League Against Epilepsy. Epilepsia 2005;46(Suppl. 9):57-66.
  12. Asadi-Pooya AA, Sperling MR. Choices of antiepileptic drugs based on specific epilepsy syndromes and seizure types. In: Asadi-Pooya AA, Sperling MR. Antiepileptic Drugs: A Clinician’s Manual. Oxford, UK: Oxford University Press; 2009. p. 95-102.

 

 

Evaluation of Developmental Delay in Infants Who Came in for 6th Month Vaccination in Isfahan City Health Centers

Omid YAGHINI, Farzaneh DANESH, Touran MAHMOUDIAN, Babak BEIGI, Shiva EBRAHIMIAN

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 29-32
https://doi.org/10.22037/ijcn.v6i2.3307

How to Cite this Article: Yaghini O, Danesh F, Mahmoudian T, Beigi B. Evaluation of Developmental Delay in Infants Who Came in for 6th Month Vaccination in Isfahan City Health Centers. Iran J Child Neurol 2012;6(2): 29-32.

 

Objective

Developmental delay is one of the most common causes of conferring the pediatric neurologist. The main part of neurological growth and development occur in the first two years especially in the first 6 months of life. Metabolic or skeletal diseases are important causes of developmental delay. Early diagnosis of deviance from the normal diagram of development in lower ages is important.

Materials & Methods

Specific ages and stages questionnaires (ASQ) for 6 months was completed in the health centers for 800 infants conferring for their vaccination in Isfahan and the retest was performed at 24 months of age by ASQ and then these two questionnaires were compared.

Results

10.5% of the infants were delayed in at least one domain. At 24 months, 38.4% of them remained delayed; 21.1% in one domain, 9.6% in two domains, 3.8% in four domains and 3.8% in five domains. Of the children who had problem in communication, 20%; in gross motor, 25%; in fine motor, 20%; and in problem solving, 30% remained delayed. In the personal social domain, none of the delayed children at 6 months remained delayed at 24 months.

Conclusion

ASQ is feasible, inexpensive, easy to use and was appreciated by the parents. It can be used as a screening test for detection of developmental delay in lower ages, but its results must be followed by other standard tests or diagnostic tools.

References

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  8. Lindsay NM, Healy GN, Colditz PB, Lingwood BE. Use of the Ages and Stages Questionnaire to predict outcome after hypoxic–ischemic encephalopathy in the neonate. J
  9. Pediatr Child Health 2008; 44(10):590-5.
  10. Yu LM, Hey E, Doyle LW, Farrell B, Spark P, Altman DG et al. Evaluation of the Ages and Stages Questionnaires in identifying children with neurosensory disability in the Magpie Trial follow-up study. Acta Paediatr 2007;96(12):1803-8.

10.  Squires J, Bricker D, Potter L. Revision of a parent completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol. 1997;22(3):313-28.

11.  Glascoe FP. Screening for developmental and behavioral problems. Ment Retard Dev Disabil Res Rev 2005;11(3):173-9.

12.  Richter J, Janson H. A validation study of the Norwegian version of the Ages and Stages Questionnaires. Acta Paediatr 2007;96(5):748-52.

13.  Shashani S, Vameghi R, Azari N, Sajedi F, Kazemnejad A. Comparing the results of developmental screening of 4-60 months old children in Tehran using ASQ & PDQ.

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14.  Shashani S, Vameghi R, Azari N, Sajedi F, Kazemnejad A. Validity and reliability determination of Denver developmental screening test- II in 0-6 years old in Tehran. Iran J Pediatr. 2010;20(3):313-22.

15.  Jorina E, Andrew M, Elaine M, Faitb G. The Age and Stage Questionnaires: feasibility of use as a screening tool for children in Canada. Can Rural Med. 2008; 13(1):9-14.

16.  Gollenberg AI, Lynch CD, Jackson LW, Guinness BM, Msall ME. Concurrent validity of the parent-completed Ages and Stages Questionnaires, 2nd Ed. with the Bayley Scales of Infant Development IIin a low risk sample.Child Care Health Dev 2010;36(4):485-90.

 

Migraine Types and Triggering Factors in Children

Habibe NEJAD BIGLARI, Parvaneh KARIMZADEH, Marzieh MOHAMMADI KORDKHEYLI, Seyedeh Masumeh HASHEMI

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 33-38
https://doi.org/10.22037/ijcn.v6i2.3308

How to Cite this Article: Nejad Biglari H, Karimzadeh P, Mohammadi Kord-kheyli M, Hashemi SM. Migraine Types and Triggering Factors in Children. Iran J  Child Neurol 2012;6(2):33-38.

Objective

Migraine is a common problem in children and the mean prevalence of migraine in Europe among 170,000 adults was 14.7% (8% in men and 17.6% in women) and in children and youth (36,000 participants), the prevalences were (9.2% for all, 5.2% in boys and 9.1% in girls) and the lifetime prevalences were (16, 11 and 20%, respectively).

To determine the epidemiology of migraine and evaluate migraine triggering factors in children.

Materials & Methods

Two-hundred twenty-eight children with a maximum age of 12 years who fulfilled the ICHD-II criteria for pediatric migraine were enrolled into the study.

Results

This study shows that migraine is slightly more common in boys and its peak incidence is between ages 8 and 12 and most patients have three to five headache attacks per month. The pain has a tightening, stabbing or vague quality in about 70% of children with migraine and bilateral headache is slightly more common. The common triggering factors in children migraine were stress, noise, sleeplessness, hunger and light and the common relieving factors were sleep, analgesics, silence, darkness and eating.

Conclusion

Migraine is a common problem in children with an equal incidence in boys and girls before adolescence and more common in girls after adolescence.

 

References

  1. Powers SW, Andrasik F. Biobehavioral treatment, disability, and psychological effects of pediatric headache. Pediatr Ann 2005;34(6):461-5.
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  3. Fallahzadeh H, Alihaydari M. Prevalence of migraine and tension-type headache among school children in Yazd, Iran. J Pediatr Neurosci 2011;6(2):106-9.
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Efficacy and Safety of Intravenous Sodium Valproate in Convulsive Status Epilepticus in Children in Shahid Sadoughi Hospital

Razieh FALLAH, Yaser YADEGARI, Mahdi SALMANI NODOUSHAN

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 39-44
https://doi.org/10.22037/ijcn.v6i2.3309

How to Cite this Article: Fallah R, Yadegari Y, Salmani Nodushan M. Efficacy and Safety of Intravenous Sodium Valproate in Convulsive Status Epilepticus in Children in Shahid Sadoughi Hospital. Iran. J. Child. Neurol 2012;6(2):39-44.

 

Objective

Status epilepticus (SE) is the most common pediatric neurologic emergency with high mortality and morbidity. There is no consensus on the drug of choice in the treatment of children. The purpose of this study was to evaluate the clinical efficacy and safety of intravenous sodium valproate as a third-line drug in the treatment of generalized convulsive SE of children.

Materials & Methods

In a retrospective study, medical records of those children who were admitted to Shahid Sadoughi Hospital of Yazd due to refractory generalized convulsive SE and were treated by intravenous sodium valproate as a third-line drug from 2009 to 2011 were evaluated.

Results

Six girls and five boys with a mean age of 5.12 ± 1.2 years (range: 3 - 9.6 years) were evaluated.

Intravenous valproate was effective for cessation of seizures in seven patients (63.6 %). The mean dose of valproate for stopping seizures was 27.1 ± 1.4 mg/kg/day.

Children whose seizures were controlled by sodium valproate were older than non- responsive children (mean± SD: 4.8 ± 1.2 years vs. 3.1 ± 0.43 years, p= 0.03) and they also had shorter ICU stay days (mean± SD: 2.6 ± 1.4 days vs. 5.6 ± 2.8 days, p= 0.01).

Two children had mild and transient nausea and vomiting. None of them had cardiopulmonary or severe paraclinical side effects.

Conclusion

Intravenous sodium valproate may be used as an effective and safe third-line antiepileptic drug in the treatment of pediatric generalized convulsive status epilepticus.

References

  1. Raj D, Gulati S, Lodha R. Status epilepticus. Indian J Pediatr 2011;78(2):219-26.
  2. Shearer P, Riviello J. Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols. Emerg Med Clin North Am 2011;29(1):51-64.
  3. Mikati MA. Status epilepticus. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE. Nelson textbook of pediatrics. 19th ed. Philadelphia: Saunders; 2011. P. 2013-7.
  4. Nair PP, Kalita J, Misra UK. Status epilepticus: Why, what, and how. J Postgrad Med 2011;57(3):242-52.
  5. Saz EU, Karapinar B, Ozcetin M, Polat M, Tosun A, Serdaroglu G et al. Convulsive status epilepticus in children: etiology, treatment protocol and outcome. Seizure 2011;20(2):115-8.
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  7. Shiloh-Malawsky Y, Fan Z, Greenwood R, Tennison M. Successful treatment of childhood prolonged refractory status epilepticus with lacosamide. Seizure 2011;20(7):586-8.
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  9. Chang YC, Lin JJ, Wang HS, Chou ML, Hung PC, Hsieh MY. Intravenous valproate for seizures in 137 Taiwanese children - valproate naive and non-naive. Acta Neurol Taiwan 2010;19(2):100-6.
  10. Wheless JW, Vazquez BR, Kanner AM, Ramsay RE, Morton L, Pellock JM. Rapid infusion with valproate sodium is well tolerated in patients with epilepsy. Neurology 2004;63(8):1507-8.
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  15. Misra UK, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilepticus: A pilot study. Neurology 2006;67(2):340-2.
  16. Kwan SY. The role of intravenous valproate in convulsive status epilepticus in the future. Acta Neurol Taiwan 2010;19(2):78-81.
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Seizure is a rare presentation for acute hemolysis due to G6PD deficiency.

We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD) and probably secondary methemoglobinemia, following the ingestion of fava beans.

A Novel Mutation of GDAP1 Associated with Charcot-Marie-Tooth Disease in An Iranian Family

Esmaeel MOHAMMADI PARGOO, Omid ARYANI, Seyyed Hassan TONEKABONI, Behnam KAMALIDEHGHAN, Massoud HOUSHMAND

Iranian Journal of Child Neurology, Vol. 6 No. 2 (2012), 30 June 2012 , Page 49-54
https://doi.org/10.22037/ijcn.v6i2.3311

As a result of higher distributed consanguinity in the Mediterranean region and the Middle East, autosomal-recessive forms of Charcot-Marie-Tooth (ARCMT) are more common in these areas. CMT disease caused by mutations in the ganglioside-induced differentiation-associated protein 1 (GDAP1) gene is a severe autosomal recessive neuropathy resulting in either demyelinating CMT4A neuropathy or axonal neuropathy with vocal cord paresis. The patient was an 8-year-old boy with AR inheritance that showed some delayed achievement of motor milestones, including walking, also bilateral foot drop, wasting of distal muscles in the legs, pes cavus and marked weakness of the foot dorsiflexors. He had no hoarseness or vocal cord paralysis. Total genomic DNA was extracted from whole peripheral blood of the patient and his family by using standard procedures. PCR- sequencing method were used to analysis the whole coding regions of the GDAP1 gene. A novel homozygote insertion of T nucleotide in codon 34 was detected (c.100_101insT) that probably led to an early stop codon. This mutation may be associated with a common haplotype, suggesting a common ancestor that needs further investigation in the Iranian population.