Iranian Journal of Child Neurology

Headache is one of the most common reason that children are referred to the Pediatric Neurology Services. It is said that ten percent of children aged 5 to 15 years have migraine.

Subsequently, it is essential for clinician to have a through, comprehensive and systematic approach to the evaluation and management of the child or adolescent who complain of headache.

This writing aims to explore the symptoms of headache, its epidemiology, classification, appropriate evaluation, differential diagnosis and management.

Headaches are divided into primary and secondary categories. Migraine and tension type headaches are prototype of primary headaches without underlying pathology. On the other hand, the type of headache which stems from organic diseases such as: brain tumor, increased intracranial pressure, systemic disease, drug toxicity or Ear Nose  and Throat problems are considered secondary.

 On the whole, the majority of children with primary headache have two patterns of headache. One is a chronic low-grade and the other is an intermittent disabling headache. The cause of the former is either caffeine or analgesic abuse, and the latter is predominantly migraine.

Traditionally, if a child presents himself with chief complain of headache, care taker physician begins with history taking followed by thorough physical and neurological examinations.

In the majority of the cases, this initial process leads to a diagnosis or indicate the need for further testing.

Once the diagnosis is made, a management program can be put into place.

Key words: Headaches, Child,  Children, Migraine. 

Objective

Nocturnal enuresis is a common childhood problem and has various  treatments.

This study was carried out to compare oral and nasal vasopressin in the treatment of nocturnal enuresis in 5- to 12-year-old children who were referred to the Shahid Beheshti Clinic in 2008.

Materials & Methods

This study included 100 children (62 males and 38 females) with nocturnal enuresis. One group (50 patients) received 20 mcg nasal vasopressin which increased up to 40 mcg, depending on the patients' response. The other group (50 patients) received 0.2 mg oral vasopressin which increased up to 0.4 mg.

The patients were followed up for one month after response to the last dose of drug. Data were recorded in prepared forms and analyzed using Chi-Square and Fisher Test.

Results

The success rate with oral and nasal method was 80% and 92%, respectively (P=0.08). Only 2% of the children had complications during the treatment; one child treated orally developed gastroenteritis and another child treated with the nasal method developed convulsions (P=1). Sixteen percent of the children treated with the oral method and 28% of the children treated with the nasal method had recurrence (P=0.148).

Conclusion

Oral and nasal forms of vasopressin have equal therapeutic effects. However, oral form of the treatment has fewer serious side effects and is easier to use. Therefore, the use of oral medicine is recommended.

Objective

To determine the changes in thyroid function tests in children who underwent antiepileptic therapy in Shahid Beheshti Hospital, Kashan, in 2008.

Materials & Methods

This analytical-observational study was carried out in a cohort fashion without an external control group (self controlled) on 45 children with new onset epilepsy who had not been previously treated with antiepileptic medications. Three subjects were excluded from the study because of presenting clinical symptoms of hypothyroidism. Plasma levels of TSH, T3, FT3, T4 and FT4 hormones were measured and compared at baseline and 3 and 6 months after treatment.

Results

The results of Mann-Whitney statistical analysis suggested that the increase in the plasma level of TSH was significant only in the Sodium Valproate group.

The plasma level of T3 significantly decreased 3 and 6 months after treatment in the Phenobarbital group while the plasma level of FT3 significantly decreased only in the Sodium Valproate group. The decrease in T4 plasma level was significant in all groups (Carbamazepine group, Sodium Valproate group and Phenobarbital group) 3 and 6 months after the onset of treatment but the decreasing in FT4 plasma level was only significant in the Carbamazepine group 6 months after the commencement of treatment.

Conclusion

Phenobarbital had the least effect on thyroid hormones. Considering the effect of such medications on thyroid function tests, it seems necessary to check the plasma levels of hormones periodically after beginning the treatment.

Objective

Febrile seizure is the most common seizure disorder in children. Its pathophysiology is not fully understood yet; however, some risk factors have been cited for it. Iron is one of these influential elements and is involved in the metabolism of some neurotransmitters which are reduced in irondeficiency anemia and also increases the sensitivity of neural cells during a febrile episode. The present study aimed to determine the rate of febrile seizure in thalassemic patients and to compare it with the corresponding rate in the normal population.

Materials & Methods

This descriptive cross-sectional study was conducted on 766 patients with thalassemia major. They were all older than 6 months and were referred to Dastghaib Cooly's Clinic, affiliated to Shiraz University of Medical Sciences, from Oct 2006 to May 2007, and 766 normal and healthy children as the control group. Questionnaires containing demographic data and past history of febrile seizure, age of febrile seizure, number of episodes, hospitalization, and related family history were prepared and filled through interviewing the parents.

Results

Febrile seizure was detected in 7 cases of the patient group (0.9%) versus 18 cases (2.3%) of the control group. The frequency of febrile seizure in the controls was 2.5 times more than that in the thalassemia group, which was statistically significant (P < 0.05).

Conclusion

This study showed a lower rate of febrile convulsion in thalassemic patients compared to the control group. Accordingly, it could be suggested that high iron storage is a protective factor against febrile convulsion.

Objective

Febrile seizure is the most common convulsive disorder in childhood. The role of iron in metabolism of neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron deficiency anemia and febrile seizures.

The aim of this study was to investigate the relationship between iron deficiency anemia and febrile seizures.

Materials & Methods

This case - control study was performed on 132 cases and 88 controls, aged 9 months to 5 years, from July 2007 to June 2009 in Baqyiatallah Hospital. Patients were selected using simple random sampling. The case group included children with first febrile seizure (core temperature over 38.5˚C during  seizure) without a central nervous system infection or an acute brain insult. The control group included children suffering from a febrile illness without seizure. Iron deficiency anemia was defined with one of these laboratory indexes: 1) Hemoglobin (Hb) <10.5mg/dl 2) Plasma ferritin <12ng/dl 3) Mean corpuscular volume (MCV) <70  fl. The data collected from patients were analyzed with SPSS.13 software.

Results

Low plasma ferritin was found in 35 cases (26.5%) compared to 26 controls (29.5%), low Hb level was found in 4 cases (3%) compared to 6 controls (6.8%) and low MCV was found in 5 cases (3.8%) compared to 6 controls (6.8%).

There was no significant difference in plasma ferritin , Hb level and MCV indices between the two group.

Conclusion

Considering the above-mentioned results, there is no relationship between iron deficiency anemia and febrile seizures.

Objective

This study was planned to compare the effects of neurodevelopmental treatment and sensory integration therapy on gross motor function in children with cerebral palsy

Materials & Methods

Twenty two children with spastic CP were randomly divided into two groups. Sensory integrative therapy was given to the first group (n=11), and neurodevelopmental treatment was given to the second group (n=11). All children were evaluated with GMFM-88. Treatment was scheduled for three - one hour sessions per week for 3 months.

Results

Twenty two children with spastic CP (11 diplegia and 11 quadriplegia) participated in this study. When two groups were compared, a significant difference was found in lying and rolling (P=0.003), sitting  (0.009), crawling and kneeling (0.02) and standing ability (P=0.04). But there was no significant difference in walking, running, and jumping abilities between the two groups (0.417). Paired t-tests revealed a significant difference between pre and post test results, with increases in scores of lying and rolling, sitting, crawling and kneeling, standing in sensory integration therapy (SIT) and neurodevelopmental treatment (NDT) approaches.

Conclusion

 Neurodevelopmental treatment and sensory integration therapy improved gross motor function in children with cerebral palsy in four dimensions (lying and rolling, sitting, crawling and kneeling, standing). However, walking, running and jumping did not significantly improve.

Objective

Hyperextension of the big toe is described here as a simple and reliable sign to predict undercorrection of cavus deformity of clubfoot in the Ponseti Method.

Materials & Methods

This retrospective study was conducted on children with clubfoot who were treated successfully by Ponseti Method in the King Fahad Hospital, Saudi Arabia, and Emam Reza Hospital, Mashad, Iran, from 2003 through 2008. The total number of the patients in our study was 191, with 306 affected feet. Of them, 115 children had bilateral clubfeet (230 feet) and 76 had unilateral clubfoot.

There were 119 males and 72 females. Hyperextension of the big toe at MTPJ was present in five cases of clubfoot. The average follow-up period was 20 months (range: 8-38 months).

Results

The authors observed that hyperextension of big toe at MTPJ had a linear relationship with the severity of cavus deformity of clubfoot. On the other hand, the big toe had a normal relationship with other toes after satisfactory treatment of the initial or relapsed cavus deformity by Ponseti Method.

Conclusion

Hyperextension of the big toe at MTPJ can be regarded as a reliable prognostic sign for detecting the severity, correction, and the number of castings needed for cavus deformity correction in clubfoot treatment in the Ponseti Method.

Objective

Proteus Syndrome is an extremely rare, sporadic and progressive disorder. We describe a four-month-old male baby with central nervous system manifestations in this article.

Clinical presentation

A four-month-old boy was admitted into our hospital with three tonic - clonic generalized seizure attacks which started from the day before admission. Each seizure attack lasted less than 10 minutes and the baby was well between attacks. No fever was detected. On physical examination, abnormal facial features, macrocrania, a wide nasal bridge, overgrowth of the right lower limb, macrodactyly in the third left toe, epidermal nevus on the left side of the abdomen and skin vascular abnormalities were detected. His developmental status was normal. Brain Magnetic Resonance Imaging (MRI) revealed left sided hemihypertrophy, ventricle enlargement and macrocrania on the same side.

Rabson-Mendenhall syndrome is a rare genetic disorder characterized by growth retardation, dysmorphisms, lack of subcutaneous fat, acanthosis nigricans, enlarged genitalia, hirsutism, dysplastic dentition, coarse facial features, paradoxical fasting hypoglycemia, postprandial hyperglycemia, extreme hyperinsulinemia and pineal hyperplasia. Herein, we described a 10- year-old girl with physical features of the Rabson-Mendenhall syndrome that was presented with polyuria. To our knowledge, this is the first report of the Rabson-Mendenhall syndrome from Iran.