Iranian Journal of Child Neurology
Year:2015 | Volume:9 | Issue:4|Papers Count:12

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.

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.

Diagnosis of abnormal fontanel size, a potential clue to recognition of differentdisorders, requires an understanding of the wide variation of normal fontanelsize. The anterior fontanel is the largest, prominent and most important forclinical evaluation. The aim of this study was to establish and define normalrange of fontanel size from birth to 24 months of age in healthy Iranian childrenthat might be generalized to other populations.Materials & MethodsTotally, 550 subjects enrolled randomly in this cross sectional study. They wereapparently normal healthy children, from birth to 24 months of age, including208-term newborn and 342 infant from birth to 2 yr old. Fontanel size wasmeasured and recorded as the mean of the length (anterior- posterior dimension)and width (transverse dimension). Mean anterior fontanel sizes in our sampleswere classified for periods of 3 months. Nomograms and statistical analyseswere performed and depicted by Excel Microsoft Office 2007 and two-tailedt-test respectively.ResultsThe 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 15-18months of age. The mean posterior fontanel size was 0.8 cm in newborns andclosed in all infants in 2 months of age. There was no significant difference inanterior fontanel size between two genders except in newborn and 6-9 monthsold (P>0.05).ConclusionAbnormal fontanel can indicate a serious medical condition. Therefore, it isimportant to understand normal variations, to utilize standardized techniques formeasurement and appropriate standards of normal range in different age groupsand populations. This study provides a normal range of mean fontanel size inIranian infants as a local reference. It might be generalized to other populations.

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.

ObjectiveEpilepsy is a disorder of the brain characterized by an enduring predispositionto generate seizures. Infectious agents are mentioned in its etiology. Withidentifying and appropriate treatment of these infectious agents, preventing theirsecondary outcomes, including seizure is possible. This study was conductedto determine frequency of anti-Toxoplasma antibodies (IgG, IgM) and anti-Toxocara antibody (IgG) in epileptic patients.Materials & MethodsStudy sample consisted of 141 epileptic patients and 144 healthy people. Afterobtaining informed consents and completing demographic questionnaire, serumsamples were taken from participants. The diagnostic test of Toxoplasma IgG & IgM and Toxocara antibodies was performed under the same conditions usingELISA method in a qualified private laboratory. Samples from patients andcontrol groups with positive ELISA test in terms of anti-Toxocara antibody werealso used for confirmatory Western blot test.ResultAccording to ELISA results, 28 (19.85%) epileptic patients and 2 (1.38%) ofhealthy people had anti-Toxocara antibodies (P<001), while 39 (30.46%) of thecontrol group people and 14.18% of patients had anti-Toxoplsma antibodies(P=0.001).ConclusionFrequency of anti-Toxoplasma gondii is lower in epileptic than healthy individualsand this result is contrary to investigations that have reported higher levels ofthis antibody in such patient groups. ELISA results for Toxocara showed thatthe frequency of anti-Toxocara antibody in epileptic patients might empower theprobability that this parasite may cause central nervous system damage. Westernblotting has high specificity and is a proper confirmative method for diagnosisof toxocariasis.

Prevalence of neonatal stroke has been reported 1/2300-1/4000 live births andaccounts for 12-20% of the cases of neonatal seizures. Although stroke has beenintroduced as the second cause of the neonatal seizures in literatures, it mayremain unclear in diagnostic evaluations of seizure in neonates. This study wasperformed to assess the prevalence of stroke in neonates with seizure.Materials & MethodsIn this cross-sectional study, all neonates ≥ 28 weeks of gestation with a diagnosisof seizures admitted to the NICU of Boo-Ali Sina Hospital in Sari, north ofIran, were enrolled. Brain CT scan and a Transcranial Doppler ultrasonographywere performed for the all cases. In cases that stroke were reported in one ortwo above modalities, an MRI was also performed and prevalence of strokewas reported. Putative risk factors of stroke were analyzed with univariate andmultivariate statistical methods.ResultsFrom 174 newborn infants, 75.3% of neonates were male. Prevalence of strokewas 8%, 2.3% and 3.4% in Doppler ultrasonography, CT scan and MRI reportsrespectively. Umbilical venous catheterization was the risk factor of stroke inthe 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%) inneonates with stroke.ConclusionInvestigation of stroke as an etiology of neonatal seizures is essential becauseseizure may be the only symptom of neonatal cerebral infarction. Dopplerultrasonography can be a valuable diagnostic tool at first in critically ill neonatesor in situations that MRI is not available primarily. Further studies with notice tooutcome assessment of these infants recommended.

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.

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.

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.

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.

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.

Objective Essential Palatal Tremor (PT) is a disorder in which radiological brain images appear normal but the clicking noise caused by peritubal, palatal muscle contractions remains the main complaint of patients. The condition occurs rarely in childhood. This paper demonstrates such a rare case with bilateral presentation of essential PT in a 12-yr-old girl could successfully be treated with botulinum toxin therapy at Otorhinolaryngology Department in 2013, as she was still asymptomatic after 16 months. Besides, being minimally invasive with negligible side effects, this choice of treatment with botulinum toxin A (BTA) leads to a long-term symptom free outcome from essential PT.