Iranian Journal of Child Neurology
Year:2017 | Volume:11 | Issue:4|Papers Count:13

Objective: Baby walkers are used all around the world as fun equipment without any dangers. In contrast with public beliefs, some researchers have claimed they can cause developmental delay. We aimed to investigate their effect on child development through a systematic review.Materials & Methods: We searched PubMed, Google Scholar, EMBASE, and Scopus for related articles in English and included all study designs. All articles, which fulfilled the inclusion criteria, were included without considering the year of publication.Results: Of 315 articles found in PubMed, 1630 citations in Google Scholar, 18 articles in EMBASE, and 38 papers in Scopus, only 9 articles fulfilled the inclusion criteria. Among them, a cohort study and two cross-sectional studies reported developmental delay in thaspects in baby walker users. Other studies including clinical trials did not show any developmental delay in these children.Conclusion: Evidence against baby walker is not enough regarding its negative effect on child development. This subject needs to be addressed more, considering a large number of baby walker users worldwide.

Objective: Duchenne muscular dystrophy (DMD) is one of the mortal diseases, subjected to study in terms of molecular investigation. In this study, the protein interaction map of this muscle-wasting condition was generated to gain a better knowledge of interactome profile of DMD.Materials & Methods: Applying Cytoscape and String Database, the protein-protein interaction network was constructed and the gene ontology of the constructed network was analyzed for biological process, molecular function, and cellular component annotations.Results: Among 100 proteins related to DMD, dystrophin, utrophin, caveolin 3, and myogenic differentiation 1 play key roles in DMD network. In addition, the gene ontology analysis showed that regulation processes, kinase activity, and sarcoplasmic reticulum were the highlighted biological processes, molecular function, and cell component enrichments respectively for the proteins related to DMD.Conclusion: The central proteins and the enriched ontologies can be suggested as possible prominent agents in DMD; however, the validation studies may be required.

Objective: The present study was conducted to investigate the effect of happiness program on performance for mothers of children with cleft lip and palate.Materials & Methods In this semi experimental study, 64 mothers of children with cleft lip and palate referring healthcare team in Isfahan University of Medical Sciences, Iran were enrolled by simple random sampling in 2015. They were divided to two groups of control and intervention. Then, the program of happiness training was implemented within 10 sessions of two hours each and performance questionnaire were filled out prior two months after the last session. The data were analyzed by paired t-test, independent t-test, chi-square and Mann-Whitney.Results: Mean age of the mothers in intervention and control groups was 33.3±6.3 and 33.5±5.8 yr, respectively. Mean age of the children in intervention and control groups was 6.34±3.37 and.03±3.36 yr, in that order. No significant difference was seen on demographic variables between the two groups. Besides, no significant difference was noticed on mean score of performance domains in the two groups before training. However, after 2 months a significant difference on mean score of performance domains was observed (P<0.000). Intervention group showed significant differences on mean score of performance domains before and after intervention (P<0.000). However, the control group had no significant change.Conclusion: Given the effect of happiness, program in promoting mothers performance for children with cleft lip and palate, this program can be used in healthcare centers to empower mothers and enhance performance in taking care of children.

Objective: Long Term Video-EEG Monitoring (LTM) may give us important information in the preoperative assessment of these patients. We performed this study for the first time in pediatric age group in Iran.Materials and Methods: In this cross-sectional study, 43 children between 4 to 18 yr, with intractable epilepsy referred to Shefa Neuroscience Research Center, Tehran, Iranfrom2007-2012, were enrolled to study in order to evaluate their long-term video EEG findings.Results: The patients mean age was10.07 yr, from which 24 (65.9%) were boys.Seven patients with definite epileptogenic zone were advised to perform lesionectomy surgery.In two patients, there was not any seizure onset focus but corpus callosotomy was advised to control their frequent falling.Eight cases were recommended to perform electrocorticography or invasive EEG monitoring and26 cases to adjust medical treatment. In three cases, there was not any electrical seizure activity during clinical attacks, so discontinuing anti-epileptic drugs were recommended fordiagnosis of conditions that mimic epilepsy.Conclusion: It is necessary to perform LTM in patients with refractory epilepsy in order to determine their treatment strategy. If there is any doubt about pseudoseizureLTM can help to differentiate epilepsy from conditions that mimic epilepsy.

Objective: This study aimed to assess the seroprevalence of Toxoplasma gondii in children with anxiety disorders.Materials & Methods: This cross-sectional study was conducted between Sep 2012 and May 2013 in Pediatrics Clinic of Baqiyatallah Hospital, Tehran, Iran. Children were assessed clinically. Diagnosis of patients with anxiety disorders was based on DSM-4 system, performed by child psychiatrist. Then their anti-Toxoplasma antibodies were measured. A questionnaire was verbally administered to all individuals’ parents including demographic information and questions about life style, family history, medical history, economic situation, residence, nutritional patterns and contact with animals.Results: Ninety-six male and female cases with a mean age of 8.56±2.5 and 8.42±1.9 yr underwent analysis. Anti- T. gondii IgG antibody was found in one case of each group. There was no significant difference between case and control groups for serum Toxoplasma IgG antibody (P=0.14). No case individuals had Anti- T. gondii IgM antibody, while it was found in one control individual. No significant difference was seen between case and control groups for Toxoplasma IgM antibody (P=0.27).Conclusion: Toxoplasmosis has no direct effect on the incidence of anxiety disorders. More studies are needed with a larger volume of individuals in future.

Objective: This study aimed to investigate the effectiveness of cognitive-behavioral therapy on relieving migraine headaches in migraine sufferers.Materials & Methods: In this quasi-experimental study with pre-test and post-test method, the samples were outpatients of public hospitals in Ilam City, southwestern Iran since May-Jul 2010. They were selected based on inclusion and exclusion criteria, and divided into experimental and control groups. The data were analyzed using SPSS ver.16 and via multivariate covariance method.Results: Cognitive-behavioral therapy affected on reducing the duration of symptoms of migraine in sufferers (P<0.05).Conclusion: Cognitive behavioral therapy effects on reducing the time duration of symptoms of migraine headaches. Thistherapeutic method increases the level of individual, familial, social and occupational activities by reducing the time duration of symptoms and this method helps the individuals to resume their activities and regain their previous control instead of founding themselves incapable and helpless due to the pain they suffer from.

Objective: Kinesio taping is a relatively new technique, which uses in rehabilitation of neurologic diseases. The aim of this study was to investigate the effects of Kinesio taping on hand grip and active range of motion of hand in children with cerebral palsy (CP).Materials and Methods: In this experimental study with pre-test and three post-tests, 32 children with CP randomly were placed in experimental (n=17) and control group (n=15). Kinesio taping was applied on dorsum of forearm and hand. Evaluation was performed initially, two days after taping and two days after tape removal. Goniometer was used to evaluate active range of motion of wrist extension. In addition, vigorimeter was used to evaluate of grip strength.Results: In pre-test, there was no difference between groups but in post-tests; initially after application of taping with P<0.05, two days after application of taping with P<0.05 and follow-up (two days after removed taping) with P<0.05 were significant differences between trial and control group.Conclusion: Kinesio taping in neurorehabilitation of children with CP can be a useful option to promote power or grip strength and active range of motion of wrist and thumb.

Objective: The aim of this study was to assess the effect of parent report gross motor function level of cerebral palsy (CP) children on the parent report quality of life of CP children.Materials & Methods Sampling of this cross-sectional study was done in occupational therapy clinics and CP children’s schools in 2016 in Zanjan, Iran. Samples size was 60 CP children aged 6-12 yr and for sampling method, a non-probability convenience was used. For assessing the quality of life of CP children the cerebral palsy quality of life (CP QOL) questionnaire and for assessing the level of gross motor function of CP children the Gross Motor Function Classification System Family Report Questionnaire (GMFCSFRQ) were used.Results: The average age of children (22 males and 30 females) was 8.92 yr old (minimum 6 yr and maximum 12 yr). The relationship between the level of gross motor function and participation and physical health was direct and significant (r=0.65). The relationship between functioning, access to services and family health with the level of gross motor function was direct but was not significant (P>0.05) and the relationship between pain and impact of disability and emotional well-being with the level of gross motor function was significant (P<0.05).Conclusion: There was no strong correlation between the level of gross motor function and quality of life of children with cerebral palsy. It means that the level of gross motor function cannot be used as a predictor of quality of life for children with cerebral palsy alone.

Objective: Glutaricaciduria type 1 (GA1), is a rare, treatable neuro metabolic disease, due to glutaryl- CoA dehydrogenase (GCDH) gene mutation. In regions without neonatal blood screening (NBS), patients are diagnosed in symptomatic period. This study was carried out to assess patients with GA1 for clinical, biochemical, neuroimaging findings and GCDH gene mutations analysis.Materials & Methods: In this cross-sectional study, clinical manifestation, neuroimaging and metabolic findings of eleven Iranian GA1 patients of MofidChildren’s Hospital, Tehran, Iran between 2001 and 2011, were evaluated. Mutational analysis of the GCDH gene was performed on genomic DNA. Genomic DNA was extracted from peripheral lymphocytes using QIAamp DNA Micro Kit (Qiagen). All 11 exons and flanking intronic regions of the GCDH gene were amplified by polymerase chain reaction (PCR).Results: All patients were diagnosed before 32 months old. Clinical presentations of GA1 include acute encephalopathic crisis and/or developmental delay and macrocephaly. Seven GCDH gene mutations were detected in our patients. The most frequent GCDH mutations occurred in exon7 then exon8, 10 and11. G244 C in exon7, R294 Q in exon8 and N373 S in exon 10 were three novel mutations. There was no correlation between of genotype and phenotype in our patients.Conclusion: Physician must remember GA1 in differential diagnosis of acute encephalopathic crisis, macrocephaly, developmental delay, movement disorders such as dystonia and dyskinesia. Early detection, proper treatment and selective screening of patients’ siblings can prevent neurologic disabilities.

Objective: Tyrosinemia type 1 is a hereditary disorder with liver, kidney and nervous system involvement. Neurological crises can occur in tyrosinemic patients without treatment or when treatment stops. Here we report three children that developed diaphragmatic paralysis after discontinuation of nitisinone. In patients with tyrosinemia type 1, combined treatment with nitisinone and a low-tyrosine diet have prevented neurological crises. The purpose of this article was to express the importance of taking nitisinone (NTBC) for tyrosinemia diseases and risks of inadvertent discontinuation.Materials & Methods: We describe three children referred to emergency department of Nemazee Hospital, Shiraz, Iran in December 2015 with tyrosinemia type 1 who stopped NTBC treatment, presenting with respiratory. Clinical findings, laboratory results, and imaging study were assessed in three patients on admission and after starting nitisinone.Results: All patients developed diaphragmatic paralysis and respiratory distress after interruption of nitisinone treatment. Two of the patients were improved after starting nitisinone. One patient expired due to respiratory failure. Full recovery occurred about 2 months after starting nitisinone.Conclusion: Discontinuation of nitisinone can induce diaphragmatic paralysis and respiratory failure. Therefore, we should advise patients to use NTBC for the long term and not interrupt it.

Limp is described as any deviation from a normal gait pattern for the child’s age. Limping takes many forms and is one of the most enigmatic complaints in pediatric medicine. It is never normal, and both benign and life-threatening illnesses can present with limp. The provisional diagnosis can be a challenge to establish even after history, physical, and laboratory examinations.

Premature tooth loss is a disastrous situation that affects deciduous or permanent teeth era with different causes. It may be attributed to some disorders like Papillon-Lefevre syndrome or coffin-lowry syndrome but because of ambiguous nature, precise diagnosis is not easily possible. Moreover, it has very low incidence and defines by few and limited case series, with vague characters to some extent, confusion in detecting the right diagnosis is a common possibility. Hence, it is expectable to have a wrong diagnosis for this case. In this study, a 5-yr-old boy with chief complaint of early tooth loss despite having blindness in left eye and palmar keratosis is reported, although he had some other manifestation of oculodentodigital dysplasia (ODDD) like ataxia, dysarthria and nail deformity, ignoring other extra and intra oral finding. He was diagnosed as Papillon-Lefevre syndrome already, just because of early tooth loss and palmar keratosis.

Cerebral vasculitis is a serious complication of meningitis with Streptococcus pneumoniae. We report a 5 yr old girl who was admitted in May 2015 at Fortis Hospital, Kolkata, India and was diagnosed to have pneumococcal meningitis with vasculitis on DWMRI within a week of onset of fever. She was given high dose of methyl-prednisolone simultaneously with antibiotics and successfully treated without any neuro-sequelae. Although vasculitis has been documented to develop as sequelae to bacterial meningitis usually in the second week, our patient had an early presentation. Treatment with high dose steroid along with antibiotics resulted in dramatic improvement with no neurodeficit. DW-MRI is an important investigation to pick up early, evidence of vasculitis in a patient with meningitis who is showing neurological deteriorations despite improvement in blood parameters.