Iranian Journal of Child Neurology (IJCN)
Volume:4 Issue: 4, Autumn 2010

Headache is a frequent symptom in children and adolescents. Migraine is one of the most common types of primary headache disorders in children that at times can be extremely disabling. Many clinical features of migraine in children differ from that starting in adulthood. This review discusses the epidemiology, clinical features, management, and prognosis of migraine headache in children and adolescents.

Sensorineural hearing loss is believed to be the result of a physiologic malfunction in the inner ear or acoustic nerve. Depending on the rapidity of progression and severity, sensorineural hearing loss can be endlessly annoying, frightening and can constitute a permanent after effect. Moreover, there is no surgical procedure that can reverse or lessen the severity of a sensorineural hearing loss. Furthermore, children with sensorineural hearing loss present with additional disabilities in 30 to 40% of the cases. Children with profound sensorineural hearing loss may exhibit abnormalities of vestibular structures, which may lead to impairment of postural control, locomotion and gait. The development of gross motor functions such as head control, sitting and walking are likely to be delayed in these children. Evaluation of motor skills and balance are the coreof the pediatrician and physical therapist's expertise and practice. Knowledge of the reliable, valid and inexpensive assessment tools for measuring motor skills and balance are necessary to gauge the progression of the disease and the impact of treatment. In this review, we aim to summarize inexpensive tools such as TGMD-2, PBS, and P-CTSIB.

ObjectiveConsiderable medical and legal debates have surrounded the prognosis and outcome of obstetrical brachial plexus injuries and obstetricians are often considered responsible for the injury. In this study, we assessed the factors related to the outcome of brachial plexus palsy.Material & MethodsDuring 24 months, 21 neonates with obstetrical brachial plexus injuries were enrolled. Electrophysiology studies were done at the age of three weeks. They received physiotherapy and occupational therapy. They were examined every 3 months for one year and limbs function was assessed according to Mallet scores; also, maternal and neonatal factors were collected by a questionnaire.Results There were 10 boys and 11 girls. Of all, 76.2% had Erb's palsy, 19% had total brachial palsy and 4.8% had klumpke paralysis.Risk factors including primiparity, high birth weight, shoulder dystocia, and prolonged second stage of labor were assessed.Electrophysiology studies showed neuropraxia in 52.4% and axonal injuries in 42.9% of the patients. At the end of the first year, 81% of the patients had functioned recovery around grade III or IV of Mallet scores. There were only significant relationships between functional improvement and neurophysiologic findings.ConclusionOutcome of obstetrical brachial injuries has a close relationship toneurophysiologic study results than other risk factors.

ObjectiveEpilepsy occurs with a yearly incidence of 40 per 100,000 children, of which more than 25% are resistant to drug therapy. Epilepsy may occur in autoimmunediseases like lupus, celiac disease and myasthenia gravis. In this study, the relationship between celiac disease and refractory epilepsy was evaluated in children with idiopathic epilepsy.Material & MethodsHundred-fifty-five children (mean age, 6.7±3.3 years) with idiopathic and cryptogenic epilepsy referred to the neurology clinic were studied in two groups; drug controlled epilepsy (control, 82 patients) and refractory epilepsy groups(case, 73 patients). Both groups underwent serological tissue transglutaminase antibody measurement by ELISA. In seropositive cases, small intestine biopsy was conducted. Data analysis was performed using student's t test and 2 test.ResultsSeven (0.04%) patients had celiac disease based on a positive tissue transglutaminase antibody and three patients (0.01%) based on a positive biopsy.Three patients (2.4%) with drug controlled epilepsy (control group) and five with refractory epilepsy (case group) had seropositive celiac disease (p=0.255). In the biopsy survey of six seropositive patients, one patient (1.2%) in the drug controlled epilepsy and two patients (2.7%) in the refractory epilepsy group had positive biopsy for celiac disease (p = 0.604). One seropositive patient did not cooperate for biopsy.ConclusionIf the relationship between celiac disease and epilepsy, especially in cases of symptomatic or oligosymptomatic celiac is proved, using gluten free diet increases the ability to control epilepsy particularly in refractory cases. We suggest celiac disease survey is not required in patients with idiopathic epilepsy.

ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association between risk factors and delayed motor development (developmental quotient below 70 indicating a significant delay) was analyzed using correlating risk factors; including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and the control group consisted of 140 infants who had a DQ score of more than 70. ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92]), low birth weight (OR = 5.86 [95% CI; 3.07, 11.18]), preterm delivery (OR =6.17 [95% CI; 3.04, 12.52]), Premature rupture of membranes (PROM)>24 hours (OR = 6.18[95% CI; 2.07, 18.51]) and hyperbilirubinemia leading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65]) were associated with an increased risk for neuromotor delay on developmental examination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important.

ObjectiveHeadaches are common during childhood. In addition, sleep disorders are common problems in children, too. Although it is commonly thought that headache and sleep problems are related, there is not enough evidence to confirm this relationship. Finding evident relations between these problems would help practitioners a lot to make earlier diagnosis and plan treatment modalities for both problems as soon as possible. This study aimed to assess the relative frequency of sleep disorders in migraine and non migraine children.Material & MethodsIn a cross sectional study, 148 children were enrolled in migraine (60) and non migraine (88) groups. They were aged 6 to 14 years. Migraine group consisted of patients who had definite migraine according to IHS (International Headache Society) criteria. Ten sleep problems (snoring, nightmares, sleep walking, sleeptalking, bedtime struggle, bruxism, sweating during sleep, excessive daytime sleepiness, insomnia in early or mid night and sleep apnea) were compared between 2 groups. Fisher exact and chi square tests were used for making comparisons.ResultsWe found relationships between night sleep and daytime headaches. Some of these relationships were easy to explain but for some others, finding complicatedexplanations are necessary. Our findings showed that bruxism, sleep walking, early and midnight insomnia was significantly higher in migraine children. There was a common etiology for headache and sleep disorders. Also, parents and migraine children were well familiar with the effect of relaxation on decreasing migraine episodes. They provided appropriate facilities for night sleep for this reason.Conclusionwe found relationships between night sleep and daytime headaches. Some of these relationships were easy to explain but for some others, finding complicatedexplanations are necessary.

ObjectiveThere are few studies evaluating the relative frequency of different etiologies of hydrocephalus in pediatric population, in Iran; therefore, this topic was considered in the present study.Material & MethodsIn a prospective study, the study group consisted of all children fulfilling the imaging criteria for having hydrocephalus, aged below 12 years, admitted at Rasht 17th Shahrivar and Poursina Hospitals, between March 2006 andSeptember 2008. Demographic data and information on the etiology and type of hydrocephalus, and surgical and pathological diagnosis were recorded for all cases. All data were analyzed with SPSS version 13 software.ResultsThere were a total of 67 patients, with a mean age of 33.25 ± 43.40 months. Hydrocephalus was seen most frequently in the first 2 years of life. Thirty three patients (49.3%) were female and 34 (50.7%) were male. Mean age of the girls and boys was 30.78 ± 46.46 and 35.64 ± 40.77 months, respectively (p=0.650). Communicating and obstructive hydrocephalus was seen in 30 (44.8%) and 37 cases (55.2%), respectively. There was no statistically significant difference in the types of ydrocephalus between the two sex groups. Mean age in obstructive and communicating groups was 3.76 ± 46.17 and 35.09 ± 40.42 months, respectively (p=0.0006). The most common causes of hydrocephalus were myelomeningocele for obstructive (19.4% of total cases), and TORCH and meningitis for communicating (8.9% of total cases for each).ConclusionIn our study, there was a mild preponderance for male sex and obstructive type. Mean age of the patients with obstructive hydrocephalus was significantly lower than those with communicating type. Overall, the most common causeof hydrocephalus was myelomeningocele.

Incontinentia Pigmenti (IP) (Bloch_Sulzberg syndrome) is a rare neurocutaneous syndrome characterized by multisystemic involvement that is prenatally lethal in the majority of affected males and shows great clinical variability when expressed in women. The diagnosis of IP is performed based on clinical features and the family history with the support of histological findings. We report a 10-day-old female neonate with typical skin lesions and frequent seizure. Skin biopsy showed second stage IP.