Iranian Journal of Child Neurology (IJCN)
Volume:6 Issue: 2, Spring 2012

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 & MethodsA 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.ResultsAccording 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.ConclusionMost 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.

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 processesand compromise the child’s intellectual and cognitive functioning, leading totremendous cognitive, behavioral and psychosocial consequences. Childrenwith epilepsy are at increased risk for emotional and behavioral problems.In addition to the direct effects of epilepsy, there are multiple contributoryfactors including the underlying neurological abnormalities and adverse effectsof medication. This review discusses the current understanding of variouspsychiatric aspects of childhood epilepsy, including the neuropsychological,behavioral and psychosocial concomitants of childhood epilepsy.

ObjectivePrimary 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.

Objective We investigated the correlation between different interictal EEG abnormalities observed in patients with idiopathic (genetic) generalized epilepsies (IGEs) and their seizure types. Material & MethodsIn 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. ResultsThree-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. ConclusionInterictal 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.

ObjectiveDevelopmental 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 & MethodsSpecific 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. Results10.5% 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. ConclusionASQ 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.

ObjectiveMigraine 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 & MethodsTwo-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. ResultsThis 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. ConclusionMigraine is a common problem in children with an equal incidence in boys and girls before adolescence and more common in girls after adolescence.

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

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.

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.