دکتر علی اکبر مومن

Epilepsies and epileptic syndromes are among the most common chronic neurological disorders in neonates, infants, and children. Remission occurs in 70% of epileptic children, while other cases experience frequent seizures and become refractory to various treatment modalities. Refractory seizures have a significant adverse impact on the quality of life of epileptic children and their families. Prognosis of epilepsies is determined based on the risk of seizure or convulsion recurrence. Some of the most important risk factors for recurrence are the age at seizure presentation, neurodevelopment of the child, etiology of seizures, seizure frequency before anticonvulsant withdrawal, response to antiepileptic medications, type of epileptic syndromes, and electroencephalography of the patient. Recognition of the risk factors for seizure recurrence results in the optimal management of the treatment protocols, thereby reducing the adverse effects of epileptic seizures on patients and their families. The present study aimed to provide a narrative review of the most important risk factors for the recurrence of epilepsies in children by two child neurologists.

Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures. Infectious agents are mentioned in its etiology. With identifying and appropriate treatment of these infectious agents, preventing their secondary outcomes, including seizure is possible. This study was conducted to determine frequency of anti-Toxoplasma antibodies (IgG, IgM) and anti- Toxocara antibody (IgG) in epileptic patients.Study sample consisted of 141 epileptic patients and 144 healthy people. After obtaining informed consents and completing demographic questionnaire, serum samples were taken from participants. The diagnostic test of Toxoplasma IgG & IgM and Toxocara antibodies was performed under the same conditions using ELISA method in a qualified private laboratory. Samples from patients and control groups with positive ELISA test in terms of anti-Toxocara antibody were also used for confirmatory Western blot test.According to ELISA results, 28 (19.85%) epileptic patients and 2(1.38%) of healthy people had anti-Toxocara antibodies (P<001), while 39 (30.46%) of the control group people and 14.18% of patients had anti-Toxoplsma antibodies (P=0.001).Frequency of anti-Toxoplasma gondii is lower in epileptic than healthy individuals and this result is contrary to investigations that have reported higher levels of this antibody in such patient groups. ELISA results for Toxocara showed that the frequency of anti-Toxocara antibody in epileptic patients might empower the probability that this parasite may cause central nervous system damage. Westernblotting has high specificity and is a proper confirmative method for diagnosis of toxocariasis.

Factors influencing the choice of the subject could strengthen the knowledge and motivation to enter the field to promote the health of society. This study explores factors influencing specialty choice of Ahvaz Jundishapur University of Medical Sciences pediatric department residents In this cross-sectional study all 38 pediatric residents were was undertaken using a questionnaire designed to assess their reasons with regard to pediatric course choice. The nameless questionnaire with sixteen questions was completed separately. The reliability and validity of the questionnaires were verified by experts and Cronbach''s alpha 0. 810. From 38 pediatric residents, including 26 female (71%) and 12 male (29%), twenty six (70. 3%) were married. Mean age was 33. 1±4. 2 years. participating in the study mentioned factors such as «helping patients», «raising knowledge and skills» and «the ability to do a better service» with the average of 4. 32, 4. 26 and 4. 18 respectively as high priority; and factors such as «lack of heavy duty,» «comfortable and effortless» and «lack of urgency», respectively, with an average of 2. 18, 2. 24 and 2. 37 had a low priority in choosing pediatric specialty course. According to the t-test, statistically significant differences were observed between gender, marital status and factors influence specialty choice of pediatric course (P)

Approximately 5–10% of preschool age children are considered developmentally disabled. Brain Magnetic Resonance Imaging (MRI) plays a key role in the diagnostic evaluation in these children. Many congenital or acquired brain anomalies are revealed with MRIs. Although the majority of these abnormalities are sporadic but patients with subcortical band heterotopia or double cortex syndrome have sex-linked inheritance. We are going to present the first case in Iran from Ahvaz city, which was presented with status epilepticus associated with developmental delay and finally diagnosed as double cortex syndrome, because band heterotopia cases especially for continuous or generalized form is rare.A 4.5-year-old developmentally delayed girl was admitted for generalized tonic clonic seizure attack of 1 hr, upward gaze, locked mouth, and urinary incontinence (status epilepticus) in the child neurology ward. She had a history of recurrent seizures that started as febrile seizures since she was 12 months of age and had frequent admissions for having recurrent seizure attacks. She was the only child of consanguineous parents with negative family history of any neurologic problems. She was a product of uneventful term pregnancy, vaginal delivery with a low Apgar score at birth who was admitted for six days in the neonatal ward for hypotonia and cyanosis. At 4.5 years of age, she had HC: 45cm (<3%) Length: 102 cm (25–75%), and BW: 18kg (75%).She was able to sit, walk with support, speak a few words, and communicate with others. A physical exam was unremarkable. Lab data including CBC, blood biochemical, and urinalysis results were all within normal limits, but the electroencephalography (EEG) revealed generalized poly spike-wave discharges. A brain MRI showed corpus callosal dysplasia, generalized band heterotopia, and polymicrogyria. She was discharged home with oral valproate and regular outpatient follow-ups.In the diagnostic evaluation of developmentally delayed and epileptic children, a brain MRI is strongly recommended for accurate diagnosis of anomalies such as neuronal migration disorders (band heterotopia) and others, because appropriate therapeutic management, prognosis, prevention, and geneticcounseling for prenatal diagnosis are dependent on definite diagnosis of the proband case.

Headache is a common complaint in children, and it has a significant effect on their daily living activities. Having a definite diagnosis for the cause of the headache is very important for its appropriate management.. We report a 12-year-old boy complaining of chronic headache, with a positive family history of migraine. The only abnormal finding in his general and neurological examinations, and CT scan evaluation of his brain and paranasal sinuses, was a retention cyst in his sphenoid sinus. The child’s symptoms did not improve after receiving migraine medications or treatment for sinusitis. Further investigations revealed positive serological results for brucellosis infection. His symptoms were relieved, and imaging evidence of sinus involvement disappeared after brucellosis treatment. The child remained headache free in later follow-ups.. In evaluating the cause of children’s headaches, brucellosis must be considered in differential diagnosis..

Spinal muscular atrophy (SMA) is the second most common lethal autosomal recessive disease. It is a neuromuscular disorder caused by degenerative of lower motor neurons and occasionally bulbar neurons leading to progressive limb paralysis and muscular atrophy. The SMN1 gene is recognized as a SMA causing gene while NAIP has been characterized as a modifying factor for the clinical severity and age at disease onset in SMA patients (SMA subtypes). The relationship between NAIP deletion and type of SMA remains to be clarified; we investigated this gene alteration in all types of SMA patients. Molecular analysis was performed on fifty patients with a clinical diagnosis of SMA in Khuzestan province. In addition to common PCR-RFLP analysis for exon 7 and 8 of SMN1 gene, as an internal control we analysed NAIP deletion with PCR of exon 5 of this gene in a multiplex PCR with exon 13 of it. Homozygous-deletion frequency rate for the telomeric copy of SMN (SMN1) exon 7 in all types (type I, II, Ш) of SMA was approximately 90% and the frequency of deletion in exon 7 and 8 together in all types estimated about 70%. Moreover NAIP gene was deleted in about 60% of these patients and this shows deletion in 91% of type I SMA patients. The correlation between NAIP-deletion and SMN1 mutation showed a high frequency rate. In this study, high frequency of NAIP gene deletion in all type of disease shows the importance role of it in disease pathogenesis. High frequency of NAIP deletion in SMA type I, also shows the importance of the gene in type and severity of disease so it may be a modifier factor in severity of disease.

ObjectiveThis study was conducted to determine the frequency of urinary tract infection(UTI) among children with febrile convulsion (FC).Materials & MethodsWe analyzed the hospital records of 137 children who had been admitted to thepediatric ward from March 2004 to February 2007 because of FC. Informationsuch as age, sex, developmental status, type of FC, family history of seizure,urine sampling method, and the results of antibiograms were recorded.ResultsThe age distribution of 137 patients (82 boys, 55 girls) was as follows: 1-6 monthsof age, 1 infant (0.7%); 6-12 months, 21 infants (15.3%); 1-3 years, 75 (54.8%);3-5 years, 30 (21.9%); and more than 5 years, 10 (7.3%). Three out of the 82boys and 6 out of the 55 girls had UTI (3.7% vs. 10.9%, total, 6.6%). The agedistribution of these 9 patients was as follows: 1-6 months, 1 patient (11.1%);7-12 months, 5 (55.6%); and 1-3 years, 3 (33.3%). The relative incidence of UTIwas 6.6%. The most common organisms causing infections were Escherichiacoli in 8 and Proteus spp., in 1 patient (88.8% vs. 11.1%). Simple FC was seenin all 9 patients with UTI.ConclusionIn this study, the relative frequency of UTI among children with FC was 6.6%and this frequency was higher that the incidence of UTI in girls and boys(3-5% and 1%, respectively). Therefore, we recommend that UTI should beconsidered as an important cause of FC in children.