Iranian Journal of Child Neurology (IJCN)
Volume:17 Issue: 1, Winter 2023

Repetitive transcranial magnetic stimulation (rTMS), often recognized as a safe and tolerable method with promising therapeutic potential for the treatment of a variety of neurological disorders, has been extensively studied by medical engineering scientists in recent decades. Epilepsy has always been one of the vital foci in the therapeutic role of rTMS, especially its low-frequency type. However, various reports, clinical trials, and review articles published in recent years have yielded conflicting results regarding the efficacy and sideeffects of rTMS in patients. In this review article, reviewing studies published from January 2000 to October 2021, we examined the efficacy and side effects of rTMS with a specific look at its therapeutic applications in epilepsy. Our study indicates promising results in the clinical application of this technique for patients with epilepsy. Among other things, it has the ability to reduce interictal epileptic abnormalities, does not interfere with neuropsychological function in normal people, does not worsen cognitive function and even improves Stroop function, rarely has serious side effects such as seizures and psychotic symptoms, has low risk in children as adults, and has potential for improving suicidalideation. Despite some limitations in this study, including the small number of studies performed and the heterogeneity among studies, this review article suggests significant rtMS potentials in improving the complications of epilepsy. Our review also showed that the reported side effects of using this technique are not very common. Therefore we can recommend further use of this technique as a promising tool in clinical research.

Duchene Muscular dystrophy (DMD) is the common X-linked heterogenous progressive muscular dystrophy characterized by mutations in the DMD gene. The frequency of dystrophin gene mutations is varied in different DMD population. A precise diagnosis can help to reduce the severity of DMD since it aids in planning of targeted medical treatment and required therapies. This study was aimed to investigate the mutation type, their rate and distribution of DMD’S in southern India.

Materials & Methods:

 An observational study was conducted on 250 genetically confirmed DMD patients from March,2019 to March,2021. The distribution pattern and rate of mutations (deletion, duplication, nonsense mutations, minor mutations) were investigated.

Results :

Mutation spectrum was studied on 250 DMD patients, of which 63% exon deletion pattern were reported. 16% deletions were detected in proximal hot region (exons 3-28). The duplications were found 21% in the proximal hotspot largest region (exon 3-25). 16% of the patients reported single deletion (45 exon), 10.7% reported deletions of exon 44. Point mutations detected in 6%, small mutations were detected in 1.2%, non-sense mutations were detected in 2% of study population respectively. Missense Missense Mutations were detected in 0.8% of study population .

Conclusion :

This study estimates mutation spectrum of exon deletion pattern (63%) was predominantly identified in distal region; duplication was most frequent in proximal region. Point mutations, Nonsense mutations and small mutations have a least accountability. This study adds a real world evidence for developing research therapies in DMD

to investigate the effect of auditory temporal processing training on the alleviation of stuttering severity in children who stutter (CWS) diagnosed with auditory temporal processing (ATP) disorders.

Thirty-one (31) CWS diagnosed with ATP disorders participated in this study (intervention group: 17 participants between 7 to 12 years old; control group: 14 participants between 8 to 12 years old). The ATP test and SSI-3 were examined before, after 12 sessions (about 540 minutes) training, and three months following the conclusion of the intervention.

According to the results, ATP improved significantly in the intervention group after auditory temporal training and the differences between the intervention and control group were significant (p<0.05). The improvement of ATP skills remained stable in the post-training evaluation after three months (p>0.05). Although the SSI-3 score was further improved in the intervention group, but there was no significant difference between two groups (p=0.984).

The findings revealed that ATP training acted as a complementary therapy alleviating stuttering severity of CWS with ATP disorders to some extent.

Childhood stroke is linked to high personal costs for affected children and their families since more than half of the survivors are impaired for a long time, hampering their normal development and lifestyle. Thus, the present study aimed to evaluate the neurological developmental outcomes of children admitted to Namazi hospital, Shiraz, Iran, for ischemic and hemorrhagic stroke with a five-year follow-up. Ma a retrospective cohort study on children admitted to Namazi Hospital due to ischemic and hemorrhagic stroke during the past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients on follow-up. The SPSS 21.0 software was used for statistical analysis.

This is a retrospective cohort study on children admitted to Namazi hospital due to ischemic and hemorrhagic stroke during past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients at the time of follow up. The SPSS 21.0 software was used for statistical analysis Settings.

The patients’ mean age at the time of stroke was 6.87 ± 4.60 years. The mean follow-up period was 3.5 ± 1.64 years. 53.1% of the children (N=17) were diagnosed with hemorrhagic stroke, and 46.9% (N=15) with ischemic stroke. The most frequent symptoms first presented by the study population were a decrease in the level of consciousness (LOC) (40.6%), headaches (37.5 %), and hand/arm/leg weakness (34.4%), respectively. The number of patients in the poor and severe outcome group was 73.3% in the ischemic and 52.9% in the hemorrhagic group.

Conclusion:

Hemorrhagic stroke was slightly more frequent than ischemic stroke, and stroke was more frequent in boys. A decrease in LOC and headaches were the most common symptoms upon admission. The left sensorimotor area was the most involved in both ischemic and hemorrhagic groups. In addition, trauma was the most common cause of stroke in this study population.

Neonatal seizure is a significant problem in this life course, and its timely and effective treatment is crucial. In this study, we compared the efficacy of levetiracetam versus phenytoin for treating the acute phase of neonatal seizures.

In this single-blind case-control study, 60 consecutive children with neonatal seizures referred to the Children’s medical center in Tehran, Iran, in 2018 were studied. Those neonates who had at least 30 minutes of seizure after Phenobarbital treatment were assigned to receive either phenytoin (20 mg/kg) or levetiracetam (initial dose of 40-60 mg/kg) through block randomization. The efficacy and safety of the two drugs were compared between the groups.

The response rate was 83.3% and 86.7% in phenytoin and Levetiracetam groups, respectively, which was not significantly different between groups (P=1.000). Adverse effects were nearly similar between groups (6.7% in the phenytoin group and 3.3% in the Levetiracetam group, P=1.000).

Levetiracetam and phenytoin are both practical and safe for treating neonatal seizures.

Tissue damage caused by febrile convulsion has not still been proved or refuted completely. Given the fact that lactate dehydrogenase as an intracellular enzyme can be increased due to tissue damage, we decided to evaluate serum and cerebrospinal fluid lactate dehydrogenase in children with febrile convulsion.

This is a cross-sectional study on 166 children aged 6-24 month, in three groups of simple febrile convulsion (n=56), complex febrile convulsion (n=27) with 3 different subgroups (recurrence in 24 hours, duration >15 minutes, and with focal components), and control (n=83). Patients’ serum and cerebrospinal fluid specimens were collected after meeting the inclusion criteria. Demographic information was documented and patients’ serum and cerebrospinal fluid lactate dehydrogenase and glucose were measured. Data were analyzed using SPSS software.

The mean serum lactate dehydrogenase in simple febrile convulsion, complex febrile convulsion, and controls were 501.57± 143.70, 553.07±160.22, and 505.87±98.73 U/L, respectively. The mean cerebrospinal fluid lactate dehydrogenase in simple, complex febrile convulsion, and control groups were 22.58±11.92, 29.48±18.18, and 21.56±17.32 U/L, respectively. Only cerebrospinal fluid lactate dehydrogenase difference between complex febrile convulsion and control group (p=0.039) (In the duration >15 minutes subgroup and controls, p=0.028) was statisticallysignificant. There was a significantThere was a significant difference between sex and serum lactate dehydrogenase in the same subgroup of complex group (p=0.012).

Complex febrile convulsion may lead to increase of lactate dehydrogenase in cns of CNS cellular damage

Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder which may be associated with impaired Theory of Mind (ToM) and social cognition. ToM is a domain in social cognition which refers to one's ability to attribute beliefs, intents, perspectives, and understandings to oneself or others and to understand other's mental state.

The present study enrolled 52 ADHD of adolescents and 41 healthy age-matched controls in this study. This study applied The Reading the Mind in The Eyes Task (RMET) and Theory of Mind Assessment Scale (Th.o.m.a.s.) for all participants. The results of these tasks were compared between the two study groups.

e no significant differences between these two study groups in terms of ToM abilities using mean scores in Th.o.m.a.s inventory and the Reading the Mind in the Eyes test. Also, we did not find any association between the mean score in ToM (in both study groups) and our study parameters of gender, mean age, birth rank, family structure, and income.

This study did not support the hypothesis that adolescents with ADHD perform worse on ToM tasks.

To determine the clinical and MRI characteristics of multiple sclerosis (MS) in the children and adolescents.

In this cross-sectional study, information of 95 MS patients was obtained from the Iranian MS registry. Disease characteristics and imaging data were collected using medical records.

 Ninety-five patients including 64 female and 31 male subjects with mean age of 13.97±2.4 (range, 8-18) years were enrolled. The most frequent signs and symptoms were ophthalmic symptoms (n=61, 64.2%), brainstem signs (n=44, 46.3%), cerebellar signs (n=32, 33.6%) and pyramidal signs (n=26, 27.3%). Blurred vision (n=21, 34.4%) was the most common ophthalmic symptom and ataxia (n=24, 75%) the most prevalent cerebellar sign. The most common brainstem signs/symptoms were motor symptoms and vertigo (each n=14, 31.8%) and the most common pyramidal sign/symptom was right upper monoparesis (n=14, 23.3%). Active demyelinating lesions were reported in brain MRI of all patients, mostly appeared as periventricular (n=91, 95.8%) and pericallosal (n=55, 57.9%) lesions. Acute demyelinating spinal lesions were presented in 38 patients (51.3%) with a prominent involvement of the cervical spine (n=33, 86.8%).

In our study, the most frequent signs and symptoms were eye symptoms, brainstem signs, cerebellar signs and pyramidal signs, respectively. Moreover, our results showed that MRI plays a critical role in the diagnostic evaluation of MS in children with presence of brain lesions in all patients and spinal lesion in a considerable portion of patients.

Precise and early diagnosis of neonatal asphyxia may improve its outcomes. New studies aim to identify diagnostic biomarkers in neonates at risk for brain damage. The current study was designed to evaluate the diagnostic value of new biomarkers neonatal asphyxia.

This prospective study was conducted with an available sampling of infants upper 35 weeks of gestational age, including neonates with asphyxia (case group) and healthy controls, 2014-2022, in Ghaem Hospital, Mashhad, Iran. Data collection was performed utilizing a researcher-made questionnaire, including maternal and neonatal characteristics, as well as clinical and laboratory evaluation. Serum umbilical cord levels of interleukin-6 (IL6), interleukin-1-beta (IL- 1β), pro-oxidant-antioxidant balance (PAB), and heat shock protein-70 (HSP70), as well as nucleated red blood cells count (NRBC), were determined. Data were analyzed by t-test, Chi-square, receiver operating characteristic (ROC), and regression models.

Variables interleukin-6(IL6) (P<0.0001), IL1β (P<0.0001), PAB (P<0.0001), NRBC/100WBC (P<0.0001) and HSP70 (P<0.0001) in the two groups, the difference was statistically significant. In the diagnosis of asphyxia, the most sensitive marker (89%) was IL1β more than 2.39 pg/ml and HSP 70 upper than 0.23 ng/ml while IL6 higher than 9pg/ml determined as the most specific marker (85%). For the diagnosis of asphyxia, combination of HSP + PAB and IL6 + lL1b + PAB + NRBC/100WBC possesses the prediction power of 93.2% and 87.3% respectively.

According to data analysis, the combination of new biochemical markers (NRBC count, IL6, IL1β, PAB, HSP 70) could be a reliable marker for the diagnosis of infants with asphyxia. The composition of the HSP + PAB indicators is more valid predictions 93.2% compared to the other combined indicators for the diagnosis of asphyxiated neonates. PAB values correlate with the severity of asphyxia.

Imbalance of phenylalanine (PA) to tyrosine level and decrease dopamine brain level in phenylketonuria (PKU) patients may be have a role in susceptibility of them to have attention-deficit/hyperactivity disorder (ADHD). This study was done to evaluate frequency of ADHD in referred patients to PKU Clinic in Yazd, Iran.

In this cross-sectional analytical study, all older than 3 years PKU patients who were referred to PKU Clinic of Shahid Sadoughi Hospital, Yazd, Iran in 2018 evaluated and ADHD symptoms in them was assessed via parent face-to-face interview. The patient had ADHD if had at least score of 20 in ADHD diagnostic rating scale via parent interview based on DSM-VI criteria.

Fourteen boys and 21girls with mean age of 9.55±1.8 years were evaluated that 51.5% of diagnosed with PKU had ADHD. ADHD was more frequent in girls (77.8% vs. 41% in boys, P=0.03). Mean age of diagnosis of PKU was significantly higher in patients with ADHD (52.54±15.65 months vs. 29.75±9.65 months, P = 0.03). Mean of PA level in the last 6 months (15.59±5.95 vs. 8.72+5.18, P= 0.005) and mean of the last six PA level (14.76±4.71 vs. 8.96±3.86, P= 0.03) were significantly higher in ADHD group.

Prevalence of ADHD in phenylketonuria patients in present study was much more than other studies. Late diagnosis of PKU and long term high phenylalanine blood and brain level might be associated with its increased and neonatal screening, regular follow-up and continuous evaluation of PKU patients for ADHD symptoms should be performed.

Pseudotumor cerebri syndrome (PTCS) is an uncommon disease in children. On-time diagnosis and treatment can prevent irreversible visual loss. Although headache is the most common complaint of children with this syndrome, the present case report reported a child with neck rigidity and torticollis, declined by the reduction of intracranial pressure. Despite the importance of torticollis and neck rigidity presented in various significant neurological disorders in need of thorough investigations, in the case of unexplained symptoms of those disorders, it is recommended to consider fundoscopic examinations for PTCS to prevent its vital complications.