Iranian Journal of Child Neurology (IJCN)
Volume:17 Issue: 4, Autumn 2023

The etiology of polyneuropathies varies in the pediatric population, where hereditary or metabolic disorders are far more common than in adults. However, treatable polyneuropathies, also prevalent in these settings, are those to prioritize. Moreover, diagnosing subacute and chronic symptoms in children can be challenging compared to adults. Therefore, selecting the best and most relevant laboratory investigations and paraclinical studies is critical. This taskcan be relatively challenging in countries with limited resources or insurance coverage. This study describe the various types of polyneuropathies found in children and their characteristics and suggest an algorithm for using the best laboratory tests in the context of the Iranian healthcare system.

This study aimed to investigate the relationship between fine motor skills and reading components and compare the fine motor skills of normal children and children with dyslexia.

In this study, 47 children with dyslexia children and 47 normal children in the first to the third grade of elementary school in the age range of seven to nine years were examined with the Bruininks- Oseretsky Test of Motor Proficiency and NEMA reading test. Data were analyzed using Kolmogorov-Smirnov, Shapiro-Wilk, U Mann-Whitney methods, multiple linear regression, and Spearman correlation coefficient.

The results showed children with dyslexia were significantly weaker in fine motor skills than normal children (p <0.001). In addition, a relationship existed between the subtest of response speed and reading accuracy in normal children, but it was in normal children. A significant relationship was found between visual-motor control subtests and Upper-limb speed and dexterity with reading accuracy and speed. None of the motor subtests were related to reading comprehension. In children with dyslexia, no association was found between motor subtests and reading components.

Seemingly, fine motor skills can be used as an essential factor along with other effective factors in improving the reading skills of children with reading disabilities

Premature birth causes some permanent or temporary abnormalities in the hearing system of the newborn. Inadequate development of the central auditory nervous system and balance, as well as the delay in the formation of the nerve myelin, can be the cause of many hearing disorders, including permanent or temporary auditory neuropathy spectrum disorder (ANSD). The present study aims to identify and understand developmental delay disorder in the hearing system of infants and investigate the possibility of temporary auditory neuropathy in infants.

In this comparative analytical study, twenty premature infants were randomly selected for hearing tests using auditory brainstem response and transient otoacoustic emissions at the time of discharge and three months after the first evaluation. The different components of these tests were analyzed and compared before and after developing the auditory system.

The OAEs test showed a signal-to-noise ratio above six dB with appropriate amplitudes in all infants. The grand average waveform of the ABR showed a significant difference between the amplitudes of waves III and V before and after maturation in both ears (p<0.05). In addition, the absolute latency of waves, specifically III and V, showed a significant difference between the two assessment times (0.05).

Breath holding spells (BHS) are a type of syncope in children that is commonly seen in the first years of life. Although these attacks do not cause serious damage to the child's brain, in severe or
repeated cases, they expose the brain to hypoxia and cause a lot of stress in parents. In these cases, the clinician should consider therapy. The purpose of this study is to investigate the effectiveness of Risperidone in the treatment of BHS in children visiting the neurology clinic of the Children's Medical Center Hospital.

In this randomized clinical trial, the statistical population included patients with the history of Breath Holding spells grades 2 to 3 (after ruling out of seizure disorders) over one year old, visiting the neurology clinic of Tehran Children's Medical Center in 2019. The subjects were randomly selected from patients visiting the clinic using a table of random numbers from the admit ion list. After providing the necessary explanations and obtaining informed consent from their parents, they were treated with low-dose Risperidone (maximum 1 mg) for three months. The patients were observed for three months in terms of frequency and severity of spells monthly.

In this study, the median (25th and 75th percentile) age of subjects was 2.3 (2.0-2.6) years. Both the number and severity of seizures in the subjects had a statistically significant decrease in the period after treatment with Risperidone (P<0.001). The studied boys and girls experienced statistically significant decrease in terms of both the frequency of spells (P-value of 0.002 and 0.039) and intensity of seizures (P=0.016) and P=0.008), respectively after treatment with Risperidone. Also, in the studied children under 2 years old and over 2 years old, both the frequency (P=0.021 and P=0.004) and intensity of spells (P=0.008) 0.016 for subjects under and over 2 years, respectively) had a statistically significant decrease after treatment with risperidone compared to pretreatment.

According to the results of this study, it seems that both the frequency and the intensity of spells in children (regardless of gender and age group), experienced a statistically significant decrease after treatment with Risperidone. We suggest conducting a more comprehensive study considering a larger sample size in order to estimate this issue more correctly.

Febrile seizure is a neuroinflammatory disease involving feverinduced seizures affecting children in the early stages of life. TNFα is a pro-inflammatory cytokine reported to be elevated in FS. Specific promoter variants of TNFα could be associated with its elevated cytokine expression and susceptibility to FS. The present study analyzed the association of specific TNFα variants, including TNFα-238 G/A (a genetic variant; G: Guanine, A: Adenine) (rs361525), TNFα -308 G/A (rs1800629), and TNFα -376 G/A (rs1800750) promoter polymorphisms, with FS susceptibility, and TNFα serum levels in an Iranian population

Sixty-eight FS patients and 136 controls were enrolled. The SSPPCR method was utilized to analyze TNFα promoter genotypes. This research also confirmed the genotyping results by sequencing samples of ten patients and normal controls.

The GG (a genetic sequence; G: Guanine) genotype of -238 SNP was associated with the increased risk of FS [OR = 12.65, 95% CI (2.83-56.60), P-value = 0.0012]. The AA (a genetic sequence; A: Adenine) genotype in the-308 region was increased in patients with FS and associated with the disease [OR = 4.62, 95% CI (1.46-14.56), P-value = 0.028]. The increased occurrence of heterozygous AG in the -376 SNP among control groups has been linked to a decreased risk of FS [OR = 0.22This study revealed that AGA (a genetic sequence; G: Guanine, A: Adenine) (-238/ -308/ -376) haplotype with the highest frequency in controls was associated with a decreased risk of FS, while GAA (a  genetic sequence; G: Guanine, A: Adenine) (-238/ -308/ -376) carriers were more susceptible to FS., 95% CI (0.11-0.43), P-value = 0.0001].

The current study suggested that TNFα gene promoter variants at rs361525, rs1800629, and rs1800750 could be associated with the susceptibility to FS and altered serum levels of TNFα.

The current study aimed to determine the proxy measurements for height in children with Cerebral Palsy (CP).

In a cross-sectional descriptive study, the length/height of Nigerian children with CP was studied over eighteen months using descriptive statistics. The study subjects comprised children aged 15 months to 17 years with C P. Height/length, weight, arm span, forearm length, mid-upper arm circumference, foot length, head circumference, hip circumference, leg length, and tibia length were measured to the nearest 0.1 cm using standard procedures. The relations between segmental measurements and weight with height were investigated using linear regression.

A total of 31 children were studied. The correlation between height/ length and other linear measurements has a significantly strong positive relationship. Regression analysis showed that when used singly, the weight and thigh length offered a high explanation for the height variability with little estimation error. On the other hand, weight had a lower mean difference between observed and predicted height (0.21and -0.76, respectively), with thigh length overestimating the height.

Weight measurement may be the preferred proxy for height in children with C P.

Development refers to the progressive enhancement of skills and functional capacity, i.e., qualitative changes in the child’s functions. The process of development begins before birth and continues throughout life. The present study aims to evaluate the effectiveness of the “Care for Child Development (CCD)” program on 4-42 months children’s developmental skills in orphanages.

In this study, two orphanages in the capitals of East and West Azerbaijan provinces were selected using the convenience sampling technique, and thirty children were included. Then, they were randomly divided into two intervention and control groups (each group, N=15). Next, after obtaining consent from the head of the orphanages, a group of volunteers from the healthcare center performed the CCD program, considering children’s chronological ages (4 to 42 months), for three sessions a week, with each session lasting two hours and it lasted for three months. At the end of the intervention process, the Bayley Scale of Infant and Toddler Development 3rd version (BSID-III) and the Ages and Stages Questionnaire-II (ASQ) were completed for the two intervention and control groups to compare them in the cognitive, motor, communication, and personal-social domains.

Comparing the two control and intervention groups using the T-test (difference in mean) indicates that except for the domain of cognitive skills (Bayley: P-value = 0.176), there was statistically a significant difference between the two groups in communication (ASQ: P-value= 0.001; Bayley: P-value = 0.003), motor (ASQ: P-value = 0.000; Bayley: P-value = 0.009), and personal-social (ASQ: P-value <0.000)skills.

In the present study, it was concluded that it is required to apply interventions, including standard ones such as the CCD program in environments like orphanages, to enhance the developmental skills of those children living in them

Enhancing the independence of children with cerebral palsy in their daily activities can significantly alleviate caregiver stress and challenges, thereby improving the quality of life for caregivers.. This study aimed to identify the influential factors in the independence level of children with CP in Activities of Daily Living (ADL) (selfcare) and Instrumental Activities of Daily Living (IADL) (home participation).

In this cross-sectional study, 116 children with different types of CP (61 boys and 55 girls) in the 4-6 age range and their parents were non-randomly selected through convenience sampling. The Iranian-Children Participation Questionnaire was used to measure the children's independence level in self-care activities and home participation. Several instruments, along with a demographicquestionnaire, were used to assess personal factors, such as the Gross Motor Function Classification System, Manual Ability Classification System, Communication Function Classification System, SPARCLE (for determining children's cognitive level), and Eating and Drinking Ability Classification System. Eventually, the collected data were analyzed using stepwise linear regression

The results showed that the level of Gross Motor Function Classification System (GMFCS) and Communication Function Classification System (CFCS) and the child's age had the most correlation with the independence level in self-care activities. Moreover, GMFCS Manual Ability Classification System (MACS), cognitive level, and child's age were most associated with home participation.

Personal factors are more effective than environmental factors in determining the independence of children with CP.

Epidemiologic studies point to an increased prevalence of migraine in children in recent decades. Migraine treatment involves acute and prophylactic therapy. Recently, such anti-epileptic drugs as
Levetiracetam have been used to treat adult migraines. The present study aimed to compare the efficacy of Levetiracetam, Sodium Valproate, and Propranolol in preventing migraine headaches in children.

In this clinical trial, children with migraine were randomly divided into three groups. Each group consisted of 13 children. Two groups were treated with Propranolol and Sodium Valproate, respectively. Another group (the case) was treated with Levetiracetam. The patients were assessed based on headache score, PedMIDAS, and headache frequency before and three months after the intervention. Finally, the data was analyzed using descriptive and analytical statistical methods.

Levetiracetam significantly reduced the headache severity (P=0.026), frequency (P=0.024), and PedMIDAS score (P=0.001) in children with migraine. However, no significant difference was found between the three groups. The percentage of patients who experienced pain relief was detected as 69.24%, 92.31%, and 30.76% in the Propranolol, Sodium Valproate, and Levetiracetam groups, respectively.

This study concluded that Levetiracetam can be used as a migraine prophylaxis drug in children.

The objective assessment tests overcome the variability of subjective methods. Cortical recordings with gap pre-pulse inhibition of the acoustic startle reflex stimulus have been used as objective tinnitus assessments in humans. This study aims to investigate this possible objective tinnitus test and compare gap-induced inhibition in different stimulus parameters and brain regions.

Twenty People (18-50 years old) without hearing loss and tinnitus were included. The sound stimuli consisted of continuous background noise with a loud startle tone preceded by a silent gap (20 and 40 ms duration, 120 and 150 ms distance from the startle). The N1-P2 complex amplitude and topoplot maps were extracted in 27-channel cortical response recording after signal processing. Four brain regions of interest (ROI) of anterio-frontal, centro-frontal, right, and left temporal were investigated.

The results showed that the maximum inhibition occurred in a 40 ms gap duration and 150 ms distance in all 4 ROIs. In comparing ROIs, the centro-frontal and left temporal regions revealed the most inhibition (p<0.05). The decrease in the amplitude of the N1 and P2 in that region could also be traced in the 100 and 200 ms topoplots.

Gap-induced inhibition was observed in all gap-embedded stimuli and all ROIs. However, the 40-150 mode and centro-frontal and left temporal regions had maximum inhibition in normal subjects. It provides a promising tool for objectively assessing tinnitus in humans with particular implications in children

The first onset of many psychiatric disorders usually occurs inchildhood or adolescence. The structured interview of Preschool Age Psychiatric Assessment (PAPA) was developed in response to the need for a standardized and reliable method to assess psychiatric disorders in preschool-age children. This study aimed to translate DSM-5-based PAPA into Farsi and evaluate its face and content validity and reliability.

The procedure was a forward translation of PAPA to Farsi, evaluation for face and content validity, finalization of items within the expert panel, backward translation to English, matching the original PAPA with randomly selected items from the backward translation version, and revision as needed, and finally evaluation for the validity of the changes for localization and cultural considerations. The interviews based on the final Farsi version were performed on thirty parents of children from two to five years old (chosen from Tabriz health centers) to determine the reliability and were repeated at an interval of two weeks.

The mean of CVI=0.91 and Modified Kappa=0.90 were obtained, and reliability with Cronbach’s alpha was 0.89.

The Farsi version of the DSM-5-based PAPA diagnostic interview has good face and content validity and reliability.

Seizure is a common sign in neonates hospitalized in the neonatal intensive care units (NICU) that may lead to morbidity and mortality. Most neonatal seizures are subclinical. Conventional EEG (cEEG) is the gold standard for detecting and monitoring seizures but is not widely available. Amplitude-integrated electroencephalography (aEEG) has been used for over a decade to evaluate infants with seizures. In this study, we tried to determine the efficacy of aEEG as
a widely available diagnostic tool in diagnosing seizures.

All cases with seizures or suspicious seizures were admitted to the NICU of the Children’s Medical Center for one year. cEEG and aEEG were performed for these infants. aEEG was recorded for at least six hours with a description of the tracing. Clinical information, outcomes, and questionnaires (patient information) were recorded in detail. The obtained data were analyzed with the SPSS version 24 software.

Eleven out of twenty-five aEEG recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (68%) and hypotonia (28%); the mortality rate was 12%. No significant correlation was observed between aEEG findings and gender, age, familial relation, outcome, ultrasound result, type of seizure, and underlying disease.

Indicatively, phenobarbital can impair thyroid function in adults and children. The present research aims to evaluate the thyroid hormone levels in preterm neonates who had received phenobarbital treatment.

This study was conducted on preterm neonates who weighed less or equal to 2500 g when phenobarbital was prescribed for treatment in the first 15 days of life. TSH and total T4 measurements were performed before and three months after initiation of phenobarbital.

In this study, the sum of preterm neonates stood at 94, of which 53 were girls, with a mean birth weight of 2004.41 ± 315.41g. Weight of 8.5% were under 1500 g. The mean gestational age was estimated at 33.64 ± 2.01 weeks. Mean T4 levels were 12.24 ± 1.96 and 12.07 ± 1.95 (p=0.334), and mean TSH levels were 5.34 ± 2.14 and5.15 ± 2.15 (p=0.376) before and after prescribing phenobarbital, respectively. The same results were compared based on sex, gestational age, birth weight, and height for T4 and TSH and T4 based on head circumference. The only significant difference was TSH in preterm infants with head circumference <32 cm before and after prescribing phenobarbital (p=0.030).

In preterm newborns that had less than 2500 g birth weight, phenobarbital did not significantly alter the serum thyroid hormone levels

COVID-19 is a pandemic disease in which most patients have pulmonary symptoms. However, several cases of CNS involvement associated with COVID-19 have been reported.Acute necrotizing encephalopathy of childhood (ANEC) is a rare CNS complication of viral infections such as influenza, herpes virus, and COVID-19, leading to high mortality and morbidity rates. Several cases of COVID-19-associated acute necrotizing encephalopathy (ANE) have been reported since March 2020 in adults, with just a few cases in pediatrics.This article reports a 5-month-old child who presented with seizures, with the final diagnosis of ANE as a complication of COVID-19. MRI findings of ANEC, as reported in most COVID-19-associated ANEC case reports, involve bilateral, symmetric, multifocal lesions in the central thalami. Moreover, the brainstem, cerebral white matter, and cerebellum could be affected.The prognosis of COVID-19-associated ANE is poor, leading to neurologic dysfunction or mortality. COVID-19-associated ANE cases must be reported, especially in pediatrics, with detailed clinical history, laboratory data, and radiologic findings to introduce diagnostic criteria, prognosis, and a management protocol.