فهرست مطالب
Iranian Journal of Child Neurology (IJCN)
Volume:9 Issue: 3, Summer 2015
- تاریخ انتشار: 1394/06/06
- تعداد عناوین: 11
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Pages 1-8Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non- parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist.Keywords: Sedation, Children, Procedural sedation, Non, parenteral medications
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Pages 9-12ObjectiveAnthropometry (measurement of body dimensions) has been used for clinical diagnosis of growth and developmental disorders during pregnancy and after birth. Different brain volumes have also been shown in abnormal developmental disorders. This study compares the different horizontal diameters of the left- and right-hand thumbnails and asymmetry of lateral cerebral ventricles in children with developmental delays.Materials and MethodsThis retrospective case control study was carried out in the Pediatric Neurologic Outpatient of a university hospital in Tehran, Iran (2009–2011). Twenty-eight patients with motor developmental disorders (case) and 28 healthy individuals (control) had brain MRIs and volume of lateral cerebral ventricles size had been studied. The maximum horizontal diameters of the left and right thumbnails were measured by calipers during physical and neurological exams by a pediatric neurologist. Finally, we compared and analyzed different horizontal diameters of the left and right hand thumbnails and asymmetry of lateral cerebral ventricles.ResultsThere was a significant correlation between asymmetry of brain lateral ventricles size and mean difference of horizontal diameter of thumb nails (P = 0.0001). A meaningful relation between brain hemispheres asymmetry and developmental delay (P = 0.04) was seen.ConclusionThe asymmetry of thumbnails can be a marker for asymmetry of lateral ventricles and child developmental delays.Keywords: Motor developmental delay, Asymmetrical thumbnail size, Asymmetry of lateral ventricles
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Pages 13-16ObjectiveMigraine is known as one of the most disabling types of headache. Among the variety of theories to explain mechanism of migraine, role of serum magnesium is of great importance. Serum magnesium, as a pathogenesis factor, was considerably lower in patients with migraine. We established this study to see if serum ionized magnesium, not its total serum level, was different in migraineurs from normal individuals.Materials and MethodsIn this case control study, all participants were recruited from Neurology Clinic of Imam Hossein Hospital, Tehran, Iran. Ninety-six people were entered in the study, 48 for each of case and control groups. The two groups were matched by age and sex. Migrainous patients were selected according to the criteria of International Headache Society. Various characteristics of headache were recorded based on patients’ report. Controls had no history of migraine or any significant chronic headaches. Serum ionized magnesium level was measured in both of the case and control groups and the results were compared to each other. P value of <0.05 was considered as significant.ResultsCase group consisted of 13 males, 35 females, and control group included 14 males, as well as 34 females. Mean age was 33.47± 10.32 yr for case and 30.45 ±7.12 yr for control group. Twenty-eight patients described the intensity of their headaches as moderate; 15 patients had severe and the 5 remainders had only mild headaches. Mean serum level of ionized Mg was 1.16± 0.08 in case group and 1.13± 0.11 in control group of no significant difference (P >0.05).ConclusionSerum ionized magnesium, which is the active form of this ion, was not significantly different in migraineurs and those without migraine. This may propose a revision regarding pathogenesis of migraine and question the role of magnesium in this type of headache.Keywords: Headache, Migraine, Serum ionized magnesium
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Pages 17-23ObjectiveDevelopmental delay screening is essential in pediatric medicine. The purpose of this study was to estimate the developmental delay in apparently normal children at entry to kindergarten.Materials and MethodsIn this cross- sectional study conducted in 2013, the developmental status of a sample of children who entered to kindergarten at the age of 4-60 months were evaluated by the Persian version of ages and stages questionnaires (ASQ) in Isfahan county, central Iran.ResultsTotally 680 children were enrolled, 11.8% of them were suspected to delayed in at least one domain and 1.3% and 1.2% in two and three domains, respectively. Developmental delay was in the following items: 5% in problem solving; 4.9% in fine motor; 3.2% in gross motor, 2.2% and 1.2% in personal – social and communication domains, respectively.ConclusionConsiderable proportions of apparently normal children who are entering kindergarten had developmental delay, which could be detected by evaluation with appropriate screening tools.Keywords: Developmental delay, Developmental screening, Child development, Iran
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Pages 24-33ObjectiveFew studies exist on the demographics and trends of pediatric central nervous system (CNS) tumors in Iran. In this study, we retrospectively reviewed all cases with confirmed CNS tumors admitted to Mofid Pediatric Hospital, Tehran, Iran during the last 18 years.Materials and MethodsData on gender, age of diagnosis, pathologic classification and tumor location were extracted from the available medical records. We used the last version of International Classification of Childhood Cancer.ResultOverall, 258 (81.9%) brain tumors and 57 (18.1%) spinal tumors were identified. Our subjects comprised of 147 (46.7%) female and 168 (53.3%) male children. More male dominancy was observed in brain tumors with a male to female ratio of 1.2 compared with 1.03 of spinal tumors. Malignant CNS tumors were most common in 1-4 yr age group. The four most common brain tumors in our subjects were astrocytomas, medulloblastoma, ependymoma and craniopharyngioma. Overall, 53.1% of the brain tumors were supratentorial. Gliomas, PNET and neuroblastma were the most frequent primary spinal tumors in our study. We observed an increasing trend for both brain and spinal tumors that was more remarkable in the last 5 years.ConclusionOur results are comparable with similar single center studies on CNS tumors during childhood. The observed disparities could be attributed to the single center nature of our study and geographical, environmental and racial variations in pediatric CNS tumors. The increasing trend of both brain and spinal tumors could warrant further investigations at provincial and national levels to investigate probable contributing environmental risk factors.Keywords: Pediatric brain tumors, Pediatric spinal tumors, Demography, Trends
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Pages 34-39ObjectiveIntraventricular hemorrhage (IVH) occurs in preterm infants; however, the occurrence of this event is less frequent in term neonates. The present study evaluated clinical characteristics, pathophysiological features, and early outcome of term neonates with IVH in a referral neonatal center in Iran.Materials and MethodsThis study was performed on 30 full-term neonates admitted to the Neonatal Intensive Care Unit (NICU) of Ali-Asghar Hospital, Tehran, Iran between March 2005 and April 2011. IVH was diagnosed using cranial ultrasonography, or brain magnetic resonance imaging (MRI).ResultsThe mean age at onset of symptoms was 3.9 days. Seizure was the commonest clinical symptoms followed by poor feeding and fever. The sources of bleeding in the brain were choroid plexus (60%), germinal matrix (20%) and parenchyma (6.7%). Severity of bleeding included 33.3% grade I, 30.0% grade II, 36.7% grade III to IV. Fifteen (50%) cases had coagulopathy. Twenty-five (83.3%) cases were discharged with a good condition, three (10%) cases were referred to surgical ward and two cases (6.7%) died in NICU.ConclusionThe main source of IVH in term neonates is choroid plexus; the most common clinical symptoms include seizure and poor feeding, and one-third of IVH events are graded as III to IV. Most affected neonates are discharged from NICU without CNS complication, about 10% need to refer to surgical interventions, and death was occurred in a few of neonates.Keywords: Intraventricular hemorrhage, Term neonate, Outcome
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Pages 40-49ObjectiveChildren with Autism Spectrum Disorders (ASD) tend to have problems in establishing and maintaining their social relationships. Some professionals believe this social impairment is the result of deficit in Theory of Mind (ToM). This study was conducted to explore the effectiveness of ToM training on such children.Materials and MethodsA quasi-experimental method, pre- test, post-test with control group was used. The sample included of 12 girls and 12 boys with High Functioning Autism Spectrum Disorders (HFASD). Two instruments were used as follows: the Theory of Mind test and the social skills questionnaire (1). The samples were randomly placed in the experimental and control groups. The experimental groups had 15 sessions of ToM training and the control groups had just regular school program.ResultsThe data were analyzed by Kolmogorov-Smirnov, independent t- and twoway- variance tests. The scores for social skills in the experimental group were significantly more than the control group.ConclusionToM training might improve the social skills of children with autism spectrum disorders.Keywords: Theory of Mind, Children, High Functional Autism Spectrum Disorders, Social skills
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Pages 50-56ObjectiveNeural tube defects (NTDs) are the most common congenital defects of central nervous system due to neural tube closure deficit during the third and fourth weeks of gestational age. Our study was performed to detect the incidence and risk factors of NTDs in Kashan, center of Iran.Material and MethodsThis case-control study was done on all pregnancies with NTD affected neonates (n=91) and 209 pregnancies with normal neonates from February 2007 to December 2012 in three hospitals in Kashan, center of Iran. Annual and the mean incidence of NTDs were calculated. Risk factors including neonatal gender, maternal age, gravidity, maternal abortion history, maternal gestational diabetes (GDM), folic acid use, familial marriage, maternal body mass index (BMI), birth season and family history of NTDs were evaluated by interview with mothers. Univariate and multivariate logistic regression were used to analyze the risk factors.ResultsThe mean incidence of NTDs was 2.33 per 1000 births. The multivariate analysis indicated that maternal history of abortion (OR: 4.9, CI: 1.9-12.8), and maternal obesity (OR: 5.4, CI: 1.3-21.8) were significantly associated with NTDs.ConclusionMaternal history of abortion and BMI were the major risk factors of NTDs.Keywords: Body mass index, Ethnicity, Neural tube defects, Abortion history, Incidence
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Pages 57-61ObjectiveMetachromatic leukodystrophy disorder (MLD) is one of the rare neurometabolic diseases caused due to lack of saposin B and arylsulfatase A enzyme deficiency.Materials and MethodsEighteen patients diagnosed as metachromatic leukodystrophy in the Neurology Department of Mofid Children’s Hospital in Tehran, Iran between 2010 and 2014 were included in our study. The disorder was confirmed by clinical, EMG-NCV, arylsulfatase A enzyme checking and neuroimaging findings along with neurometabolic and genetic assessment from reference laboratory in Iran. We assessed age, gender, past medical history, developmental status, clinical manifestations, and neuroimaging findings of 18 patients with metachromatic leukodystrophy.ResultsFrom 18 patients, 80% were offspring from consanguineous marriages. A family history of metachromatic leukodystrophy disease was positive for four patients. Twelve patients had late infantile form of this disorder and six patients had juvenile form. A history of tonic type seizure was positive in 20% of the patients and tonic spasm was confirmed with clinical information. Electromyographgraphy (EMG) in 96% of patients was abnormal with demyelinating sensorimotor neuropathy pattern. MRI in all patients showed the leukodystrophic pattern as arcuate fibers sparing and subcortical rim in white matter and periventricular involvement. Our diagnosis was confirmed by EMG-NCV findings with sensorimotor neuropathy pattern and the assessment of arylsulfatase A enzyme function.ConclusionMLD is an inheritance metabolic disorder, which was confirmed by the assessment of arylsulfatase A enzyme function, peripheral blood leukocyte that assessed in a referral laboratory in Iran.Keywords: Metachromatic leukodystrophy, Neurometabolic disorder, Children
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Pages 62-68Linear scleroderma “en coup de sabre” is a subset of localized scleroderma with band-like sclerotic lesions typically involving the fronto-parietal regions of the scalp. Patients often present with neurologic symptoms. On imaging, patients may have lesions in the cerebrum ipsilateral to the scalp abnormality. Infratentorial lesions and other lesions not closely associated with the overlying scalp abnormality, such as those found in the cerebellum, have been reported, but are extremely uncommon. We present a case of an 8-year-old boy with a left fronto parietal “en coup de sabre” scalp lesion and describe the neuroimaging findings of a progressively enlarging left cerebellar lesion discovered incidentally on routine magnetic resonance imaging. Interestingly, the patient had no neurologic symptoms given the size of the mass identified.Keywords: Linear Scleroderma “en coup de sabre”, Localized scleroderma, Morphea, Cerebellum, MRI
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Pages 69-72Sciatic nerve injury is one of the frequent mononeuropathies in children that occurs due to different causes such as nerve compression, trauma and stretch during surgery. Gluteal injection is an uncommon cause of sciatic injury in developed countries. Poor techniques and frequent injections are the common cause of injection palsy. Proneal division of the sciatic nerve is more prone to injury due to anatomic and structural characteristics. The diagnosis is based on electrophysiological studies and the recovery rate is poor. In this study, in a period of 2 years between 2012 and 2013, we report seven children under 6 years old (three females and four males) with abnormal gait and foot pain following gluteal injection in pediatric electrodiagnostic center. Five children had proneal component and two with tibial component injuries. Five children were followed for one year and only one showed good recovery.Keywords: Gluteal injection, Sciatic nerve injury, Children