History, Studies and Specific Uses of Repetitive Transcranial Magnetic Stimulation (rTMS) in Treating Epilepsy

How to Cite This Article: Noohi S, Amirsalari S. History, Studies and Specific Uses of Repetitive Transcranial Magnetic Stimulation (rTMS) in Treating Epilepsy. Iran J Child Neurol. Winter 2016; 10(1):1-8. AbstractObjectiveIn this study, repetitive Transcranial Magnetic Stimulation (rTMS) and its specific use for treating epilepsy were carefully scrutinized. Materials & MethodsTarget researches such as review articles, case reports, books and theses, which had to do with therapeutic method of rTMS were surveyed. It is worth mentioning that until the final stages, the search for records and documents related to rTMS went on and in the end, the collected data underwent a qualitative analysis. ResultsAs the literature review suggests, TMS principally applies electromagnetic induction to generate an electric current inside the brain without physical contact. The therapeutic uses of rTMS are for a wide range of mental disorders, namely epilepsy, chronic pains, motor disorders and so on. ConclusionDespite safety concerns and possible side effects, many researchers subscribe to rTMS and see a bright future for it

Thyroid Function Test Imbalance in Epileptic Children Under Anticonvulsive Therapy

How to Cite this Article: Ravi Torkaman M, Amirsalari S, Saburi A. Thyroid Function Test Imbalance in Epileptic ChildrenUnder Anticonvulsive Therapy. Iranian Journal of Child Neurology 2012;6(1):43-44. Dear Editor,There have been many studies regarding the impact of antiepileptic drugs(AEDs) on thyroid function. There are some challenging scopes which must beconsidered for conducting the study adressing the focused question. “Which oneof the thyroid hormones is related to the AEDs consumption?”. Some studiesdemonstrated that there may be alterations in all thyroid function tests (T3, T4 andTSH) after antiepileptic therapy in children (1). Some studies concluded that longtermprescription of anticonvulsive medications resulted in a decline in serum T4levels, although it had no effect on serum TSH levels. However, changes in serumT3 level was challenging and it must be investigated further (2).There were some confounding factors which may interfere with the conclusion.One of them is the type of the study. There are various study plans for this purposesuch as cross-sectional, case-control, experimental, self-controlled cohort anddouble-blind randomized clinical trial studies. It seems that the proper protocol ofstudy for this propose is a double-blind randomized clinical trial study. By usingother designs, the authors cannot interpret the effect of AEDs on thyroid function;however, they can discuss the prevalence of thyroid hormone imbalance and thecoordination among T3, T4 and TSH.Moreover, one of the confounding factors is the thyroid binding globulin (TBG)effect. It has appeared that some of the AEDs may change the amount of TBGand in this way may affect the amount of thyroid hormones (3). Clonazepamand valproic acid do not have any enzyme inducing effects, but phenobarbital,carbamazepine, phenytoin and primidone may induce the hepatic enzyme (4-6). Therefore, it seems necessary to analyze each group of patients based on thetype of drug which is prescribed and also by using the free amount of thyroidhormones, the researcher will be able to exclude the TBG effect. In addition, ageis an important factor which should be considered. The epileptic patients showextra-thyroid adverse effects such as vitamin D and bone metabolism disordersdue to antiepileptic drugs (7). Other secondary clinical disorders which interactwith the thyroid metabolism should be considered and overruled in the study withthe mentioned proposal, especially in the older population.It appears that the confounding effect of the duration of AED intake mustbe adjusted regarding the children’s age using multivariate analysis such asregression model or partial correlation test. The etiological mechanism of serumconcentrations of thyroid hormone change by AEDs has not been clarified clearlyand besides, patients with a personal or family history of thyroid disorders mayprogress to overt thyroid hormone imbalance secondary to AED consumption (6). Therefore, it is suggested that the pure etiologicalmechanism of thyroid disorders due to AEDs shouldbe studied in such cases. Previous reports suggestedthat return to normal of all parameters was observedafter withdrawal of anticonvulsive therapy and thisreversibility of the thyroid hormone imbalance may bea clue for further investigations in order to study thepatho-physiologic mechanism of this disorder (6).Recently, new pharmaceutical drugs have beensuccessfully used for epileptic patients. It is expectedthat the therapeutic role of these new medications willbecome more prominent in these patients in the futureand future studies should be focused on their adverseeffects.Disclosures: None. References: 1. Talebian A, Eslamian MR, Shiasi K, Moravveji A,Khodayari M, Abedi AR. Changing in thyroid functiontest in children underwent antiepileptic therapy. Iran JChild Neurol 2010;4(1):17-22.2. Mahyar A, Ayazi P, Dalirani R, Hosseini SM, DaneshiKohan MM. Serum thyroid hormone levels in epilepticchildren receiving ant-convulsive drugs. Iran J ChildNeurol 2011;5(4):21-4.3. Eirís-Puñal J, Del Río-Garma M, Del Río-Garma MC,Lojo-Rocamonde S, Novo-Rodríguez I, Castro-GagoM. Long-term treatment of children with epilepsy withvalproate or carbamazepine may cause subclinicalhypothyroidism. Epilepsia 1999;40(12):1761-6.4. Kirimi E, Karasalihoglu S, Boz A. Thyroid functions inchildren under long-term administration of antiepilepticdrugs. Eastern J Med 1999;4(1):23-6.5. Amirsalari S, Kayhanidost ZT, Kavemanesh Z, Torkman M, Beiraghdar F, Teimoori M, et al. Thyroid functionin epileptic children who receive carbamazepine,primidone, phenobarbital and valproic acid. Iranian JChild Neurol 2011;5(2):15-20.6. Verrotti A, Di corcia G, Trotta D, Chiarelli F. Thyroidfunction in children treated with antiepilepticdrugs: effects of treatment withdrawal. Ital J Pediatr 2003;29:242-6.7. Pack AM, Morrell MJ, McMahon DJ, Shane E. Normal vitamin D and low free estradiol levels in women onenzyme-inducing antiepileptic drugs. Epilepsy Behav 2011;21(4):453-8

Investigation of Correlation between Remotely Sensed Impervious Surfaces and Chloride Concentrations

Water quality and nonpoint source (NPS) pollution are important issues in many areas of the world, including the Greater Toronto Area where urban development is changing formerly rural watersheds into impervious surfaces. Impervious surfaces (i.e. roads, sidewalks, parking lots, strip malls, building rooftops, etc.) made out of impenetrable materials directly impact hydrological attributes of a watershed. Therefore, understanding the degree and spatial distribution of impervious surfaces in a watershed is an important component of overall watershed management. According to Environment Canada’s estimates, road salts, also considered nonpoint source pollutants, represent the largest chemical loading to Canadian surface waters. The main objective of this study is to verify the often assumed correlation between impervious surfaces and chlorides that result from the application of road salts, focusing on a case study in the selected six major watersheds within the Greater Toronto Area. In this study, Landsat-5 TM images from 1990, 1995, 2000, and 2005 were used in mapping urban impervious surface changes within the study area. Pixel-based unsupervised classification technique was utilized in estimation of percentage impervious surface coverage for each watershed. Chloride concentrations collected at Water Quality Monitoring Stations within the watersheds were then mapped against impervious surface estimates and their spatiotemporal distribution was assessed. In a GIS environment, remotely sensed impervious surface maps and chloride maps were overlaid for the investigation of their potential correlation. The main findings of this research demonstrate an average of 12.9% increase in impervious surface areas as well as a three-fold increase in chloride concentrations between 1990 and 2005. Water quality monitoring stations exhibiting the highest amounts of chloride concentrations correspond with the most impervious parts of the watersheds. The results also show a correlation (coefficient of determination of 0.82) between impervious surfaces and chloride concentrations. The findings demonstrate that the increase in imperviousness do generate higher chloride concentrations. Correspondingly, the higher levels of chloride can potentially degrade quality of surface waters in the region. Through an innovative integrated remote sensing approach, the study was successful in identifying areas most vulnerable to surface water quality degradation by road salts

Computerized cognitive training for improving cochlear-implanted children's working memory and language skills

Abstract Sensory deprivation, including hearing loss, can affect different aspects of a person’s life. Studies on children with hearing impairment have shown that such patients, especially those with cochlear implants (CIs), suffer from cognitive impairments, such as working memory problems and poor language skills. The present study aimed to examine the efficacy of cognitive computer training in improving working memory and language skills in children with a CI.This research was a quasi-experimental study with a pre-test-post-test design and a control group. Fifty-one children with a CI aged 6-12 years were recruited through convenience sampling and randomly assigned to the control and treatment groups. The Wechsler Working Memory Subtest and the Test of Language Development (TOLD) were used to evaluate children’s working memory and language skills pre- and post-treatment. The treatment group attended twenty 50-60-minute cognitive computer training sessions three times a week.Sina-Working Memory Training was used to provide the treatment group with working memory training, whereas no intervention was provided to the control group. Univariate and multivariate analysesof covariance were used to analyze data.The results demonstrated the efficacy of cognitive computer training in improving the performance of cochlear-implanted children’s working memory (auditory and visual-spatial) (P < 0.01). The results also pointed to improved performance in sentence imitation (P < 0.01), word discrimination (P < 0.01), and phonemic analysissubtests (P < 0.01).Overall, the findings indicated that cognitive computer training might improve working memory and language skills for children with CI. Therefore, the development and execution of such programs for children with CIs seem to improve their cognitive functions, such as working memory and language skills

Neurobrucellosis Presenting with Unilateral Abducens Nerve Palsy

How to Cite This Article: Andisheh M, Amirsalari S, Torkaman M, Sabzechian M, Afsharpaiman Sh. Neurobrucellosis Presenting with Unilateral Abducens Nerve Palsy. Iran J Child Neurol. Spring 2017; 11(2):61-64. AbstractOne of the rare complications of brucellosis is neurobrucellosis. There have been numerous reports showing clinical forms of brucellosis affecting CNS, such as cranial nerve involvement, myelitis, vascular disease, radiculoneuritis, meningitis, meningoencephalitis, and demyelinating disease. In this case report, we introduce a 2.5 yr old girl with unilateral abducens nerve palsy referred to Baghiyatallah Hospital Outpatient Clinic, Tehran, Iran in June 2015. References 1. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005; 352:2325–2336.2. Al-Sous MW, Bohlega S, Al-Kawi MZ, Alwatban J, McLean DR. Neurobrucellosis: clinical and neuroimaging correlation. AJNR Am J Neuroradiol 2004; 25:395–4013.Bingöl A, TogayIsikay C. Neurobrucellosis as an exceptional cause of transient ischemic attacks. Eur J Neurol 2006; 13:544–548.4.Adaletli I, Albayram S, Gurses B, et al. Vasculopathic changes in the cerebral arterial system with neurobrucellosis. Am J Neuroradiol 2006; 27:384–386.5.Shakir RA, Al-Din AS, Araj GF, Lulu AR, Mousa AR, Saadah MA. Clinical categories of neurobrucellosis. A report on 19 cases. Brain 1987; 110:213–223.6.Esra Özkavukcu, Zeynep Tuncay, Ferda Selçuk, İlhan Erden: An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings; Turkish Society of Radiology 20097. Tena D, Gonzáles-Praetorius A, LópezAlonso A, Peña JL, Pérez-Pomata MT, Bisquert J. Acute meningitis due to Brucella spp. Eur J Pediatr 2006; 165:726–727.8. Rangel Guerra R, Martinez HR, Leon Flores L. Neurobrucellosis. Report of five cases and literature review. Rev Inwest Clin 1982;34:62–8.9. Mugerwa RD, D’Arbela PG. Brucella meningitis; a case report and review of the literature. East African Med J 1976;53:266–9.10. Bashir R, Al-Kawi MZ, Harder EJ, Jinkins J. Nervous system brucellosis: diagnosis and treatment. Neurology 1985; 35:1576–1581.11. Al Deeb SM, Yaqub BA, Sharif HS, Phadge JG. Neurobrucellosis: clinical characteristics, diagnosis, and outcome. Neurology 1989; 39:498–501.12. Lubani MM, Dudin KI, Araj GF, Manandhar DS, Rashid FY. Neurobrucellosis in children. Pediatr Infect Dis J 1989;8:79–82.13. Santini C, Baiocchi P, Berardelli A, Venditti M, Serra P. A case of brain abscess due to Brucella melitensis. Clin Infect Dis 1994;19:977–8.14. Koussa S, Chemaly R. Neurobrucellosis presenting with diffuse cerebral white matter lesions. Eur Neurol 2003; 50:121–123.15. Fincham RW, Sahs AL, Joynt RJ. Protean manifestation of nervous system brucellosis. Case histories and a wide variety of clinical forms. JAMA 1963; 184:269–27516. Marconi G. Su un caso di sclerosis multipla acuta insorta dopo un’infezione da Brucella abortus. Riv Patol Nerv Ment 1966; 87:548–565.17. Bussone G, La Mantia L, Grazzi L, Lamperti E, Salmaggi A, Strada L. Neurobrucellosis mimicking multiple sclerosis: a case report. Eur Neurol 1989; 29:238–240.18. KarakurumGöksel B, Yerdelen D, Karataş M, et al. Abducens nerve palsy and optic neuritis as initial manifestation in brucellosis. Scand J Infect Dis 2006; 38:721–725.19. Yilmaz M, Ozaras R, Mert A, Ozturk R, Tabak F. Abducent nerve palsy during treatment of brucellosis. Clin Neurol Neurosurg 2003; 105:218–220

Effectiveness of Neurogenesis in treating Children with Cerebral Palsy

How to Cite this Article: Amirsalary S, Dehghan L, Dalvand H, Haghgoo H. Effectiveness of Neurogenesis in treating children with Cerebral Palsy. Iran J Child Neurol 2012;6(2):1-8. objectiveTissue-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. References1. Buonomano DV, Merzenich MM. Cortical plasticity: from synapses to maps. Annu Rev Neurosci 1998; 21:149-86.2. Haghgoo H. Fundemental of neurosciences. 1st ed. Tehran; USWR Press; 2011.3. Payne BR, Lomber SG. Reconstructing functional systems after lesions of cerebral cortex. Nat Rev Neurosci 2001 Dec;2(12):911-9.4. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005 Apr;47(8):571-6.5. Joghataei M, Kazem M. Barresi sathe niazhaie jamee be khadamate behzisti colle keshvar [persian].Tehran: University of. Social Welfare and Rehabilitation Sciences; 1990.6. Johnson A. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002 Sep;44(9):633-40.7. Yeargin-Allsopp M, Van Naarden Braun K, Doernberg NS, Benedict RE, Kirby RS, Durkin MS. Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration. Pediatrics 2008 Mar;121(3):547-54.8. Uvebrant P. Hemiplegic cerebral palsy. Aetiology and outcome. Acta Paediatr Scand Suppl 1988;345:1-100.9. Marin-Padilla M. Developmental neuropathology and impact of perinatal brain damage. II: white matter lesions of the neocortex. J Neuropathol Exp Neurol 1997 Mar;56(3):219-35.10. Tzarouchi LC, Astrakas LG, Zikou A, Xydis V, Kosta P, Andronikou S, et al. Periventricular leukomalacia in preterm children: assessment of grey and white matter and cerebrospinal fluid changes by MRI. Pediatr Radiol 2009 Dec;39(12):1327-32.11. Dehghan L, Dalvand H. Neuroplasticity after stroke [persian]. Modern rehabilitation 2008;1(4).12. Sanai N, Tramontin AD, Quiñones-Hinojosa A, Barbaro NM, Gupta N, Kunwar S, et al. Unique astrocyte ribbon in adult human brain contains neural stem cells but lacks chain migration. Nature 2004 Feb;427(6976):740-4.13. Doetsch F, Garcia-Verdugo JM, Alvarez-Buylla A. Cellular composition and three-dimensional organization of the subventricular germinal zone in the adult mammalian brain. J Neurosci 1997 Jul 1;17(13):5046-61.14. Laywell ED, Rakic P, Kukekov VG, Holland EC, Steindler DA. Identification of a multipotent astrocytic stem cell in the immature and adult mouse brain. Proc Natl Acad Sci U S A 2000 Dec 5;97(25):13883-8.15. Seri B, Garcia-Verdugo JM, McEwen BS, AlvarezBuylla A. Astrocytes give rise to new neurons in the adult mammalian hippocampus. J Neurosci 2001 Sep 15;21(18):7153-60.16. Seri B, Garcia-Verdugo JM, Collado-Morente L, McEwen BS, Alvarez-Buylla A. Cell types, lineage, and architecture of the germinal zone in the adult dentate gyrus. J Comp Neurol 2004 Oct 25;478(4):359-78.17. Sugiura S, Kitagawa K, Tanaka S, Todo K, OmuraMatsuoka E, Sasaki T, et al. Adenovirus-mediated gene transfer of heparin-binding epidermal growth factor-like growth factor enhances neurogenesis and angiogenesis after focal cerebral ischemia in rats. Stroke 2005 Apr;36(4):859-64.18. Ellsworth JL, Garcia R, Yu J, Kindy MS. Fibroblast growth factor-18 reduced infarct volumes and behavioral deficits after transient occlusion of the middle cerebral artery in rats. Stroke 2003 Jun;34(6):1507-12.19. Wada K, Sugimori H, Bhide PG, Moskowitz MA, Finklestein SP. Effect of basic fibroblast growth factor treatment on brain progenitor cells after permanent focal ischemia in rats. Stroke 2003 Nov;34(11):2722-8.20. Baldauf K, Reymann KG. Influence of EGF/bFGF treatment on proliferation, early neurogenesis and infarct volume after transient focal ischemia. Brain Res 2005 Sep 21;1056(2):158-67.21. Chmielnicki E, Benraiss A, Economides AN, Goldman SA. Adenovirally expressed noggin and brain-derived neurotrophic factor cooperate to induce new medium spiny neurons from resident progenitor cells in the adult striatal ventricular zone. J Neurosci 2004 Mar 3;24(9):2133-42.22. Cho SR, Benraiss A, Chmielnicki E, Samdani A, Economides A, Goldman SA. Induction of neostriatal neurogenesis slows disease progression in a transgenic murine model of Huntington disease. J Clin Invest 2007 Oct;117(10):2889-902.23. Gonzalez-Perez O, Jauregui-Huerta F, GalvezContreras AY. Immune system modulates the function of adult neural stem cells. Curr Immunol Rev 2010 Aug 1;6(3):167-73.24. Doetsch F, Alvarez-Buylla A. Network of tangential pathways for neuronal migration in adult mammalian brain. Proc Natl Acad Sci 1996 Dec 10;93(25):14895-900.25. Weickert CS, Webster MJ, Colvin SM, Herman MM, Hyde TM, Weinberger DR, et al. Localization of epidermal growth factor receptors and putative neuroblasts in human subependymal zone. J Comp Neurol 2000 Jul 31;423(3):359-72.26. Magavi SS, Leavitt BR, Macklis JD. Induction of neurogenesis in the neocortex of adult mice. Nature 2000 Jun 22;405(6789):951-5.27. Lois C, Garcia-Verdugo JM, Alvarez-Buylla A. Chain migration of neuronal precursors. Science. 1996 Feb 16;271(5251):978-81.28. Wichterle H, Garcia-Verdugo JM, Alvarez-Buylla A. Direct evidence for homotypic, glia-independent neuronal migration. Neuron 1997 May;18(5):779-91.29. Lois C, Alvarez-Buylla A. Long-distance neuronal migration in the adult mammalian brain. Science 1994 May 20;264(5162):1145-8.30. Mason HA, Ito S, Corfas G. Extracellular signals that regulate the tangential migration of olfactory bulb neuronal precursors: inducers, inhibitors, and repellents. J Neurosci 2001 Oct 1;21(19):7654-63.31. Lundy-Ekman L. Neuroscience: fundamentals for rehabilitation. 3rd ed. Philadelphia: WB Saunders; 2007.32. Mizuno K, Hida H, Masuda T, Nishino H, Togari H. Pretreatment with low doses of erythropoietin ameliorates brain damage in periventricular leukomalacia by targeting late oligodendrocyte progenitors: a rat model. Neonatology 2008;94(4):255-66.33. Lin S, Fan LW, Pang Y, Rhodes PG, Mitchell HJ, Cai Z. IGF-1 protects oligodendrocyte progenitor cells and improves neurological functions following cerebral hypoxia-ischemia in the neonatal rat. Brain Res 2005 Nov 23;1063(1):15-26.34. Gonzalez FF, Abel R, Almli CR, Mu D, Wendland M, Ferriero DM. Erythropoietin sustains cognitive function and brain volume after neonatal stroke. Dev Neurosci 2009;31(5):403-11.35. Goldman SA. Adult neurogenesis: from canaries to the clinic. J Neurobiol 1998 Aug;36(2):267-86.36. Tureyen K, Vemuganti R, Bowen KK, Sailor KA, Dempsey RJ. EGF and FGF-2 infusion increases post ischemic neural progenitor cell proliferation in the adult rat brain. Neurosurgery 2005 Dec;57(6):1254-63; discussion -63.37. Im SH, Yu JH, Park ES, Lee JE, Kim HO, Park KI, et al. Induction of striatal neurogenesis enhances functional recovery in an adult animal model of neonatal hypoxic-ischemic brain injury. Neuroscience 2010 Aug 11;169(1):259-68.38. Greenough WT, Black JE, Wallace CS. Experience and brain development. Child Dev 1987 Jun;58(3):539-59.39. Daadi MM, Davis AS, Arac A, Li Z, Maag AL, Bhatnagar R, et al. Human neural stem cell grafts modify microglial response and enhance axonal sprouting in neonatal hypoxic-ischemic brain injury. Stroke 2010 Mar;41(3):516-23.40. Lee JA, Kim BI, Jo CH, Choi CW, Kim EK, Kim HS, et al. Mesenchymal stem-cell transplantation for hypoxic-ischemic brain injury in neonatal rat model. Pediatr Res 2010 Jan;67(1):42-6.41. Yasuhara T, Matsukawa N, Yu G, Xu L, Mays RW, Kovach J, et al. Behavioral and histological characterization of intrahippocampal grafts of human bone marrow-derived multipotent progenitor cells in neonatal rats with hypoxic-ischemic injury. Cell Transplant 2006;15(3):231-8.42. van Velthoven CT, Kavelaars A, van Bel F, Heijnen CJ. Repeated mesenchymal stem cell treatment after neonatal hypoxia-ischemia has distinct effects on formation and maturation of new neurons and oligodendrocytes leading to restoration of damage, corticospinal motor tract activity, and sensorimotor function. J Neurosci 2010 Jul 14;30(28):9603-11.43. Chopp M, Li Y, Zhang ZG. Mechanisms underlying improved recovery of neurological function after stroke in the rodent after treatment with neurorestorative cellbased therapies. Stroke 2009 Mar;40(3 Suppl):S143-5.44. 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TREATMENT OF INFANTILE SPASMS; TETRACOSECTIDE OR VIGABATRIN? A COMPARATIVE STUDY

Objective:Infantile spasms (IS) is an age specific epileptic syndrome. Due to poor response of IS to conventional antiepileptic drugs, scientists are always on the lookout for newer, more effective drugs to treat the condition.Materials & Methods:In this study, 50 infants with IS symptoms, aged between 2-24 months, were randomly divided into two equal groups, each treated either with Vigabatrin or ACTH (long acting   Tetracosectide); the results for clinical efficacy of medication and drug side effects were compared.Results:After the sixth week of treatment, in the Vigabatrin group, 28% complete remission and 40% reduction in seizure frequencies was seen, while in the Tetracosectide group there were 40.9%  complete remission and 45.5% reduction in seizure frequencies, showing no significant difference between the clinical responses found in the two groups (P=0.44).Conclusion:Vigabatrin effeciacy is similar to Tetracosectide, but since it is impossible to evaluate visual field constriction, a probable irreversible side effect of Vigabatrin , It's better to use Tetracosectide for the first line in the treatment of IS .Keywords:Infantile spasms,Hypsarrhythmia, Vigabatrin,Tetracosectide

Risk Factors and Prognosis of Epilepsy in Children with Hemiparetic Cerebral Palsy

ObjectiveEpilepsy is reported in 15-90% of the children with Cerebral Palsy (CP) but its clinical course is not well defined.We conducted a retrospective study on children with hemiparetic CP who were referred to Pediatric Neurology Department of Mofid Hospital. The aim of our study was to evaluate the risk factors and prognosis of epilepsy in children with hemiparetic CP.Materials & MethodsWe evaluated 64 children with hemiparetic CP who were referred to Pediatric Neurology Department of Mofid Hospital between 2006 and 2008.According to our protocol, patients were divided into two groups: 34 children in the case group (hemiparetic patients with epilepsy) and 30 children in the control group (hemiparetic patients without epilepsy).ResultsPrenatal, perinatal and postnatal events, maternal age at the time of delivery, socioeconomic status of the family, familial history of epilepsy, neuroimaging findings, side of the hemiparesia and age at diagnosis of hemiparesis were not considered as risk factors for epilepsy in hemiparetic children, but microcephaly, severity of hemiparetic CP and mental retardation were significantly associated with an increased risk of epilepsy in children with hemiparetic CP.ConclusionOur study showed that microcephaly, severity of hemiparesis and mental retardation were risk factors for developing epilepsy in children with hemiparetic CP; furthermore, they had negative effects on rehabilitation outcome in these patients.

The Impacts of Hinged and Solid Ankle-Foot Orthoses on Standing and Walking in Children with Spastic Diplegia

How to Cite This Article: Dalvand H, Dehghan L, Feizi A, Hosseini SA, Amirsalari S. Iran J Child Neurol. 2013 Autumn; 7(4):12-19.AbstractObjective The purpose of this study was to examine the impacts of hinged and solid anklefoot orthoses (AFOs) on standing and walking abilities in children with spastic diplegia.Materials & MethodsIn a quasi-experimental design, 30 children with spastic diplegia, aged 4-6 years were recruited. They were matched in terms of age, IQ, and level of GMFCS E&R. Children were randomly assigned into 3 groups: a hinged AFO group (n=10) plus occupational therapy (OT), a solid AFO group (n=10) plus OT, a control group who used only OT for three months. Gross motor abilities weremeasured using Gross Motor Measure Function (GMFM).ResultsWe obtained statistically significant differences in the values between baseline and after treatment in all groups. The groups were also significantly different in total GMFM after intervention. Furthermore, there were differences between hinged AFOs and solid AFOs groups, and between hinged AFOs and control groups.ConclusionWe concluded that gross motor function was improved in all groups; however, hinged AFOs group appears to improve the gross motor function better than solid AFOs and control groups.ReferencesMiller F. Cerebral palsy. 1st ed. New York: Springer Science & Business Media; 2005.Wren TL, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: Influence of cerebral palsy subtype, age, and previous surgery. J Pediat Orthoped 2005;25(1):79-83.Knutosn L, Clark D. Orthotic devices for ambulation in children with cerebral palsy and myelomeningocele. Phys Ther 1991;71:947-60.Figueiredo EM, Ferreira GB, Maia Moreira RC, Kirkwood R, Fetters L. Efficacy of Ankle-Foot Orthoses on Gait of Children with Cerebral Palsy: Systematic Review of Literature. Pediat Phys Ther 2008; 20(3):207-23.Brehm MA, Harlaar J, Schwartz M. Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy. J Rehabil Med 2008;40(7):529-34.Abel MF, Juhl GA,Vaughan CL, Damiano DL. Gait assessment of fixed ankle-foot orthoses in children with spastic diplegia. Arch Phys Med Rehabil 1998;79(2):126-33.Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy. Disabil Rehabil 2007;29(2):139-44.Wilson H, Haideri N, Song K, Telford D. Ankle-foot orthoses for preambulatory children with spastic diplegia. J Pediat Orthoped 1997;17(3):370-6.Romkes J, Hell AK, Brunner R. Changes in muscle activity in children with hemiplegic cerebral palsy while walking with and without ankle-foot orthoses. Gait Posture 2006;24(4):467-74.Radtka SA, Skinner SR, Dixon DM, Johanson ME. A comparison of gait with solid, dynamic, and no ankle-foot orthoses in children with spastic cerebral palsy. 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Long term video-EEG monitoring findings in children and adolescents with intractable epilepsy

Introduction:   In spite of appropriate management, seizures are not controlled in10 to 20 percent of epileptic children. If we can find the epileptogenic focus and resect it by surgery, patient may be cured from refractory seizures. Long Term Video-EEG Monitoring (LTM) may give us important information in the preoperative assessment of these patients. We performed this study for the first time in pediatric age group in Iran.Materials and Methods: In this cross-sectional study, 43 children between 4 to 18 years, with intractable epilepsy who were Referred to Shefa Neuroscience Research Center between 1386_1391, were enrolled to study in order to evaluate their long-term video EEG findings.Results: Forty-three children were enrolled to this study with mean age of 10.07 years, that 24(65.9%) were boys and 19(44.1%) were girls.Seven patients with definite epileptogenic zone were advised to perform lesionectomy surgery, in 2 patients there was not any seizure onset focus but corpus callosotomy was advised to control their frequent falling. Eight cases were recommended to perform Electrocorticography or invasive EEG monitoring. Twenty-six cases were recommended to adjust medical treatment. In 3 cases there was not any electrical seizure activity during clinical attacks, so discontinuing anti-epileptic drugs were recommended with diagnosis of conditions that mimic epilepsy.Conclusions:   It is necessary to perform LTM in patients with refractory epilepsy in order to determine their treatment strategy. If there is any doubt about pseudoseizure LTM can help to differentiate epilepsy from conditions that mimic epilepsy