CAN HOMEOPATHY USED SIMULTANEOUSLY WITH REHABILITATION BE EFFECTIVE IN THE TREATMENT OF CHILDREN WITH CEREBRAL PALSY?

ObjectiveDifferent medical and rehabilitation interventions have been used for treatment of cerebral palsy (CP). In addition to conventional methods, complementary medicine such as homeopathy has been used in treatment of neurodevelopmental disorders. This study has been done to determine what effect homeopathic treatment would have on motor development (MD) of children with spastic CP, when added to rehabilitation normally used for such children.Materials & MethodsThis 2004 study was a double blind clinical trial, conducted on twentyfour subjects recruited from a developmental disorders clinic in Tehran. Using the minimization technique, subjects were divided to the case and control groups. Routine rehabilitation techniques were carried out for 4 months on both groups. In addition the cases were given homeopathy drugs, while the controls received placebos. Levels of gross and fine motor development were assessed with the Denver Developmental Screening Test II (DDST II). Data was collected by assessment forms, direct observations and examinations. Dependant variables in the two groups were compared at the beginning and at the end of the study.ResultsThe average ages of the case and control groups were 28 and 28.4 months respectively. Gross and fine motor development and motor developmental quotient in the case group, compared to the controls showed no statistically significant differences.ConclusionBased on the results of this study adding homeopathy to rehabilitation had no significant effect on motor development of CP children. Considering the documented effects of homeopathy on the physical status of children with CP it would be better not to reject the possibility of effects of homeopathy on motor development of children with CP. As homeopathy is young in Iran, it is recommended to conduct further more extensive research on the effects of homeopathy on neurodevelopmental diseases.Key Words:Spastic cerebral palsy, Motor development, Homeopathy

Muscle Tonicity of Children with Spastic Cerebral Palsy: How Effective Is Swedish Massage?

ObjectiveMassage therapy is one of the most widely used complementary and alternative medicine therapies for children. This study was conducted to determine the effect of Swedish massage on the muscle tonicity of children with spastic cerebral palsy (CP).Materials & MethodsThis study was a single blind clinical trial conducted on forty children with spastic CP, recruited from clinics of the University of Social Welfare & Rehabilitation Sciences. They were randomly assigned to intervention and control groups. Routine occupational therapy techniques were performed during a 3 monthperiod in both groups, while the intervention group also received Swedish massage for 30 minutes before every rehabilitation session. Muscle tonicity was evaluated at the  beginning of the study and 3 months later using the Modified Ashworth Scale.ResultsThe average ages of children in the intervention (n=13) and control (n=14) groups were 49.5 and 42.1 months respectively. Although after intervention, tonicity of upper and lower limbs, trunk and neck in the intervention group in comparison with controls had no significant differences, there were statistically significant differences in reduction rate of tonicity in upper limbs and trunk between the two groups (P <0.05).ConclusionMassage therapy is not a panacea for improvement of spasticity in children with CP but the encouraging results of other studies on children with CP indicate that further studies are needed for more definite results

Swedish massage and abnormal reflexes of children with spastic cerebral palsy

Objectives: Massage therapy is one of the most widely used complementary and alternative medicine therapies for children. This study was conducted to determine the effect of wedish massage on abnormal reflexes in children with spastic cerebral palsy (CP). Material and Methods: This study was a single blind clinical trial conducted on forty children with spastic CP who were recruited from clinics of the University of Social Welfare & Rehabilitation Sciences. They were randomly assigned to intervention and control groups. The routine occupational therapy (OT) techniques were performed during a 3 month-period in both groups. The intervention group also received Swedish massage for 30 minutes before every OT session. Primary, spinal, brain stem, midbrain, cortical and automatic reflexes were evaluated at the beginning of the study and 3 months later. The data analysis was done by parametric and nonparametric tests. Results: Finally, thirteen subjects in the intervention group and 14 subjects in the control group were remained and studied. The average ages in the intervention and control groups were 49.5 and 42.1 months respectively. There were no statistically significant differences in abnormal reflexes in the intervention group in comparison to the control (P > 0.05). Conclusion: Adding Swedish massage to traditional OT techniques had no significant effects on abnormal reflexes in children with spastic cerebral palsy. Evidently more research is required in order to completely reject the effects of Swedish massage on abnormal reflexes of children with CP

Motor Developmental Delay in 7500 Iranian Infants: Prevalence and Risk Factors

ObjectiveThe purpose of this study was to determine the prevalence and the most common risk factors of motor developmental delay in infants.Materials & MethodsFollowing ethical approval, a study was carried out on the prevalence and risk factors of infants with motor developmental delay. The first stage was conducted through a cross-sectional study to determine the prevalence of motor developmental delay on 7500 infants and the second stage was an analytic case - control survey to identify the most common risk factors on 140 infants, aged one month to three years with motor developmental delay. Data was collected using a demographic questionnaire, the Parents Evaluation of Developmental Status questionnaire, the Denver Developmental Screening Test II, a neurological assessment form, and the movement and tone assessment form.ResultsThe prevalence of motor developmental delay in 7500 infants was 18.7/1000. The most common risk factors in infants with motor developmental delay were prematurity (25.6%), low birth weight (19.2%), neonatal seizures (7.5%), hyaline membrane disease (6.7%), systemic infections of mothers during pregnancy (5.9%), severe neonatal hyperbilirubinemia (5%) in sequence. Motor developmental delay was significantly correlated with consanguinity of parents (p=0.001), prematurity (p=0.046), abnormal head circumference at birth (p=0.038), and low birth weight (p=0.026).ConclusionThe prevalence of motor developmental delay appears to be high and further studies should focus on different preventive strategies, controlling the most common risk factors and emphasizing on early detection and treatment of high risk infants.

Genetic regulation of pituitary gland development in human and mouse

Normal hypothalamopituitary development is closely related to that of the forebrain and is dependent upon a complex genetic cascade of transcription factors and signaling molecules that may be either intrinsic or extrinsic to the developing Rathke’s pouch. These factors dictate organ commitment, cell differentiation, and cell proliferation within the anterior pituitary. Abnormalities in these processes are associated with congenital hypopituitarism, a spectrum of disorders that includes syndromic disorders such as septo-optic dysplasia, combined pituitary hormone deficiencies, and isolated hormone deficiencies, of which the commonest is GH deficiency. The highly variable clinical phenotypes can now in part be explained due to research performed over the last 20 yr, based mainly on naturally occurring and transgenic animal models. Mutations in genes encoding both signaling molecules and transcription factors have been implicated in the etiology of hypopituitarism, with or without other syndromic features, in mice and humans. To date, mutations in known genes account for a small proportion of cases of hypopituitarism in humans. However, these mutations have led to a greater understanding of the genetic interactions that lead to normal pituitary development. This review attempts to describe the complexity of pituitary development in the rodent, with particular emphasis on those factors that, when mutated, are associated with hypopituitarism in humans

Consensus Middle East and North Africa Registry on Inborn Errors of Immunity

Background: Inborn errors of immunity (IEIs) are a heterogeneous group of genetic defects of immunity, which cause high rates of morbidity and mortality mainly among children due to infectious and non-infectious complications. The IEI burden has been critically underestimated in countries from middle- and low-income regions and the majority of patients with IEI in these regions lack a molecular diagnosis. Methods: We analyzed the clinical, immunologic, and genetic data of IEI patients from 22 countries in the Middle East and North Africa (MENA) region. The data was collected from national registries and diverse databases such as the Asian Pacific Society for Immunodeficiencies (APSID) registry, African Society for Immunodeficiencies (ASID) registry, Jeffrey Modell Foundation (JMF) registry, J Project centers, and International Consortium on Immune Deficiency (ICID) centers. Results: We identified 17,120 patients with IEI, among which females represented 39.4%. Parental consanguinity was present in 60.5% of cases and 27.3% of the patients were from families with a confirmed previous family history of IEI. The median age of patients at the onset of disease was 36 months and the median delay in diagnosis was 41 months. The rate of registered IEI patients ranges between 0.02 and 7.58 per 100,000 population, and the lowest rates were in countries with the highest rates of disability-adjusted life years (DALY) and death rates for children. Predominantly antibody deficiencies were the most frequent IEI entities diagnosed in 41.2% of the cohort. Among 5871 patients genetically evaluated, the diagnostic yield was 83% with the majority (65.2%) having autosomal recessive defects. The mortality rate was the highest in patients with non-syndromic combined immunodeficiency (51.7%, median age: 3.5 years) and particularly in patients with mutations in specific genes associated with this phenotype (RFXANK, RAG1, and IL2RG). Conclusions: This comprehensive registry highlights the importance of a detailed investigation of IEI patients in the MENA region. The high yield of genetic diagnosis of IEI in this region has important implications for prevention, prognosis, treatment, and resource allocation

Choroid plexus tumours

Choroid plexus tumours are rare epithelial brain tumours and limited information is available regarding their biology and the best treatment. A meta-analysis was done to determine prognostic factors and the influence of various treatment modalities. A thorough review of the medical literature (1966–1998) revealed 566 well-documented choroid plexus tumours. These were entered into a database, which was analysed to determine prognostic factors and treatment modalities. Most patients with a supratentorial tumour were children, while the most common sites in adults were the fourth ventricle and the cerebellar pontine angle. Cerebellar pontine angle tumours were more frequently benign. Histology was the most important prognostic factor, as one, five, and 10-year projected survival rates were 90, 81, and 77% in choroid plexus-papilloma (n=353) compared to only 71, 41, and 35% in choroid plexus-carcinoma respectively (P<0.0005). Surgery was prognostically relevant for both choroid plexus-papilloma (P=0.0005) and choroid plexus-carcinoma (P=0.0001). Radiotherapy was associated with significantly better survival in choroid plexus-carcinomas. Eight of 22 documented choroid plexus-carcinomas responded to chemotherapy. Relapse after primary treatment was a poor prognostic factor in choroid plexus-carcinoma patients but not in choroid plexus-papilloma patients. Treatment of choroid plexus tumours should start with radical surgical resection. This should be followed by adjuvant treatment in case of choroid plexus-carcinoma, and a ‘wait and see’ approach in choroid plexus-papilloma