The Comparison between Effect of Chloralhydrate and Diphenhydramine on Sedating for Electroencephalography

How to Cite This Article: Hassanzadeh A, Aminzadeh V. The Comparison between Effect of Chloralhydrate and Diphenhydramine on Sedating for Electroencephalography. Iran J Child Neurol. Autumn 2016; 10(4):25-29.AbstractObjectiveElectroencephalography (EEG) is the most effective diagnostic tool in distinguishing epileptic seizure. Chloral hydrate (CH) is a sedative hypnotic drug, commonly used as a method of sedation in children aged<3 yr.Furthermore, diphenhydramine (DH) is a first generation antihistaminic drug (H1 receptor blocker) with anti-cholinergic effect. In this study, we aimed to compare the effects of CH and DH on sedating for EEG. Materials & MethodsThis retrospective cohort study was conducted on patients’ records of aged 15-72 months undergone an EEG and required sedation. Overall, 200 children were assessed including 100 patients in group 1 (CH) and 100 patients in group 2 (DH). Data were gathered by a form including age, sex, the cause of EEG, complication, success rate, first dose success, as well as sleep and awake latency.Data were reported by descriptive statistics (mean, standard deviation, number, and percent) and analyzed by t-test and chi-square using SPSS 19. ResultsTotally, 113(56%) male patients with the mean age of 35.62±14.00 months participated in this study. Vomiting and agitation were the most frequent complications in CH and DH groups, respectively. Most of patients in both group indicated successful sedation. CH indicated higher rate of success by first dose toward DH. In addition, CH mentioned lower sleep latency and significant difference was noted between groups. The mean duration of awake latency was higher in DH groups which showed significant difference. ConclusionCH might be a more effective drug in comparison with the DH for sedation. According to the availability and low cost of DH, investigators are advised to perform further investigations. References1. Marcdante K, Kliegman RM, Behrman RE, Jenson HB. Nelson essentials of pediatrics: Elsevier Health Sciences; 2010.2. Sahyoun C, Krauss B. Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr 2012;24(2):225-32.3. Temme J, Anderson J, Matecko S. Sedation of children for CT and MRI scanning. Radiol Technol. 1990; 61(4):283- 5.4. Soni H. Martindale: The complete drug reference–38th edition. Nursing Standard 2014;28(47):32-.5. Gauillard J, Cheref S, Vacherontrystram M, Martin J. Chloral hydrate: a hypnotic best forgotten? Encephale 2002;28(3 Pt 1):200-4.6. Kay GG, Berman B, Mockoviak SH, Morris CE, Reeves D, Starbuck V, et al. Initial and steady-state effects of diphenhydramine and loratadine on sedation, cognition, mood, and psychomotor performance. Arch Intern Med 1997;157(20):2350-6.7. Roehrs T, Zwyghuizen-Doorenbos A, Roth T. Sedative effects and plasma concentrations following single doses of triazolam, diphenhydramine, ethanol and placebo. Sleep 1993;16(4):301-5.8. Engorn B, Flerlage J. The Harriet Lane Handbook: Mobile Medicine Series, Expert Consult: Elsevier Health Sciences; 2014.9. Malviya S, Voepel-Lewis T, Tait A, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002;88(2):241-5.10. Fallah R, Jalili S, Golestan M, Karbasi SA, Jarahzadeh M-H. Efficacy of chloral hydrate and promethazine for sedation during electroencephalography in children; a randomised clinical trial. Iran J Pediatr 2013;23(1):27-31.11. Bektas O, Arıca B, Teber S, Yılmaz A, Zeybek H, Kaymak S, et al. Chloral hydrate and/or hydroxyzine for sedation in pediatric EEG recording. Brain Dev. 2014;36(2):130- 6.12. Roach CL, Husain N, Zabinsky J, Welch E, Garg R Moderate sedation for echocardiography of preschoolers. Pediatr Cardiol 2010;31(4):469-73.13. Fávero ML, Ponce FAS, Pio MRB, Tabith Junior A, Silva FLC. Chloral hydrate to study auditory brainstem response. Braz J Otorhinolaryngol 2010;76(4):433-6.14. Ashrafi MR, Mohammadi M, Tafarroji J, Shabanian R, Salamati P, Zamani GR. Melatonin versus chloral hydrate for recording sleep EEG. Eur J Paediatr Neurol 2010;14(3):235-8.15. Heistein LC, Ramaciotti C, Scott WA, Coursey M, Sheeran PW, Lemler MS. Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors. Pediatrics 2006;117(3):e434-41.16. Cengiz M, Baysal Z, Ganidagli S. Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging. Paediatr Anaesth 2006;16(6):621-6

Acute Necrotizing Encephalopathy of Childhood (ANEC): A Case Report

How to Cite This Article: Hassanzadeh Rad A, Aminzadeh V. Acute Necrotizing Encephalopathy of Childhood (ANEC): A Case Report. IranJ Child Neurol. Winter 2017; 11(1):75-77.AbstractAcute Necrotizing Encephalopathy of childhood (ANEC) is a specific type of encephalopathy. After viral infection, it can be diagnosed by bilateral symmetrical lesions predominantly observed in thalami & brainstem of infants & children.Although, it is commonly occurred in Japanese and Taiwanese population. The goal of this article is to report a rare case of ANEC in a 15 months old girl infant from Thaleghani Hospital, Ramian, Gorgan, northern Iran.References1. Mizuguchi M, Mizuguchi M, Abe J, et al. Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions. J Neurol, Neurosurg Psychiatr 1995;58(5):555-561.2. Mizuguchi M. Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan & Taiwan. Brain Dev 1997;19:81-82. 3. Narra R, Mandapalli A, Kamaraju SK. Acute Necrotizing Encephalopathy in an Adult. J Clin Imag Sci 2015;5:20. doi:10.4103/2156-7514.156117.4. Kim JH1, Kim IO, Lim MK, et al. Acute necrotizing encephalopathy in Korean infants and children: imaging findings and diverse clinical outcome. Korean J Radiol 2004 Jul-Sep;5(3):171-7.5. Salehiomran MR, Nooreddini H, Baghdadi F. Acute Necrotizing Encephalopathy of Childhood; A Case Report. Iran J Child Neurol 2013;7(2):51-54.6. Protheroe SM ,Mellor DH. Imaging in influenza A encephalitis. Arch Dis Child 1991;66:702-705. 7. Barkovich AJ. Infections of the nervous system. Pediatic neuroimaging 3rd ed. Philadelphia:Lippincoot Williams &Wilkins, 2000:744-746. 8. Kumar S1, Misra UK, Kalita J, et al. MRI in Japanese encephalitis.Neuroradiology 1997:39:180-184. 9. Abe T1, Kojima K, Shoji H, et al. Japanese encephalitis. J MRI 1998;8:755-761.10. Fenichel G. Clinical pediatric neurology; 4th ed. 2002:54

A Report of Guillain–Barré Syndrome With Myalgia and Mild Weakness

How to Cite This Article: Aminzadeh V, Hassanzadeh Rad A. A Report of Guillain–Barré Syndrome With Myalgiaand Mild Weakness. Iran J Child Neurol. 2014 Spring; 8(2):70-72. We report a rare case that revealed severe myalgia as the chief complaint that is not mentioned in the list of frequent symptoms of Guillain Barré.Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP).Required features for diagnosis of GBS are progressive motor weakness of more than one limb and areflexia. We report an 11-yearoldboy who was referred to the emergency department with complaints of generalized body pain and gate problem.It seems that if myalgias are the chief complaint and weakness is mentioned as a less important symptom, clinicians should consider GBS after ruling out otherreasons for myalgia especially inflammatory myositis. References1. Landaverde JM, Danovaro-Holliday MC, Trumbo SP, Pacis-Tirso CL, Ruiz-Matus C. Guillain-Barré syndrome in children aged <15 years in Latin America and the Caribbean: baseline rates in the context of the influenza A (H1N1) pandemic. J Infect Dis 2010 Mar;201(5):746-50.2. Edward J. Filipponea, D Mitul Kanzariaa Rodney Bellb Eric Newmana, D John L. Farber. Secondary Membranous Nephropathy Associated with Guillain-Barré Syndrome. Case Rep Nephrol Urol 2013;3:34–39.3. Kuwabara S. Guillain-Barré syndrome: epidemiology, pathophysiology and management. Drugs 2004;64(6):597-610.4. Hughes RAC, Swan AV, Raphael JC, Annane D, van Koningsveld R, van Doorn PA. Immunotherapy for Guillain-Barré syndrome: a systematic review. Brain 2007;130:2245-2257.5. Dy M, Leshner RL, Crawford JR An Unusual Case of Recurrent Guillain-Barre Syndrome of a Different Subtype Five Years after Initial Diagnosis.Case Rep N eurol Med 2013; 2013: 356157.6. McLean S, Sheng F, Oon SF. Childhood Guillain-Barre Syndrome: Comparing Intravenousimmunoglobulin Treatment with Supportive Care.Trinity Student Medical Journal. 2005; 6:60–7.7. Swaimann K. Ashwal S. Ferriero D. Pediatric neurology: principles and practice. 4th ed. Philadelphia: Mosby-Elsevier 2006.p 1920.8. Sejvar JJ, Kohl KS, Gidudu J, et al. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599-612.9. Hicks CW, Kay B, Worley SE, Moodley M. A clinical picture of Guillain-Barré syndrome in children in the United States. J Child Neurol 2010 Dec;25(12):1504-10.10. Borade A, Lad S, Ansari N, Dhongade R. Guillain-Barré syndrome in child with prolongintubation. Indian J Med Sci 2010 Jul;64(7):325-8.11. Roodbol J, de Wit MC, Walgaard C, de Hoog M, Catsman-Berrevoets CE, Jacobs BC. Recognizing Guillain-Barré syndrome in preschool children. Neurology 2011 Mar 1; 76(9):807-10.

Infantile Spasms Treated with Intravenous Methypredinsolone Pulse

How to Cite This Article: Hassanzadeh Rad A, Aminzadeh V. Infantile Spasms Treated with Intravenous Methypredinsolone Pulse. Iran J Child Neurol. Spring 2017; 11(2):8-12.AbstractObjectiveInfantile spasms is diagnosed late even by expert pediatricians. Late diagnosis (later than 3 weeks) can have a negative effect on the long-term prognosis. We aimed to investigate infantile spasms treated with intravenous methylprednisolone pulse.Materials & MethodsIn this case series study, 20 infants with infantile spasms in 17-Shahrivar Hospital, Rasht, Iran were enrolled. Drugs were administered based on Mytinger protocol that included 3 days of methylprednisolone pulse and 56 days of oral prednisolone. The control of spasms and the omission of hypsarrhythmia in infants follow-up were the primary and secondary outcomes, respectively. Remission was indicated if the caregivers mentioned no spasms or >50% decrease regarding drug initiation for at least 5 consecutive days and the electroencephalography during sleep period noted the omission of hypsarrhythmia.Results Eleven female (55%) and 9 male (45%) patients with the mean age of 4.95±1.39 months were enrolled. Mean rapid remission was noted as 4.41±1.50 days. Twelve patients (60%) noted early remission. seizure was controlled in 3(15%) patients completely after 24 months. Five (25%) occasional seizures were noted controlled by routine anticonvulsant drugs after 24 months and 12 (60%) no response was mentioned. Most of the patients (65%) had cryptogenic etiology for infantile spasms. Uncontrolled seizure was mentioned after initial remission.Conclusion Methyl prednisolone is an appropriate drug based on easy administering, low cost, and its accessibility. References1.Widjaja E, Go C, McCoy B, Snead OC. Neurodevelopmental outcome of infantile spasms: a systematic review and meta-analysis. Epilepsy Res 2015;109:155-62.2. Mackay M, Weiss S, Adams-Webber T, Ashwal S, Stephens D, Ballaban-Gill K, et al. Practice Parameter: Medical Treatment of Infantile Spasms Report of the American Academy of Neurology and the Child Neurology Society. Neurology 2004;62(10):1668-81.3. Abbas A, Elseed M, Hamed A, Mohamed IN. The role of oral prednisolone in the management of infantile spasms in resource-limited countries: experience from Sudan. Khartoum Med J 2016 Apr 5;7(3): 1012-18.4. Riikonen R. A long-term follow-up study of 214 children with the syndrome of infantile spasms. Neuropediatrics 1982;13(1):14-23.5. O’Callaghan FJ, Edwards SW, Alber FD, Hancock E, Johnson AL, Kennedy CR, et al. Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms (ICISS): a randomised, multicentre, open-label trial. The Lancet Neurol 2017;16:33-42.6. Pellock JM, Hrachovy R, Shinnar S, Baram TZ, Bettis D, Dlugos DJ, et al. Infantile spasms: a US consensus report. Epilepsia 2010;51(10):2175-89.7. Hrachovy RA, Frost JD, Kellaway P, Zion TE. Double-blind study of ACTH vs. prednisone therapy in infantile spasms. J Pediatr 1983;103(4):641-5.8. Delesalle F, Staumont D, Houmany MA, Breviere GM, Piette F. Pulse methylprednisolone therapy for threatening periocular haemangiomas of infancy. Acta Derm Venereol 2006;86(5):429-32.9. Nguyen J, Fay A. Pharmacologic therapy for periocular infantile hemangiomas: a review of the literature. Semin Ophthalmol 2009: 24(3):178-184.10. Mytinger JR, Quigg M, Taft WC, Buck ML, Rust RS. Outcomes in treatment of infantile spasms with pulse methylprednisolone. J Child Neurol 2010: 25(8): 948-53.11. Azam M, Bhatti N, Krishin J. Use of ACTH and prednisolone in infantile spasms: experience from a developing country. Seizure 2005;14(8):552-6.12. Lux AL, Edwards SW, Hancock E, Johnson AL, Kennedy CR, Newton RW, et al. The United Kingdom Infantile Spasms Study comparing vigabatrin with prednisolone or tetracosactide at 14 days: a multicentre, randomised controlled trial. The Lancet 2004;364(9447):1773-8.13. Kossoff EH, Hartman AL, Rubenstein JE, Vining EP. High-dose oral prednisolone for infantile spasms: an effective and less expensive alternative to ACTH. Epilepsy Behav 2009;14(4):674-6

A Brief Review of the New AAP (American Academy of Pediatrics) Guideline on Febrile Urinary Tract Infection in 2- to 24-month infants.

In recent years, based on controversial issues regarding the diagnosis, treatment and follow up in patients with febrile urinary tract infection (UTI), various investigations have been performed and conventional methods have been modified. Hence, American Academy of Pediatrics (AAP 1999 and 2011) and National Institute for Health and Clinical Excellence (NICE 2007) designed guidelines to justify a method for diagnosis, treatment and follow- up of UTI. The current revised version (AAP 2011) has important changes in approaching febrile UTI in 2- to 24-month infants such as the necessity of performing urinalysis and urine culture, revised sampling methods, modified treatment methods (parenteral or oral therapy), radiological follow-up, and finally antibiotic administration. The aim of this study was to summarize the recent AAP guideline (2011) and present a simpler algorithm. Keywords: Urinary Tract Infections; Infants; Child; Vesico-Ureteral Reflu

A Cost Effective Innovation to Microscopic Studies

No Abstrac

risk factors of Febrile Status Epilepticus

Objective: we aimed to investigate risk factors of FSE in children.Materials and methods: This is an analytic case control study which was conducted on all patients  records with first FS admitted to 17 shahrivar hospital during 2007-2014, Rasht. cases were children aged 6 to 60 months with febrile status epilepticus and controls were children with complex and simple febrile seizures. Data were gathered by a checklist including age, sex, type of milk consuming during first year, temperature, the interval  between fever and seizure, family history of epilepsy and febrile seizure, and prematurity.  Data were reported by descriptive statistics (number, percent, mean, standard deviation) and analyzed by chi square in SPSS 19.Results: In this study, 756 patients with FS participated including 39 patients with FSE, 194 complex febrile seizure (CFC) and 523 simple febrile seizure(SFC).Most of the patients (57.8%) experienced seizure with low grade fever (<39 c). The mean age in SFC group was significantly higher than FSE patients. Significant relation was noted between groups regarding body temperature during seizure (p=0.006), family history of febrile seizure (0.029), family history of epilepsy (p=0.042) and the premature birth (p=0.023)Significant relation was noted between FSE and CFC groups regarding body temperature during seizure (p=0.004), family history of febrile seizure (0.011), family history of epilepsy (p=0.037), and the premature birth (p=0.025) between FSE and CFC groups.In Conclusion: According to results, It seems that further investigation which assess these factors can be recommended

Circadian Rhythm and the Seasonal Variation in Childhood Febrile Seizure

How to Cite This Article: Sharafi R, Hassanzadeh Rad A, Aminzadeh V. Circadian Rhythm and the Seasonal Variation in Childhood Febrile Seizure. Iran J Child Neurol. Summer 2017; 11(3):27-30. AbstractObjectiveWe aimed to assess the circadian rhythm and the seasonal variation in childhood febrile seizure (FS).Materials & MethodsThis descriptive cross-sectional study was conducted retrospectively on patients’ records. Investigators assessed the records of patients with simple FS aged 6 to 60 months referred to Emergency Department of 17-Shahrivar Hospital, Rasht northern Iran during Jan 2010 to Jan 2013. Data were gathered by a checklist including age, sex, temperature, duration of seizure, seasonal, months, diurnal variation, and level of consciousness.ResultsTotally, 349 patients including 193 (55.3%) boys and 156 (44.7%) girls with the mean age of 22.85±18.34 months were enrolled in this study. The mean temperature of patients was 38.45±0.53°C. The mean duration of seizure was 97.91±57 sec. Awake, drowsy and slept patients were noted in 170 (48.7%), 33 (9.5%) and 146 (41.8%) cases, respectively. Most of the FS occurred in winter 118 (33.8%), afternoon 132 (37.8%) and in Jan 55 (15.8%).ConclusionBody temperature adjusted by hypothalamus affecting by circadian rhythm. FS is the most common form of seizure in childhood occurred by multifactorial issues. Otherwise, the occurrence of seizure in patients with epilepsy may be affected by the circadian rhythm. Seizures happen more frequent at a specific time in 24 h during a day.References1. Dubé CM, Brewster AL, Richichi C, Zha Q, Baram TZ. Fever, febrile seizures and epilepsy. Trends Neurosci 2007; 30(10):490-6.2. Patterson KP, Baram TZ, Shinnar S. Origins of temporal lobe epilepsy: febrile seizures and febrile status epilepticus. Neurotherapeutics 2014;11(2):242-50.3. Racinais S, Fernandez J, Farooq A, Valciu S, Hynes R. Daily variation in body core temperature using radiotelemetry in aluminium industry shift-workers. J Thermal Biol 2012;37(4):351-4.4. Scales WE, Vander AJ, Brown MB, Kluger MJ. Human circadian rhythms in temperature, trace metals, and blood variables. J Appl Physiol 1988;65(4):1840-6.5. Martinez D, Lenz MD, Menna-Barreto L. Diagnosis of circadian rhythm sleep disorders. Jornal Brasileiro de Pneumologia 2008 34(3):173-80.6. Azevedo CV, Sousa I, Paul K, MacLeish MY, Mondejar MT, Sarabia JA, et al. Teaching chronobiology and sleep habits in school and university. Mind Brain Edu 2008;2(1):34-47.7. Ishihara K. Development of body temperature rhythm: 6 years follow up of three cases. Psychiatr Clin Neurosci 2001;55(3):229-30.8. Torshin V, Vlasova I. Biorhythmologic aspects of seizure activity. Bulletin Exp Biol Med 2001;132(5):1025-8.9. Uberos J, Augustin-Morales M, Molina Carballo A, Florido J, Narbona E, Muñoz-Hoyos A. Normalization of the sleep–wake pattern and melatonin and 6- sulphatoxymelatonin levels after a therapeutic trial with melatonin in children with severe epilepsy. J Pineal Res 2011; 50(2):192-6.10. Ogihara M, Shirakawa S, Miyajima T, Takekuma K, Hoshika A. Diurnal variation in febrile convulsions. Pediatr Neurol 2010;42(6):409-12.11. Manfredini R, Vergine G, Boari B, Faggioli R, Borgna- Pignatti C. Circadian and seasonal variation of first febrile seizures. J Pediatr 2004;145(6):838-9.12. Panahandeh K, Harandi V, Esma’ili Jazanabadi F. Evaluation of seasonal variation and circadian rhythm of febrile seizures in children admitted to the pediatric ward of Rasoul-e-Akram hospital. Razi J Med Sci 2008; 15(59): 59-66.13. Mikkonen K, Uhari M, Pokka T, Rantala H. Diurnal and seasonal occurrence of febrile seizures. Pediat Neurol 2015;52(4):424-7

The adverse effects of gestational diabetes mellitus on maternal and neonatal kidneys

Gestational diabetes mellitus (GDM) is a complication of pregnancy defined as any level of early or first detection of glucose intolerance in pregnancy. It is a prevalent metabolic disorder associated with several maternal and neonatal complications. On the other hand, chronic kidney disease is a leading cause of premature morbidity and mortality worldwide, and diabetic nephropathy accounts for approximately half of all cases of end-stage renal disease. Due to these two conditions’ high prevalence and significance, any possible association would be a public health concern requiring further investigation. To this end, the current study aimed to review the adverse effects of GDM on maternal and neonatal kidneys

Is there any need for emergency neuroimaging in children with first complex febrile seizure?

Objectives:The current study aimed to assess the need for emergency neuroimaging in children with first CFC.Materials and methods: This is an analytic cross-sectional study which was conducted on children aged 6 -60 months with first CFS.  Data were gathered by a form which assess age, sex, radiology type, temperature, the duration of fever before convulsion, the duration and the frequency of convulsion, family history of febrile seizure. Data were reported by descriptive statistics (mean, standard deviation, frequency, and percent) and analyzed by Fisher Exact Test in SPSS version 19.Results: In this study, 111 patients with first CFC and mean age of 21.18±11.83 months enrolled. Regarding the type of CFC, results showed that the highest and lowest frequencies belonged to multiple and multiple focal prolonged FC, respectively.  Upper respiratory infection was the most common diagnosis. 2 unimportant abnormal neuroimaging results were noted. Conclusion:In this study results showed that performing emergency neuroimaging in patients with first CFS was not mandatory in the absence of developmental disorders, abnormal neurologic examination, underlying neurological disorder, and head trauma. This result is more important in our country, according to the lack of access to neuroimaging modalities in many hospitals in our country and due to its irradiation risk in childhood and cost consuming