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

Outcomes of Cochlear Implantation in Post-lingually Deaf Patients.

peer reviewed[en] INTRODUCTION: Cochlear implantation has been mentioned as the most effective therapeutic intervention in deaf patients and especially those with post-lingual deafness. We aimed to assess hearing improvement of post-lingually deaf patients after cochlear implantation. MATERIALS AND METHODS: in this cross-sectional study all the post-lingually deaf patients who had undergone cochlear implantation (CI) surgery between December 2010 and February 2016 were assessed. Patients were recalled and after explaining the study process and signing an informed consent form, an audiometry was done by a single audiologist. In addition, demographic information, cause of hearing loss, age of onset, history of hearing aid use and surgical complications were recorded in a pre-designed checklist. RESULTS: Twenty-nine male and 21 female with a mean age of 22.52±19.45 years underwent analysis. Most of patients (80%) had progressed condition since childhood. Sudden sensorineural hearing loss (SSNHL) was the most prevalent (10%) known etiology of deafness followed by meningitis (6%), Trauma (2%) and ototoxic drugs (2%) in the remaining 20% of the patients. Patients had the highest mean (37.1±12.61 dB) in 4000 Hz frequency and the lowest mean of hearing threshold level (32.6±8.37 dB) was for 1000 Hz frequency. Mean hearing threshold level was significantly lower in patients with lower ages of cochlear implantation (p=0.435). Patients with higher ages of deafness onset showed lower degree of hearing improvement (p=0.462). CONCLUSION: The results of our study suggest that cochlear implantation significantly improves hearing function of post-lingual patients and can be considered as a certain cure for these patients in Iran

The Effect of Foot Serial Casting Along with Botulinum Toxin Type-A Injection on Spasticity in Children with Cerebral Palsy

Abstract: Background & Aims: The goal of this study was to determine the effect of foot serial casting along with botulinum toxin type-A injection on spasticity in children with cerebral palsy. Methods: This study was a randomized clinical trial performed as a pre-post, double blind study. It was performed on 25 children with hemiplegia and diplegia (2-8 years) in Tehran city, who were referred to valiasr rehabilitation foundation. Participants were chosen by simple randomized sampling and were matched for age, Gross Motor Function Classification System (GMFCS) and type. They were randomly divided into two groups. The first group (n=13) underwent BTX-A injection alone and the second group (n=12) had BTX-A injection and foot serial casting after the injection. Clinical assessments were done using the GMFCS and Modified Ashworth Scale before and at 1, 3, 6 and 12 months after the interventions. Data were analyzed by Wilcoxon signed rank test and mann-whitney U. Results: Comparison of two groups in regard to the right and left knee spasticity at, 1, 3, 6 and 12 months after injection showed no significant difference in comparison to those before interventions. Furthermore, comparison of right and left ankle spasticity before injection with that at 1, and 3 months follow ups did not show statistically significant difference, but significant differences were found when compared with 6 and 12 month follow-ups (P<0.05) Conclusion: It seems, one of the proper approaches to reduce spasticity in children with cerebral palsy is foot serial casting along with botulinum toxin type-A injection and it can decrease the muscle tone when applied more than six months. Keywords: Cerebral palsy, Botulinum toxin type A, Muscle spasticity, Casts, Occupational therap

The frequency of congenital long QT syndrome based on new formula in children with sensori-neural hearing loss

Introduction: Long QT syndrome (LQTS) is a repolarization cardiac disorder that can lead to syncope, cardiac arrest and sudden death in apparently healthy individuals. The congenital type can be accompanied with congenital sensory-neural deafness (Jervell-Lang-Nielsen syndrome). Although there are limited studies assessed the frequency of LQTS in these children in developed countries, regarding introducing the new formula, it is necessary to re-evaluate the frequency of this syndrome. Materials and Methods: This cross-sectional and descriptive study was done on 203 patients with congenital sensory-neural hearing loss (SNHL) that had cochlear implant surgery in Baqiyatallah cochlear implant center from 2008 to 2012. Corrected QT was calculated with this formula: QTC = QT + 1.75 (heart rate-60) Patients with QTC > 460 ms, were categorized in four groups: Long QT: QT > 460, Borderline: 440 470 and very markedly: >500. Also, cardiac arrhythmias or arrest were evaluated in patients during cochlear implant surgery and in the postoperative recovery period. Result: Prevalence of LQTS in patients was 12.32 (25 patients). Prevalence of markedly long QT and very markedly long QT were 8.87 (18 patients) and 2.46 (5 patients) respectively. The prevalence of borderline group was 14.29 (29 patients). None of the patients during or after surgery were affected by cardiac arrhythmias or arrest. Conclusion: This study showed higher prevalence of LQTS in patients with SNHL than the normal population, and we suggest that all patients with congenital deafness should be screen for LQTS

The Efficacy of Botulinum Toxin Type a Injection in the Hamstring and Calf Muscles With and Without Serial Foot Casting in Gait Improvement in Children With Cerebral Palsy

Background: The goal of this study was to compare the efficacy of botulinum toxin type A (BTX-A) injection in the hamstring and calf muscles with and without ankle serial casting in the improvement of gait in children with cerebral palsy (CP).Methods : This double-blind prospective clinical trial was performed on 25, 2 to 8-year-old children with hemiplegic or diplegic CP in Tehran, Iran in 2010. The participants were chosen by simple randomized sampling and were matched for age, gross motor function classification system (GMFCS) and type of CP and were randomly divided into two groups: children in the first group (13) only received BTX-A injection, but the second group (12) received BTX-A and serial foot casting starting one week after the injection.Results : Comparison of the gross motor function, right and left knee spasticities and passive ROM of both knees between the two groups before and 1, 3, 6 and 12 months after the injections were not statistically significant (P>0.1). Furthermore, comparison of the right and left ankle spasticities and passive ROM before the injections and in1 and 3-month follow-ups did not show a statistically significant difference (P>0.1), but the differences were significant in 6 and 12-month follow-ups (P<0.05).Conclusion: BTX-A injection with serial foot casting vs. BTX-A alone was more effective in decreasing spasticity and improving passive ROM in the ankle of children with CP, but such injections in the hamstrings were not useful in these regards