Differences in Mean Platelet Volume and Platelet Count between Children with Simple and Complex Febrile Seizures

How to Cite This Article: Nikkhah A, Salehiomran MR, Asefi SS. Differences in Mean Platelet Volume and Platelet Count between Children with Simple and Complex Febrile Seizures. Iran J Child Neurol. Spring 2017; 11(2):44-47.AbstractObjectiveThe aim of our study was to find the relationship of MPV (Mean Platelet Volume) levels and platelet counts as markers of inflammation between simple and complex febrile seizures.Materials & MethodsIn this retrospective comparative study, we investigated the recordings of 356 children between 5 months and 6 yr with diagnosis of simple and complex febrile seizure (SFS&CFS) in Amircola’s Children’s Hospital, Babol University of Medical Sciences, Babol, Iran between Mar 2011 and Dec 2015.ResultsMean age was similar in two groups. The MPV of the CFS group (8.32±0.48fl) was lower than that of the SFS group (8.58±0.34fl) but this difference was not significant statistically. The platelet count of the CFS group (315.03×103 ±117.17×103) was higher than that of SFS group (291.82×103 ± 87.49×103) but there was no significant statistical difference.ConclusionWe did not find significant differences between two groups. Therefore, further studies about this idea should be performed. References 1. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34:592–596.2. Shinnar S. Febrile seizure. In: Swaiman KF, Ashwal S, Ferriero DM, editors. Pediatric neurology principle & practice. 4th ed, vol. 1.Philadelphia: Lippincott Williams & Wilkins Press; 2006. P. 1079-1089.3. Shinnar S, Glauser TA. Febrile seizures. In: Pellock JM, Bourgeois FD, Edwin Dodson W. editors. Pediatric 47 epilepsy, Diagnosis & Therapy. 3rd ed. New York: Demos Press; 2008. P. 293- 301. Shinnar S, Glauser TA. Febrile seizures. J Child Neurol 2002; 17(suppl1):S44-S52.4. Lux AL. Treatment of febrile seizures: historical perspective, current opinions, and potential future directions. Brain Dev 2010; 32(1):42-50.5. Jons T, Jacobsen S.J. Childhood Febrile Seizures: Overview and Implications. Int J Med Sci 2007; 4(2):110- 4.6. Iwasaki N, Nakayama J, Hamano K, et al. Molecular genetics of febrile seizures. Symposium I Epilepsia 2002; 43(9): 32-5.7. Amirsalari S, Keihani doust Z, Ahmadi M, et al. Relationship between iron deficiency anemia and febrile seizures. Iran J Child Neurol 2010; (4)1:27-30.8. Ghasemi F, Valizadeh F, Taee N. Iron-deficiency Anemia in Children with Febrile Seizures. A Case-Control Study. Iran J Child Neurol 2014; (8) 2:38-44.9. Bidabadi E, Mashouf M. Association between iron deficiency anemia and first febrile convulsion: a case-control study. Seizure 2009; 18: 347-51.10. Hartfield DS, Tan J, Yager JY, et al. The association between iron deficiency and febrile seizures in childhood. Clin Pediatr 2009; 48(4): 420-6.11. Ozaydin E, Arhan E, Cetinkaya B, et al. Differences in iron deficiency anemia and mean platelet volume between children with simple and complex febrile seizures. Seizure 2012; 21(3): 211-214.12. Weyrich AS. Platelets: more than a sack of glue. American Society of Hematology (ASH). Hematology 2014; 5(1):400-3.13. Rondina MT, Weyrich AS, Zimmerman GA. Platelets as cellular effectors of inflammation in vascular diseases. Circ Res 2013; 112(11):1506-1519.14. Semple JW, Italiano JE Jr, Freedman J. Platelet and the immune continuum. Nat Rev Immunol 2011; 11(4):264- 274.15. Mahmut Abuhandan, Abdullah Solmaz, et al. Evaluation of Selenium Levels and Mean Platelet Volume in Patients with Simple Febrile Convulsion. Iran J Pediatr 2014; 24(4):401-405

The Effect of Anticonvulsant Drugs (Phenobarbital and Valproic Acid) on the Serum Level of Cholesterol, Triglyceride, Lipoprotein and Liver Enzymes in Convulsive Children

ObjectiveStudies on the effect of various antiepileptic drugs on serum lipids show contradictory results. We aimed to find the effect of Phenobarbital and Sodium Valproate monotherapy on serum lipid profile and liver function tests in epileptic children.Materials & MethodsThis cohort study was conducted in Amirkola Children Hospital. One hundred and ten children with epilepsy were included in this study. Children with hepatic or renal disease, those receiving medications which could alter liver function tests or serum lipid profile were excluded from the study. Patients were allocated into two groups. The first group, including 63 patients, received Phenobarbital and the second group, including 47 patients, received Sodium Valproate, both in divided doses. A venous blood sample was collected after overnight fasting to evaluate serum triglyceride, total cholesterol, LDL, HDL, and liver function tests. Data was analyzed with SPSS version 17.ResultsIn children receiving Phenobarbital, total cholesterol, LDL, HDL, ALP, SGOT and SGPT increased significantly after treatment, but TG level showed no significant changes. In children receiving Sodium Valproate, HDL, ALP, SGOT, SGPT significantly increased after treatment but there were no statistically significant changes in total cholesterol, LDL and TG. In our study, the plasma levels of LPa elevated significantly after treatment with Phenobarbital and Sodium Valproate (P Value=0.0001). This increase was more significant in patients receiving Sodium Valproate.ConclusionOur results suggested a need for monitoring serum total cholesterol, HDL, LDL, and TG levels in patients receiving Phenobarbital and Valproic Acid.

Prognosis of Guillain-Barré Syndrome in Children

How to Cite This Article: Salehiomran MR, Nikkhah A, Mahdavi M. Prognosis of Guillain-Barré syndrome in Children. Iran J Child Neurol. Spring 2016; 10(2):38-41.AbstractObjectiveGuillain-Barre Syndrome (GBS) is an acute polyradiculoneuropathy characterized by progressive motor weakness of limbs and areflexia. In this study, our aim was to evaluate the clinical pattern and prognosis of children with Guillain-Barre syndrome.Materials & MethodsThis cross-sectional study was conducted in the Pediatric Neurology Unit of Amirkola Children’s Hospital, Babol, Iran during the period of 5 years from October 2008 to September 2013. We assessed the clinical features, results of electrodiagnostic tests, functional status, treatment and outcome of 17 children diagnosed with GBS.ResultsOf 17 (male to female ratio = 1.6:1) children studied, all had motor weakness, 4 children (23.5 %) and cranial nerve palsies. Respiratory paralysis was found in one child requiring assisted ventilation. Antecedent illness preceding GBS was recorded in 7 (41.2%) children. The GBS subtype distribution as per electrodiagnostic studies was as follows: acute inflammatory demyelinating  polyradiculoneuropathy (AIDP) in 12 (70.6%) acute motor axonal neuropathy (AMAN) in 3 (17.6%), acute motor sensory axonal neuropathy (AMSAN) in 2 (11.8%). IVIG constituted the treatment given in all of the patients. Complete recovery was observed in 16 children and the remaining one child was dependent to wheelchair.ConclusionGBS in children is not poor prognostic disorder and our recommendation is administration of IVIG as soon as possible after clinical diagnosis. Except for one child who remained wheelchair bound, there was no mortality or morbidity in long-term observation. Besides, strong limitation of our study was the low number of subjects. References1. Van Doorn PA, Ruts L, Jacobs BC, et al. Guillain-Barre Syndrome: Clinical features, Pathogenesis. Lancet Neurol 2008 Oct; 7(10):939 -50.2. Dhadke SV, Dhadke VN, Bangar SS, Korade MB. Clinical Profile of Guillain Barre Syndrome. J Asso Physicians India 2013; 61: 168-72.3. Pi-Lien H, Chang W, Huang L et al. A clinical and electrophysiologic survey of childhood Guillain-Barre syndrome. Pediatr Neurol 2004; 30(2): 86-91.4. Koul R, Al-Futaisi A, Chacko A et al. Clinical Characteristics of Childhood Guillain-Barré Syndrome. Oman Med J 2008; 23(3): 158–61.5. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 1990; 27(suppl): S21-S24.6. Akbayram S, Doan M, Akgün C, Peker E, Sayın R, Aktar F, et al. Clinical features and prognosis with Guillain- Barré syndrome. Ann Indian Acad Neurol 2011; 14: 98-102.7. Loeffel VB, Rossi LN, Mumenyhaler M. The Landry Guillain-Barré syndrome complication prognosis and natural history of 123 cases. J Neural SG 1977; 33: 71-79.8. Maneesh Kumar, Shrikiran Aroor, Suneel Mundkur, Sandeep Kumar. Guillain-Barré Syndrome: A Clinical Study of Twenty Children. J Clin Diagc Res 2015 Jan; 9(1): 9-12.9. Korinthenberg R, Schulte Monting J. Natural history and treatment effects in Guillain-Barre syndrome: a multicentre study. Arch Dis Child 1996; 74: 281–87

Intermittent Diazepam versus Continuous Phenobarbital to Prevent Recurrence of Febrile Seizures: A Randomized Controlled Trial

How to Cite This Article: Salehiomran MR, Hoseini SM, Ghabeli Juibary A. Intermittent Diazepam Versus Continuous Phenobarbital to Prevent Recurrence of Febrile Seizures: A Randomized Controlled Trial. Iran J Child Neurol. Winter 2016;10(1):21-24.AbstractObjectiveFebrile seizure is the most common neurologic problem in children between 3 months to 5 years old. Two to five percent of children aged less than five yr old will experience it at least one time. This type of seizure is age dependent and its recurrence rate is about 33% overalls and 50% in children less than one yr old.The prophylactic treatment is still controversial, so we conducted a randomized controlled clinical trial to find out the effectiveness of continuous phenobarbital versus intermittent diazepam for febrile seizure.Materials & MethodsThis clinical trial was conducted in the Department of Pediatric Neurology, Babol University of Medical Sciences, Babol, Iran between March 2008 and October 2010. All children from 6 month to 5 yr old referred to Amirkola Children’s Hospital, Babol, Iran were enrolled in the study. Children with febrile seizure that had indication for prophylaxis but did not receive any prophylaxis previously were enrolled in the study. For prophylactic anti convulsion therapy, patients were divided randomly in two groups. One group received continuous phenobarbital and another treated with intermittent diazepam whenever the children experienced an episode of febrile illness for up to one year after their last convulsion.ResultsOf all 145 studied cases, the recurrent rate in children under prophylaxis with diazepam was 11/71 and in phenobarbital group was 17/74. There was no significant difference in the recurrence rate in both groups.ConclusionThere was no significant difference in the effectiveness of phenobarbital and diazepam in prevention of recurrent in febrile seizure and we think that in respect of lower complication rate in diazepam administration, it cloud be better choice than phenobarbital

Acute Necrotizing Encephalopathy of Childhood; A Case Report

How to Cite this Article: Salehi Omran MR, Nooreddini H, Baghdadi F. Acute Necrotizing Encephalopathy of Childhood; A Case Report. Iran J Child Neurol. 2013 Spring;7(2):51-54. AbstractAcute Necrotizing Encephalopathy of Childhood (ANEC) is an atypical disease followed by respiratory or gastrointestinal infection, high fever, which is accompanied with rapid alteration of consciousness and seizures. This disease is seen nearly exclusively in East Asian infants and children who had previously a good health. Serial MRI examinations demonstrated symmetric lesions involving the thalami, brainstem, cerebellum, and white matter. This disease has a poor prognosis, often culminating in profound morbidity and mortality. A 22-month infant with ANEC hospitalized in Amirkola Children Hospital has been evaluated. References1. Mizuguchi M. Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and Taiwan. Brain Dev. 1997 Mar;19(2):81-92. Review.2. Wang HS, Huang SC. Acute necrotizing encephalopathy of childhood. Chang Gung Med J 2001 Jan;24(1):1-10.3. Campistol J, Gassió R, Pineda M, Fernandez-Alvarez E. Acute necrotizing encephalopathy of childhood (infantile bilateral  thalamic necrosis): two non-Japanese cases. Dev Med Child Neurol 1998 Nov;40(11):771-4.4. Ito Y, Ichiyama T, Kimura H, Shibata M, Ishiwada N, Kuroki H, Furukawa S, Morishima T. Detection of influenza virus RNA by reverse transcription-PCR and proinflammatory cytokines in influenza-virus-associated encephalopathy. J Med Virol 1999 Aug;58(4):420-5.5. Sugaya N. Influenza-associated encephalopathy in Japan. Semin Pediatr Infect Dis 2002 Apr;13(2):79-84. Review.6. Skelton BW, Hollingshead MC, Sledd AT, Phillips CD, Castillo M. Acute necrotizing encephalopathy of childhood: typical findings in an atypical disease. Pediatr Radiol 2008 Jul; 38(7):810-3.7. Wong AM, Simon EM, Zimmerman RA, Wang HS, Toh CH, Ng SH. Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome. AJNR Am J Neuroradiol 2006 Oct; 27(9): 1919-23.8. Mizuguchi M. [Acute necrotizing encephalopathy of childhood]. Ryoikibetsu Shokogun Shirizu 2000; (30 Pt 5):527-30. Review. Japanese.9. San Millan B, Teijeira S, Penin C, Garcia JL, Navarro C. Acute necrotizing encephalopathy of childhood: report of a Spanish case. Pediatr Neurol 2007 Dec; 37(6): 438- 41.10. Mizuguchi M, Abe J, Mikkaichi K, Noma S, Yoshida K, Yamanaka T, et al. Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions. J Neurol Neurosurg Psychiatry 1995 May; 58(5): 555-61.11. Weng WC, Peng SS, Lee WT. Acute necrotizing encephalopathy of childhood with spinal cord involvement: a case report. J Child Neurol 2010 Dec; 25(12):1539-41.12. Ozawa T, Nakashima Y, Ito R, Hirano A, Kondo T. EEG findings in a case of acute necrotizing encephalopathy of childhood associated with influenza A virus infection. No To Hattatsu 2001 Jan;33(1):63-8. Japanese.13. Kurachi Y, Kawahara H, Hatakeyama K, Yazawa K, Kubota M, Oka A, et al. Acute necrotizing encephalopathy with horizontal gaze palsy. No To Shinkei 1997 Aug;49(8): 753-8. Japanese

Treatment of large cutaneous facial hemangioma with ropranolol in a child with biliary atresia and esophageal varices

Introduction: Biliary atresia (BA) is the most common cause of neonatal jaundice, for which surgery is indicated. It may lead to portal hypertension and esophageal varices. Sometimes, BA is related to other congenital anomalies and malformation, while a coexistence of BA with facial hemangioma has not been reported, yet. Infantile hemangioma is a childhood benign vascular tumor. Beta blocker has an effect on hemangioma and esophageal varices. Case Report: A 30-day-old girl with an infantile hemangioma was referred to Amirkola Children's Hospital. According to intraoperative cholangiography and liver biopsy information, BA was diagnosed. Also, she had a large infantile cutaneous hemangioma on her face. Portal hypertension and esophageal varices were diagnosed in her under observation. So, propranolol was prescribed for her. A year after that, her facial hemangioma was gradually getting better. Conclusions: association of BA with infantile cutaneous hemangioma is rare and cutaneous hemangioma can be treated by propranolol

Acute Disseminated Encephalomyelitis: A Review of Eleven Cases in Childhood in North of Iran

Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder. The pathogenesis is unclear, but it is thought to be immune-mediated. The prognosis is favorable, with most children making a full recovery. Objectives: The present report analyzed different clinical presentations, response to treatment and outcome in a series of 11 patients with ADEM who referred to our tertiary center in north of Iran from 2010 to 2014. Materials and Methods: In this retrospective simple descriptive review, eleven cases with ADEM admitted in the neurology ward from 2010 to 2014 were enrolled. The clinical findings and laboratory and imaging results of patients were reviewed. All of these cases were evaluated with neurological examination, serologic tests for bacterial meningitis and viral encephalitis (especially, herpes simplex virus) and brain MRI without contrast. After discharge, patients were followed for at least six months (6 to 12 months) clinically and radiologically. Results: Of 11 children, 8 were male and 3 female. Their ages ranged between 4 and 10 years. The mean interval between the preceding infection and symptoms of encephalomyelitis was nine days. The most common presenting symptoms were ataxia in 45.4%, fever and headache in 36.4% and altered consciousness in 18.2% of patients. Neurological examination revealed pyramidal motor signs such as brisk deep tendon reflexes (hyperreflexia) (81.8%), cranial nerve involvement (18.2%), dysarthria (9.1%) and abnormal movements (9.1%). We followed up these patients in long-term for 6 to 12 months. Only in 1 child who received IVIG, mild ataxia had reminded. Conclusions: The prognosis of acute disseminated encephalomyelitis (ADEM) is favorable. Early diagnosis and prompt treatment of ADEM would probably reduce morbidity

Acute Disseminated Encephalomyelitis: A Review of Eleven Cases in Childhood in North of Iran

Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder. The pathogenesis is unclear, but it is thought to be immune-mediated. The prognosis is favorable, with most children making a full recovery. Objectives: The present report analyzed different clinical presentations, response to treatment and outcome in a series of 11 patients with ADEM who referred to our tertiary center in north of Iran from 2010 to 2014. Materials and Methods: In this retrospective simple descriptive review, eleven cases with ADEM admitted in the neurology ward from 2010 to 2014 were enrolled. The clinical findings and laboratory and imaging results of patients were reviewed. All of these cases were evaluated with neurological examination, serologic tests for bacterial meningitis and viral encephalitis (especially, herpes simplex virus) and brain MRI without contrast. After discharge, patients were followed for at least six months (6 to 12 months) clinically and radiologically. Results: Of 11 children, 8 were male and 3 female. Their ages ranged between 4 and 10 years. The mean interval between the preceding infection and symptoms of encephalomyelitis was nine days. The most common presenting symptoms were ataxia in 45.4%, fever and headache in 36.4% and altered consciousness in 18.2% of patients. Neurological examination revealed pyramidal motor signs such as brisk deep tendon reflexes (hyperreflexia) (81.8%), cranial nerve involvement (18.2%), dysarthria (9.1%) and abnormal movements (9.1%). We followed up these patients in long-term for 6 to 12 months. Only in 1 child who received IVIG, mild ataxia had reminded. Conclusions: The prognosis of acute disseminated encephalomyelitis (ADEM) is favorable. Early diagnosis and prompt treatment of ADEM would probably reduce morbidity

Passion for Life: Lived Experiences of Patients after Coronary Artery Bypass Graft

Background: Coronary artery bypass graft surgery (CABG) improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. Methods: This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG.  Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Results: Passion for life was the main theme extracted from the participants’ interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. Conclusion:  The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery

Debilitating progressive encephalitis in a patient with BTK deficiency

X-linked agammaglobulinemia (XLA), also known as Bruton’s tyrosine kinase (BTK) deficiency, is a primary antibody deficiency, characterized by low number of B cells, agammaglobulinemia and increased susceptibility to a variety of infections. Herein, we report a case of XLA with confirmed BTK mutation that developed neurological deficits. While we could not detect any responsible microorganism in spite of comprehensive workup, brain magnetic resonance imaging revealed moderate brain atrophy. The diagnosis of progressive encephalitis was made for this patient. Patients with XLA have a higher chance of encephalitis compared with other primary antibody deficiencies. Given the violent nature of encephalitis, it is a concern among XLA patients