Bilateral Ptosis as the First Presentation of Guillain-Barre Syndrome

How to Cite This Article: Talebian A, Soltani B, Talebian M. Bilateral Ptosis as the First Presentation of Guillain-Barre Syndrome. Iran J Child Neurol. Winter 2016; 10(1):70-72.AbstractObjectiveGuillain-Barre syndrome (GBS) is the most common cause of acute weakness in children. It has multiple variant forms with different presentations. A rare initial sign is ptosis. In this study, we present a 10-year-old girl with bilateral ptosis without opthalmoplegia followed by a weakness in extremities with a favourable response to intravenous immunoglobulin. Due to the patient’s initial eyelid levators, myasthenia gravis was ruled out by a Tensilon test and electrophysiological studies. Our report highlights the possibility of GBS as a cause of isolated ptosis, especially in cases without ophthalmoplegia

Incidence and Risk Factors of Neural Tube Defects in Kashan, Central Iran

How to Cite This Article: Talebian A, Soltani B, Sehat M, Zahedi A, Noorian A, Talebian M. Incidence and Risk Factors of Neural Tube Defects in Kashan, Central Iran. Iran J Child Neurol. Summer 2015;9(3):50-56.AbstractObjectiveNeural tube defects (NTDs) are the most common congenital defects of centralnervous system due to neural tube closure deficit during the third and fourthweeks of gestational age. Our study was performed to detect the incidence andrisk factors of NTDs in Kashan, center of Iran.Material & MethodsThis case-control study was done on all pregnancies with NTD affectedneonates (n=91) and 209 pregnancies with normal neonates from February2007 to December 2012 in three hospitals in Kashan, center of Iran. Annual andthe mean incidence of NTDs were calculated. Risk factors including neonatalgender, maternal age, gravidity, maternal abortion history, maternal gestationaldiabetes (GDM), folic acid use, familial marriage, maternal body mass index(BMI), birth season and family history of NTDs were evaluated by interviewwith mothers. Univariate and multivariate logistic regression were used toanalyze the risk factors.ResultsThe mean incidence of NTDs was 2.33 per 1000 births. The multivariate analysisindicated that maternal history of abortion (OR: 4.9, CI: 1.9-12.8), and maternal obesity (OR: 5.4, CI: 1.3-21.8) were significantly associated with NTDs.ConclusionMaternal history of abortion and BMI were the major risk factors of NTDs

Causes and Associated Factors of Headaches among 5 to 15-year-old Children Referred to a Neurology Clinic in Kashan, Iran

How to Cite This Article: Talebian A, Soltani B, Haji Rezaei M. Causes and Associated Factors of Headaches among 5 to 15-year-old ChildrenReferred to a Neurology Clinic in Kashan, Iran. Iran J Child Neurol. 2015 Winter;9(1):71-75.AbstractObjectiveHeadaches are common neurologic problems for children and adolescents. They are divided into two types: primary and secondary. Primary headaches include migraines and tension-type as well as comprise the majority of headaches. We detect the causes of headaches and their associations with demographic variables among children and adolescents.Materials & MethodsThis cross-sectional study was performed on 5–15 year-old children with headaches from March 2010 to April 2012 who presented at a pediatric neurology clinic in Kashan, Iran. Diagnosis of headaches was done in accordance with the International Classification of Headache Disorders. Data regarding the type of headache, age, gender, pain severity, aura, family history, and sleep disorder were collected.ResultsOne hundred fourteen children (44 male and 70 female) with headaches were enrolled in the study. The types of headaches were comprised as follows: 67 cases of migraines, 38 cases of tension-type headaches, 2 cases of cluster headaches, and 7 cases of secondary headaches. Pulsating headaches, family history of headaches, insomnia, and pain severity had higher prevalence in migrainous patients.ConclusionPhysicians should extend their information gathering about primary and secondary headaches. Sleep disturbances and a family history of headaches were the most important factors associated with migraine headaches.ReferencesCuvellier JC, Donnet A, Guegan-Massardier E, Nachit-Ouinekh F, Parain D, Vallee L. Treatment of primary headache in children: a multicenter hospital-based study in France. J Headache Pain 2009; 10: 447-53.Lateef TM, Merikangas KR, He J, Kalaydjian A, Khoromi S, Knight E, et al. Headache in a national sample of American children: prevalence and comorbidity. J Child Neurol 2009; 24: 536-43.Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trondelag Health Study (Head-HUNT-Youth), a large populationbased epidemiological study. Cephalalgia 2004; 24: 373- 9.Isik U, Topuzoglu A, Ay P, Ersu RH, Arman AR, Onsuz MF, et al. The prevalence of headache and its association with socioeconomic status among schoolchildren in istanbul, Turkey. Headache 2009; 49: 697-703.Abu-Arafeh I, Macleod S. Serious neurological disorders in children with chronic headache. Arch Dis Child 2005; 90: 937-40.Lewis DW. Headaches in children and adolescents. Am Fam Physician 2002; 65: 625-32.The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 Suppl 1: 9-160.Tavasoli A, Aghamohammadpoor M, Taghibeigi M. Migraine and Tension-Type Headache in Children and Adolescents Presenting to Neurology Clinics. Iran J Pediatr 2013; 23: 536-540.Bruni O, Fabrizi P, Ottaviano S, Cortesi F, Giannotti F, Guidetti V. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia 1997; 17: 492-8.Isik U, Ersu RH, Ay P, Save D, Arman AR, Karakoc F, et al. Prevalence of headache and its association with sleep disorders in children. Pediatr Neurol 2007; 36: 146-51.Miller VA, Palermo TM, Powers SW, Scher MS, Hershey AD. Migraine headaches and sleep disturbances in children. Headache 2003; 43: 362-8.Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002; 59: 490-8.Lewis DW,Koch T. Headache evaluation in children and adolescents: when to worry? When to scan? Pediatr Ann 2010; 39: 399-406.Hershey AD, Powers SW, Bentti AL, Degrauw TJ. Effectiveness of amitriptyline in the prophylactic management of childhood headaches. Headache 2000; 40: 539-49.Donald W. Headache in children and adolescent. Am Fam Physician 2002; 65: 625-33.Kroner-Herwig B, Gassmann J. Headache disorders in children and adolescents: their association with psychological, behavioral, and socio-environmental factors. Headache 2012; 52: 1387-401.Wober-Bingol C, Wober C, Wagner-Ennsgraber C, Zebenholzer K, Vesely C, Geldner J, et al. IHS criteria and gender: a study on migraine and tension-type headache in children and adolescents. Cephalalgia 1996; 16: 107-12.Abu-Arafeh I,Russel G. Prevalence of headache and migraine in schoolchildren. British medical journal 1994; 308: 765-9.Ayatollahi SM,Khosravi A. Prevalence of migraine and tension-type headache in primary-school children in Shiraz. East Mediterr Health J 2006; 12: 809-17.Fallahzadeh H,Alihaydari M. Prevalence of migraine and tension-type headache among school children in Yazd,Iran. J Pediatr Neurosci 2011; 6: 106-9.Russell MB, Iselius L, Ostergaard S, Olesen J. Inheritance of chronic tension-type headache investigated by complex segregation analysis. Hum Genet 1998; 102: 138-40.Stewart WF, Linet MS, Celentano DD, Van Natta M, Ziegler D. Age and sex specific incidence rates of migraine with and without visual aura. Am J Epidemiol 1991; 134: 1111-20

Vincristine-Induced Cranial Neuropathy

How to Cite This Article: Talebian A, Goudarzi RM, Mohammadzadeh M , Mirzadeh AS. Vincristine-Induced Cranial Neuropathy. Iran J Child Neurol. 2014 Winter; 8(1):66-68. AbstractVincristine (VCR) is a vinca alkaloid that is used for treatment of many malignancies.The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. Described here is the case of a 2.5-year-old boy, a known case of Wilms’ tumor, treated by vincristine (0/067 mg/kg/day) and dactinomycin (0/045 mg/kg/day) after surgery. Three weeks after treatment, he presented with bilateral ptosis.Neurological examination revealed bilateral ptosis with normal pupillary reflex and eye movement. He received 3.015 mg cumulative dose of vincristine before development of ptosis.Treatment with pyridoxine (150 mg/m2 p.o. BID) and pyridostigmine (3 mg/kg p.o. BID) started as neuroprotective agents, and after 7 days the problem disappeared.The treatment continued for 6 weeks and there were no signs of ptosis or a recurrence in follow up 2 months later. References:Toopchizade V, Hosseini M, et al. Electrophysiological signs of neuropathy caused by vincristine. Medical Journal of Tabriz University of Medical Sciences. 2010 Autumn;31(3); 19-25.Gursel E.S. Vincristine-Induced Unilateral Ptosis in a Child. Pediatr Neurol 2009; 41:461-463.Ngamphaiboon N, Sweeney R, Wetzler M, Wang ES. Pyridoxine treatment of vincristine-induced cranial polyneuropathy in an adult patient with acute lymphocytic leukemia: Case report and review of the literature. Leuk Res. 2010 Aug;34(8):e194-6.Lash SC, Williams CP, Marsh CS, Crithchley C, Hodgkins PR, Mackie EJ. Acute Sixth-Nerve Palsy After Vincristine Therapy. Journal of AAPOS 2004 Feb;8(1): 67-8.Bay A, Yilmaz C, Yilmaz N, Oner AF. Vincristine induced cranial polyneuropathy. Indian J Pediatr. 2006 Jun;73(6):531-3.Tuxen M K, Hansen SW. Complication of treatment, Neurotoxicity secondary to antineoplastic drugs. Cancer Treatment Reviews 1994;20:191-214.Ozyurek H, Turker H, Akbalik M, Bayrak AO, Ince H, Duru F. Pyridoxine and pyridostigmine treatment in vincristine-induced neuropathy. Pediatr Hematol Oncol. 2007 Sep;24(6):447-52.Duman O, Tezcan G, Hazar V. Treatment of vincristineinduced cranial polyneuropathy. J Pediatr Hematol Oncol. 2005 Apr;27(4):241-2.Müller L, Kramm CM, Tenenbaum T, Wessalowski R, Göbel U. Treatment of vincristine-induced bilateral ptosis with pyridoxine and pyridostigmine. Pediatr Blood Cancer. 2004 Mar;42(3):287-8.Dejan S, Dragana B, Ivana P, Borivoje B, Marko P. Vincristine induced unilateral ptosis. J Pediatr Hematol Oncol. 2009 Jun;31(6):463

A Study on Causes and Types of Abnormal Increase in Infants’ Head Circumference in Kashan/Iran

How to Cite This Article: Talebian A, Soltani B, Moravveji AR, Salamati L, Davami M. A Study on Causes and Types of Abnormal Increase in infants’ Head Circumference in Kashan/Iran. Iran J Child Neurol. 2013 Summer; 7(3): 28- 33. ObjectiveHead circumference is a valuable index of brain growth and its disturbances can indicate different disorders of nervous system. Abnormal increased head circumference (macrocephaly) is common and observed in about 2% of infants. In this study, the causes and clinical types of abnormal increase in infants’ head circumference were investigated in Kashan, Iran.Materials & MethodsThis cross-sectional study was performed on 90 infants less than 2 years of age with abnormal increase in head circumference in Kashan, during 2009- 2011. The data were collected by history taking, physical examination, growth chart, and imaging.Results65 (72%) cases out of 90 infants were male and 25 ( 28%) cases were female. Fifty-three (58.8%) cases had familial megalencephaly, 30 (33.4%) had hydrocephalus, and other causes were observed in 7 (7.8%) cases. Eighty-three percent of Infants with familial megalencephaly and 50% with hydrocephalus had normal fontanels. In 90.6% of cases withfamilial megalencephaly, family history for large head was positive. Motor development was normal in 100% of cases with familial megalencephaly and 76.7% of hydrocephalic infants.Conclusion Familial megalencephaly was the most common cause of macrocephaly in the studied infants, and most of them had normal physical examination and development, so, parental head circumferences should be considered in the interpretation of infant’s head circumference and in cases of abnormal physical examination or development, other diagnostic modalities, including brain imaging should be done. References1. Lunde A, Melve KK, Gjessing HK, Skjaerven R, Irgens LM. Genetic and environmental influences on birth weight, Birth length, Head circumference, and gestational age by use of population-based parentoffspring data. American J Epidemiol 2007;165(7):734-41.2. Sankaran S, Das A, Bauer CR, Bada HS, Lester B, Wright LL, et al. Association between patterns of maternal substance use and infant birth weight, length and head circumference.Pediatrics 2004;114(2):e226-34.3. Demestre Guasch X, Raspall Torrent F, Vila Ceren C, Sala Castellvi P, Elizari Saco MJ, Martinez-Nadal S, et al. Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational. An Pediatr (Barc) 2009;70(3):241-52.4. Fenichel, GM. Disorders of cranial volume and shape. In: Clinical Pediatric Neurology: A Signs and Symptoms Approach, 6th ed. Philadelphia: Elsevier Saunders; 2009.p. 368.5. Kinsman SL, , Johnston MV. Hydrocephalus. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia, PA: Elsevier/Saunders, Philadelphia; 2011. p. 2008-11.6. Nard, JA. Abnormal head size and shape. In: Gartner JC,Zitelli BJ, editors. Common and Chronic Symptoms in Pediatrics. St. Louis: Mosby; 1997.7. Menkes JH, Sarnat HB, Flores-Sarnat L. Malformations of the central nervous system. In: Menkes JH, Sarnat HB, Maria BL, editors. Child Neurology. 7th ed. Philadelphia:  Lippincott Williams & Wilkins; 2006. p. 284.8. Williams CA, Dagli A, Battaglia A. Genetic disorders associated with macrocephaly. Am J Med Genet A 2008;146A(15):2023-37.9. Varma R, Williams SD, Wessel HB. Neurology. In: Zitelli BJ, Davis HW, edtors. Atlas of Pediatric Physical Diagnosis. 5th ed. Philadelphia: Mosby Elsevier; 2007. p. 563.10. Rekate HL. Hydrocephalus in children. In: Winn HR, Youmans JR, editors. Youmans Neurological Surgery. 5th ed. St Louis: Saunders. 2003. 3387-404.11. Gupta SN, Belay B. Intracranial incidental findings on brain MR images in a pediatric neurology practice: a retrospective study. J Neurol Sci 2008;264(1-2):34-7.12. Alper G, Ekinci G, Yilmaz Y, Arikan C, Telyar G, Erzen C. Magnetic resonance imaging characteristics of benign macrocephaly in children. J Child Neurol 1999;14(10):678-82.13. Smith R, Leonidas JC, Maytal J. The value of head ultrasound in infants with macrocephaly. Pediatr Radiol 1998;28(3):143-6.14. Day RE, Schutt WH. Normal children with large heads benign familial megalencephaly. Arch Dis Child 1979;54(7):512-7.15. Kumar R. External hydrocephalus in small children. Childs Nerv Syst 2006;22(10):1237-41.16. Rollins JD, Collins JS, Holden KR. United states head circumference growth reference charts: birth to 21 years. J Pediatr 2010;156(6):907-13.17. Medina LS, Frawley K, Zurakowski D, Buttros D, DeGrauw AJ, Crone KR. Children with macrocrania: Clinical and imaging predictors of disorders requiring surgery. AJNR Am J Neuroradiol 2001;22(3):564-70.18. Lorber J, Priestly BL. Children with large heads: a practical approach to diagnosis in 557 children, with special reference to 109 children with megalencephaly. Dev Med Child Neurol 1981;23(4):494-504.19. Zahl SM, Wester K. Routine measurement of head circumference as a tool for detecting intracranial expansion in infants: what is the gain? A nationwide survey. Pediatrics 2008;121(3):e416-20.20. Alvarez LA, Maytal J, Shinnar S. Idiopathic external hydrocephalus: natural history and relationship to benignfamilial macrocephaly. Pediatrics 1986;77(6):901-7.21. Yew AY, Maher CO, Muraszko KM, garton HJ. Longterm health status in benign external hydrocephalus. Pediatr Neurosurg 2011;47(1):1-6.22. Muenchberger H, Assad N, Joy P, Brunsdon R, Shores EA. Idiopathic macrocephaly in the infant: long-term neurological and neuropsychological outcome. Childs Nerv Syst 2006;22(10):1242-48

Changing in Thyroid Function Test in Children Underwent Antiepileptic Therapy

ObjectiveTo determine the changes in thyroid function tests in children who underwent antiepileptic therapy in Shahid Beheshti Hospital, Kashan, in 2008.Materials & MethodsThis analytical-observational study was carried out in a cohort fashion without an external control group (self controlled) on 45 children with new onset epilepsy who had not been previously treated with antiepileptic medications. Three subjects were excluded from the study because of presenting clinical symptoms of hypothyroidism. Plasma levels of TSH, T3, FT3, T4 and FT4 hormones were measured and compared at baseline and 3 and 6 months after treatment.ResultsThe results of Mann-Whitney statistical analysis suggested that the increase in the plasma level of TSH was significant only in the Sodium Valproate group.The plasma level of T3 significantly decreased 3 and 6 months after treatment in the Phenobarbital group while the plasma level of FT3 significantly decreased only in the Sodium Valproate group. The decrease in T4 plasma level was significant in all groups (Carbamazepine group, Sodium Valproate group and Phenobarbital group) 3 and 6 months after the onset of treatment but the decreasing in FT4 plasma level was only significant in the Carbamazepine group 6 months after the commencement of treatment.ConclusionPhenobarbital had the least effect on thyroid hormones. Considering the effect of such medications on thyroid function tests, it seems necessary to check the plasma levels of hormones periodically after beginning the treatment

Risk factors associated with positional plagiocephaly in healthy Iranian infants: a case-control study

Abstract Objectives Deformation of the skull by external forces in the absence of synostosis has been defined as positional plagiocephaly. The aim of this investigation was to determine the risk factors of positional plagiocephaly (PP) in healthy Iranian infants. Materials & Methods This case-control study was performed on 300 healthy Iranian infants aged 8-12 weeks who referred to pediatric neurology clinic at Shahid Beheshti Hospital of Kashan. Plagiocephaly evaluations were done by using Argenta’s scale. Results Based on multivariate logistic regression analysis, there was significant association between PP and male gender (OR=2.26; P=0.002), head circumference (OR=1.22; P=0.006), multiple pregnancy (OR=2.55; P=0.03), abnormal presentation in uterine (OR=2.18; P=0.02), primiparity (OR=2.43; P=0.003), and supine sleep position (OR=2.97; P<0.001). But type of delivery, firmness of headrest, oligohydramnios, and prolonged labor were not correlated with PP. Conclusions The current investigation supports the idea that head circumference, male gender, primiparity, multiple pregnancy, supine sleep position, and abnormal presentation in uterine are correlated with a greater incidence of PP. Further investigations should be undertaken to fully understand PP and its related risk factors

The Etiology and Clinical Evaluations of Neonatal Seizures in Kashan, IRAN

How to Cite This Article: Talebian A, Jahangiri M, Rabiee M, Masoudi Alavi N, Akbari H, Sadat Z. The Etiology and Clinical Evaluations ofNeonatal Seizures in Kashan, IRAN. Iran J Child Neurol. Spring 2015;9(2):29-41. AbstractObjectiveDetection of seizure, its etiology, and clinical types is important for guiding therapy. This study was designed to evaluate the etiology and clinical evaluations of neonatal seizures in Kashan, Iran.Materials and MethodsThe data of 100 hospitalized neonates with a complaint of seizures in Kashan City, from January 2006 to January 2011 were evaluated. The pediatric neurologist made the final diagnosis. The gestational age, neonate admission age, type of delivery, and laboratory and radiological investigations were reviewed   from the medical records. The relation of seizure etiology and other variables were compared using the Chi-square test. All the statistical analyses were performed using SPSS (ver 11.5).ResultsA total of 100 neonates were hospitalized with a diagnosis of seizures. The overall incidence rate of seizures was 2.6 per 1,000 live births. A total of 59% of seizures happened in the first three days of life. The etiologies of seizures were hypoxicischemic encephalopathy (HIE) (36%), hyponatremia (12%), hypoglycemia (11%), intracranial hemorrhage (11%), infections (10%), hypocalcemia (8%), metabolic disorders (7%), the structural anomalies (5%), and hypomagnesaemia (4%). In 23% of neonates, no specific etiology was found and 23% had multiple etiologies. In 45% of neonates, the EEG was not recorded. The type of the seizures were focal-clonic (26%), tonic (25%), multifocal clonic (34%), subtle(11%), and myoclonic (4%). The types of the seizure were unrelated to the paraclinical findings.ConclusionNeonatal seizures are common and HIE was the main cause of seizures in this study. The clinical evaluation of neonatal seizures needs improvement

Comparison of the Frequency and Complications of Inappropriate Antidiuretic Hormone Secretion in Patients with Septic and Aseptic Meningitis

ObjectiveDue to the high prevalence of syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). This study was carried out to evaluate the prevalence and relevant parameters of SIADH in children with septic and aseptic memingitis hospitalized at Kashan Shahid Beheshti Hospital between 1996 and 2006.Materials & MethodsThis descriptive study was conducted on 230 patients with meningitis hospitalized in the pediatric wards of Kashan Shahid Beheshti Hospital between 1996 and 2006. Relevant information (age, gender, type of meningitis, serum sodium and potassium, urine specific gravity (USG), blood sugar, blood urea nitrogen, serum creatinin, hydration condition) was collected from patients' records. Data was analyzed using Mann-Whitney and K2 tests.ResultsOut of 230 patients with meningitis, 33 had incomplete records and only 197 patients were recruited for this study. Sixty eight cases (34.5%) suffered from SIADH. It was more frequent among 1-2 year old  children.According to this research, SIADH was diagnosed in 57% of the 121 patients with hyponatremia, 58.7% of the 167 patients with USG > 1.004, 74% of the 93 patients with serum osmolity < 280 mOs/L and 100% of the patients with BUN < 10 mg%.ConclusionDue to the high prevalence of SIADH in septic and aseptic meningitis and its complication, it is recommended to restrict fluid therapy and monitor serum sodium, urine specific gravity and other diagnostic tests for SIADH.Keywords: Hyponatremia; Meningitis; SIADH, Septic, Asepti