[ effect of foot serial casting along with botulinum toxin type-A injection on spasticity in children with cerebral palsy]

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. 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. 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] 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

Flap outcome using "C" shaped and "new" incisions in pediatric cochlear implantation

Skin flap failure is a significant, though relatively uncommon complication of cochlear implant surgery. To achieve a good surgical result, a proper plan to locate the prospective implant is required. Thus, a new design of flap was evaluated in this regard. Two hundred and eleven consecutive children undergoing cochlear implantation in Baqiyatallah Cochlear Implant Center were compared with 75 cases who were operated through the classic "C shaped" fashion from Jul/14/2007 to Feb/14/2009. There was one case of flap necrosis in the classic approach but there were no major flap complications in "new" design, also keloid formation as a minor complication was rare in the "new" method. The "new" design is easier to apply with fewer complications, so it can be recommended in children undergoing cochlear implantation

[Accompanying problems in children with cerebral palsy and their relationship to type and level of motor disability]

There are some accompanying problems in children with cerebral palsy. These problems may affect the children and their family even more than cerebral palsy. The aim of this study was to investigate the rate of six common accompanying problems and their relationship to type and level of motor function. In this study, 120 children aged 2 to 14 years old were selected from 4 rehabilitation centers in Tehran. At first consent of the child's mothers were obtained, and then child's medical history was gathered and accompanying problems were extinguished. The gross motor function level and the type of cerebral palsy were determined. The data was analyzed by SPSS-16 using kolmogrov smironov test and spearman's rho correlation coefficient. The speech disorder was the most and hearing problem was the least common among children. The type of cerebral palsy was associated significantly with intellectual disabilities, speech, feeding problems and number of problems [p<0.05].There was significant correlation between Gross motor function classification system and intellectual disabilities, speech, feeding problems, seizure and number of problems [p<0.05]. According to high occurrence of accompanying problems in children with cerebral palsy especially more severe ones, early detection and treatment of these problems could enhance the quality of life of the children and their family

Treatment of infantile spasms; tetracosectide or vigabatrin? A comparative study

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. 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. 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]. 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