Management of spasticity in children with cerebral palsy

Cerebral palsy is the most common cause of spasticity and physical disability in children and spasticity is one of the commonest problems in those with neurological disease. The management of spasticity in children with cerebral palsy requires a multidisciplinary effort and should be started as early as possible. There are a number of treatments available for the management of spasticity. This article reviews the variety of options available for the clinical management of spasticity

[An assessment of Toxoplasmosis antibodies seropositivity in children suffering Autism]

Background: Toxoplasma gondii, is a mandatory intracellular protozoa, that many people worldwide are infected with. In children, the infection enters central nervous system and leads to inflammation of the gray matter. Autism, is a complex developmental disorder, altering social communication, with unknown origin. Neuropathologi-cal changes in autism are the same as those occurred in brain toxoplasmosis

The objective of this survey was to evaluate positive serology of toxoplasma gondii, in autistic children

Methods: This case-control study was done on 3-12 years old children, referring to the neurology and psychiatry sub-special clinics of Baqiyatallah hospital and also autistic children of Omid-e Asr and Navid-e Asr general rehabilitation centers in Tehran, Iran. The study performed at 2012-2013. Forty autistic children were placed in the case group and 40 children, suffering from no neuropsychiatric disease or other ones, were placed in the control group. A folder, containing demographic data, type of the disorder, onset of diagnosis and child characteristics at birth, such as time of birth [preterm/ term] fulfilled for each child. Sampling was done with 5 ml blood, for determining IgM and IgG antibody levels against toxoplasma gondii, using ELISA method. Data analyzed by the software SPSS ver. 17 and descriptive and analytic analysis were done, using central and dispersion indexes and also chi-Square test

Results: The autistic group contained 34 boys and 6 girls [85 and 15 percent respectively], with the average age of 6 [+/-2.71] years old [minimum of 2.33 and maximum of 12]. The average age at the time of diagnosis was 4.01 [+/-1.87] years old. 87. The non-autistic group contained 17 boys and 23 girls [42.5 and 57.5 percent respectively], with the average age of 5.67 [+/-3.09] years old [minimum of two and maximum of 12]. IgM and IgG serology of all autistic children were negative, while in non-autistic group, 2.5 percent (1 child) were positive and 97.5 percent [39 ones] were negative. There were no statistically significant difference among these two groups according to the serology results. [P=0.31]

Conclusion: There was no statistically significant difference in comparing positive serology of toxoplasmosis, between the two groups. However, to obtain a perfect result, a larger sample size are required

specificity and sensitivity of transient otoacoustic emission in neonatal hearing screening compared with diagnostic test of auditory brain stem response in Tehran hospitals

Since early detection [specially before 6 months of age] of deaf people leads to better hearing and speech outcome after treatment, several clinical trials have been performed in order to find a cost effective, short duration screening test for diagnosis of neonatal hearing impairment. The aim of this study was to assess the sensitivity and specificity of Transient Otoacustic Emission [TEOAE] test in newborns comparing with auditory brain stem response [ABR] in the age of 3 months and to analyze the association between risk factors and hearing loss in neonates. A cross-sectional study was conducted January 2008 - May 2009 in Tehran. 1000 newborns [526 boys and 474 girls] were assessed. First, all of neonates were evaluated by TEOAE 24h after birth. If responses of OAE were failing, they were retested 10 to 15 days after birth by TEOAE. Also, All Neonates were assessed by ABR in the age of 3 months. Descriptive Statistics was used to analyze data. Eighteen out of 1000 neonates failed double-checked TEOAE tests, of which 6 were confirmed by ABR test [12 false positive results]. Nine out of 1000 neonates had impaired ABR tests, from these patients, 6 had failed OAE as well, but 3 had normal OAE [3 false negative results]. From these 9 patients 2 had profound hearing loss and received cochlear implantation. We found that OAE has 66.7% sensitivity and 98.8% specificity in diagnosis of neonatal hearing impairment. Its positive and negative predictive value was 33.3% and 99.7% respectively. Also we did not find statistically significant relationship between hearing loss and risk factors. TEOAE as a simple, non-invasive, short duration and cost effective method, is a suitable test for neonatal hearing screening. Even though only two thirds of patients were detected by this method, 99.7% negative predictive value makes it a good screening test. We recommend OAE as a suitable primary neonatal hearing screening all over the country

Thyroid function test in pre-term neonates during the first five weeks of life

Congenital hypothyroidism [CHT] is one of the most common congenital endocrinal disorders. The prevalence of CHT is estimated about 1 in 3,000 newborns. The prevalence, etiology and associated disorders of abnormal thyroid screening tests are reported in different ranges. In this study, we assessed the pre-term newborns for CHT and associated factors that influence thyroid function. One hundred newborns with the gestational age fewer than 35 weeks were investigated. Baseline serum thyroid stimulating hormone [TSH] and free thyroxin [FT4] levels were measured during the first 5 days of life and were repeated during the first 5 weeks. We analyzed the effects of demographic factors and the presence of respiratory distress syndrome on the alteration of thyroid function tests during the first 5 weeks of life. The mean gestational age [GA] at delivery was 32.35 +/- 1.97 [range 28 to 35] weeks. CHT was observed in 13[13%] preterm infants. GA was the only factor which affect the FT4 changes over the two weeks follow-up [P < 0.001, b: -2.783, Power: 70.2%] although the differences between baseline and follow-up amount of TSH were not significantly influenced by GA [P = 0.062, power: 46%]. However, the adjusted TSH and FT4 serum level changes during follow-up were significantly different between two groups [between CHT and normal, P = 0.006, 0.000, respectively]. It seems that thyroid function tests should be repeated in preterm infants, especially for patients with lower gestational age, to confirm the diagnosis of CHT. Also, CHT should be considered among the newborns that are affected by RDS.

Magnetic resonance imaging findings in epileptic children and its relation to clinical and demographic findings

Epilepsy is an important disease with a cumulative incidence of 3% all over the life and more than half of them are started from childhood. In this study we surveyed magnetic resonance imaging [MRI] findings in epileptic children and its relation with clinical and demographic findings in order to find better diagnostic and treatment modalities for these children in the future. In this cross sectional study, we investigated consecutively all 1 to 15-year-old epileptic children who referred to the pediatric neurology outpatient clinic from 2004 to 2010. Two hundred children were enrolled for investigation. There were 85 [42.5%] girls and 115 [57.7%] boys, aged 1 to 15-year-old [7.7 +/- 4]. 196 [98%] of the children had abnormal electroencephalography [EEG]. Abnormal MRI was seen in 57 [28.5%] patients and consisted of brain atrophy [10%], increasing white matter signal intensity in T2-weighted images [8%], benign cysts [5%], brain tumors [4%] and vascular abnormalities [1.5%]. Abnormal MRI findings had significant relation with abnormal EEG, age, positive family history for epilepsy, dysmorphic appearance, and abnormal physical exam. Considering 98% EEG abnormalities in these epileptic children, benign nature of MRI findings in most of our cases, the high price of MRI and the small minority of patients who benefit from active intervention as a result of MRI, we suggest to use EEG for confirmation of epilepsy and perform MRI for patient with abnormal physical exams, focal neurologic deficits or focal EEG abnormalities

repot of surgical complications in a series of 262 consecutive pediatric cochlear implantations in Iran

Cochlear implantations have become a routinely performed and successful surgical intervention in both adults and children. The current article reports the complications encountered in various age groups of consecutive children who underwent implantation in our center. We performed a prospective analysis of all profoundly deaf children who underwent cochlear implantation from March 2006 to July 2009 at Baqhiyatallah Cochlear Implantation Center. All patients were younger than 5 years old at the time of implantation. The minor complications occurred in 49 [18.7%] cases, The most common postoperative complications were temporary facial weakness detected in 15 cases [5.7%] all of which were reversible. Magnet wound was observed in 14 [5.3%] patients, keloid formation in 10 [3.8%], wound infection in 2 [0.8%], otitis media in 5 [2%], and electrode movement, meningitis, vertigo, Laryngospasm each in 1 [0.4%] case was detected among our patients. Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications as long as the patient is monitored closely

[ 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]

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]. 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. 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]. 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

Thyroid function in epileptic children who receive carbamazepine, primidone, phenobarbital and valproic acid

In this study, we investigated the changes of the serum levels of thyroidhormones including Thyroxine [T4], Triiodothyronine [T3], T3 resin uptake andThyroid stimulating hormone [TSH] in epileptic children during treatment withanti-epileptic drugs [AEDs] including carbamazepine [CBZ], primidone [PRM],phenobarbital and valproic acid [VPA]. This study consisted of four case-series comparisons, was conducted on 115epileptic children [37 girls and 78 boys with an age range between 2 months and 15 years, mean: 62.06 A +/- 44.97 months]. These children were divided into4 groups who took either phenobarbital [n=29], PRM [n=28], CBZ [n=29], or VPA [n=29] for 3 months. Thyroid hormone levels [T3, T3 resin uptake, T4 and TSH] were measured at the beginning and three months after starting the study. At first, all patients were euthyroid and there were no clinical or laboratory findings suggestive of hypothyroidism. Regarding thyroid hormones before and after the administration of phenobarbital, carbamazepine, valproic acid and primidone, there were no significant changes in serum T3, T4, T3 resin uptake and TSH levels. Our findings showed that short term therapy with phenobarbital, carbamazepine, valproic acid and primidone had no effect on thyroid function tests

Risk factors and prognosis of epilepsy in children with hemiparetic cerebral palsy

Epilepsy is reported in 15-90% of the children with Cerebral Palsy [CP] but its clinical course is not well defined. We conducted a retrospective study on children with hemiparetic CP who were referred to Pediatric Neurology Department of Mofid Hospital. The aim of our study was to evaluate the risk factors and prognosis of epilepsy in children with hemiparetic CP. We evaluated 64 children with hemiparetic CP who were referred to Pediatric Neurology Department of Mofid Hospital 2006 and 2008. according to our protocol, patients were divided into two roups: 34 children in the case group [hemiparetic patients with epilepsy] and 30 children in the control group [hemiparetic patients without epilepsy]. Prenatal, perinatal and postnatal events, maternal age at the time of delivery, socioeconomic status of the family, familial history of epilepsy, neuroimaging findings, side of the hemiparesia and age at diagnosis of hemiparesis were not considered as risk factors for epilepsy in hemiparetic children, but microcephaly, severity of hemiparetic CP and mental retardation were significantly associated with an increased risk of epilepsy in children with hemiparetic CP. Our study showed that microcephaly, severity of hemiparesis and mental retardation were risk factors for developing epilepsy in children with hemiparetic CP; furthermore, they had negative effects on rehabilitation outcome in these patients

Prevalence of readmission for hyperbilirubinemia in healthy newborns

The aim of this study was estimation of prevalence of jaundice readmission and observes neonatal jaundice risk factors in singleton infant with birth weight more than 2500 gr. This study was done among women who delivered a normal singleton infant with birth weight of >/= 2500 gr in Najmieh Hospital, Tehran, from 2004-2005. Maternal age, race, blood group and Rh, drug consumption during pregnancy, oxytocin consumption during labour, rupture of membranes together with neonatal sex, weight, maturity, gravity and length of nursery stay were recorded. The infants were followed during neonatal period to see if they were readmitted, and the reason of admission. The prevalence of readmission for neonatal jaundice was assessed and the risk factors for neonatal jaundice were compared between the icteric and non-icteric babies. The prevalence of readmission because of jaundice was 12.6%. The maternal data recorded from all mother-baby pairs were not significantly different except for maternal race, Rh group and drug consumption during pregnancy. Arab mothers compared with other race groups had more icteric babies [P=0.001]. Rh-negative mothers had more icteric infants [17.9%] compared with Rh-positive mothers [12%] [P=0.01]. Premature infants were hospitalized significantly more than mature babies [20.3% versus 12.1%, P=0.04]. The length of primary nursery stay differed significantly between two groups [mean [SD] 27 [9.8] hours for icterics versus 30 [2.5] hours for non-icterics, P < 0.001]. The mean age of readmission was fifth postnatal day. We conclude that infants, especially infants of Arab or negative Rh group mothers and premature babies, discharged early from the nursery should be advised to visit a pediatrician within the next 48-72 hours of birth to avoid complications of severe jaundice

[Tehran university of medical sciences: participation in twenty five percent of pediatric science production in Iran]

Scientific articles are indicators of research interests and efforts in every country. The aim of our study was to compare the scientific output between universities of medical sciences in Iran on pediatrics in the Pubmed database. In a descriptive study, we searched in Pubmed in order to assess the Iranian pediatrics publications with these words: "[Pediatric [*MeSH] OR Neonate [MeSH] OR Newborn[MeSH] OR Infant [MeSH] OR Child [MeSH] OR Children [MeSH] OR Adolescent[MeSH] OR Adolescence [MeSH]]" AND [Iran [*AD] OR Iranian [AD] OR Persian [AD]]. The identified articles were published May 1957 to December 2007 and we selected all articles from universities of medical sciences in Iran. We extracted year of publication, affiliation of authors and impact factor from hard copy of articles. From 819 papers published, 565 were authored by members of universities of medical sciences. Tehran University of Medical Sciences with 142 articles [17.3% of all, 25.1% from publications of universities of medical sciences] held the first place, Shiraz University of Medical Sciences with 116 [14.2% of all, 20.5% from publications of universities of medical sciences] the second place and Shaheed Beheshti University of Medical Sciences with 88 [10.7% of all, 15.5% from publications of universities of medical sciences] the third place. Regarding Impact Factors [IF] Tehran, Shaheed Beheshti and Shiraz Universities of Medical Sciences with 153, 93 and 81 were in the first, second and third place, respectively. Tehran University of Medical Sciences had twenty five percent of pediatric science production in Iran. This university had published higher number of papers on pediatrics among of medical sciences in Iran

[Frequency of multiple pregnancy and its complications in three educational hospitals, Tehran]

Multiple pregnancies are high-risk pregnancies since they are associated with increased perinatal and maternal problems. The aim of our study was to determine the frequency of multiple pregnancies and their maternal and perinatal complications. In a cross-sectional study we assessed 94 multiple pregnancies and 199 neonates in three educational hospitals [Baqiyatollah, Najmie and Mahdie] in Tehran in the first half of 2006. The information was collected from hospital registries of mothers and their neonates. Of 4584 deliveries, 84 [1.8%] were twins, 9 [0.19%] were triplets and 1 [0.02%] was quadruplets. 59 [62.7%] mothers had preterm labor and 14 [14.8%] had pre-eclampsia. We found discordant birth weigh>/=20% in 24 [25.4%] and Twin-to-Twin Transfusion in 3 [3.1%] mothers. 174 [87.4%] neonates were admitted in neonatal intensive care unit or pediatric department. The frequency of mortality and respiratory distress in neonates was 27 [13.5%] and 107 [53.7%], respectively. 39 [19.5%] of neonates had Apgar scores<7 and seizure was not observed in neonates. 65 [32.6%] neonates were normal weight [>2500 gram], 104 [52.4%] low birth weight, 21 [10.5%] very low birth weight and 9 [4.5%] extremely low birth weight. Hypocalcaemia, hypoglycemia and anemia was detected in 45 [22.6%], 24 [12%] and 48 [24.1%] neonates respectively. Regard to increasing the prevalence of multiple pregnancies, better use of infertility modalities, early diagnosis of the multiple pregnancies, prevention of preterm birth, close fetal surveillance, atraumatic labor and delivery can improve maternal and perinatal outcome