Journal of Pediatric Neurology - Volume 6, issue 3

Authors: Gordon, Neil

Article Type: Research Article

Abstract: Strokes in childhood, although relatively uncommon, have high rates of morbidity and mortality. The clinical findings of ischemic and hemorrhagic strokes are reviewed; both have a significant recurrence risk while the latter carries a particularly high mortality, although outcome in survivors may be better. Neonatal strokes also have to be considered and have variable outcome, although death and recurrence are uncommon. Risk factors for childhood strokes differ from those causing strokes in adults. Cardiac and blood …disorders, for instance congenital heart disease and sickle cell disease, are obvious examples, and now more attention is being given to coagulation and metabolic disorders. Infections, especially those due to viruses such as varicella, can precipitate strokes in children, and there are a number of genetically determined conditions, that can lead to strokes. The latter include blood and metabolic diseases, as well as mitochondrial disorders, which can mimic childhood strokes. Other mimics may also be serious but others are not, such as migraine and syncope. The management of children who have suffered a stroke has to be considered in both the short and long term. For ischemic stroke, management considerations include the use of aspirin, anticoagulants and thrombolytic agents, while hemorrhagic stroke may require emergency neurosurgery and a multidisciplinary team to reduce the risk of recurrence. Rehabilitation requires the involvement of a variety of therapists and needs further study, but assessment of affected children for special educational needs will almost certainly be required. Show more

Keywords: Childhood, stroke, management

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 197-201, 2008

Authors: Yamamoto, Toshiyuki | Nishikawa, Tomoko | Yamanaka, Michiko | Takada, Fumio | Kurosawa, Kenji

Article Type: Research Article

Abstract: To obtain basic data for improving genetic counseling, we focused on couples' decision-making with regard to having additional children after notification of their status as a carrier of a reciprocal balanced chromosomal translocation. Carrier status is typically determined after birth of a child with a birth defect derived from a chromosomal unbalanced translocation inherited from the parents' balanced translocation. From April 2004 to December 2004, 15 couples from Kanagawa prefecture of Japan were interviewed. Children …of the couples had unbalanced translocations, and one member of each couple was diagnosed or hypothesized to be a carrier of a reciprocal translocation. Clinical and familial information was obtained by personal interviews in our hospital, and then statistically analyzed. Fifteen couples were interviewed in which the mean age of propositi, fathers, and mothers were 4.7, 31.2, and 31.1 years, respectively. The couples were divided into two groups according to their decision-making process. Each couple that did not want more children already had at least one healthy child before the birth of the propositus. Each couple that did not disclose their own carrier status had a propositus younger than 2 years old. Each couple that had at least one healthy child before the birth of the propositus carrying an unbalanced translocation showed reluctance towards another pregnancy. On the other hand, each couple that did not have healthy children before the birth of the propositus showed strong willingness for a future pregnancy. Each couple that had a propositus younger than 2 years old needed more time to accept the evidence of their carrier status. Show more

Keywords: Genetic counseling, birth defect, chromosomal examination, reciprocal balanced chromosomal translocation, decision-making

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 203-208, 2008

Authors: Pearsall-Jones, Jillian G. | Piek, Jan P. | Martin, Neilson C. | Rigoli, Daniela | Levy, Florence | Hay, David A.

Article Type: Research Article

Abstract: The high level of comorbidity between Developmental Coordination Disorder (DCD) and Attention Deficit Hyperactivity Disorder (ADHD) suggests that these disorders may have a shared etiology. We used a co-twin control design to study monozygotic (MZ) twins concordant and discordant for DCD and ADHD. In a total of 922 sets of MZ twins, 866 sets were eligible. We found equal numbers of DCD concordant and discordant sets; more ADHD concordant than discordant sets; nine sets in which …both twins met criteria for DCD+ADHD; 773 sets of twins did not meet criteria for either DCD or ADHD. The only significant sex difference between groups was for ADHD discordant sets, with more males than females. For DCD groups there were no significant sex differences, with slightly more girls than boys affected in both groups. There was a greater number of oxygen perfusion complications in DCD affected than unaffected twins, suggesting that, given equal numbers of DCD concordant and discordant sets and a similar number of DCD girls and boys, the role of pre- and perinatal environmental factors is stronger in the etiology of DCD than in ADHD. Factors such as placental difficulties and hypoxia have also been related to cerebral palsy, which suggests that DCD may fall on the upper end of a continuum of movement disorder that includes cerebral palsy. The results suggest different etiological pathways for DCD and ADHD. Second born twins were at greater risk for oxygen perfusion difficulties in sets concordant for DCD, ADHD, and unaffected for either. Show more

Keywords: Monozygotic twin, genetic, discordant, concordant, ADHD, DCD, etiology

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 209-219, 2008

Authors: Singhi, Pratibha | Mittal, Bhagwant R. | Nagaraj, Ravishankar | Malhi, Prabhjot

Article Type: Research Article

Abstract: Single photon emission tomography (SPECT) of the brain was studied in 22 children with primary autism with varying degrees of severity. Fifteen children had no perfusion abnormalities on SPECT imaging. Of the remaining seven, decreased perfusion in the left frontoparietal cortex was seen in three, and in the left inferior and medial frontal cortex in two children. No correlation could be found between SPECT, electroencephalography, and magnetic resonance imaging findings. Our findings are similar to those …previously reported in some studies, and present areas of further inquiry regarding therapeutic intervention or diagnosis. Show more

Keywords: Autism, children, imaging, SPECT

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 221-225, 2008

Authors: Mostafa, Gehan A. | EL-Sherif, Dalia F. | Hamza, Rasha T. | AL Shehab, Abeer

Article Type: Research Article

Abstract: One of the most consistent biological findings in autism is elevated blood serotonin levels. Immune abnormalities, including allergy, are also commonly observed in this disorder. Allergy may play a role in pathogenesis of autism wherein immune responses to allergens may induce the production of brain autoantibodies found in many autistic children. Hyperserotonemia may be the reason behind the increased frequency of allergic manifestations in autistic children through reduction of T-helper 1-type cytokines. Thus, we investigated …the possible connection between hyperserotonemia and the increased frequency of allergic manifestations in 40 autistic and 40 healthy matched children. Autistic children had significantly higher serum serotonin levels than controls [125 (250.75) vs. 41.5 (41.5) ng/mL, P < 0.001]. Fifty five percent (22/40) of autistic children had elevated serum serotonin. Allergic manifestations (bronchial asthma, atopic dermatitis and allergic rhinitis) were elicited in 45% of autistic patients which were significantly higher than controls (10%, P < 0.001). Moreover, autistic patients with allergic manifestations had significantly higher serum serotonin levels than those without (P < 0.001). Furthermore, there was a significant positive correlation between serum serotonin and total immunoglobulin E levels in autistic patients (r = 0.8, P < 0.001). In conclusion, hyperserotonemia may be a contributing factor to the increased frequency of allergic manifestations in some autistic children. Inclusion of serum serotonin levels as a correlate may be useful in future immune studies in autism to help unravel the long-standing mystery of hyperserotonemia and its possible role in the pathophysiology of this disorder. In addition, the effect of blood serotonin lowering drugs in hyperserotonemic autistic children, on amelioration of allergic manifestations and immune abnormalities, should be studied. Show more

Keywords: Allergy, autism, hyperserotonemia, immune, serotonin

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 227-236, 2008

Authors: Zoair, Amr M. | Abd El-Aziz, Sahar A. | Awny, Mostaf M. | Sharkawy, Hamed M. El | El-Bendary, Amal S. | El-Kader, El Sayed Abd

Article Type: Research Article

Abstract: Massive intraventricular hemorrhage (IVH) in neonates is followed by progressive ventricular dilatation in 55–80% of cases if the infant survives. The initial mechanism of posthemorrhagic hydrocephalus (PHH) is thought to be obstruction by multiple small blood clots of the channels of the cerebrospinal fluid (CSF) to areas of absorption. Plasminogen activator inhibitor-1 (PAI-1) is the principal regulator of fibrinolysis in blood and one of the most highly controlled of the fibrinolytic components. The aim of this …study is to measure plasminogen and PAI-1 levels in plasma and CSF of the neonates after IVH to assess endogenous fibrinolytic activity and to predict the development of PHH. Fifteen full term and preterm neonates with IVH were enrolled in the study. Ten neonates without IVH were used as a control group. Cranial ultrasound was performed at age of 2 weeks and 2 months. Plasma and CSF plasminogen and PAI-1 levels were assessed for these neonates. CSF PAI-1 was significantly higher in infants with IVH than in the controls (P < 0.001). There was no significant difference in the CSF and plasma plasminogen between infants with IVH and controls (P > 0.05). CSF PAI-1 was significantly higher in infants with PHH than in infants with posthemorrhagic ventricular dilatation (P < 0.05), with a sensitivity (100%) and specificity (100%). CSF PAI-1 is a very sensitive and specific parameter than CSF plasminogen for prediction of PHH in neonates with IVH, and this might be useful to evaluate the specific therapeutic programs of these neonates. Show more

Keywords: Neonatal, plasminogen, hemorrhagic hydrocephalus

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 237-242, 2008

Authors: Masalha, Rafik | Afawi, Zaid | Mahajnah, Muhammad | Mashal, Abdalla | Hallak, Maher | Alsaied, Ibrahim | Bolotin, Arkady | Ifergan, Gal | Wirguin, Izik

Article Type: Research Article

Abstract: Deficiencies of nutrients such as vitamin B12, folic acid and iron are frequently associated with impairment of memory, concentration and learning ability. Deficiencies of these micronutrients are very rare in Western countries, whereas they are common in developing countries. This study was carried out to determine the impact of vitamin B12 deficiency, folic acid deficiency and/or anemia on the academic achievement of elementary school children from a low socio-economic population, i.e., impoverished Bedouin …population living in southern Israel. Sixty-seven elementary school children, nine to eleven years of age, were randomly tested. Serum levels of vitamin B12, folic acid, and hemoglobin were measured using automated chemiluminescence systems. An individual questionnaire was filled out for each student, which included information on number of meat meals consumed per week, the number of people in the family and information about the father's employment status. Significant positive correlations were observed between number of meat meals consumed per week and low vitamin B12 levels and attainment of low marks in school, respectively. There was a negative correlation between the total number of family members and the attainment of low marks in school. No correlation between anemia or low folic acid levels and school performance was observed. Despite the small sample number, results indicated a high prevalence of vitamin B12 deficiency among these elementary school children, which could be linked to inadequate meat meal intake. This ultimately affected school performance of these children. Show more

Keywords: Impoverished Bedouin community, school performance, vitamin B12 deficiency

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 243-248, 2008

Authors: Ednick, Mathew | Wong, Brenda | Inge, Thomas | Knue, Marianne | Kalra, Maninder

Article Type: Research Article

Abstract: Medical records of spinal muscular atrophy type 1 patients, who underwent elective laparoscopic Nissen fundoplication and gastrostomy tube insertion and extubation using a standardized clinical protocol, were retrospectively reviewed. All seven patients were successfully extubated using the protocol and discharged home on bi-level positive airway pressure without oxygen supplementation. There were no major respiratory complications in the post-operative period.

Keywords: SMA-1, pulmonary complications, extubation protocol, laparoscopic Nissen fundoplication, gastrostomy tube insertion

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 249-252, 2008

Authors: Prasad, Rajniti | Mishra, Om Prakash | Mittal, Roopali | Bhutada, Anand

Article Type: Research Article

Abstract: Neurocysticercosis is common in children but calcification of falx cerebri is extremely rare. We report a 5-year-old male child with falcine calcification, who was diagnosed as neurocysticercosis based on clinical, epidemiological, serological and imaging findings. The child was treated with albendazole and carbamazepine and seizure free for last 2 years.

Keywords: Neurocysticercosis, falx cerebri, calcification

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 253-255, 2008

Authors: Koul, Roshan | Al-Futaisi, Amna

Article Type: Research Article

Abstract: Two children with refractory seizures had significant weight loss on addition of levetiracetam. Despite improved seizure control, we had to withdraw levetiracetam. Withdrawal of the drug resulted in gradual improvement of weight. Similar findings were reported in adult patients. Although, levetiracetam is generally believed not to affect weight, these recent reports indicate that this drug has the potential of inducing considerable weight loss in both adults and children. Parents need to be warned about this potential …side effect. Show more

Keywords: Levetiracetam, weight loss, epilepsy

Citation: Journal of Pediatric Neurology, vol. 6, no. 3, pp. 257-260, 2008