Journal of Pediatric Neurology - Volume 9, issue 3

Authors: Frank-Briggs, Angela Ine

Article Type: Research Article

Abstract: Attention deficit hyperactivity disorder (ADHD or AD/HD) is a neurobehavioral developmental disorder, primarily characterized by the co-existence of attention problems and hyperactivity. It affects about 3 to 5% of children globally, with symptoms starting before 7 yr of age and in about 50% of cases continuing into adulthood. It is a source of concern to the clinicians as it is often comorbid with other mental disorders, particularly anxiety, conduct disorder, depression, epilepsy and learning …disabilities. The aim of this review is to draw close attention to the disorder, highlight its causes, features and the challenges in management. Data was sourced from literature in Medline publications, World Health Organization and other medical journals. ADHD affects all races, ethnic groups and socioeconomic levels, the cause is unknown and there is no cure for it. Management is multidisciplinary including behavioral therapy, psychotherapy and drug treatment. There is dearth of information about ADHD in our environment but the disorder is not uncommon. The combined problems of malaria, malnutrition, pneumonia, human immunodeficiency virus and acquired immune deficiency syndrome and other infectious illnesses may be masking emphasis on this neurodevelopmental condition. ADHD is a common neurodevelopmental disorder worldwide. Management of the condition is challenging. Awareness of the general populace, skills in the diagnosis and optimal management are currently low in developing countries like Nigeria. There is need for improvement in these areas. Show more

Keywords: ADHD, causes, features, comorbidities, challenges, management

DOI: 10.3233/JPN-2011-0494

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 291-298, 2011

Authors: Khashaba, Mohamed T. | Shouman, Basma O. | Hasanein, Bothina M. | Shaltout, Ali A. | Al-Marsafawy, Hala M. | Abdel-Aziz, Mohamed M. | Ahmad, Tahmina | Aly, Hany

Article Type: Research Article

Abstract: Proinflammatory cytokines play a role in the pathogenesis of hypoxic-ischemic encephalopathy (HIE). We aimed: 1) to characterize the expression of interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) in the cerebrospinal fluid (CSF) of term infants with HIE, and 2) to determine the impact of a single dose of magnesium sulfate (MgSO_{4} ) on their concentrations. We analyzed the samples of CSF that were collected during a randomized controlled trial on the …use of MgSO_{4} in neonatal asphyxia. Two samples were obtained from each subject; one was obtained on admission and the second sample was collected at 72 hr of life. The grades of HIE in the 47 included newborns were mild (n=15), moderate (n=17), and severe (n=15). After the collection of the first CSF sample, 23 newborns received a single dose of MgSO_{4} , whereas the other 24~newborns received an equal volume of normal saline placebo. Concentrations of IL-1β, IL-6 and TNF-α in the CSF were quantified by enzyme-linked immunosorbent assay in all CSF samples. The initial concentration of IL-1β and IL-6 correlated with the severity grades of HIE (P= 004 and P=0001, respectively) while TNF-α did not. At 72 hr, a significant decline in the concentration of TNF-α (pg/mL) was observed in samples of MgSO_{4} -treated infants when compared to the control group (- 28 ± 90 vs. 102 ± 404, P=0.01), whereas the two treatment groups did not differ in IL-1β or IL-6. Short-term clinical outcomes correlated best with IL-1β at baseline, IL-6 at baseline and IL-6 at 72 hr. We conclude that cytokine activation, as manifested by increased IL-1β and IL-6 in the CSF, is positively correlated with the severity of HIE. Treatment with a single dose of MgSO_{4} was efficacious in aborting the activation of TNF-α but did not alter the expression of IL-1β or IL-6. Show more

Keywords: MgSO_{4}, HIE, asphyxia, pro-inflammatory cytokines, CSF

DOI: 10.3233/JPN-2011-0501

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 299-304, 2011

Authors: Emich-Widera, Ewa | Kopyta, Ilona | Kaluzna-Czyz, Monika | Kazek, Beata

Article Type: Research Article

Abstract: Child abuse is an act of doing something or failing to do something that result in harm to a child or puts a child at risk of harm. Although the occurrence of child abuse in our society is a serious problem, the statistics often remain unreliable. The purpose of our research was an assessment of the knowledge, attitudes and experiences among physicians, medical students and teachers of reporting child abuse and neglect. The questionnaire containing questions …about the demographic data of our respondents and questions regarding the analysed subject was created. The results were statistically analyzed using the Chi-square Test. The investigated group consisted of 139 teachers, 131 medical students and 53 physicians. Among the physicians, specialists with more than 10 yr of experience constituted 83% with a predomination of pediatricians. Among the teachers, those with more than 10 yr of experience constituted 67%. Medical journals and professional trainings were the main source of knowledge for the physicians, while television and radio were the source of knowledge for teachers significantly more often than with others groups. The majority of respondents encountered cases of child abuse (physicians 74%, students 29%, and teachers 58%). In spite of their declared knowledge about child abuse the majority of physicians and medical students claim that low social status and uneducated families are the risk factors of child maltreatment, while the majority of teachers are aware there is no difference (P< 0.000001). The majority of respondents encountered cases of child abuse but their knowledge of child maltreatment still remains insufficient. It is considered reasonable to extend the range of obligatory professional trainings. Show more

Keywords: Battered child syndrome, child abuse, neglect, domestic violence

DOI: 10.3233/JPN-2011-0504

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 305-310, 2011

Authors: Pandian, T. Joseley Sunderraj | Ukamath, Surendra | Jetley, Nirali | Ramaprabhu,

Article Type: Research Article

Abstract: The Clinical Test of Sensory Interaction for Balance (CTSIB) is an inexpensive, easily administered test, which provides information about the ability to stand upright under several sensory conditions. This study was intended to find the Concurrent Validity in Healthy Indian Children aged 7–12 yr using a force plate. This study included 48 normal children between the ages of 7–12 yr. The children were screened for inclusion and exclusion criteria. The CTSIB score on therapist's observation was …compared with force plate measures to find concurrent validity. The Concurrent Validity for the CTSIB was calculated using Pearson's Correlation Coefficient. The "r" value for concurrent validity was 0.681 and 0.799 with force plate measures, showing good correlation. One-way analysis of variance was done to see the difference between age group (7–8,9–10,11–12) and CTSIB using post hoc Tukey analysis. This revealed a significant difference between groups aged 7–8 and 11–12, with P=0.006, and between 9–10 and 11–12 with P=0.03. From this study, we conclude that the CTSIB is a valid test for balance evaluation in Indian children. Show more

Keywords: Clinical Test for Sensory Interaction for Balance, validity, balance rehabilitation

DOI: 10.3233/JPN-2011-0499

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 311-318, 2011

Authors: Elhefnawy, Nadia G.

Article Type: Research Article

Abstract: Neuronal ceroid lipofuscinosis (Batten disease, NCL) represents a group of common childhood neurodegenerative diseases with a shared feature of deposition of abnormal metabolic products in neurons and other tissues, including peripheral blood lymphocytes. Clinical findings and pathological features of 12 Egyptian patients affected with NCL are reviewed. The patient group included three children affected with the late-infantile form of NCL, five patients affected with the juvenile form NCL, and four infantile cases. …Ultrastructural examination of gingival biopsies revealed the characteristic deposits in fibroblasts and the endothelial cells. In spite of recent advances in immunohistochemical identification of biochemical markers, the ultrastructural identification of lipofuscinic pigments in an easily accessible tissue like the gingiva or skin remains the gold standard to identify NCL, together with clinical aspects. Show more

Keywords: Neuronal ceroid lipofuscinosis, gingival biopsy, electron microscopy

DOI: 10.3233/JPN-2011-0482

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 319-324, 2011

Authors: Degasperi, Luisa | Micciolo, Rocco | Espa, Giuseppe | Calzolari, Stefano

Article Type: Research Article

Abstract: Children with Down syndrome (DS) are known to have difficulty in learning to read and write. This weak literacy can be attributed to learning disability or to poor phonological awareness, which can also be found in typically developing children with dyslexia. The aim of this study is to verify whether phonological awareness is linked to literacy in children with DS as it is in typically developing ones. In order to show this link the authors investigate …the relationship between single word reading ability and several phonological variables. Thirty-two native Italian children with DS were asked to read 50 single words and to perform phonological tests concerning phoneme and syllable segmentation, phoneme and syllable blending, alliteration and non-word repetition. Gender, intelligence quotient, age and years of schooling were also taken into consideration in the statistical analysis. Phoneme blending, phoneme segmentation, syllable segmentation, alliteration, non-word repetition were the variables which were seen to be significantly related to reading. However, it was observed that gender, intelligence quotient, chronological age, years of education, syllable blending were not related to single word reading ability. Our study underpins the theory that literacy is linked to phonological awareness in Italian speaking children with DS in the same way that it occurs in typically developing children. Phonemic rather than syllabic awareness is seen to be the basic skill necessary in order to be able to read fluently, at least for single words, as observed in our participants with DS. Show more

Keywords: Down syndrome, reading, learning disabilities, phonology, dyslexia

DOI: 10.3233/JPN-2011-0496

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 325-332, 2011

Authors: Noureen, Nuzhat | Rana, Muhammad Tariq | Sattar, Abdul | Iqbal, Imran

Article Type: Research Article

Abstract: Epilepsy is a heterogeneous disorder and its treatment is often complicated by variable drug response. Antiepileptic properties of Valproic acid were discovered in 1963 and since then it is widely used for treatment of epilepsy. The objective of this study was to explore the correlation of steady state serum level of Valproic acid with dose, seizure response and frequency of adverse drug reactions in Pakistani children with epilepsy. This prospective analytical study was conducted in the …Neurology Department-The Children Hospital and The Institute of Child Health Multan, Pakistan from March 2009 to February 2010. Sixty children between one to 14 years of age taking Valproic acid for treatment of epilepsy, for more than 3 months as monotherapy were included. Age, sex, dose of Valproic acid, type of seizure, response of seizure with treatment and any side effect of drug were noted. Trough Valproic acid serum level was measured by Latex Enhanced Immunoturbidometric Method by Randox VPA 1 × Series Kit according to manufacturer instructions. Chi square test was used to measure the relationship of serum level with dose, seizure response and frequency of adverse drug reactions. P value of less than 0.05 was considered as significant. Our results showed that male female ratio was 1.1:1. Mean age was 7.3 ± 3.9 yr. Mean dose of Valproic acid was 32.4 ± 11.3 mg/kg/day. Generalized tonic clonic seizures were noted in 50% of patients, complex partial in 16.7%, myoclonic in 15%, absence seizures in 5% and mixed type of seizures was noted in 8.3% of patients. Complete seizure response was noted in 60% of patients, partial response in 18.3% and no response in 21.7% of patients. Serum level of 50–100 μg/mL (therapeutic) was noted in 38.30% of patients, below 50 μg/mL (subtherapeutic) in 46.8% and above 100 μg/mL (supratherapeutic) in 14.9% of patients. Serum level below 50 μg/mL was noted in 60.7% of children with complete seizure response while 50–100 μg/mL was noted in 21.7% of children with no response. Adverse drug reactions were noted in 66.6% of patients in this study. These adverse reactions were noted in 64.2% of children with serum level below 50 μg/mL, 65.2% with 50–100 μg/mL and 77.7% with serum level above 100 μg/mL. No correlation of Valproic acid serum level was noted with dose (P value 0.546), seizure response (P value 0.998) and frequency of adverse drug reactions (P value 0.743) in this study. No significant correlation of Valproic acid serum level was noted with dose, seizure response and frequency of majority of adverse drug reactions. Show more

Keywords: Children, Valproic acid, drug level, epilepsy

DOI: 10.3233/JPN-2011-0481

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 333-339, 2011

Authors: Adebami, Olusegun J. | Onigbinde, Olaniyan M. | Joel-Medewase, Victor | Oyedeji, Ademola G. | Afolabi, Adebimpe A.

Article Type: Research Article

Abstract: Neurological disorders in children cause disability, handicapping and reduction in the potential of the affected child and are therefore sources of major concern to parents, health workers and governments worldwide. To determine the pattern of neurologic abnormalities at a follow up clinic in our health facility, a descriptive study of the patients who attended the neurology clinic of Ladoke Akintola University of Technology Teaching Hospital. Osogbo for 4 yr that is, between January 2006 and December …2009 was undertaken. The data obtained at first clinic attendance included age, sex, family history of neurological disorders and clinical presentations. Detailed physical and neurological examinations and the anthropometric measurements of the patients were also performed. Two hundred and forty nine patients were studied. One hundred and forty two (57.0%) males and 107 (43.0%) females with male:female ratio 1.33:1. The ages of the patients at first contact ranged between 2 to 168 mo (2 mo to 14 yr) with the mean of 56.83 ± 49.56 mo. Leading clinical presentations were seizures in 168 (67.5%), developmental delay in 86 (34.5%), movement disorders, ataxia and gait abnormalities in 44 (17.7%), and microcephaly in 36 (14.4%). In descending order, the maain diagnoses were cerebral palsy, kernicterus and Down syndrome, post-meningitis complications, craniosynostosis, post-cerebral malaria complications and acute flaccid paralysis Patients were managed with chemotherapy, physical therapy, social and surgical care. To reduce the burden of neurologic abnormalities, a multi-pronged approach must be pursued at controlling the prevailing factors of cerebral palsy, kernicterus and meningitis. Improvement and sustained immunization programs – especially against poliomyelitis and measles – should also be ensured. Show more

Keywords: Follow-up, children, neurologic abnormalities, Nigeria

DOI: 10.3233/JPN-2011-0502

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 341-345, 2011

Authors: Adebami, Olusegun J.

Article Type: Research Article

Abstract: Acute bilirubin encephalopathy (ABE) is still a major and common health problem in developing countries in spite of the availability and efficacy of phototherapy and exchange blood transfusion. In developing countries, the prevalence of kernicterus has not shown any reduction because many babies with jaundice present very late in well established kernicterus. The study was done to determine the factors responsible for the late presentation of neonatal jaundice and development of ABE among the patients …presenting with this condition in our health facility. All newborns presenting with ABE at the special care baby unit of the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria were prospectively studied. The diagnosis of ABE was made clinically if there were neurologic abnormalities associated with hyperbilirubinemia. Twenty-eight (3.2%) of 882 babies admitted over 3 yr had ABE. There were 21 males, 7 females, and the male: female ratio 3:1. Twenty-two (78.6%) of the mothers saw at least one health worker more than 24 hr before presentation. Three (10.4%) other mothers who noticed the jaundice did not initiate any treatment while the remaining three (10.4%) mothers did not notice the jaundice in their babies until they presented at the health facility with the complaint of failure to suck. Prescribed medications before presentation were oral antibiotics, hematinics and gentamicin injections, a solution of Naphthalene balls in water and an extract of local herbs made from Pawpaw leaves. Causes of jaundice were septicemia, G6PD deficiency, ABO incompatibility, low birth weight and rhesus isoimmunization in decreasing order of frequency. Maternal factors include low socioeconomic status, teenage and low parity statuses of the mothers. Inappropriate treatment of neonatal jaundice by health workers was also one of the underlying reasons. Therefore, there is need to raise the level of awareness in the community of the occurrence and dangers of neonatal jaundice and its appropriate treatment. Health workers themselves need education and training in the early recognition and treatment of neonatal jaundice. Show more

Keywords: Acute bilirubin encephalopathy, kernicterus, late presentation, maternal factors, Southwestern Nigeria

DOI: 10.3233/JPN-2011-0485

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 347-353, 2011

Authors: Rajput, Dinesh K. | Tungaria, Arun | Srivastav, Arun K. | Kawal, Priyanka | Kumar, Raj

Article Type: Research Article

Abstract: Head injury in pediatric age groups causes lesser mass and structural lesions in comparison to adults, because the pediatric brain is more compressible and calvarium more pliable. Occipital condyle fracture with multiple cranial nerve involvement in pediatric age is a rare phenomenon. We report a case of head injury in 1-year-old female child who presented with sixth, seventh and lower cranial nerve paresis with an occipital condylar fracture. Tere have been no previous reports of such …a presentation in this age group. The mechanism, management and outcome of such cases are discussed in this respect. Show more

Keywords: Collet-Sicard syndrome, pediatric head injury, cranial nerve palsy, occipital condyle fracture

DOI: 10.3233/JPN-2011-0503

Citation: Journal of Pediatric Neurology, vol. 9, no. 3, pp. 355-358, 2011