Razi Journal of Medical Sciences

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 ABSTRACT Mental retardation in children creates one of the most important for every society. Taking care of menatally retarded child causes many emotional and financial difficulties for the family. Needless to say, the prevention of mental retardation is the keyword in the management of the problem which is feasible in many situations. To acertain the etiologic factors causing mental retardion, all children with Intelligence Quotient (IQ) less than 70, who were referred to Mofid pediatrics hospital during a 9 months period from Mehr 1375 to Khordad 1376 (Sept 1996 – May 1997) constitute the subjects of this investigation. 150 children in the age range of 4 – 15 year old were included in the protocol. Based upon diagnositc studies, mental retardation in 20% of the cases (30 of 150 ) is attributed to prenantal causes, which the most important of them were: Genetic disorders, chromosomal aberration, metabolic diseases and intrauterine infections. In 24% of the cases (36 of 150), mental retardation could be attributed to perinatal causes, like: Brith asphyxia, premature labor, traumatic brith and twin delivery. Among postnatal factors which caused mental retardtion in 27.3% of cases (41 of 150), infections, trauma, intracranial hemorrages and hypothyroidism constituted the most predminant etiologic agents. We could not delineate the causes of mental retardation in 28.7% of the patients (43 of 150). Althogh our patients were in 4 – 15 years age group, but the majority of these children were aged 4 – 5 years. 72% of them had motor developmental delay and 65% suffered from epliepsy. Behavior disorder, visual and auditory impariments and cerebral palsy were aditional findings in mentally handicaped child. 42.7% of our study group were product of consanguineous marriage. Based upon this study it seems that considering the following steps can reduce occurrence of mental retardation to a significant degree. Prevention of premature birth when feasibel, treatment and control of infectious disease, paying more attention to prevention of trauma and accidents, performing screeing test at birth for early diagnosis of some metabolic disease (PKU) and hypothyroidusm and finaly avoiding consanguineous marriage, if any case of mental retardation has happened in the family previously.

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In a cross-sectional study over a period of two years (Dec.2001- Dec.2003), 68 children with cerebral palsy(CP) and seizure aged 1-12 years were evaluated prospectively in Hazrat Rasoul Hospital. A control group of 60 children with seizure but no cerebral palsy at the same age group was also studied. The objective of the study was to find out the relationship between cerebral palsy and epilepsy and to determine the occurrence, associated factors, nature and prognosis of seizure in children with cerebral palsy. The mean age of seizure onset was 13±5.5 months in children with CP and 32±7.2 months in control group. In 42(61.7%) children with CP, seizure onset was during their first year of life while in control group this was only in 18(13.3%) ones. The incidence of neonatal seizure in CP children was considerably higher than that of control group (22.5% and 3.3%, respectively). 95% of children with cerebral palsy and 20% of children in control group had developmental delay. Generalized seizure was the most common type of seizure in both groups but the incidence of infantile spasm was higher in children with CP (11.7% vs. 1.6%). The incidence of status epilepticus as well as refractory seizure was higher in CP group. Furthermore, seizure control in CP children especially those with spastic tetraplegia was difficult and usually required polytherapy.

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    The patient was a nine-year-old girl with prolonged focal seizure admitted to the pediatric ward of Rasoul-e-Akram Hospital. The child seemed to be depressed, and in physical examination the only abnormal finding was pink discoid rashes on the cheeks. Brain Ct-Scan performed at the emergency department yielded no specific findings. In order to investigate the precise cause of focal seizure, brain MRI was performed showing widespread areas of increased signal intensity in T1-weighted and decreased signal intensity in T2-weighted images in paritotemporal and frontal area. Specific laboratory tests for lupus erythematosus was positive.

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    Background & Aim: Status epilepticus(SE) is the most common neurological emergency in childhood. Cases referred to pediatric intensive care units(PICU) are the most severely affected. Thus, data from admissions to PICU for SE may provide some insight for devlopment of stategies to reduce the severity and complications of the situation. We conducted this study to determine etiology, factors influencing the occurrence of SE and mortality of patients. Patients and Methods: In a descriptive, cross sectional retrospective study files of 134 children(aged 1 month to 12 years) were reviewed Age, etiology of SE, factors predesposing to occurrence of SE(e.g. previous neurological abnormality), course of the disease and mortality of patients were determined. Descriptive(mean±SD) and comprehensive statistics(χ2 analysis) were used. P<0.05 was considered significant. Results: The mean age of patients was 4.8±4.5yr. Status epilepticus was most common in younger children with 45% of cases occurring in those younger than 2 years. 115(85%) out of 134 patients were admitted with their first episode of SE, while 19(15%) presented with recurrence. The most common etiology group was acute symptomatic(27.7%) whereas, progressive encephalopathy with only 10 patients(7.7%) formed the least common group. 42(31.3%) of the children suffered from Refractory status epilepticus. Also 40.3%(54 out of 134) of patients were neurologically abnormal before the episode of SE(P<0.01) and the older the child the more susceptile to have SE in an abnormal neurological background(P<0.001). Twenty five children(18.6%) died 12 of them(50%) belonged to acute symptomatic group, 10(38.4%) remote symptomatic, 2(7.6%) idiopathic and only 1 patient(3.8%) died of febrile status epilepticus. Conclusion: Children under 2 years included more patients than the other age groups. The most common etiology was symptomatic group(acute & remote). Previous neurological abnormality was a significant factor in occurrence of SE. Acute symptomatic group was the most common etiology in the expired patients.

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  Background : Recognition of facial expression is an important factor in establishing a successful social interaction and deficit in this capability can cause defect in child’s social interaction. The purpose of this study was evaluation of emotional recognition training on enhancing perception of emotional expression of faces.

  Methods: This was a quasi-experimental pretest- posttest study without control group. Thirty preschool girl students aged 6 years selected with accessible sampling method participated in this study. Emotional recognition intervention was presented in a progressive method with a feedback for responses. T- Test and repeated measures were used for analysis.

  Results: Findings showed that emotional recognition can enhance ability of emotional recognition in happiness (p<0.0001), sadness (p<0.005) angry (p<0.001) and fear (p<0.000).

  Conclusion: Though the emotion perception is an implicit process with children learns it without direct education, present study found that emotional recognition could be trained with an explicit approach by therapists.

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Background: Febrile seizures (FS) occur in 5% of children with 6 to 60 months ages. Many investigations are being performed, one of them is EEG. This study was done to determine EEG in recurrent simple and complex febrile seizures.

Methods: In this descriptive, cross sectional study, we evaluated 86 patients with recurrent and complex febrile seizure admitted to neurology ward in Ali-Asghar training children hospital between 2008 and 2012. Data were recorded on age, gender, type of seizure (focal, generalized), and family history of febrile seizure, epilepsy, and EEG results.

Results: Eighty six patients had EEG. Mean (SD) age was 24.27±15.28 months. Forty three (50%) cases were 6-18 month of age. Fifty three (62%) cases were male. Thirty three (38.5%) patients had recurrent simple FS and 53 (61.5%) had complex FS. Twenty nine (37.7%) cases had family history of FS and 13(15%) cases had family history of epilepsy. Thirty six percent of cases had abnormal EEGs. Abnormal finding included slow waves (14%), sharp waves (16%) and spike waves (6%). There was significant relation between abnormal EEGs and age (p=0.04), though no meaningful relation with gender, type of seizures and family history of FS or epilepsy.

Conclusion: Seizures during a febrile illness are common in children under 5 years of age. Due to changes in EEG in children with simple, complex, and recurrent FS, performing EEG in these cases is recommended.

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Background: The aim of the present study was to evaluate any possible effects of family-based tele-intervention of the SPARK program for improving the motor proficiency and reducing the severity of autism symptoms in children with high-functioning ASD.
Methods: This research was a quasi-experimental study with pretest-post test design without a control group. Nine families of children with high-functioning ASD were recruited from rehabilitation centers for children with ASD in Tehran, Isfahan, Ghods and Kermanshah cities. The tele-rehabilitation procedure was administered by the parent to their children during 24 sessions each 45 minutes for 8 weeks. The Gilliam Autism Rating Scale (GARS) (Gilliam, 1995) and short form of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) (Bruininks, 1978) were used for data collection. Data were analyzed using pair t test.
Results: The results demonstrated that (p< 0.5) family-based tele-intervention of SPARK program has significant effect in motor proficiency, but this effect was not significant in reducing the severity of autism symptoms in children with high-functioning.
Conclusion: The results of this study showed that family-based tele-rehabilitation has appeared to be an effective intervention to reduce motor problems in children with autism spectrum disorders.
 

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Background: Developmental coordination disorders are long-term disability and related with motor, emotional and educational problems may to continue until adulthood. For this reason, the need for early intervention for these children seems necessary. Therefore, the purpose of this study was to investigate the effect of aerobic rhythmic exercises on motor skills, anxiety and academic achievement in elementary school boys with developmental coordination disorder.
Methods: In a semi-experimental study, 30 children with disorder were selected based on the parents' developmental coordination disorder diagnostic questionnaire with a mean age of 9.27 from the primary schools of Tabriz using purposeful cluster sampling. The pre-test was performed using the BOT-2 test, the March scale and the mathematical lesson scores. Subjects were randomly assigned into two groups of 15 control and testing subjects. The experimental group tested the aerobic exercise for 8 weeks, every week they have 3 sessions per hour. The control group performed their usual activities during this period. Then, from both groups, the post-test was taken. After assuring the normal distribution of data using Kolmogorov-Smirnov test, covariance analysis was used to examine the effect of training at a significant level (p<0.05).
Results: The results of the statistical tests indicated that the aerobic exercise training had a significant effect on motor skills, anxiety and academic achievement in the experimental group.
Conclusion: Therefore, according to the results of sports exercises, sports therapists for motor disorders and rehabilitation are advised to use aerobic training to reduce the motor, mental and educational problems of children with developmental coordination disorder. 
 

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Background: Cerebral palsy is a group of multi-dimensional and non-stationary disturbances in motion. Children with cerebral palsy need a careful attention of their caregivers, especially their mothers, in their daily living activities. Therefore, presenting training programs to mothers in order to take care of their children with cerebral palsy is very important. This study examines the impact of determining the effect of care education of mothers of children with cerebral palsy on their maternal depression and anxiety referring to the selected hospital in Alborz university of Medical Sciences in 2017.
Methods: In this experimental, research, 60 mothers referring to Bahonar Hospital in Karaj who had children with cerebral palsy were selected randomly, and then were divided into two control and intervention groups. The education program consisted of 6 domains for mothers during 6 sessions of 30 minutes over a period of two weeks. The training program focused on six areas such as child carriage, different forms of positioning, sleeping, getting dressed and undressed, feeding and nourishing, going to the toilet and urine control which were presented to mothers in the intervention group during six, thirty-minute sessions in two weeks. Depression and anxiety of mothers in both groups before and after the intervention were evaluated. To compare variables in two groups of control and intervention, two-samples independent T-test was used and to compare the average before and after in each group, the paired T-test was conducted. In order to analyze the homogeneity of data in quality variables, K2 or the accurate Fisher test was administered. Moreover, in order to mitigate the effect of pre-test, the average comparison of post-test was done using the ANCOVA covariance analysis and then the results were analyzed using SPSS 21.
Results: The results showed that the training program for taking care of children with cerebral palsy resulted in the reduction of mothers’ depression from mean 26.100 and standard deviation 3.546 to mean 18.966 and standard deviation 3.690 and anxiety from mean 20.966 and standard deviation 2.930 to mean 14.500 and standard deviation 2.788 in the intervention group (p˂0.0001). Considering the control group mothers, it can be stated that the results showed no significant changes in the depression and anxiety of mothers regarding the lack of training in this group. The maternal anxiety score remained at mean 25.266 and standard deviation 2.715 and the depression rate ranged from mean 26.300 and standard deviation 2.718 to mean 25.933 and standard deviation 2.970.
Conclusion: The research results showed that use of training program on how to take care of children with cerebral palsy can reduce depression and anxiety in the mothers of children with cerebral palsy.
 

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Background: Children with Hyperactivity/Attention Deficit Disorder have higher anxiety and depression than their normal peers. The aim of present study was to investigate the effects of musical rhythmic exercise on anxiety, depression and Hyperactivity / Attention Deficit Disorder of primary school children with Hyperactivity / Attention Deficit Disorder.
Methods: In this study, 40 male students (M=8.6, SD=.50) using questionnaires and clinical interviews were identified as hyperactive. Randomly divided into two groups: control (n=20) and experimental (n=20) groups. The Conner’s Form Parenting Questionnaire was used to measure attention deficit hyperactivity / attention deficit disorder, and the Multi-dimensional March Children Anxiety Questionnaire and the Kovacs Children's Depression Inventory were used respectively to assess anxiety and depression, respectively. The experimental group participated in an eight-week course (5 sessions per week) of rhythmic exercises with music. The control group performed only routine school activities (one training session per week). Covariance analysis was used for data analysis.
Results: Levine test results showed that the condition of homogeneity of variance for anxiety, depression and hyperactivity disorder activists / attention deficit is established. Also Results showed that musical rhythmic exercise has a significant effect on anxiety (F=39.25, P=0.000) and depression (F=39.25, P=0.000) and Hyperactivity / Attention Deficit Disorder (F=156.80, P=0.000). The highest rate established for the variables hyperactivity and attention deficit with an effect size of 0.80.
Conclusion: The results suggest that the combination of exercise and music as an effective intervention can be used to reduce anxiety, depression, and attention deficit hyperactivity disorder in preschool children with attention deficit hyperactivity disorder.
 

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Background: Numerous methods have been tested in the field of rehabilitation of dyslexic students. The purpose of this study was to compare the effectiveness of computer-based cognitive rehabilitation and neuro-psychological exercises on reading speed, accuracy and comprehension of students with dyslexia.
Methods: The method was quasi-experimental and its design was multi-group with pretest and posttest phases. The statistical population was included all elementary school students with developmental dyslexia of Amol and Mahmood-abad cities during the academic year of 1397-98, who were referred to learning disability centers. 45 samples were selected by convenience sampling and assessed by Raven IQ test and a Persian version of reading and dyslexia test (NAMA). Samples were randomly assigned to experimental and control groups after confirming diagnose from LD experts. Interventions were conducted in methods of computer-based cognitive rehabilitation and practical cognitive rehabilitation for experimental groups in 14 sessions, but the control group did not receive any intervention. Reading speed, accuracy and comprehension were measured via NAMA test in two pre-test and post-test stages. Data were analyzed by multivariate analysis of covariance with Bonferroni post-hoc test.
Results: The results showed that computerized cognitive rehabilitation was more effective on the amount of reading speed and accuracy, but in comprehension, the practical method was more effective.
Conclusion: Computerized cognitive rehabilitation and practical cognitive rehabilitation are effective on dyslexia and these interventions can be complementary to each other in order to improve reading performance.

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Background & Aims: According to the high prevalence of epilepsy and the using of sodium valproate as an antiepileptic drug widely given in these patients, accurate recognition of its side effects and its effects on serum lipids profile, liver enzymes, uric acid level, and thyroid function tests, especially in cases that need long-term treatment seems essential. Sodium valproate is a broad-spectrum drug that has been frequently prescribed as a first-line anticonvulsant since 1970. Similar to other anticonvulsant drugs, sodium valproate comes with some side effects, including transient and harmless outcomes such as weight gain, transient drowsiness, hair loss, hand and arm tremors at rest and activity, reversible thrombocytopenia, and moderate (about 3 times) increase in gamma-glutamyl transferase, as well as harmful complications such as hepatotoxicity, encephalopathy, coagulation disorders, pancreatitis, and bone marrow suppression. Also, sodium valproate interacts with other drugs such as phenobarbital, phenytoin (PHT), carbamazepine, lamotrigine, felbamate, rifampin, ethosuximide, and primidone. It generally confers suitable therapeutic properties, and whether it is used or prohibited or its modification due to negative side effects should be decided individually for each patient. Obesity or an increase in adipose tissue is defined using the body mass index (BMI), where the body weight (kg) is divided by the square of the body height (m). In a child over 2, obesity is defined as a BMI at or above the 95th percentile, and a BMI at the 85th to 95th percentile means that the person is overweight. On the other hand, serum concentrations of specific lipids and lipoproteins in young adults are serious risk factors for the development of cardiovascular disease during life. Several data showed that increased total cholesterol, elevated triglyceride (TG) and LDL-C, and decreased HDL-C levels, cause cardiovascular disease. Therefore, the assessment of variations in serum lipid profile levels following the consumption of anticonvulsants may help select the safest drug to prevent cardiovascular complications in patients. As we know, the complications of sodium valproate may be higher in children than adult. The aim of this study was to evaluate the effects of sodium valproate on weight, body mass index (BMI), vitamin D3, blood insulin, uric acid level, and serum lipids profile in children with newly diagnosed epilepsy.
Methods: This prospective study was performed on 30 children between 3 and 8 years of age who admitted to the pediatric ward of Rassol-e-Akram Hospital in Tehran during 2018-2019, suffered from newly diagnosed epilepsy and received sodium valproate as monotherapy to control of seizures. In this study, patients had no metabolic disease or underlying chromosomal condition, obesity, failure to thrive (FTT), or congenital anomalies were included in the study. All patients with, underlying conditions such as chronic hepatic, heart, renal, and metabolic diseases, diabetes, chromosomal disease, obesity, FTT, congenital anomalies, progressive neurological disease, gastrointestinal diseases, coagulation disorders and developmental delay were excluded from the study.
Data include demographic information (age, sex, height, weight and waist and hip circumference of children), as well as clinical characteristics such as liver enzymes (ALT, AST, ALK-P), serum lipids level (TG, TC, HDL-C, LDL-C), thyroid tests (TSH, T4), fasting blood sugar (FBS), Uric Acid level, 25 OH Vitamin D3 (Vit-D3) and blood insulin level of children before and six months after the consumption of sodium valproate, were examined
Results: The mean weight of children before and six months after the start of sodium valproate treatment was 18.54±2.99 and 21.13±3.93 (kg), respectively. This difference was statistically significant (P=0.005). Also, the mean weight Z-score of children before and after taking sodium valproate was respectively -2.497 and -2.293, that was statistically significant too. In addition to weight gain, there was also a significant increase in the abdominal and hip circumference of children after taking valproate, whereas the increase in mean BMI before and after valproate administration was not statistically significant (P=0.114). Mean values of weight, body mass index, and circumference of the abdomen and hips of children before and after taking sodium valproate were compared individually in girls and boys. However, mean weight gain, as well as the increase in the waist and hip circumference, had no relationship with gender (P> 0.05). Paraclinical features such as hepatic enzymes (ALT, AST, ALK-P), lipids profile (TG, TC, HDL-C, LDL.C), thyroid tests (TSH, T4), fasting blood sugar (FBS), the concentration of uric acid, 25 OH Vitamin D3, and the content of blood insulin level before and after consuming sodium valproate were measured individually in boys and girls. Also, sodium valproate significantly increased ALT level (P=0.046). This is while sodium valproate had no effect on other liver function markers (AST), thyroid hormones (TSH, T4), fasting blood sugar (FBS), uric acid level, 25 OH Vit-D3, and the children's blood insulin levels (P> 0.05).
Conclusion: This study was carried out in 2018 on 30 children aged 3 to 8 years who were admitted in the pediatric ward of Rasool-e- Akram Hospital with newly diagnosed epilepsy and were treated with sodium valproate to control their seizures. In this study, factors including gender, age, weight, height, and size of waist and hip, as well as hepatic enzymes (AST, ALT), and the results of laboratory testing of lipid profiles, uric acid level, thyroid hormones, vitamin D3 level, and fasting blood sugar were recorded before and 6 months after consuming sodium valproate for each patient. According to the findings of this study, it can be said that sodium valproate is a good and safe drug for children between 3 and 8 years of age, but it should be noted that taking this drug increases the chance of obesity in children. Weight gain following the consumption of sodium valproate was observed in all children in this study. The main side effect of this drug is weight gain. In addition to weight gain, a significant increase was observed in the size of the abdomen and hips of children after taking this drug. Due to the normal serum level of insulin, uric acid and lipids, it seems that the role of sodium valproate in children weight gain is more result of increased appetite than metabolic and hormonal changes.
Also, the result of significant increase in ALT enzyme level, in this study, recommended that liver enzymes should be checked before, one and six months after starting treatment as it can prevent the irreversible permanent side effects of this drug.