Ashraf Mohammadzadeh; Ahmad shah Farhat; Ezzat Khodashenas; Jalil Tavakol Afshari; Nafiseh Pourbadakhshan; Mehdi Sohrabi
Abstract
Background: The study aimed to determine the effect of zinc consumption on cell immunity in healthy 6-year-old children. In a double-blind clinical trial after the license of parents, 40 children 6-7 years old were enrolled. The male healthy and 6-7-year-old children were included and those with chronic ...
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Background: The study aimed to determine the effect of zinc consumption on cell immunity in healthy 6-year-old children. In a double-blind clinical trial after the license of parents, 40 children 6-7 years old were enrolled. The male healthy and 6-7-year-old children were included and those with chronic disease, failure to thrive, and usage of another zinc supplement in the past two months, were excluded. In the case group (N=20), twenty mg of zinc sulfate syrup has been prescribed orally for 6 months. The control group (N=20) received a placebo the same as the case group in the volume, color, bottle size, and shape. Serum zinc level and cellular proliferation were measured before intervention and 12 hours after the last dose of zinc sulfate. Zinc serum was measured by manual colorimetric method technique. A zinc level of less than 65 ug/dl is considered zinc deficiency. The lymphocyte proliferation before and after zinc treatments have been compared by paired T-test analysis. Results:The mean weight of children in the case and control group were 20.37±2.21kg and 20.92±1.98 kg respectively (P= >0.05). Serum zinc level was within the normal limit and did not differ between the two groups before and after intervention (P=0.86). After 6 months of supplementation of 20 mg zinc sulfate per day for 6 months, there were no significant improvements in Lymphocyte proliferation (with/without PHA). Conclusion: This study indicates that moderate supplementation of zinc for six months cannot efficiently improve Lymphocyte proliferation (with/without PHA) in healthy male children.
Pegah Rahbarinejad; Fatemeh Sadat Hashemi Javaheri; Mostafa Shahraki Jazinaki; Hamid Reza Kianifar; Saeedeh Talebi
Abstract
Introduction: Epidermolysis bullosa (EB) represents a diverse set of disorders that affect the skin and mucous membranes. Ensuring proper nutrition for children and adolescents with Epidermolysis Bullosa is a vital aspect of their treatment plan. The objective of this study is to demonstrate how nutritional ...
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Introduction: Epidermolysis bullosa (EB) represents a diverse set of disorders that affect the skin and mucous membranes. Ensuring proper nutrition for children and adolescents with Epidermolysis Bullosa is a vital aspect of their treatment plan. The objective of this study is to demonstrate how nutritional intervention in a specialized nutrition clinic can enhance their well-being.Methods and material: This longitudinal study was conducted over a 3-year period at Akbar Children Hospital, a tertiary facility affiliated with Mashhad University of Medical Sciences in Iran. The study included all patients diagnosed with EB based on clinical symptoms and genetic studies.Results: In the present study, the median (25-75 IQR) age of the participants was 81.0 (36.0-156.0) months, and 19% of the participants were girls. The median (25-75 IQR) weight was 17.5 (10.8-24.5) kg, and the mean ± SD of height was 109.9 ± 31.1 cm. Among all types of malnutrition, there was only a significant association between gastrointestinal complications and BMI-for-age z-score (OR: 0.08, P-value=0.039) in the crude model. After adjustment, there was no significant association between gastrointestinal complications and malnutrition. The mean values of weight at the baseline, the first, and the second appointment of the study were 21.3, 21.2, and 24.8 kg, respectively. Moreover, the mean height at the baseline, the first, and the second appointment of the study were 109.4, 121.0, and 123.4 cm, respectively.Conclusion: Regular clinic visits and tailored nutritional interventions positively impact EB patients, emphasizing the importance of managing anemia and deficiencies for their well-being.
Ashraf Mohammadzadeh; Ezzat Khodashenas; Ahmad Shah Farhat; Nafiseh Pourbadakhshan; Ali Jafarzadeh Esfehani; Mehdi Sohrabi; Aradokht Vaezi
Abstract
Introduction: Zinc has a key role in reproductive physiology, immune modulation, growth, and development. To determine the effect of zinc supplements on the anthropometry of healthy 6-yearold children.Methods: In this double-blind placebo-controlled trial was carried out on 40 children 6-7 years old. ...
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Introduction: Zinc has a key role in reproductive physiology, immune modulation, growth, and development. To determine the effect of zinc supplements on the anthropometry of healthy 6-yearold children.Methods: In this double-blind placebo-controlled trial was carried out on 40 children 6-7 years old. The intervention group (n=20) received 20mg of oral zinc sulfate syrup and the control group (n=20) received a placebo daily in the same buttle and same test for 6 months duration of study. Serum zinc levels and anthropometric measurements (weight, height, head circumference, and arm circumference) were measured before and after intervention. Zinc deficiency was defined as serum zinc level < 9.9 μmol/l.Results: Serum zinc level did not differ between the two groups (P=0.86). Zinc supplementation resulted in a significant increase in height (P= 0.008).Conclusion: This study showed that zinc supplements have a significant increase in the length of male 6-year-old children.
Samaneh Kouzegaran; Hamid Ahanchian; Seyed Ahmad Emami; Neda Ansari; Jamshid Yousefi; Nasrin Moazzen; Nafiseh Pourbadakhshan; Rana Tafrishi; Aida Ansari; Nasrinsadat Motevalli
Abstract
Introduction: Asthma is a very common chronic disease among children. As for its treatment, in recent years there is an increased tendency towards supplemental treatments. Hence, many of these patients are administered complementary and alternative treatments including herbal medicine.Methods:Through ...
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Introduction: Asthma is a very common chronic disease among children. As for its treatment, in recent years there is an increased tendency towards supplemental treatments. Hence, many of these patients are administered complementary and alternative treatments including herbal medicine.Methods:Through a cross-sectional study, we evaluated the common herbal remedies used in asthmatic children referred to the allergy clinic of Sarvar Children’s Hospital in Mashhad. All data related to the patients (i.e., age, sex, and history of all remedies consumed as well as the responsible persons prescribing the pertinent medications) were recorded in a checklist.Results: In this study, 582 asthmatic children with the average age of 77.4±41.7 months were evaluated. The overall herbal remedies usage was 59.8%. There was no significant differences between age groups, sex, or asthma severity and herbal remedy usage. Thirty-seven different herbal remedies were prescribed to the patients, the most common herb was thymes (65.3%) followed by a four-seed herbal mixture (23.6%), Plantago major (12%) and Cydonia oblonga (quince) (10.8%).Conclusion:Limited information is available regarding complementary and alternative medicine in asthmatic children in Iran. The present study showed the high prevalence of herbal medicine usage in asthmatic children in this region. Hence, further studies should determine the clinical benefits of these remedies
Fatemeh Sadat Hashemi Javaheri; Hamidreza Kianifar; Pegah Rahbarinejad; Saeedeh Talebi
Abstract
Introduction:Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Children with ASD are at risk of nutritional problems that could impact growth and anthropometric indices over ...
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Introduction:Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Children with ASD are at risk of nutritional problems that could impact growth and anthropometric indices over both the short and long term. The aim of present study was to determine prevalence of malnutrition and other factors related to the malnutrition among children and adolescent with autism disorder.Material and method:To assess the prevalence of malnutrition indicators among preschool children with ASD, a cross-sectional study was conducted among 81 children and adolescents who referred to subspecialized and specialized Autism Akbar Children‘s Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Weight and height measurements were assessed based on standard protocols. The z-score of anthropometric indices was determined for all participants. Participants were asked about nutritional problems by the interview from their parents. Result:In the current study, the mean ± SD of age was 10.1±3.7 years old. Among participants 3.7% were with Diarrhea, 33.3% with Constipation, 4.9% with Reflux, 3.7% with Flatulence, and 1.2% with Steatorrhea. The prevalence of both of food neophobia and food Allergy was 16%. Furthermore, 18.5% had poor appetite, 23.5% had moderate and 58% had good appetite. Based on standardized z-scores, the overall prevalence of under-weight, risk of overweight, overweight, and obese was 1.2%, 22.2%, 12.3%, and 7.4%, respectively. Among participants 4.9% was stunting.Conclusion:Based on aforementioned prevalence, improving nutritional problems and anthropometric indices among ASD children and adolescents are crucial issue.
Ali Alami; Maryam Aghaei; Sepideh Shayan Karkon; Raheleh Derafshi
Abstract
Introduction:Acute Poisoning in the developed countries include about 2% of all childhood deaths and more than 5% cause of death in the developing countries. Poisoning usually is defined as taking a substance which can cause an organism becoming injured. The purpose of this study was to identify sociological ...
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Introduction:Acute Poisoning in the developed countries include about 2% of all childhood deaths and more than 5% cause of death in the developing countries. Poisoning usually is defined as taking a substance which can cause an organism becoming injured. The purpose of this study was to identify sociological factors that are important in improving prevention, prognosis, and management of poisoning. Methods: This retrospective evaluated 1200 children in the pediatric ward of the 22 Bahman hospital, Gonabad, Iran, from March 2015 to July 2018. The information about Children was recorded by individual examination of the files in standardized forms including epidemiological and demographic features for statistical analysis and data were analyzed by using the U Test Chi square, Pearson correlation analysis and variance analysis in SPSS Version 21.0. Results: Acute poisoning included 2.3% of referring causes with mean age 3.7 ± 1.3 years. The mean age of poisoned children was significantly lower than other children (p value = 0/002). The majority of cases were accidental poisonings with opium (ICD-10 T40.0X1) and methadone (ICD-10 T40.3X1). Most common symptoms were neurological disorders, vomiting, tachypnea and tachycardia.Common clinical symptoms in children diagnosed with poisoning include: Neurological symptoms including seizures, hallucinations, drowsiness, decreased level of consciousness and confusion (50%), nausea and vomiting (25%), tachypnea and tachycardia (7.1%). Respiratory depression, meiotic pupil, shortness of breath, cough, tears and hallucinations (3.6%) due to referring severe toxic patients to more equipped center no death was recorded in our center. Conclusion: Acute poisoning is one of the most abudant emergencies in children. This study with identifying epidemiological and demographic factors of acute poisoning in children would help to improve prevention, and management of future programs.
Farah Ashrafzadeh; Farideh Sahebkar; Anahita Alizadeh; Majid Sezavar; Babak Karimi; Maryam Naseri; Gholamreza Khademi
Abstract
Introduction: Poisoning is the most common method of non-fatal suicide. In recent years, poisoning caused by the use of medications and chemicals has increased. The present study aimed to investigate the rate of suicide using toxic compounds in Iranian children.Methods: This retrospective study was conducted ...
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Introduction: Poisoning is the most common method of non-fatal suicide. In recent years, poisoning caused by the use of medications and chemicals has increased. The present study aimed to investigate the rate of suicide using toxic compounds in Iranian children.Methods: This retrospective study was conducted using the data of 83 children aged 5-16 years who attempted suicide using toxic substances and were admitted to the pediatric and toxicology departments of Imam Reza Hospital in Mashhad, Iran. Results: Among 500 suicide cases, 83 committed suicide using toxic substances, and 8.4% of the suicides were committed by children aged 5-7 years. In addition, 60% of the suicide cases were aged 14-16 years. In total, 45.5% of the children committed suicide with prior planning (statistically significant). The peak time of referral to the emergency department was between 6-12 PM, and more than 90% of the patients were admitted with stable vital signs. The most commonly used toxic substance was organophosphate. During admission, psychiatric counseling was not provided to 36.1% of the patients, and the clinical outcomes also showed the use of non-lethal doses. Conclusion: According to the results, it is of utmost importance to assess the underlying causes of suicide attempts in early childhood (e.g., prior planning and antisocial behaviors), especially with the increased age of children to 14-16 years in such incidents.
Farah Ashrafzadeh; Hadi Tohidi; Elnaz Faraji; Alireza Ataei Nakhaei
Abstract
Epilepsy is a major neurological disorder, which may occur in all age groups, including children. Approximately 20% of epileptic children are drug-resistant. Uncontrolled seizures pose variable risks to patients, such as increased mortality rate, trauma, and cognitive and psychiatric disorders. Therefore, ...
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Epilepsy is a major neurological disorder, which may occur in all age groups, including children. Approximately 20% of epileptic children are drug-resistant. Uncontrolled seizures pose variable risks to patients, such as increased mortality rate, trauma, and cognitive and psychiatric disorders. Therefore, effective treatment is essential to controlling seizure attacks. Although many antiepileptic drugs are currently available for clinical treatments, clinicians are concerned with the discovery of safer drugs with enhanced antiepileptic effects and fewer side-effects. Traditional medicine provides strong grounds for modern medicine. Use of some medicinal plants has been shown to reduce or prevent the further progression of epileptic seizures. The present review aimed to discuss the effectiveness of some medicinal plants in the treatment of children with intractable epilepsy. An online literature review was conducted in databases such as IranMedex, Scopus, Medline, and Google Scholar to identify the studies investigating the use of medicinal plants in children with intractable epilepsy. In addition, the files of the authors were reviewed in the reference lists and bibliographies of the retrieved articles. According to the results, herbal therapies could potentially yield new treatment options for children with intractable epilepsy. Using medicinal herbs could be a cost-efficient treatment method in these patients as a culturally acceptable option to their families.
Ali Akbar Momen; Reza Azizi Malamiri
Abstract
Epilepsies and epileptic syndromes are among the most common chronic neurological disorders in neonates, infants, and children. Remission occurs in 70% of epileptic children, while other cases experience frequent seizures and become refractory to various treatment modalities. Refractory seizures have ...
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Epilepsies and epileptic syndromes are among the most common chronic neurological disorders in neonates, infants, and children. Remission occurs in 70% of epileptic children, while other cases experience frequent seizures and become refractory to various treatment modalities. Refractory seizures have a significant adverse impact on the quality of life of epileptic children and their families. Prognosis of epilepsies is determined based on the risk of seizure or convulsion recurrence. Some of the most important risk factors for recurrence are the age at seizure presentation, neurodevelopment of the child, etiology of seizures, seizure frequency before anticonvulsant withdrawal, response to antiepileptic medications, type of epileptic syndromes, and electroencephalography of the patient. Recognition of the risk factors for seizure recurrence results in the optimal management of the treatment protocols, thereby reducing the adverse effects of epileptic seizures on patients and their families. The present study aimed to provide a narrative review of the most important risk factors for the recurrence of epilepsies in children by two child neurologists.
Farhad Heydarian; Hamid Ahanchian; Maryam Khalesi; Saeed Ebrahimi
Abstract
Introduction: Asthma is a chronic inflammatory airway disorder that is distinguished by coughing, wheezing, and dyspnea. It is the most common chronic disease among children. Epidemiological trials have suggested that there may be a correlation between vitamin C intake and the incidence of asthma. Specifically, ...
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Introduction: Asthma is a chronic inflammatory airway disorder that is distinguished by coughing, wheezing, and dyspnea. It is the most common chronic disease among children. Epidemiological trials have suggested that there may be a correlation between vitamin C intake and the incidence of asthma. Specifically, according to these studies, a rapid increase in the occurrence of asthma may be caused by a decreased intake of dietary antioxidants and various vitamins such as vitamin C. A systematic review was performed to determine the role that vitamin C, in terms of both dietary intake and serum levels, had on asthma in children. Methods: PubMed and Scopus databases were searched for studies that provide information on the effects of vitamin C on asthma in children aged between 1 and 17 years. The inclusion criteria specified that the studies involved needed to be cohort and case series involving at least ten patients. Exclusion criteria were non-English articles, case reports, and articles involving children who were aged below or above the age 1 and 17 respectively.Result: A total of 13 studies involving 6503 patients met the inclusion criteria. Dietary vitamin C intake was lower in people with asthma than in those without asthma. Lower quantity dietary intakes and serum levels of vitamin C were also associated with increased incidents of asthma.Conclusion: According to the extracted data, a relatively low dietary intake of vitamin C is associated with an increased risk of asthma and wheezing. Moreover, asthmatic patients who consumed vitamin C exhibited an improvement in their diseases.
Farah Ashrafzadeh; Mehran Beiraghi Toosi; Mohammad Hasan Mohammadi
Abstract
Introduction: Autism spectrum disorder (ASD) is a syndrome of social communication deficits and repetitive behaviors or restricted interests. While the impairments associated with ASD tend to deteriorate from childhood into adulthood, it is of critical importance that the syndrome is diagnosed at an ...
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Introduction: Autism spectrum disorder (ASD) is a syndrome of social communication deficits and repetitive behaviors or restricted interests. While the impairments associated with ASD tend to deteriorate from childhood into adulthood, it is of critical importance that the syndrome is diagnosed at an early age. One means of facilitating this is through understanding how the brain of people with ASD develops from early childhood. Magnetic resonance imaging (MRI) is the method of choice for in vivo and non-invasive investigations of the morphology of the human brain, especially when the subjects are children. In this study, we conducted a systematic review of existing structural MRI studies that have investigated brain size in ASD children of up to 5 years old. Methods: In this study, we systematically reviewed published papers that describe research studies in which the brain size of ASD children has been examined. PubMed and Scopus databases were searched for all relevant original articles that described the use of MRI techniques to study ASD patients who were between 1 and 5 years old. To be included in the review, all studies needed to be cohort and case series that involved at least 10 patients. No time limitations were placed on the searched articles within the inclusion criteria. The exclusion criteria were non-English articles, case reports, and articles that described research involving subjects that were not within the qualifying age range of 1-5 years old.Result: After an initial screening process through which the title, abstracts, and full text of the articles were reviewed to confirm they met the inclusion criteria, a total of 10 relevant articles were studied in depth. All studies found that children with ASD who were within the selected age range had a larger brain size than children without ASD.Discussion: The findings of recent studies indicate that the vast majority of ASD patients exhibit an enlarged brain; however, the extent of the enlargement varies from study to study. As such, further studies are required to develop an understanding of the areas of the brain in which enlargement manifests in children with ASD before the age of five and to verify the significance of the prognostic value of MRI as a non-invasive diagnostic technique that can be employed to detect ASD in young children.Conclusion: Based on the extracted data, brain size was related to the emergence and presence of autism in children who were below school age. The use of MRI represents a functional and non-invasive method of confirming ASD in children who have an initial ASD diagnosis.
Anoush Azarfar; Yalda Ravanshad; Mohammad Esmaeili; Fatemeh Ghane Sharbaf; Mitra Naseri; Fahime Noferesti
Abstract
Introduction:Pyelonephritis is known as kidney inflammation due to bacterial infection which should be diagnosed and treated promptly. In this article, we decided to systematically review the diagnostic value and reliability of evaluating urine excretion low molecular weight protein alpha-1-microglobulin ...
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Introduction:Pyelonephritis is known as kidney inflammation due to bacterial infection which should be diagnosed and treated promptly. In this article, we decided to systematically review the diagnostic value and reliability of evaluating urine excretion low molecular weight protein alpha-1-microglobulin (A1M). Methods: PubMed and Scopus were searched for the relevant articles about the efficacy of urine alpha-1-micriglobulin assays in the diagnosis of pyelonephritis in children. The search strategy was microglobulin AND pyelonephritis. No language and date limitations were included in this review. Results: A total of 16 articles were retrieved from PubMed and 23 articles from Scopus. After studying the abstracts, only 5 articles were selected, which specifically studied the efficacy of alpha-1-micrglobulin in the diagnosis of pyelonephritis in children.Discussion: A1M is not an acute phase protein but its concentration alters in several clinical conditions. Conclusion: Evaluating the urine concentration of A1M is a noninvasive and cost effective strategy with the diagnostic capability for urinary tract disorders such as early recognition of tubular damages during pyelonephritis.
Farhad Heidarian; Tahereh Ansarinezhad
Abstract
One of the major causes of mortality in children younger than 5 years old is acute lower respiratory tract infections (ALRI). ALRI clinical features are cough, tachypnea, fever, coryza, chest retraction, crackles and wheeze. Increased white blood cell count with left shift might happen in pneumonia. ...
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One of the major causes of mortality in children younger than 5 years old is acute lower respiratory tract infections (ALRI). ALRI clinical features are cough, tachypnea, fever, coryza, chest retraction, crackles and wheeze. Increased white blood cell count with left shift might happen in pneumonia. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) might rise in children with respiratory tract infections. Vitamin A deficiency is associated with severe childhood infections. The effect of vitamin A supplementation in childhood pneumonia depends on the prevalence and the level of vitamin A deficiency in the population. Some studies confirmed that retinol levels were significantly higher after recovery from acute pneumonia compared to acute phase. But there were no significant association between serum retinol level and the clinical manifestation.
Abdollah Banihashem; Hamid Farhangi; Mojtaba Mousavi Bazaz; Zahra Badiee; Ali Ghasemi; Sara Hesari
Abstract
Different therapeutic options in children with immune thrombocytopenic purpura include observation alone, periodic treatment with corticosteroids, intravenous immunoglobulin (IVIG) or anti-D, chronic administration of immunosuppressive agents, and splenectomy.Preference of the type of therapy depends ...
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Different therapeutic options in children with immune thrombocytopenic purpura include observation alone, periodic treatment with corticosteroids, intravenous immunoglobulin (IVIG) or anti-D, chronic administration of immunosuppressive agents, and splenectomy.Preference of the type of therapy depends on the degree of thrombocytopenia and clinical bleeding manifestations. Dexamethasone is safe but its side effects are the main disadvantages for its usage. Anti-D is more expensive than dexamethason but the side effect is rare and not dangerous and response to treatment is assessed in approximately 3 days after infusion.
Masoud Pezeshki Rad; Mina Taghavi; Jahanbakhsh Hashemi; Farzaneh Sharifipour; Abbasali Zeraati
Abstract
Glomerulonephritis (GN) is responsible for 25-30% of end-stage renal disease (ESRD) among all causes. Renal biopsy is important to determine the GN treatment method and its prognosis. In some cases, renal biopsy is required for definitive diagnosis. Biopsies were used as a diagnostic method in different ...
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Glomerulonephritis (GN) is responsible for 25-30% of end-stage renal disease (ESRD) among all causes. Renal biopsy is important to determine the GN treatment method and its prognosis. In some cases, renal biopsy is required for definitive diagnosis. Biopsies were used as a diagnostic method in different disease from 1930. They were performed blindly and at bedside. Complication rate varies from 2 to 20% in different reports. Percutaneous renal biopsy is a routine diagnostic procedure in nephrology nowadays, and it should be individualized for each patient depending on their age, BMI, coagulation status and the availability of skilled radiologist. In this paper, we review image-guided renal biopsy in glomerulonephritis.
Abolfazl Mahmoudzadeh; Yasamin Davoudi; Hossein Haghir; Maryam Salehi; Farah Ashrafzadeh; Behzad Aminzadeh; Sara Mehrnoosh; Mohammadreza Mehrnoosh
Abstract
Many children with hippocampal sclerosis underwent surgery for treatment. Early childhood convulsion occurs in 2 to 4% of population and its prognosis is good in majority of cases. It seems that hippocampal anomalies are common in patients with neocortical epilepsies. The theory of hippocampal sclerosis ...
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Many children with hippocampal sclerosis underwent surgery for treatment. Early childhood convulsion occurs in 2 to 4% of population and its prognosis is good in majority of cases. It seems that hippocampal anomalies are common in patients with neocortical epilepsies. The theory of hippocampal sclerosis association with temporal lobe epilepsy has been proposed 100 years ago. Recent studies demonstrated that there was a correlation between memory impairments and prolonged febrile convulsion (PFC), which might be a result of hippocampal injury. Transient hippocampus swelling might happen in complicated early childhood epilepsy or status epilepticus and result in hippocampal sclerosis.
Seyed Ebrahim Mansoorinejad; Farah Ashrafzadeh; Javad Akhondian; Mehran Beiraghi Toosi
Abstract
Epilepsy is described as a heterogeneous clinical syndrome results from various cerebral destructions. It is categorized to partial and generalized forms. Degree of neural system impairment and affected area determine the severity and pattern of symptoms. Patients might experience sensory, motor, or ...
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Epilepsy is described as a heterogeneous clinical syndrome results from various cerebral destructions. It is categorized to partial and generalized forms. Degree of neural system impairment and affected area determine the severity and pattern of symptoms. Patients might experience sensory, motor, or both signs and symptoms. About 60% of epileptic patients suffer from partial type. It is estimated that up to 30% of epilepsy cases would not be controlled adequately despite sufficient and proper management. Anacyclus pyrethrum, Citrus aurantium var. amara, Paeonia officinalis, Rosa Damascena and Nigella Sativa are some of herbal drugs which have antiepileptic effect. Natural agents are valuable sources to treat chronic diseases and a huge number of world`s population believe herbs are effective and safe for daily primary health care needs. There is not enough evidence about their efficacy and safety obtained from randomized control trials.