Infantile tremor syndrome in Iraqi Kurdistan

Amin, Nazar M Mohammad; Zeki, Jamal Mohammad

doi:10.1007/bf02731110

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…In such children, there were deficiencies of Vitamin B12, multiple macro-and micro-nutrients which lead to manifestations in the form of anemia, skin hyperpigmentation, tremor, and psychomotor changes. Similar result was observed in the previous studies [3,18,19].…”

Section: Discussionsupporting

confidence: 93%

Study of Clinical Profile of Infantile Tremor Syndrome and Its Correlation With Serum Vitamin B12 Level

Jain¹,

Sharma²,

Bhatt³

et al. 2019

IJCH

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Objective:The objective of this study was to assess the clinical profile of infantile tremor syndrome (ITS) and to correlate serum Vitamin B12 level with ITS. Materials and Methods: This prospective study was done in the Department of Pediatrics of a Medical College of Kota. A total of 40 children, presenting with clinical features of ITS, were included in the study. A detailed history was taken. Investigations including complete blood count with blood indices (mean corpuscular volume, mean corpuscular hemoglobin [MCH], and MCH concentration), peripheral smear, and serum Vitamin B12 level were done in accordance with the WHO guidelines. Vitamin B12 deficiency was defined as serum Vitamin B12 concentration <150 pmol/L or 203 pg/mL. Results: All patients with ITS had pallor (100%) and skin hyperpigmentation (100%). Psychomotor changes in the form of apathy and/or developmental regression/stasis were found in 40 (100%) cases. Regression of developmental milestones was found in 26 (65%) and 10 (25%) patients had stasis of milestones. Tremor was present in 14 (35%) cases. Hepatomegaly was present in the majority 25 (62.5%) of these children, whereas splenomegaly was present in only 8 (20%) patients. Hypopigmented hair was found in only 12 (30%) cases. Twenty-five (62.5%) children were exclusively breastfed (p<0.05). Of the 40 cases, 26 (65%) presented in prodromal phase and 14 (35%) presented in the tremor phase. Among 26 patients of prodromal phase, 22 (84.62%) had Vitamin B12 deficiency while among 14 cases of tremor phase, 9 (64.28%) had Vitamin B12 deficiency. The majority of ITS children had macrocytic anemia (65%) followed by dimorphic anemia (25%). A significant number of ITS patients (21, 80.77%), having macrocytic anemia, had Vitamin B12 deficient. Conclusion: We conclude that children of ITS presented with anemia, skin hyperpigmentation, psychomotor changes, apathetic look, and developmental abnormality. The majority of children were on faulty feeding in the form of prolonged exclusive breastfeeding. Vitamin B12 deficiency was present in a significant number of patients with ITS.

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Section: Discussionsupporting

confidence: 93%

Study of Clinical Profile of Infantile Tremor Syndrome and Its Correlation With Serum Vitamin B12 Level

Jain¹,

Sharma²,

Bhatt³

et al. 2019

IJCH

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“…Few such cases have been reported in literature from South East Asia and Africa too 17. Cases similar to ITS have also been reported from North America18 and Italy19 and Iraqi Kurdistan 20…”

Section: Introductionmentioning

confidence: 99%

<p>Infantile tremor syndrome: current perspectives</p>

Gupta

Rawat

Singh

et al. 2019

RRTM

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Infantile Tremor Syndrome (ITS) is a self-limiting clinical state characterized by tremors, anemia, pigmentary skin disease, regression of mental development, and hypotonia of muscles in a plump looking child. Tremors are coarse in character, decreased or disappeared in sleep and resolves within 4–6 weeks in its natural course. Various etiological factors as infectious, metabolic, nutritional have been hypothesized but none is conclusive. Consensus is developing on the role of Vitamin B12 deficiency in children with ITS but is still debatable. Empirical management of ITS children has been tried in the absence of exact etiology considering child as undernourished. Nutritional management includes supplementation of Iron, Calcium, Magnesium, Vitamin B12 and other multivitamins. Tremors can be managed with administration of propranolol most commonly or phenobarbitone, phenytoin, and carbamazepine.

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“…[ 1 ] Although first reported in the Indian subcontinent, similar cases have been reported from around the world. [ 2 ] ITS is a well-known entity, but the exact etiopathogenesis is still not known. Malnutrition, vitamin and mineral deficiency (e.g., Mg and Zn), infections, toxins, degenerative brain disease, enzyme defects (tyrosine), all have been postulated as possible causative factors.…”

Section: Introductionmentioning

confidence: 99%

Infantile tremor syndrome in modern times

et al. 2017

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Background:Infantile tremor syndrome (ITS) is a clinical syndrome of acute or gradual onset of mental and psychomotor changes, pigmentary disturbances of hair and skin, pallor, and tremors in malnourished children aged between 5 months and 3 years. It is a well-known entity, but the exact etiopathogenesis is still not known.Setting and Design:Prospective observational study carried out in the Department of Pediatrics at Dr RPGMC Tanda, Kangra in Himachal Pradesh.Materials and Methods:Demographic, clinical, and laboratory profile of 25 children with the diagnosis of preinfantile and ITS was collected who were admitted from May 2014 to June 2015.Statistical Analysis:Descriptive analysis was performed using SPSS 17 trial version.Results:These children accounted for 0.5% of total pediatric admissions. Median, standard deviation age was 10, 3.1 months. Male to female ratio was 1.27:1. Cases were present throughout the year with two peaks observed in the months of May and November. This disease was found to be more common in higher birth order (68%). Complementary feeding, that too improper, was initiated in only 4 cases (16%). Ninety-six percent cases presented with comorbid illnesses. Respiratory tract infection was the most common association, followed by urinary tract infection. There was moderate anemia with dimorphic picture (40%). Thirteen (52%) had vitamin B12 levels below normal. Magnesium levels, though statistically insignificant (P = 0.8) were lower in patients with tremors.Conclusion:This is a disease of multi-micronutrient deficiency, which can be present either alone or in association. Educating women about proper nutrition during pregnancy and timely administration of complementary feeding is of utmost importance.

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Infantile tremor syndrome in Iraqi Kurdistan

Cited by 9 publications

References 11 publications

Study of Clinical Profile of Infantile Tremor Syndrome and Its Correlation With Serum Vitamin B12 Level

Study of Clinical Profile of Infantile Tremor Syndrome and Its Correlation With Serum Vitamin B12 Level

<p>Infantile tremor syndrome: current perspectives</p>

Infantile tremor syndrome in modern times

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