Infantile tremor syndrome: Role of Vitamin B12 revisited

Gupta, Rajesh K.; Mandliya, Jagdish; Sonker, Pavan; Patil, Vandana; Agrawal, Manish; Pathak, Ashish

doi:10.4103/1817-1745.199463

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…Reduced thickness of corpus callosum was observed in six patients and prominence of Sylvian sulcus in nine 11. Similar findings of corpus callosum and Sylvian fissure along with non-specific cerebral atrophy are reported in a more recent study 33. In another such study, the MRI findings were primary hypomyelination, cerebral atrophy, dilatation of ventricular system and extracerebral spaces 35.…”

Section: Clinical Featuressupporting

confidence: 86%

“…Goraya observed 15 ITS patients out of which 13 were Vitamin B12 deficient, and role of Vitamin B12 deficiency in ITS was strongly emphasized by the authors 31. On the other hand the same author in another study found two cases with serum B12 levels below reference values, five had levels in low normal range, and remaining five had normal values out of the 12 cases of ITS 33. Thus, the role of Vitamin B12 deficiency as an etiological factor in the patients of ITS is inconclusive.…”

Section: Etiologymentioning

confidence: 95%

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<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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Section: Clinical Featuressupporting

confidence: 86%

Section: Etiologymentioning

confidence: 95%

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

Gupta

Rawat

Singh

et al. 2019

RRTM

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“…2 There is no proven macro or micro nutrient causing ITS, but most studies favour role of vitamin B12 deficiency and such was also observed in our study. 7 Corresponding with our study, low maternal serum vitamin B12 levels act as surrogate marker of infantile vitamin B12 deficiency. 1,7 Inconclusive data are also favouring deficiencies of zinc, magnesium and calcium.…”

Section: Discussionsupporting

confidence: 76%

“…7 Corresponding with our study, low maternal serum vitamin B12 levels act as surrogate marker of infantile vitamin B12 deficiency. 1,7 Inconclusive data are also favouring deficiencies of zinc, magnesium and calcium. 1,8 There are three stages of ITS on the basis of history, physical examination and follow up.…”

Section: Discussionsupporting

confidence: 76%

Clinical profile of patients with infantile tremor syndrome in a tertiary care center

Pathak

Chauhan

Pandya

2020

Int J Contemp Pediatr

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Background: Infantile tremor syndrome (ITS) is a condition reported from many areas of Indian subcontinent due to lack of proper nutrition, improper weaning or delayed introduction of complementary feeding. There is no proven macro or micro nutrient deficiency responsible for it but relation with vitamin B12 deficiency has been identified in some studies. The aim of this study was to study the clinical profile of patients with ITS.Methods: It is a prospective observational study including total 30 patients, from 6 months to 3-year age group, admitted to pediatric wards and nutritional rehabilitation centre, civil hospital, Ahmedabad, from June 2018 to December 2019.Results: Out of 30 patients studied, 69% had pre-ITS and rest had ITS, 61.5% were males and 38.4% were females, 69.2% had severe acute malnutrition, 84.6% had severe anemia and 23% of them presented with CCF, 15.4% patients had microcephaly and 23% had hypotonia. 23% had motor and speech delay. 61.5% belonged to lower socio-economic group. There was delayed introduction of complementary feeding in 63% of patients. 69% patients had severe vitamin B12 deficiency and 21% had moderate vitamin B12 deficiency.Conclusion: ITS, is commonly seen among male children belonging to lower socio-economic group among age group of 6 months to 24 months, presents with coarse tremors with moderate to severe anemia with moderate to severe acute malnutrition and is associated with deficiency of vitamin B12. Early diagnosis and treatment including nutritional rehabilitation grossly improved the outcome.

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“…To the Editor: Infantile tremor syndrome (ITS), is characterized by tremors, delayed development, pallor, skin pigmentation and hair changes [1,2]. The etiology is commonly attributed to vitamin B12 deficiency [3]. We present a boy who presented initially as diabetic ketoacidosis (DKA) and later was diagnosed to have ITS.…”

mentioning

confidence: 99%