Infantile Tremor Syndrome With Movement Disorder: Current Perspective

Abstract

Although infantile tremor syndrome is considered a rare entity, we present a typical case of this disorder. This case reinforces the association of infantile tremor syndrome with exclusive breastfeeding in infants and the absence of proper complementary feeding. A nine-month-old, irritable, listless, exclusively breastfed female presented with grade 2 malnutrition, tremors, hyperpigmentation, scarce scalp hair, and delayed developmental milestones. Laboratory investigations revealed macrocytic anemia and a low serum vitamin B12 value of 205 pg/dL. Cerebral and mild cerebellar atrophy were noted on the MRI brain scan. Accordingly, the patient was diagnosed with infantile tremor syndrome and treated with vitamin B12 and nutrient supplementation with zinc, magnesium, folic acid, and iron. The tremors improved and the child became responsive and interested in her surroundings. It is essential to recognize this condition at the earliest and initiate treatment. Basic interventions such as the promotion of proper nutrition, timely introduction of complementary feeding, and weaning practices are key factors in decreasing the incidence of this condition.

Infantile tremor syndrome with global developmental delay and microcephaly in a 16-month-old male: a case report

“…ITS typically manifests with characteristic features such as pallor, developmental regression or delay, hyperpigmentation of the skin, sparse and hypopigmented scalp hairs, and tremors 2 , 7 . Additional symptoms may include a plump appearance and apathy 10 .…”

“…The tremors are acute and coarse, involve various body parts, and are triggered by factors like infection and stress. They tend to disappear during sleep and are generally self-limiting 2 , 7 , 11 . In a case report by Gowda et at .…”

“…It is also defined by a “tetrad of pallor, developmental delay or regression, skin pigmentation, and sparse brown scalp hair 1 – 4 . It is primarily seen in children between the ages of 6 and 18 months and mostly from India, Southeast Asia, and African countries 1 , 2 , 5 . Exclusively breastfeeding infants of mothers who are vegetarians or have unrecognized pernicious anaemia are mostly affected by this condition.…”

“…The aetiology remains elusive, with most research supporting nutritional deficiencies in vitamin B12, iron, zinc, and magnesium 6 , 7 . There is a decline in the occurrence rate, which can be credited to improvements in nutritional status and greater awareness regarding proper and timely weaning practices 2 . This case report presents a case of ITS, highlighting the importance of complementary feeding.…”

Tremorsin Infantile Tremor Syndrome mimickingEpilepsia Partialis Continua

“…ITS or neurocutaneous infantile B12 deficiency syndrome is a clinical disorder characterized by mild developmental delay or neuroregression, pallor, coarse tremors of the head, tongue, and limbs, and pigmentary changes in skin and hair. 1,2 ITSispredominantly seen in exclusively breastfedinfants of vegetarian mothers but has been reported in infants of non-vegan mothers too. 3 ITS classically presents between 6-24 months of age with listlessness, apathy, sparse and light-colored hair, and hyperpigmentation over the dorsal aspects of hands, nail folds, feet, knees, ankles, buttocks, and axillae.…”