Study of clinical, haematological and radiological profile of children admitted with infantile tremor syndrome to a tertiary care teaching hospital in Northern India
Keywords:Breastfeeding, Neuroregression, Tremor, Myelination, Northern India
Background: Infantile tremor syndrome (ITS) is characterized by gradual onset of mental and psychomotor changes, pigmentary disturbances in hairs and skin, pallor, tremors and neuroregression. The aim of study was to determine clinical, haematological and radiological spectrum of children admitted with infantile tremor syndrome.
Methods: It was a prospective cross-sectional study done in age group of 6 months to 5 years conducted in department of pediatrics of a tertiary care medical college with duration of 18 months. Clinical, haematological and radiological profile parameters of 36 children admitted during study period with ITS were recorded as per prepared performa and analysed. Microsoft excel was used in creating database while data was analysed by using Statistical Package for Social Sciences (SPSS) version 23.0.
Results: Total 36 children were enrolled in study. Mean age was 12.33±3.89 months and mostly were male (55.6%). Most (72.2%) of children belonged to lower socioeconomic status and (83.3%) were exclusively breastfed. Only 11.1% had severe acute malnutrition (SAM). 77.77% had vitamin B12 levels below normal. Progressive paleness (88.9%), delayed development (61.1%) and developmental regression (58.3%) were most common complaints reported. 63.9% had tremors at presentation. In MRI findings, poor myelination with thinning of corpus callosum (16.7%) and uniform thinning of corpus callosum with subtle hypomyelination in bilateral frontal lobes (8.3%) were major findings. In majority of children tremor disappeared in 11-15 days (30.6%) after starting treatment.
Conclusions: ITS should to be considered as a differential diagnosis in an infant on exclusive breast feeding with vegetarian mother with poor weaning practices presenting with neuroregression, tremor and malnutrition with skin changes.
Clarke JTR. A Clinical Guide to Inherited Metabolic Disease. 2nd ed. Cambridge: Cambridge University Press; 2004.
Kamate M. Clinico-Investigative Profile of Infantile Tremor Syndrome. Indian J Pediatr. 2020;87(3):169-70.
Kalra V. Infantile tremor syndrome. In: Ghai OP, eds. Essential Pediatrics. 7th ed. New Delhi: CBS Publishers; 2009: 558-559.
Amin NM, Zeki JM. Infantile tremor syndrome in Iraqi Kurdistan. Indian J Pediatr. 2005;72(10):839-42.
Sirolia V, Arya S. Study of clinical profile and estimation of Vitamin B12 level in infantile and pre-infantile tremor syndrome. J Evol Med Dent Sci. 2014;40:10134-7.
Garewal G, Narang A, Das KC. Infantile tremor syndrome: a vitamin B12 deficiency syndrome in infants. J Trop Pediatr. 1988;34(4):174-8.
Sirolia V, Arya S. Study of clinical profile and estimation of Vitamin B12 level in infantile and pre-infantile tremor syndrome. J Evol Med Dent Sci 2014;3:10134-7.
Goraya JS, Kaur S. Infantile tremor syndrome. Down but not out. Indian Pediatr. 2015;52:249-50.
Ratageri VH, Shepur TA, Patil MM, Hakeem MA. Scurvy in infantile tremor syndrome. Indian J Pediatr. 2005;72(10):883-4.
Thora S, Mehta N. Cranial neuroimaging in infantile tremor syndrome (ITS). Indian Pediatr. 2007;44(3):218-20.
Kumar A, Rajput KS, Kumar N, Poswal L. Feeding Pattern And Demographic Profile Of Children With Infantile Tremor Syndrome. Int J Med Sci Educ. 2018;5(2):157-60.
Singla DA, Sharma M, Sharma S, Sharma V. The changing profile of infantile tremor syndrome in hilly terrain of India. J Neurosci Rural Pract. 2015;6(4):610-2.
Prateek G, Gupta R, Mandliya J, Singh P, Pathak A. Cranial Neuroimaging in Infantile Tremor Syndrome: The Road Ahead. J Clin Diagnos Res. 2018;12:1-4.
Brahmbhatt V, Patel P, Brahmbhatt S. Infantile tremor sdyndrome. Int J Contemp Pediatr. 2016,3:671-3.
Pohowalla JN, Kaul KK, Bhandari NR, Singh SD. Infantile "meningo-encephalitic" syndrome. Indian J Pediatr. 1960;27:49-54.
Goraya JS, Kaur S. Infantile tremor syndrome: A review and critical appraisal of its etiology. J Pediatr Neurosci. 2016;11(4):298-304.
Chhaparwal BC, Singh SD, Mehta S, Pohowalla JN. Magnesium levels in serum and in C.S.F. in "meningo-encephalitic syndrome" (tremor syndrome). Indian J Pediatr. 1971;38(283):331-3.
Agarwal R, Singh RN, Gupta BD, Agarwal DK, Arora AK. Serum magnesium, calcium, zinc in infantile tremor syndrome. Indian Pediatr. 1993;30(3):374-6.
Holla RG, Prasad AN. Infantile Tremor Syndrome. Med J Armed Forces India. 2010;66(2):186-7.