Infantile Tremor Syndrome: A Case Series

Abstract

Infantile tremor syndrome (ITS) is a rare clinical disorder characterized by coarse tremors, anemia, and regression/delay of development in children around 6 months to 1 year of age belonging to poor socioeconomic strata and on milk-based diet. It accounts for 0.2 to 2% cases in India. No conclusive etiology has been ascertained so far. Nutritional deficiency (like vitamin B12, magnesium, vitamin C, zinc) is the most accepted association. We report six such cases that presented to our hospital with the classical neurological, dermatological, and hematological findings of ITS. Investigations revealed all cases to be vitamin B12 deficient. Two of our cases had corticocerebral atrophy on neuroimaging. One case expired due to respiratory failure due to severe pneumonia. Others were treated with vitamin B12 injections. Other nutrients like iron, zinc, folic acid, and magnesium were also supplemented. Routine follow-up of these cases showed gradual improvement in clinical, hematological, and neurological parameters. Although rare, ITS should be considered in any infant presenting with anemia, malnutrition, developmental delay, hyperpigmentation, and tremors. Early treatment can prevent neurological sequelae as it is largely a preventable disease. Regular follow-up is helpful to evaluate response to treatment.

Keywords

tremors - vitamin B12 deficiency - ITS

Publikationsverlauf

Eingereicht: 04. April 2023

Angenommen: 28. April 2023

Artikel online veröffentlicht:
26. Mai 2023

• References

• 1 Gupta R, Rawat AK, Singh P, Gupta J, Pathak A. Infantile tremor syndrome: current perspectives. Res Rep Trop Med 2019; 10: 103-108
• 2 Maurya M, Maurya AK, Mishra N, Singh MV, Shukla S. Infantile tremor syndrome in children and maternal vitamin B12 Deficiency: a time for primary prophylaxis. Asian J Pharm Clin Res 2022; 15 (06) 22-25
• 3 Deshpande TV, Ingle VN. Tremor syndrome in children. Indian Pediatr 1969; 6 (08) 550-556
• 4 Jadhav M, Webb JKG, Vaishnava S, Baker SJ. Vitamin B12 deficiency in Indian infants. A clinical syndrome. Lancet 1962; 2 (7262): 903-907
• 5 Goraya JS. Acute movement disorders in children: experience from a developing country. J Child Neurol 2015; 30 (04) 406-411
• 6 Ramakumar L, Pandove SP. Infantile tremor syndrome. Indian J Pediatr 1975; 42 (331) 215-225
• 7 Gowda VK, Kolli V, Benakappa A, Srinivasan VM, Shivappa SK, Benakappa N. Case series of infantile tremor syndrome in tertiary care paediatric centre from southern India. J Trop Pediatr 2018; 64 (04) 284-288
• 8 Ratageri VH, Shepur TA, Patil MM, Hakeem MA. Scurvy in infantile tremor syndrome. Indian J Pediatr 2005; 72 (10) 883-884
• 9 Ghai OP, Paul VK, Bagga A. . Central nervous system. In: Kalra V, ed. Textbook of Essential Pediatrics. 8th ed. New Delhi: CBS Publishers; 2013:580–581
• 10 Mathur GP, Dayal RS, Prasad R, Mathur S. Tremors, mental and physical retardation, light coloured hairs and anaemia in malnourished children. Indian Pediatr 1969; 6 (07) 483-487
• 11 Goraya JS, Kaur S. Infantile tremor syndrome: a review and critical appraisal of its etiology. J Pediatr Neurosci 2016; 11 (04) 298-304
• 12 Gupta R, Pathak A, Mandliya J, Mandliya P, Sonker P. Reversible cerebral atrophy in infantile tremor syndrome. Indian Pediatr 2016; 53 (08) 727-729
• 13 Thora S, Mehta N. Cranial neuroimaging in infantile tremor syndrome (ITS). Indian Pediatr 2007; 44 (03) 218-220
• 14 Cyr A, Frehlick R, Stammers D, Crone M. Case Report: propranolol therapy for infantile tremor syndrome in a child with vitamin B12 deficiency. Front Pediatr 2021; 9 (09) 774747
• 15 Kaul KK, Belapurkar KM, Parekh P. The syndrome of tremors in infants: a long follow-up. Indian J Med Res 1972; 60 (07) 1067-1072