Biology, asked by shanayakhan8355, 1 year ago

Iron deficiency anemia treatement and incidence of febrile seizures

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Answered by srikarani
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Iron deficiency anemia is one of the most prevalent

micronutrient deficiencies in young children in

India and other parts of the world, and it is strongly

associated with persistent cognitive and motor

delays even after the anemia and iron deficit have been

repaired. Madan, et al. [1] reported recently that children

aged 6-23 months with moderate to severe iron deficiency

anemia had lower mental and psychomotor scores that

persisted to as long as 19 years of age. These children also

had lower scholastic achievement and needed more

special education assistance than iron sufficient children.

These impairments may be related to several effects of

iron deficiency in the developing brain including altered

development of neurons in the hippocampus that encodes

memories, impaired energy metabolism, delayed

maturation of myelin, and slowed visual and auditory

evoked potentials [2]. Iron deficiency has also been

associated with alterations in synaptic neurotransmitter

systems including norepinephrine, dopamine, serotonin,

glutamate and gamma-aminobutyric acid (GABA). In

addition, a paper by Kumari, et al. [3] in this issue of

Indian Pediatrics provides evidence that iron deficiency is

also a risk factor for febrile seizures in children 6 months

to three years of age. This carefully done case-control

study with a large sample size showed a highly significant

association between iron deficiency and febrile seizures.

As expected, a family history of febrile seizures or

epilepsy in first degree relatives was also linked to the

occurrence of febrile seizures in these children. The

findings are consistent with another recent case-control

study from Kenya of children 3-156 months of age, which

reported that iron deficiency is a risk factor for simple

febrile seizures but not for other types of acute seizures

[4]. An important practical lesson from this study is that

preventing iron deficiency may be an effective way to

reduce the incidence of febrile seizures.

These new data are also important because they

suggest that there may be a mechanistic link between

febrile seizures associated with iron deficiency and two

other disorders that cause enhanced brain excitability:

restless leg syndrome (RLS) and attention deficit

hyperactivity disorder (ADHD). RLS occurs in children

and adults and is characterized by an urge to move the legs,

usually associated with an unpleasant sensation while

lying down for sleep at night [5]. Family studies and

genome wide association studies suggest a genetic

contribution to RLS, but it is also strongly associated with

reduced serum ferritin levels, and magnetic resonance

imaging (MRI) has shown reduced iron stores in brain in

many patients. Altered metabolism of dopamine also

appears to play a role in enhanced neuronal excitability in

spinal motor and sensory nerves in RLS, and it usually

responds well to dopaminergic agonists along with

replenishment of iron. Iron deficiency has also been

implicated in the pathogenesis of ADHD. Juneja, et al. [6]

reported that there was a significant negative correlation

between serum ferritin levels and the Connors Rating

Scale for ADHD. Low iron levels have also been measured

in the thalamus of children with ADHD using MRI, and the

serum ferritin level has been shown to predict the optimal

dose of amphetamine needed to treat ADHD. Gilbert, et al.

[7] recently reported that children with ADHD have

impaired cortical inhibition in response to transcranial

magnetic stimulation that correlates with the severity of

ADHD. These three disorders, febrile seizures, RLS and

ADHD, may reflect different facets of altered brain

excitability that is enhanced by iron deficiency and also

influenced by genetic factors. Iron is clearly important for

brain development as well as for prevention of anemia, and

more study is warranted to understand its role in these

common neurodevelopmental disorders.

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