vitamin-b-12 and Tremor

Tremor occurs frequently as a side-effect of lithium, and it is, however, easily overlooked in the clinical setting. In this article, we attempt to review the pathophysiology and the clinical approach of lithium tremor.. We searched the Pubmed and Cochrane Library for relevant articles up to the year 2012. Sixty-four articles including 10 review papers, 3 clinical trials, and 12 case reports were reviewed.. Lithium tremor is classified as a postural tremor and subcategorized as an exaggerated physiologic tremor. Differential diagnosis includes metabolic abnormalities, benign essential tremor, Parkinson's disease, and lithium toxicity. Various methods of evaluating lithium tremor and treatment options are discussed.. When lithium tremor has developed, thorough history taking, physical examination, and blood examination including serum lithium level are needed. Pharmacotherapy is indicated only in patients with disabling tremor.

Topics: Adrenergic beta-Antagonists; Anticonvulsants; Antimanic Agents; Humans; Linoleic Acid; Lithium Compounds; Tremor; Vitamin B 12

To compare the mean Likert (caregiver impression of change) and CAPUTE scores in children with ITS treated with daily injectable vitamin B12 alone versus injectable vitamin B12 with other multinutrients at 1 wk and 1 mo of therapy.. This was an open-label, active-controlled, assessor-blinded, noninferiority, randomized clinical trial. The participants included children aged 3 mo to 2 y with infantile tremor syndrome. Children were randomized to receive either 1 mg of daily injectable vitamin B12 or 1 mg of daily injectable vitamin B12 with other multinutrients (B12 + MV). Primary outcome measure was the mean Likert score in the two arms at 1 wk. Secondary outcome measures were mean change in CAPUTE scores at 1 wk of therapy; and mean change in CAPUTE and Vineland Social Maturity Scale (VSMS) scores after 1 mo of treatment.. Seventy-two (N = 72) of the 160 screened were enrolled and randomized. The mean (SD) Likert score in the B12 group (n = 38) was 16.1 (3.7) and in the B12 + MV group (n = 34) was 14.9 (3.7); p = 0.237. Mean (SD) change in CAPUTE (CAT/CLAMS) at 1 mo in the groups was not statistically different. The mean (SD) change in social quotient in the B12 monotherapy group, 35.0 (20.7) was significantly higher than the B12 + multinutrient group 23.5 (15.4); p=0.01.. Injectable vitamin B12 monotherapy in ITS resulted in an improvement that was noninferior to combination multinutrient therapy, strongly supporting vitamin B12 deficiency as the cause of infantile tremor syndrome.. The trial was registered at CTRI.org (CTRI/2018/05/013841).

Topics: Combined Modality Therapy; Dietary Supplements; Humans; Syndrome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

To prospectively study the clinical and developmental profile; hematological profile and the B-12 status using multiple parameters in children with Infantile tremor syndrome (ITS).. In this observational study (NCT02762682) (July 2015 through December 2016) children (and their mothers) with a clinical diagnosis of ITS were evaluated clinically; and development was assessed by CAPUTE scales. A complete blood count (CBC); peripheral blood smear examination; markers of vitamin B12 status (serum B12, homocysteine, folate); acylcarnitines [using Tandem mass spectrometry (TMS)] and urine methylmalonic acid (MMA) [Gas chromatography mass spectrometry (GCMS)] were estimated. A control group of children and their mothers were sampled for comparison.. A total of 286 individuals were enrolled for this study. One-hundred-ten children with ITS were screened and 92 (20 with tremors; age 12.7 ± 5 mo, 61 boys) children and their mothers were enrolled. Fifty-one children and their mothers were enrolled as controls. The median clinical linguistic & auditory milestone-developmental quotient (CLAM-DQ) was 32 (IQR 20.6-45.5) and median cognitive adaptive test-developmental quotient (CAT-DQ) was 36.2 (IQR 18.7-49.0). All babies except 9 (ovo-veg) had vegetarian mothers. Head circumference below 2 SD (WHO standards) was seen in 84% and below 3 SD in 58%. The CBC findings were; Hb- 8.3 ± 1.6 g/dl, Thrombocytopenia-29 (32%), mean corpuscular volume (MCV)- 92.2 ± 13.4, MCV- more than 95 fL-38(42%), Red cell distribution width (RDW)- 21.6 ± 6.5, and macrocytes on peripheral smear in 68%. In 89 (97%) out of 92 children had laboratory features of deficient B12 status. Two-thirds of the mothers also had evidence of B12 deficiency.. ITS is, in all likelihood is a consequence of vitamin B12 defeciency. It has a significant impact on head growth and development of affected infants.

Topics: Adolescent; Adult; Biomarkers; Child; Child, Preschool; Erythrocyte Indices; Female; Folic Acid; Homocysteine; Humans; India; Male; Malnutrition; Methylmalonic Acid; Mothers; Prospective Studies; Tremor; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

In Norway, 5-10% of neonates and infants have biomarkers suggesting vitamin B12 deficiency from newborn screening tests and unselected clinical screening, respectively.. The aims were to identify risk factors and describe presenting symptoms and biochemical profiles in infants diagnosed with vitamin B12 deficiency.. In this case-control study, we searched hospital medical records for infants younger than one year born in 2011-2018, diagnosed with vitamin B12 deficiency. We compared 85 cases with a control group of 252 infants aged 3-7 months. Parents completed questionnaires.. Of the 85 cases with vitamin B12 deficiency, 80% presented with spells (37%) of apneas, motor seizures, or absences within the first two months of life. Tremor (29%) and irritability (18%) were the most common findings at the first examination. Serum total homocysteine ≥10 μmol/L was found in 77% of cases compared to 28% of controls (P < 0.001). None of the mothers were vegetarians, but 25% reported a previous history of vitamin B12 deficiency and 7% had celiac disease. The dose of nitrous oxide given during labor was significantly associated with infant serum total homocysteine level at diagnosis (r = 0.37, 95% confidence interval = 0.16-0.55, P < 0.001) for cases, but not for controls.. Spells, tremor, and irritability are common findings in early infant vitamin B12 deficiency. Nitrous oxide given during labor is proposed as a contributing risk factor to the development of early infant vitamin B12 deficiency.

Topics: Breast Feeding; Case-Control Studies; Child; Female; Homocysteine; Humans; Infant; Infant, Newborn; Nitrous Oxide; Seizures; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

The neurocutaneous syndrome of infantile B12 deficiency, more commonly called the infantile tremor syndrome, typically is characterized by developmental delay, sparse hair, hyperpigmentation, and tremors. When treated with injectable B12, the affected babies can develop a peculiar transient "batwing dystonia." This dystonia is possibly a nutritional recovery movement disorder due to basal ganglia dysfunction.

Topics: Dystonia; Dystonic Disorders; Humans; Infant; Movement Disorders; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Abnormal movements such as tremors and myoclonus may be observed during both treatment and deficiency of vitamin B12, particularly in infants. Infantile tremor syndrome (ITS) is defined by the tetrad of pallor, developmental delay/regression, skin pigmentation, and brown scanty scalp hair.. In this report, two cases with ITS aged less than one year who had myoclonic movements during vitamin peroral B12 treatment are discussed based on hematologic, neurological, and magnetic resonance images (MRI) findings, one of whom developed a whole-body tremor and rhythmic myoclonic movements, titubation, and restlessness in the hands and feet as well as diffuse cerebral atrophy on brain MRI.. The infants of mothers with nutritional vitamin B12 deficiency may develop sudden abnormal movements following peroral vitamin B12 therapy and that the differential diagnosis of these disorders is highly important for the prevention of long-term neurological sequela by treatment.

Topics: Female; Humans; Infant; Mothers; Myoclonus; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Infantile Tremor Syndrome (ITS) is a disorder of infancy, and characterized by developmental delay and/or regression, pallor, skin hyperpigmentation and hypopigmented hair. It is commonly seen in infants in whom exclusive breastfeeding is given inappropriately for longer durations than recommended. ITS is predominantly reported from the Indian subcontinent and in children from a lower socioeconomic background. It is a clinical diagnosis and vitamin B12 deficiency is the most commonly accepted etiology of this entity.. The primary objectives of study were to compare the plasma and urine amino acid levels among children with ITS spectrum with those of healthy children. The secondary objectives were to compare the plasma and urine amino acid levels among children with ITS and Pre-ITS.. This cross-sectional, observational study was carried out at a tertiary care hospital in North India.. A total of 50 children aged < 36 months with ITS/Pre-ITS were enrolled. Children with Pre-ITS and ITS were compared with healthy age-matched study subjects.. Thirty-nine (78%) cases and twelve (24%) healthy children had low serum vitamin B12 levels. Folate levels were normal in all the controls, while only one case had folate deficiency. There were significant differences (p < 0.05) in the values of 32 amino acids in plasma. Among 44 urinary amino acids, levels of 30 amino acids were significantly different in the cases compared with the controls (p < 0.05).. Several changes in amino acids in the children suffering from ITS were observed. These changes may be a reflection of the metabolic derangements in ITS.

Topics: Amino Acids; Child; Cross-Sectional Studies; Female; Folic Acid; Humans; Infant; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

The primary objective of the study was to compare the trace element status in children with infantile tremor syndrome (ITS) with healthy controls. Blood counts, serum vitamin B12, plasma homocysteine, plasma ferritin and trace elements - magnesium, zinc and selenium were compared. Twenty-six children (11 with tremors, 14 boys, mean age 11.5 ± 3.5 mo) and 19 controls were enrolled for this study. Low vitamin B12 levels (67% vs. 5%) and elevated plasma homocysteine 96% vs. 26%) was significantly more (P < 0.001) in cases. Eight controls had hypoferritinemia, while none with ITS had it (p < 0.001). None of the children in either group had low serum levels of zinc or magnesium. Low levels of selenium were seen in six cases and five controls. This study did not show any association between the studied nutrients/ trace elements and ITS while, it showed a strong association of ITS with vitamin B12 deficiency supporting that it is a Neurocutaneous Infantile B-12 deficiency (NIB) syndrome.

Topics: Adolescent; Child; Cross-Sectional Studies; Female; Ferritins; Homocysteine; Humans; India; Magnesium; Male; Mass Spectrometry; Plasma; Selenium; Trace Elements; Tremor; Vitamin B 12; Vitamin B 12 Deficiency; Zinc

Severe hyperhomocysteinemia (>100 µmol/L) is often associated with inborn errors of homocysteine metabolism. It manifests typically in neonatal period with developmental delay, hypotonia, feeding problems or failure to thrive. Adult-onset forms are rare and include less severe manifestations. Early diagnosis is crucial because effective treatment is available. A 23-year-old man presented with a 3-week history of speech and gait impairment, and numbness in lower limbs. Neurological examination revealed dysarthria, decreased vibratory sensation in both legs and appendicular and gait ataxia. Brain MRI revealed T2-hyperintense symmetric white matter lesions and cortical atrophy. He had folate and vitamin B

Topics: Age of Onset; Betaine; Dysarthria; Folic Acid; Gait Ataxia; Homocystinuria; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Muscle Spasticity; Psychotic Disorders; Tremor; Vitamin B 12; Young Adult

Infantile tremor syndrome (ITS) is a nutritional deficiency syndrome, frequently reported from the Indian subcontinent caused by vitamin B12 deficiency. The West syndrome (WS), on the other hand, is a type of epileptic encephalopathy with variable etiology.. We present a series of five children who presented with symptoms consistent with ITS and received standard intramuscular vitamin B12 therapy to which good response was observed. All these children were readmitted with WS with a time lag varying from 2 to 12 months. Magnetic resonance imaging brain and metabolic screen were within normal limits. Three out of five patients responded well to adrenocorticotropic hormone (ACTH), remaining two required additional drugs. We hypothesize that WS could have developed after ITS due to developmental desynchronization.. In the Indian scenario, it is particularly important to be aware of appearance of WS after ITS, because of high prevalence of ITS and devastating nature of WS.

Topics: Adrenocorticotropic Hormone; Brain; Child; Humans; Infant; Injections, Intramuscular; Magnetic Resonance Imaging; Spasms, Infantile; Syndrome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Infantile tremor syndrome (ITS) owing to vitamin B

Topics: Humans; Infant; Male; Respiratory Insufficiency; Respiratory Paralysis; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Administration, Oral; Humans; Infant; Injections, Intramuscular; Male; Syndrome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Humans; Infant; Male; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Megaloblastic; Blood Transfusion; Child; Humans; Transfusion Reaction; Tremor; Vitamin B 12

Retrospective chart review of 15 patients with infantile tremor syndrome in which mothers had their serum vitamin B12 measured, showed low (<200 pg/mL) serum vitamin B12 in 9 and low-normal (<200-350 pg/mL) in 6. Of the 9 mothers who had undergone complete blood counts, anemia was present in 6 and macrocytosis in 3. Vitamin B12 deficiency appears to be common in mothers of infants with infantile tremor syndrome.

Topics: Female; Humans; Infant; Mothers; Retrospective Studies; Syndrome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Retrospective chart review of 21 infants with infantile tremor syndrome for vitamin B12 deficiency showed low serum vitamin B12 levels in 8/16 (50%). Of the eight infants with normal levels, six had received vitamin B12 before referral. Macrocytosis and low maternal serum B12 was found in 12 and seven cases each. Treatment with vitamin B12 alone produced rapid recovery.

Topics: Breast Feeding; Child, Preschool; Developmental Disabilities; Female; Humans; Hyperpigmentation; India; Infant; Male; Mothers; Retrospective Studies; Syndrome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

The aetiology spectrum for neuroregression in infants and toddlers is diverse. Vitamin B12 deficiency-mediated neuroregression is less commonly considered as a differential. Prevalence of pernicious anaemia in the general population is 0.1% and is extremely rare in children. We describe a 35-month-old toddler with neuroregression, seizures, coarse tremors, bleating cry and neuropathy. His clinical symptomatology mimicked grey matter degenerative illness and infantile tremor syndrome, a nutritional deficiency-mediated movement disorder. His vitamin B12 level was low and serum homocysteine level was elevated. Haematological manifestations were not overt and anti-intrinsic factor antibody was positive. With parenteral vitamin B12 therapy, there was a dramatic response with clinical and laboratory translation. This report emphasises the need for a high index of suspicion and screening for markers of vitamin B12 deficiency in all children with unexplained acute or subacute neuroregression, seizures and movement disorders as it is potentially reversible.

Topics: Anemia, Pernicious; Child, Preschool; Developmental Disabilities; Drug Therapy, Combination; Dyskinesias; Humans; Male; Seizures; Tremor; Vitamin B 12; Vitamin B Complex

Topics: Humans; Infant; Male; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Syndrome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Involuntary movements can appear before and after initiation of vitamin B12 treatment. The pathogenesis of involuntary movements in vitamin B12 deficiency and their relationship with cobalamin injection remain unclear due to a lack of video-EEG documentation making the electroclinical correlation difficult to ascertain. Here, we report video-EEG and neuroimaging findings of an 11-month-old girl with vitamin B12 deficiency, who acutely developed involuntary movements a few days after initiation of vitamin B12 treatment with normal vitamin plasmatic levels. Abnormal movements were a combination of tremor and myoclonus involving the face, mouth, and left arm, which disappeared after discontinuation of therapy. [Published with video sequences].

Topics: Atrophy; Brain; Dyskinesias; Electroencephalography; Female; Humans; Infant; Magnetic Resonance Imaging; Myelin Sheath; Myoclonus; Tremor; Video Recording; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

In developing countries, a deficiency of cobalamine and folate contributes significantly to megaloblastic anaemia. Neurological observations in infants and young children with megaloblastic anaemia have included hypotonia, developmental regression, tremors and other abnormal movements. Following therapy with vitamin B12, coarse tremors occurred in six of 51 patients (12%) with megaloblastic anaemia. The tremors, which were noticed initially in the hands and feet, gradually became generalised and disappeared during sleep. They subsided within 5-11 days. Thirteen of 25 (52%) patients developed thrombocytosis between day 3 and week 5 of follow-up. In one child, the platelet count increased to >1300 x 10(9)/L. The importance of recognising these clinical findings during treatment of megaloblastic anaemia is emphasised.

Topics: Anemia, Megaloblastic; Child; Child, Preschool; Developing Countries; Folic Acid; Folic Acid Deficiency; Humans; India; Infant; Platelet Count; Thrombocytosis; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

The authors describe a 16-month-old infant presenting with neurologic developmental regression, severe pancytopenia, excessive skin pigmentation, and tremor resulting from nutritional vitamin B12 deficiency. She had been exclusively breast-fed and had refused to take any other food. Laboratory studies showed severe pancytopenia, a decrease in serum B12 levels, and an increase in urinary methylmalonic acid levels. Bone marrow aspiration was compatible with megaloblastic changes. Schilling test was normal. The serum B12 level of the mother was also low. Megaloblastic anemia resulting from inadequate B12 intake was diagnosed. Parenteral B12 therapy was initiated. The neurologic picture did not completely resolve, but pancytopenia, tremor, and hyperpigmentation of the extremities recovered completely.

Topics: Anemia, Megaloblastic; Female; Humans; Hyperpigmentation; Infant; Pancytopenia; Treatment Outcome; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Macrocytic; Anti-Bacterial Agents; Breast Feeding; Developmental Disabilities; Diet, Vegetarian; Female; Humans; Infant; Male; Mother-Child Relations; Pneumonia; Syndrome; Treatment Outcome; Tremor; Vitamin B 12

Topics: Anemia, Megaloblastic; Bone Marrow; Deoxyuridine; Developmental Disabilities; Erythrocytes; Female; Folic Acid; Humans; Infant; Iron; Male; Syndrome; Transcobalamins; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Child; Child, Preschool; Female; Hair; Humans; Infant; Infant, Newborn; Intellectual Disability; Male; Pigmentation Disorders; Tremor; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Brain Chemistry; Cysteamine; Dimercaprol; Liver; Rats; Seizures; Sulfhydryl Compounds; Tremor; Vitamin B 12

Topics: Anemia; Diagnosis; Humans; India; Infant; Intellectual Disability; Pigmentation Disorders; Syndrome; Tremor; Vitamin B 12