Infantile tremor syndrome: A review and critical appraisal of its etiology

Abstract

Infantile tremor syndrome (ITS) is defined by the tetrad of pallor, developmental delay/regression, skin pigmentation, and brown scanty scalp hair. Involuntary movements in the form of tremors supervene in the natural course of the illness in a significant number of cases. The disorder occurs in exclusively breast-fed infants of vegetarian mothers belonging to economically deprived sections of society. Most of the children eventually recover but are frequently left with long-term cognitive and language neurodeficits. ITS continues to be seen in clinical practice, but there has been no consensus on its causation. Last comprehensive review was published in 1987 describing the ITS as a syndrome of unknown or multiple etiologies. Several important papers have been published since then. This review attempts to provide comprehensive and up-to-date information on the subject incorporating recently published studies. In the end, the issue of etiology is objectively re-examined in the light of available evidence some of which has been published in recent years.

<p>Infantile tremor syndrome: current perspectives</p>

“…Nutritional management has been implemented as per standard guidelines for management of severe acute malnutrition 2,11. Iron, calcium, magnesium,Vitamin B12 alongwith multivitamins have been supplemented 2,37. Tremors have been observed to diminish considerably after administration of propranolol2 although phenobarbitone,2 phenytoin2 and carbamazepine38 have also been tried occasionally.…”

Infantile tremor syndrome

“…6 It has been observed in earlier studies the presence of LRTI, exact reason for this high incidence of LRTI is not known but may be due to presence of less antioxidants due to deficiency of Vitamin C. 7 Infantile tremor syndrome cases always present with various vitamins deficiency and varying degree of anemia. 8 It is most commonly found in children belonging to poor socioeconomic status and who are on exclusive breast feeding of vegetarian mother. Low Vitamin B12 levels in the mother may also be low in the breast milk.…”

Movement Disorders and Hematologic Diseases

“…Most of the literature describing infantile tremor syndrome (ITS) comes from the Indian subcontinent where it accounts for 0.2%–2% of pediatric hospital admissions, though cases have been described worldwide 6 . ITS affects pediatric patients between 2 to 24 months of age and is more common in boys and families with low socioeconomic status 7,8 …”

“…Leukocytosis may be related to concurrent infection. Nutritional deficiencies and hepatosplenomegaly have also been reported 6–8 . Though this condition is self‐limiting, some patients may have long‐term mild cognitive sequelae 9…”

“…Undernutrition may have a role and deficiencies in vitamin B12, magnesium, calcium and zinc have been reported, though findings are inconsistent. The role of infectious, toxic, and metabolic factors has also been speculated 6 . Treatment includes nutritional supplementation and supportive measures.…”