West syndrome due to vitamin B12 deficiency

Abstract

Vitamin B 12 is one of the essential vitamins affecting various systems of the body. Vitamin B 12 deficiency in infants often produces haematological and neurological deficits including macrocyticanaemia, neurodevelopmental delay or regression, irritability, weakness, hypotonia, ataxia, apathy, tremor andseizures. In this article, we report the case of a six-month-old male patient diagnosed with West syndrome associated with vitamin B 12 deficiency. Although the patient had no evidence of macrocytic anemia in complete blood count, we measured the level of vitamin B 12 because the patient had hypotonicity and found it to be low. No other problem was found in the other investigations directed to the etiology of West syndrome. He was being exclusively breast-fed and vitamin B 12 deficiency was related with nutritional inadequacy of his mother. Vitamin B 12 deficiency should be considered in the differential diagnosis of patients presenting with different neurological findings. In addition, vitamin B 12 deficiency should be considered as a rare cause in West syndrome which has a heterogeneous etiology. (Turk Pediatri Ars 2015; 50: 251-3)

Vitamin B12 Deficiency Observed in Children With First Afebrile Seizures

“…This phenomenon may be explained by an increased sensitivity of brain neurons covered with damaged myelin to the stimulating effects of glutamate. Seizures can be of different semiology from GTC seizure to IS [ 1 , 3 , 4 ]. Roschitz et al described GTC seizures associated with VB12 deficiency.…”

“…A small number of cases with West syndrome secondary to VB12 deficiency have been reported in the literature [ 3 , 14 ]. Serin et al presented a six-month-old boy with IS, drowsiness and psychomotor regression diagnosed with West syndrome who improved significantly after VB12 treatment, and his EEG was found to be normal after three months [ 3 ]. Our non-contiguous patients were an eight-month-old girl and a six-month-old boy.…”

“…In infants, VB12 deficiency may be characterized by signs of developmental delay, such as irritability, apathy, ataxia, anorexia, and mental retardation. More rarely, it can cause seizures, including infantile spasm (IS) [ 3 - 5 ]. Seizures even may appear as the first sign of VB12 deficiency [ 1 , 4 ].…”

West Syndrome in an Infant With Vitamin B12 Deficiency Born to Autoantibodies Positive Mother

“…Epilepsy is a rare clinical manifestation of infantile vitamin B12 deficiency (9), although few reports have described its causal association with infantile spasms including West syndrome (11)(12)(13)(14). In general, West syndrome prognosis is unfavorable due to frequent neurological comorbidity; however, all five infants with vitamin B12 deficiency-associated West syndrome showed good prognosis with good seizure outcome, and none showed neurodevelopment delay at the last follow-up (11)(12)(13)(14). All children were exclusively breast-fed, and all, except one child, were due to maternal vegetarian diet.…”

Compromiso neurológico grave por déficit de vitamina B12 en lactantes hijos de madres veganas y vegetarianas

“…En los niños con deficiencia congénita, el daño del sistema nervioso central (SNC) se caracteriza por la pérdida de sustancia blanca con mielinización retardada. [2][3][4][5] La deficiencia de B12 puede deberse a la ingesta insuficiente o ser secundaria a otras enfermedades; se Pediatría práctica absorbe, principalmente, en íleon distal, por lo que es indispensable el factor intrínseco, secretado por el estómago. Los niños con resección gástrica, ileal o patología grave del intestino delgado pueden tener deficiencia por malabsorción, igual que aquellos con deficiencia de factor intrínseco de Castle o anemia perniciosa.…”