CLINICO-RADIOLOGICAL CORRELATION OF MRI BRAIN FINDINGS AT DIAGNOSIS AND AFTER SIX MONTHS OF TREATMENT IN INFANTILE TREMOR SYNDROME

Abstract

Background: Infantile tremor syndrome (ITS) continues to be reported from South-East Asian countries despite improvements in child nutrition programs, and its etiopathogenesis remains incompletely understood. Objectives: This study aimed to evaluate neuroimaging abnormalities on magnetic resonance imaging (MRI) of the brain and correlate them with clinical findings at diagnosis and after six months of treatment in children with ITS. A secondary objective was to generate hypotheses regarding the possible etiopathogenesis of the syndrome. Methods: This prospective cohort study was conducted over an 18-month period at a tertiary care hospital. Children aged six months to three years diagnosed with ITS, were enrolled. Clinical, hematological, and biochemical parameters of the children and their mothers were recorded at baseline using a predesigned proforma. Non-contrast MRI of the brain was performed after initial stabilization and repeated at six months during follow-up. Clinical, hematological, and biochemical assessments were also repeated at follow-up. Results: A total of 49 children were included in the final analysis. Males constituted 57.1% of cases, and a majority had a history of faulty feeding practices. At admission, both children and their mothers demonstrated macrocytic anemia with low serum vitamin B12 levels. After six months of treatment, the prevalence of anemia declined to 57.1%, and vitamin B12 deficiency reduced to 14.3%. At follow-up, abnormal clinical findings persisted in 14.3% of children, developmental delay in 18.4%, and abnormal MRI findings in 57.1%. Normal MRI scans increased from 8.2% at baseline to 42.9% after six months (p < 0.01). A significant correlation was observed between improvement in clinical features and improvement in MRI findings. Conclusion: The study demonstrates a significant association between clinical recovery and radiological improvement in children with ITS. Partial reversibility of neuroimaging abnormalities was observed over a six-month period following appropriate intervention, supporting the reversible nature of the disease when diagnosed and treated early.