101
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Han JY, Han SB. Seizures Related to Influenza in Pediatric Patients: A Comparison with Seizures Associated with Other Respiratory Viral Infections. J Clin Med 2021; 10:jcm10143088. [PMID: 34300253 PMCID: PMC8303985 DOI: 10.3390/jcm10143088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 01/27/2023] Open
Abstract
Although febrile seizures are the most common neurological complications of influenza, there are few studies comparing seizure characteristics and outcomes between patients with influenza and those with other respiratory virus (RV) infections. Medical records of pediatric patients presenting with seizures accompanied by fever, in whom RV infections were identified, were retrospectively reviewed to compare the characteristics and outcomes of seizures with fever due to influenza (n = 97) to those due to other RV infections (n = 113). Patients with influenza were older than those with other RV infections (p < 0.001), and 22.7% of them were aged ≥5 years. Seizure characteristics of complex febrile seizures were observed more frequently in patients with other RV infections than in those with influenza; however, the frequency of epilepsy was comparable between the two groups. For patients with influenza, children aged <5 years and those aged ≥5 years showed similar seizure characteristics and outcomes. Further neurological evaluations should not be based solely on patient age in children with influenza who experience late-onset seizures at ≥5 years of age. Long-term sequelae should be further investigated in these patients.
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Affiliation(s)
- Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-42-220-9218
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102
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Hypocalcemia as a Cause of Complex Febrile Seizures in a Toddler. Case Rep Pediatr 2021; 2021:1798741. [PMID: 34336337 PMCID: PMC8294952 DOI: 10.1155/2021/1798741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
A 13-month-old boy had suffered three episodes of complex febrile seizures. At this admission, there were signs of hyperexcitability, such as Trousseau sign and QTc prolongation. A point of care blood gas analysis revealed severe hypocalcemia. Therefore, prior to administering intravenous calcium gluconate, we took blood samples to investigate the etiology of this hypocalcemia: magnesium, parathormone, and 25-hydroxyvitamin D. Since both parathormone and phosphate were significantly elevated and 25-hydroxyvitamin D was within the normal range, pseudohypoparathyroidism was diagnosed. After two years of follow-up, serum calcium had normalized in our patient under supplementation of vitamin D and calcium. He had been free of convulsions, although different febrile episodes had occurred.
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103
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Kannikeswaran N, Sivaswamy L, Farooqi A, Sethuraman U. Children With Complex Febrile Seizures: Is Hospital Admission Necessary? Clin Pediatr (Phila) 2021; 60:363-369. [PMID: 34014115 DOI: 10.1177/00099228211017702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with complex febrile seizure (CFS) are often hospitalized for concerns for serious bacterial infection (SBI) or seizure recurrence. We describe the yield of diagnostic studies and seizure recurrence during hospitalization in CFS children. We performed a retrospective review of 372 visits in 350 developmentally normal children aged 6 to 60 months between 2011 and 2016 for CFS. Majority of patients were male (200; 57.1%), with a mean age of 19.8 ± 11.3 months. Active seizures were noted in 42 (11.3%), status epilepticus in 35 (9.4%) while 97 (26.1%) had a seizure in the pediatric emergency department. The distribution of SBI was as follows: bacteremia (3; 1.1%), urinary tract infection (7; 3.7%), pneumonia (15; 6.8%), and bacterial meningitis (0; 0%). Electroencephalography (EEG) abnormality was rare (7/158; 4.4%). Seizure recurrence during hospitalization was uncommon (19; 5.1%). Logistic regression analysis did not reveal any predictors for seizure recurrence. The seizure recurrence rate during hospitalization, EEG yield, and SBI incidence was low in children with CFS.
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Affiliation(s)
- Nirupama Kannikeswaran
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Usha Sethuraman
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
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104
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Pokhrel RP, Bhurtel R, Malla KK, Shah LK. Study of Febrile Seizure among Hospitalized Children of a Tertiary Centre of Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:526-530. [PMID: 34508412 PMCID: PMC8369564 DOI: 10.31729/jnma.6092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/28/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. METHODS This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. RESULTS Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. CONCLUSIONS Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.
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Affiliation(s)
- Ram Prasad Pokhrel
- Department of Paediatrics, College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Radha Bhurtel
- Department of Nursing, College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan, Nepal
| | | | - Love Kumar Shah
- Department of Pediatrics, Janaki Medical College, Janakpur, Nepal
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105
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Riviello JJ, Erklauer J. Evidence-Based Protocols in Child Neurology. Neurol Clin 2021; 39:883-895. [PMID: 34215392 DOI: 10.1016/j.ncl.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medical care has become more complex as the scientific method has expanded medical knowledge. Medicine is also now practiced across different medical systems of varying complexity, and creating standard treatment guidelines is one way of establishing uniform treatment across these systems. The creation of guidelines ensures the delivery of quality medical care and improved patient outcomes. Evidence-based medicine is the application of scientific research to produce these treatment guidelines. This article shall focus on the current treatment guidelines used for inpatient pediatric neurology.
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Affiliation(s)
- James J Riviello
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
| | - Jennifer Erklauer
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA; Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA
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106
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Kurniawan A, Lainama MS, Diarsvitri W. Mean Platelet Ratio, Neutrophil to Lymphocyte Ratio, and the Risk of Febrile Seizures in Children Aged 6–59 Months. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND: The occurrence of febrile seizure is affected by numerous factors, but some studies indicated that inflammatory cytokines might contribute to the development of febrile seizure. In resource limited settings, complete blood count (CBC) might serve as potential indices for inflammatory response.
AIM: The aim of the present study was to determine the role of mean platelet ratio and neutrophil to lymphocyte ratio (NLR) on the risk of febrile seizures in children aged 6–24 months and 25–59 months at S.K. Lerik Regional Public Hospital in Kupang City, East Nusa Tenggara, Indonesia.
METHODS: A case-control study was carried out in 104 patients (52 in the case group and 52 in the control group) aged 6–59 months. The CBC tests were taken on the first visit in the emergency room at S.K. Lerik Regional Public Hospital.
RESULTS: Our study found that the odds for experiencing febrile seizure in younger children aged 6–24 months were 3.281 (95% confidence interval 1.470, 7.324) times as large as the odds for older children aged 25–59 months. There was a significant but weak correlation between the types of febrile seizure or fever and age of children (r = 0.279; p = 0.012).
CONCLUSIONS: Children aged 6–24 months had higher risk of developing febrile seizure, compared to children aged 25–59 months. Further, for each unit decrease in NLR, we expected a 0.883 decrease in the odds for febrile seizures in the case group, compared to control group.
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107
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Rivas-García A, Ferrero-García-Loygorri C, Carrascón González-Pinto L, Mora-Capín A, Lorente-Romero J, Vázquez-López P. Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:317-324. [DOI: 10.1016/j.nrleng.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/20/2019] [Indexed: 10/21/2022] Open
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108
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Trofimova A, Milla SS, Ryan ME, Pruthi S, Blount JP, Desai NK, Glenn OA, Islam MP, Kadom N, Mirsky DM, Myseros JS, Partap S, Radhakrishnan R, Rose E, Soares BP, Trout AT, Udayasankar UK, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Seizures-Child. J Am Coll Radiol 2021; 18:S199-S211. [PMID: 33958113 DOI: 10.1016/j.jacr.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
In children, seizures represent an extremely heterogeneous group of medical conditions ranging from benign cases, such as a simple febrile seizure, to life-threatening situations, such as status epilepticus. Underlying causes of seizures also represent a wide range of pathologies from idiopathic cases, usually genetic, to a variety of acute and chronic intracranial or systemic abnormalities. This document discusses appropriate utilization of neuroimaging tests in a child with seizures. The clinical scenarios in this document take into consideration different circumstances at the time of a child's presentation including the patient's age, precipitating event (if any), and clinical and electroencephalogram findings and include neonatal seizures, simple and complex febrile seizures, post-traumatic seizures, focal seizures, primary generalized seizures in a neurologically normal child, and generalized seizures in neurologically abnormal child. This practical approach aims to guide clinicians in clinical decision-making and to help identify efficient and appropriate imaging workup. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Sarah S Milla
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sumit Pruthi
- Panel Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | - Orit A Glenn
- University of California San Francisco, San Francisco, California
| | - Monica P Islam
- Nationwide Children's Hospital, Columbus, Ohio, American Academy of Neurology, Acting Director, Nationwide Children's Hospital Epilepsy Program, Director, Nationwide Children's Hospital Evoked Potential and Neurophysiologic Intraoperative Monitoring Program; Director, Nationwide Children's Hospital Tuberous Sclerosis Complex Clinic
| | - Nadja Kadom
- Emory University and Children's of Atlanta (Egleston), Atlanta, Georgia
| | | | - John S Myseros
- Children's National Hospital, Children's National Health System, Washington, District of Columbia, Neurosurgery expert, Vice Chief, Neurosurgery, Children's National Hospital
| | - Sonia Partap
- Stanford University, Stanford, California, American Academy of Pediatrics
| | | | - Emily Rose
- Keck School of Medicine of USC, Los Angeles, California, American College of Emergency Physicians
| | - Bruno P Soares
- University of Vermont Medical Center, Burlington, Vermont, Division Director, Neuroradiology, Vice Chair of Imaging Research, University of Vermont Medical Center
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Officer, Joint Review Committee on Educational Programs in Nuclear Medicine Technology
| | | | | | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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109
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Declines in the Number of Lumbar Punctures Performed at United States Children's Hospitals, 2009-2019. J Pediatr 2021; 231:87-93.e1. [PMID: 33080276 DOI: 10.1016/j.jpeds.2020.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate trends in lumbar puncture (LP) performance among US children's hospitals to assess how these trends may impact pediatric resident trainee exposure to LP. STUDY DESIGN We quantified LPs for emergency department (ED) and inpatient encounters at 29 US children's hospitals from 2009 to 2019. LP was defined by either a LP procedure code or cerebrospinal fluid culture billing code. Temporal trends and hospital variation in LP were assessed using logistic regression analysis. RESULTS A total of 215 030 LPs were performed during the study period (0.8% of all encounters). Twenty six thousand and five hundred twenty three and 16 696 LPs were performed in the 2009 and 2018 academic years, respectively (overall 37.1% reduction, per-year OR, 0.935; 95% CI, 0.922-0.948; P < .001), and the rate of LP decreased from 10.9 per 1000 hospital encounters to 6.0 per 1000 hospital encounters over the same period. CONCLUSIONS LP rates have declined across US children's hospitals over the past decade, potentially resulting in reduced clinical exposure for pediatric resident trainees. Improved procedural simulation during residency may augment the clinical experience.
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110
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Jain S, Santhosh A. Febrile Seizures: Evidence for Evolution of an Operational Strategy from an Armed Forces Referral Hospital. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:151-159. [PMID: 33790685 PMCID: PMC8007563 DOI: 10.2147/phmt.s294729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022]
Abstract
Purpose Current recommendations for 'Febrile seizures' management include emergency first aid and treatment along with intermittent prophylaxis. Evidence of practices, efficacy, side-effects, and complications should lead to refined and rational management strategies. Patients and Methods Study of cases referred and treated at a tertiary level hospital, providing referral services to a large state in India. Evidence sought for the research questions identified, these were (i) immediate treatment: First aid components and practices; response to drug treatment (ii) intermittent prophylaxis: effectiveness, compliance, and side-effects (iii) complications arising due to treatment side-effects: quantifying the number of cases of CNS infections missed as a result of alterations in consciousness levels due to benzodiazepines. Results A total of 85 febrile seizure cases were studied. Full correct "First Aid" was provided by only 13 parents. Total 35 cases (41.18%) had seizures lasting more than 05 minutes. Emergency treatment for these included rectal diazepam in 14 cases with 57.14% success in terminating seizure, and intranasal midazolam in 21 cases with 71.43% success. The cases with persisting seizures were managed as status epilepticus treatment algorithm. Intermittent prophylaxis prevented recurrence of seizures in 90%, however side-effects were reported in 36.36%. There was no case of CNS infection missed. Conclusion Safe and effective management strategy should include "Health education" for correct first aid and 'Protocols' for timely and correct emergency treatment by parents/pre-hospital teams/emergency duty doctors. Intermittent prophylaxis is effective but refinements needed to minimize side-effects. Vigilant clinical monitoring obviates the fear that treatment may mask CNS infection.
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Affiliation(s)
- Sunil Jain
- Department of Paediatrics, Command Hospital (Northern Command), Jammu & Kashmir, India
| | - Abhijith Santhosh
- Medical Officer, Emergency Department, Command Hospital (Northern Command), Jammu & Kashmir, India
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111
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Stelzle D, Storz C, Baxmann A, Liang LA, Burtscher C, Matuja W, Schmutzhard E, Winkler AS. Febrile seizures in an urban Tanzanian population: lessons learned from a community-based random cluster survey. Trop Med Int Health 2021; 26:492-502. [PMID: 33415795 DOI: 10.1111/tmi.13548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the cumulative incidence of febrile seizures, to evaluate the accuracy of our screening questionnaire and to describe clinical characteristics of children with febrile seizure in an urban population in Tanzania. METHODS A large random cluster sampled population was screened for a febrile seizure history as part of a larger epilepsy study using a standardised questionnaire in a two-stage door-to-door survey in Tanzania. A subset of screen positive participants was further examined for confirmation of diagnosis and evaluation of clinical characteristics. RESULTS Overall, 49 697 people were screened for a febrile seizure history of whom 184 (0.4%) screened positive. Women more commonly screened positive than men (112 [0.4%] vs. 72 [0.3%]). There was no marked difference between age groups or education. The positive predictive value of the screening tool was 37% (95% CI 24-51%) but its accuracy varied with the age of interviewed individuals. Cumulative incidence rates were estimated between 1.1% and 2.0% after adjusting for the inaccuracy of the screening tool. Most febrile seizures occurred before the age of two (65%) and most children had more than one episode (80%). A large proportion of children had complex febrile seizure (65%), often caused by malaria or respiratory infections. CONCLUSIONS The community-based cumulative incidence of a febrile seizure history in an urban Tanzanian population was similar to rates reported from other rural populations after adjusting for the inaccuracy of our screening tool. Based on the integrated nature of the febrile seizure questionnaire, screening positivity rates may have been too low. This has implications for the design of future studies. The majority of cases had complex febrile seizures often associated with malaria. This has implications for clinical case management.
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Affiliation(s)
- Dominik Stelzle
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany.,Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Corinna Storz
- Department of Neuroradiology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arlette Baxmann
- Department of Emergency Medicine, Hospital Bogenhausen, Munich, Germany
| | - Linda A Liang
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erich Schmutzhard
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, School of Medicine, Technical University of Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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112
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Alp EK, Elmacı AM. The Association between Serum Sodium Levels and Febrile Seizures Recurrence: Is the Degree of Hyponatremia a Risk Factor? JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1722851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractFebrile seizures are common disorders in childhood. We evaluated the serum electrolyte levels and the associated factors in children with single and recurrent febrile seizures in 24 hours period of hospitalization. The medical records of children who were clinically diagnosed with febrile seizures and hospitalized were retrospectively revealed and analyzed. Data were collected for children aged 1 to 6 years including demographic parameters and serum electrolyte levels. A total of 244 children were enrolled in the study in which 209 were diagnosed with single febrile seizures and 35 of them with recurrent febrile seizures. Serum sodium levels were significantly lower in children with recurrent febrile seizure (138.5 ± 2.38 and 134.2 ± 3.55, p < 0.001). Correlation analysis revealed that mild hyponatremia is associated with recurrence of febrile seizure within 24 hours. However, receiver-operating characteristics analysis for hyponatremia showed lower sensitivity (50.3%) and specificity (43.1%) values for optimal cutoff value of 133.5 mmol/L of serum sodium level. Our study suggested that serum sodium levels were significantly lower in children with recurrent febrile seizures. However, because of its lower sensitivity and specificity values, mild hyponatremia cannot be used as an indicator for febrile seizure recurrence.
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Affiliation(s)
- Esma Keleş Alp
- Department of Pediatrics, Dr. Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya, Turkey
- Department of Pediatric Nephrology, Dr. Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya, Turkey
| | - Ahmet Midhat Elmacı
- Department of Pediatrics, Dr. Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya, Turkey
- Department of Pediatric Nephrology, Dr. Ali Kemal Belviranlı Obstetrics and Children's Hospital, Konya, Turkey
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113
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Ganta A, Nelson A, Singer-Granick C, Khokhar A. Fever and Seizure in an 11-month old Girl. Pediatr Rev 2021; 42:96-99. [PMID: 33526576 DOI: 10.1542/pir.2020-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Avani Ganta
- Rutgers New Jersey Medical School, Newark, NJ
| | - Adin Nelson
- Rutgers New Jersey Medical School, Newark, NJ
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114
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Seizure Rescue Medications for Out-Of-Hospital Use in Children. J Pediatr 2021; 229:19-25. [PMID: 33228949 DOI: 10.1016/j.jpeds.2020.10.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022]
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115
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Shiraki A, Yasui M, Kidokoro H, Kido S, Ando H, Takahashi Y, Natsume J. Initial treatment of seizures in children in an emergency department in rural Japan. Brain Dev 2021; 43:288-293. [PMID: 32888737 DOI: 10.1016/j.braindev.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although the initial treatment of childhood seizures is important, treatment within an appropriate time window is often difficult in resource-limited areas. This study examined childhood seizure treatment in a rural area in Japan. METHODS We retrospectively investigated children presenting to Nakatsugawa Municipal General Hospital emergency department between 2015 and 2018. From the hospital database, we identified children who were diagnosed with seizures, epilepsy, or acute infectious encephalitis/encephalopathy or were given benzodiazepines. We considered etiology, seizure duration, and treatment according to the specialties of the doctors providing initial care. RESULTS We extracted 236 seizure events: 40 initially treated by pediatricians, 16 by a mobile doctor team, and 180 by other doctors. Twenty patients had continuous seizures for longer than 5 min on admission. Two were treated by pediatricians at presentation; it took 4 and 7 min after arrival to stop the seizures. Four were treated by a mobile team, and 14 by other doctors; the median response times were 11.5 (range 3-47) and 19 (range 5-60) min, respectively. All patients treated by pediatricians or mobile doctor teams received intravenous or intramuscular diazepam, whereas 50% of those treated by other doctors initially received diazepam suppositories. In three of the 20 events, establishing intravenous access was difficult. SIGNIFICANCE In rural Japan, many children with seizures are initially treated by doctors other than pediatricians or emergency physicians, and they require a longer time to achieve seizure cessation. Non-intravenous benzodiazepine formulas, which have not yet been approved in Japan, would be helpful.
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Affiliation(s)
- Anna Shiraki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Pediatrics, Nakatsugawa Municipal General Hospital, Gifu, Japan
| | - Masahiro Yasui
- Department of Pediatrics, Nakatsugawa Municipal General Hospital, Gifu, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Kido
- Department of Pediatrics, Nakatsugawa Municipal General Hospital, Gifu, Japan
| | - Hideo Ando
- Department of Pediatrics, Nakatsugawa Municipal General Hospital, Gifu, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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116
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de Suremain N, Lecarpentier T, Guedj R. Crises fébriles chez l’enfant : à propos d’une histoire familiale. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2020-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les crises fébriles (CF) sont les crises convulsives les plus fréquentes prises en charge dans les services d’urgence dans la population des moins de cinq ans. Elles sont une crise accompagnée de fièvre, sans infection du système nerveux central, se produisant chez les enfants entre six mois et cinq ans. Les critères utilisés et enseignés pour classer les crises en simples ou complexes n’ont pas la même signification en pratique clinique pour prendre la décision d’effectuer une ponction lombaire et/ou une imagerie cérébrale, et pour l’indication de la prescription d’un antiépileptique de recours ou de fond. Certains facteurs sont prédictifs de la récurrence fébrile, tandis que d’autres sont prédictifs d’une épilepsie. À partir de deux cas cliniques de CF complexes, nous proposons une démarche de prise en charge et de faire une revue des syndromes épileptiques survenant au décours des CF chez le jeune nourrisson.
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Yu MKL, Leung CPP, Wong WHS, Ho ACC, Chiu ATG, Zhi HH, Chan GCF, Chan SHS. Clinical Spectrum and Burden of Influenza-Associated Neurological Complications in Hospitalised Paediatric Patients. Front Pediatr 2021; 9:752816. [PMID: 35127584 PMCID: PMC8811455 DOI: 10.3389/fped.2021.752816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Influenza is one of the most common causes of acute respiratory tract infections around the world. Influenza viruses can cause seasonal epidemics. There remains limited information on the impact of both seasonal influenza A and influenza B related hospitalisations from neurological complications in paediatric populations in Asia. OBJECTIVES To examine both the clinical spectrum and healthcare burden of influenza-associated neurological complications (IANCs) within the paediatric population of Hong Kong. METHODS We conducted a population-based retrospective study to identify all paediatric patients (<18 years) admitted to a public hospital in Hong Kong with a confirmed influenza A or B infection between 2014 and 2018 using the Clinical Data Analysis and Reporting System of the Hospital Authority. The clinical spectrum of the paediatric patients with IANCs was studied. The clinical burden of paediatric influenza patients with IANCs were compared to paediatric influenza patients without neurological complications. RESULTS A total of 28,016 children admitted to the paediatric wards diagnosed to have influenza A or B infection were identified, accounting for 5.7% (28,016/489,955) of total paediatric admissions. 67.3% had influenza A and 32.7% had influenza B, and 8.9% had IANCs. The mean annual incidence of IANCs in children was 57 per 100,000 population. The spectrum of IANCs in our paediatric patients included febrile seizures (80.6%), myositis (11.4%), seizures with fever (5.4%), influenza-associated encephalitis/encephalopathy (IAE) (2.6%) and rarely Guillain-Barré syndrome (0.04%). Most paediatric patients with IANCs (85.5%) presented at a young age of <6 years. Paediatric patients with IANCs had significant longer hospital stays (p < 0.001), higher percentages of mechanical ventilation use (p < 0.05) and PICU admissions (p < 0.001), and higher mortality rates (p < 0.001) compared to those without neurological complications. Amongst those with IANCs, IAE was the sole cause of all seven reported mortalities. CONCLUSIONS Seasonal influenza A & B is a common cause of hospitalisation for paediatric patients in Hong Kong. We found neurological complications from influenza A and B caused a significantly higher clinical burden compared to those without neurological complications. Children in younger age groups (<6 years old) are at highest risk and thus increasing vaccination coverage to this age group is recommended.
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Affiliation(s)
- Michael Kwan Leung Yu
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Cherry Pui Pik Leung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wilfred Hing Sang Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Alvin Chi Chung Ho
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Annie Ting Gee Chiu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Helen Hui Zhi
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Godfrey Chi Fung Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sophelia Hoi Shan Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.,Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
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118
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Kurlemann G. Fieberkrämpfe. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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119
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Sawires R, Buttery J, Fahey M. A Review of Febrile Seizures: Recent Advances in Understanding of Febrile Seizure Pathophysiology and Commonly Implicated Viral Triggers. Front Pediatr 2021; 9:801321. [PMID: 35096712 PMCID: PMC8793886 DOI: 10.3389/fped.2021.801321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Febrile seizures are one of the commonest presentations in young children, with a 2-5% incidence in Western countries. Though they are generally benign, with rare long-term sequelae, there is much to be learned about their pathophysiology and risk factors. Febrile seizures are propagated by a variety of genetic and environmental factors, including viruses and vaccines. These factors must be taken into consideration by a clinician aiming to assess, diagnose and treat a child presenting with fevers and seizures, as well as to explain the sequelae of the febrile seizures to the concerned parents of the child. Our article provides an overview of this common childhood condition, outlining both the underlying mechanisms and the appropriate clinical approach to a child presenting with febrile seizures.
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Affiliation(s)
- Rana Sawires
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Jim Buttery
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Child Health Informatics, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Michael Fahey
- Department of Neurology, Monash Children's Hospital, Clayton, VIC, Australia.,Neurogenetics Department, Monash Paediatrics, Monash University, Clayton, VIC, Australia
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120
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Eldardear A, Alhejaili FAD, Alharbi AMD, Alrehaili FSS, Mohammed KTA, Binladin AKA, Aloufi MKS. Incidence of Meningitis in Patients Presenting With Febrile Seizures. Cureus 2020; 12:e11941. [PMID: 33312825 PMCID: PMC7723394 DOI: 10.7759/cureus.11941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Febrile seizures are very commonly encountered in the setting of the pediatric emergency department; it represents 72.2% of seizures presenting to the pediatric emergency department in Saudi Arabia and affects about 3-8% of children. Febrile seizures are usually benign and treated conservatively. This is in contrast to bacterial meningitis, which carries a fatality rate of 14.4%. Meningitis presents with seizures in 23% of cases. Differentiation between febrile seizures and meningitis is therefore of utmost importance to avoid poor outcomes. On the other hand, this may cause many patients with febrile seizures to get exposed to unnecessary invasive testing. This study aims to define the incidence of meningitis in patients with febrile seizures and the proportion of these patients who undergo invasive lumbar puncture. METHODS This retrospective cross-sectional study was conducted at the Maternity and Children's Hospital in Madinah, Saudi Arabia. All patients presenting with febrile seizures in the period between January 2015 and June 2019 were covered. Patients' data were gathered from the hospital database and files. Descriptive analysis was performed using SPSS. RESULTS A total of 1375 patients were studied, with a male-to-female ratio of 1.44:1. The median age of the sample was 24 months (interquartile range: 13 - 42). Lumbar puncture was done for 108 (7.67%) of them. Only nine patients (8.3%) had meningitis, while the other 99 (91.7 %) had no meningitis. CONCLUSION Febrile seizures are a common disease among children. The distinction between febrile seizures and meningitis is paramount to avoid poor outcomes. Bacterial meningitis is rare among patients with febrile seizures. The clinical judgement remains the cornerstone in deciding which patients should undergo invasive testing.
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Affiliation(s)
- Amr Eldardear
- Pediatric Neurology, Taibah University, Madinah, SAU
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Chen R, Li S, Wang X, Zhou J, Lu Y, Kang A. Analysis of cytokines and trace elements in children with febrile seizures. Transl Pediatr 2020; 9:809-817. [PMID: 33457303 PMCID: PMC7804487 DOI: 10.21037/tp-20-398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Febrile seizure (FS) is a common neurological condition in children and affects 2-5% of cases of fever. FS occurs with temperature >38 °C without symptoms of central nervous system infection, severe electrolyte imbalance, or clear cause. METHODS From June 2018 to December 2019, 65 children with FS, and 60 children with acute upper respiratory tract infections without seizures who were admitted to the pediatric department, and 60 healthy children as the control group were selected for the study. The serum iron (SI), serum calcium (SC), interleukin (IL)-6, IL-10 and procalcitonin (PCT) levels in the two groups of children were detected. The FS group was further divided into simple FS (SFS) and complex FS (CFS). RESULTS The duration of fever in the FS group was significantly longer than in the control group (P<0.05). The SC and SI levels of the FS group were significantly lower than those in the control group (P<0.05). The SC and SI levels of the CFS group were also lower than those of the SFS group (P<0.05), and the IL-6 levels of the CFS group were significantly higher than in the SFS group (P<0.05). CONCLUSIONS A decrease in the levels of SI, and SC and an increase of IL-6 were closely related to the occurrence of FS, suggesting that clinical attention should be paid to monitoring changes of SI, SC and IL-6 levels in children with FS. As the levels of SI and SC decrease, the frequency of possible seizures may increase. Care should be taken to correct electrolyte disorders in time.
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Affiliation(s)
- Rongrong Chen
- Department of Pediatrics, Nantong Maternal and Child Health Care Hospital, Nantong, China
| | - Shuangshuang Li
- Department of Pediatrics, Nantong Maternal and Child Health Care Hospital, Nantong, China
| | - Xiaokang Wang
- Department of Orthopedics, Nantong Maternal and Child Health Care Hospital, Nantong, China
| | - Jinjun Zhou
- Department of Pediatrics, Nantong Maternal and Child Health Care Hospital, Nantong, China
| | - Yi Lu
- Department of Pediatrics, Nantong Maternal and Child Health Care Hospital, Nantong, China
| | - Aijian Kang
- Department of Pediatrics, Nantong Maternal and Child Health Care Hospital, Nantong, China
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122
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Romantseva L, Lin N. Acute Seizures-Work-Up and Management in Children. Semin Neurol 2020; 40:606-616. [PMID: 33155186 DOI: 10.1055/s-0040-1718718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Seizures are common in the pediatric population; however, most children do not go on to develop epilepsy later in life. Selecting appropriate diagnostic modalities to determine an accurate diagnosis and appropriate treatment as well as with counseling families regarding the etiology and prognosis of seizures, is essential. This article will review updated definitions of seizures, including provoked versus unprovoked, as well as the International League Against Epilepsy operational definition of epilepsy. A variety of specific acute symptomatic seizures requiring special consideration are discussed, along with neonatal seizures and seizure mimics, which are common in pediatric populations.
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Affiliation(s)
- Lubov Romantseva
- Section of Pediatric Neurology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Nan Lin
- Section of Pediatric Neurology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
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123
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Mewasingh LD, Chin RFM, Scott RC. Current understanding of febrile seizures and their long-term outcomes. Dev Med Child Neurol 2020; 62:1245-1249. [PMID: 32748466 DOI: 10.1111/dmcn.14642] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 12/01/2022]
Abstract
In this paper we reframe febrile seizures, which are viewed as a symptom of an underlying brain disorder. The general observation is that a small cohort of children will develop febrile seizures (2-5% in the West), while the greater majority will not. This suggests that the brain that generates a seizure, in an often-mild febrile context, differs in some ways from the brain that does not. While the underlying brain disorder appears to have no significant adverse implication in the majority of children with febrile seizures, serious long-term outcomes (cognitive and neuropsychiatric) have been recently reported, including sudden death. These adverse events likely reflect the underlying intrinsic brain pathology, as yet undefined, of which febrile seizures are purely a manifestation and not the primary cause. A complex interaction between brain-genetics-epigenetics-early environment is likely at play. In view of this emerging data, it is time to review whether febrile seizures are a single entity, with a new and multidimensional approach needed to help with predicting outcome. WHAT THIS PAPER ADDS: A febrile seizure is due to a brain's aberrant response to high temperature. Problems in a small group of children are now being identified later in life. There is no clear correlation between duration or other characteristics of febrile seizures and subsequent mesial temporal sclerosis.
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Affiliation(s)
- Leena D Mewasingh
- Department of Paediatric Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK.,The Royal Hospital for Sick Children, Edinburgh, UK
| | - Rod C Scott
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA.,Department of Neurology, Great Ormond Street Hospital NHS Trust, London, UK
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124
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Raj Ghosh G, Nelson ALA. Indications for epilepsy monitoring in pediatric and adolescent health care. Curr Probl Pediatr Adolesc Health Care 2020; 50:100890. [PMID: 33139209 DOI: 10.1016/j.cppeds.2020.100890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Seizures present in childhood with infinite diversity. History alone may suffice for diagnosis in some cases; more often additional evidence is needed to clarify events of concern. Electroencephalography (EEG) is a primary methodology used for seizure identification and management. Pediatric and adolescent health care providers are increasingly asked to make decisions about when and how to refer patients for eventual monitoring and must then be able to confidently interpret any resulting report(s). Comprehensive literature review was undertaken to provide a succinct and up-to-date overview aimed at general and subspecialty non-neurologist pediatric and adolescent health care providers to not only convey a solid general understanding of EEG and what it entails for patients and their families, but also foster a deeper understanding of the indications for monitoring-and how to interpret documented findings. In plain language this resultant guide reviews EEG basics, provides a crash course in the various types of EEG available, discusses broad indications for epilepsy monitoring, guides counseling and management for patients and their families both before and after EEG, and ultimately aids in the interpretation of both findings and prognosis. This review should allow both primary and subspecialty non-neurologic pediatric and adolescent health care providers to better identify when and how to best utilize EEG as part of a larger comprehensive clinical approach, distinguishing and managing both epileptic and nonepileptic disorders of concern while fostering communication across providers to facilitate and coordinate better holistic long-term care of pediatric and adolescent patients.
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Affiliation(s)
- Gayatri Raj Ghosh
- The Department of Neurology, NYU Langone Health, 462 First Avenue, 7th Floor Room 7W12C, New York, NY 10016, United States
| | - Aaron L A Nelson
- The Department of Neurology, NYU Langone Health, 462 First Avenue, 7th Floor Room 7W12C, New York, NY 10016, United States; The Department of Neurology, Bellevue Hospital Center, New York, NY, United States.
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Abstract
BACKGROUND The terminology and classification of seizures and epilepsy has undergone multiple revisions in the last several decades, which can lead to confusion and miscommunication amongst physicians and researchers. In 2017, the International League Against Epilepsy (ILAE) revised the classification of both seizures and epilepsy types in an effort to use less ambiguous terminology. Over time, definitions for status epilepticus, febrile seizures, and neonatal seizures have also evolved, as has the delineation of various epilepsy syndromes by age. METHODS Review of the literature for old and new terminology and various epilepsy syndromes was accomplished using the PubMed database system. RESULTS In the following article, we review old terminology for classifying seizures and epilepsy as compared to the new (2017) ILAE guidelines. We discuss neonatal seizures, status epilepticus, febrile seizures, autoimmune epilepsy and various epilepsy syndromes by age of onset. CONCLUSION Adopting a classification system that uses plain language allows for more effective and efficient communication between individuals and across specialties. Definitions of various syndromes and seizure types have evolved over time and are reviewed.
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Affiliation(s)
- Shelley Varnado
- Department of Neurology, NYU Langone Health, 223 East 34th Street, New York, NY 10016, United States
| | - Dana Price
- Department of Neurology, NYU Langone Health, 223 East 34th Street, New York, NY 10016, United States.
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Kawakami I, Inoue M, Adachi S, Koga H. The weather condition and epidemics as triggers for febrile seizure: A single-center retrospective observational study. Epilepsy Behav 2020; 111:107306. [PMID: 32759072 DOI: 10.1016/j.yebeh.2020.107306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the association between the weather and epidemic condition and risk of febrile seizures (FSs) in Japan. STUDY DESIGN This single-center, retrospective study included 560 children (age, 6-60 months) with FSs who were transported to our center by ambulance from January 2011 through December 2018. The weather (temperature, atmospheric pressure, relative air humidity, amount of rainfall, sunshine duration, and air concentration of nitrogen dioxide [NO2] and sulfur dioxide [SO2]) and epidemic (influenza virus infection, infectious gastroenteritis, and exanthem subitum) conditions in this region were compared between the periods (days or weeks) with the transportation of children with FS to our hospital and those without such transportation. RESULTS In the univariate analyses, neither daily or weekly weather condition nor weekly epidemic condition was correlated to FS transportation. Furthermore, the multiple logistic regression analysis suggested that epidemic influenza virus infection (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.08-1.73) and infectious gastroenteritis (OR, 1.64; 95% CI, 1.09-2.54) were the independent risk factors for FS occurrence and weather condition was not associated with FS risk. CONCLUSIONS Febrile seizure incidence may be increased by epidemic febrile infections but not by weather condition.
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Affiliation(s)
- Isao Kawakami
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan
| | - Masataka Inoue
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan
| | - Shunichi Adachi
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan
| | - Hiroshi Koga
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan.
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Kim SH, Yun SW, Kim HR, Chae SA. Exosomal microRNA expression profiles of cerebrospinal fluid in febrile seizure patients. Seizure 2020; 81:47-52. [DOI: 10.1016/j.seizure.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 01/18/2023] Open
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Piroutek MJ. Febrile Seizure Team-based Learning. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2020; 5:T45-T68. [PMID: 37465331 PMCID: PMC10334448 DOI: 10.21980/j8jd12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/02/2020] [Indexed: 07/20/2023]
Abstract
Audience This modified team-based learning (mTBL) is designed for junior and senior emergency medicine and pediatric residents. Introduction/Background Febrile seizures are the most common cause of seizures in children under 5 years old and are frequently evaluated in the emergency department.1,2 Febrile seizures can be frightening for parents to witness and often necessitate extensive parental reassurance and education by the emergency medicine (EM) provider. Most febrile seizures are brief, do not require a broad workup, and have a benign prognosis. With introduction of conjugate vaccines for Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae in the United States in 1987 and 2000 respectively, the incidence of bacterial meningitis is low, but still present.3-7 The most recent American Academy of Pediatrics practice guidelines no longer recommend routine lumbar puncture on children presenting with simple febrile seizures.2 A review of the current literature shows that bacterial meningitis in children after a complex febrile seizure is unexpected when the clinical examination is not suggestive of meningitis or encephalitis.5-8 The goal of this mTBL is for residents to feel comfortable counseling parents about their child currently in the emergency department and the future risk of recurrence. The second goal is for residents to identify which patients presenting with fever and a seizure do require workup beyond simply identifying the source of the fever. Educational Objectives By the end of this educational session, the learner will:List the characteristics of a simple febrile seizure.Discuss the management of a child with a simple vs. complex febrile seizure.Discuss the risk factors that correlate with an increased risk of a subsequent febrile seizure.Determine when a lumbar puncture should be considered in a febrile child with a seizure.Identify when to give anti-epileptics and construct an algorithm for their use.Discuss with parents, provide education and return precautions. Educational Methods This didactic session is a mTBL. The classic learner responsible content (LRC) has been omitted and a short PowerPoint presentation is given to start the session before the individual and group readiness assessment tests. Research Methods A post-TBL survey was given to each participant. A Likert scale was used to assess each participant's assessment for the learning session in the following categories: overall, context, quality, and speaker feedback. They were also given fields to enter ways in which they would improve their practice after this learning exercise and suggestions they had for improving the current educational opportunity. Results In the pilot session of this mTBL, 4 out of 11 participants (EM residents and pediatric emergency medicine [PEM] fellows) completed the post-TBL survey. Overall, this session was rated as "outstanding" (Likert 5/5) by 1 and "excellent" (Likert 4/5) by 3 for a weighted average of 4.25. All participants completing the survey found the activity "highly relevant," "very engaging," and wanted to repeat the activity in the future. Negative feedback consisted of wanting a video of a child having a seizure to be played and having a more interactive PowerPoint portion of the session like the interaction in the readiness assessment tests and group application exercise. Discussion Overall the content was effective as evidenced by the list of ways residents said they would improve their practice on the post-TBL survey. In the future, I would extend the session from 60 minutes to 90 minutes to allow for more time for the group application exercise and discussion of answers. I found this to be an enjoyable, highly interactive experience with high engagement of the residents during the session. Topics Simple febrile seizures, complex febrile seizures, seizure with fever, meningitis, lumbar puncture, status epilepticus.
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Affiliation(s)
- Mary Jane Piroutek
- Children’s Hospital of Orange County, Department of Emergency Medicine, Orange, CA
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Evers KS, Hügli M, Fouzas S, Kasser S, Pohl C, Stoecklin B, Bernasconi L, Kuhle J, Wellmann S. Serum Neurofilament Levels in Children With Febrile Seizures and in Controls. Front Neurosci 2020; 14:579958. [PMID: 33132834 PMCID: PMC7550525 DOI: 10.3389/fnins.2020.579958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022] Open
Abstract
Objective Neuroaxonal damage is reflected by serum neurofilament light chain (sNfL) values in a variety of acute and degenerative diseases of the brain. The aim of this study was to investigate the impact of febrile and epileptic seizures on sNfL, serum copeptin, and prolactin levels in children compared with children with febrile infections without convulsions. Methods A prospective cross-sectional study was performed in children aging 6 months to 5 years presenting with fever (controls, n = 61), febrile seizures (FS, n = 78), or epileptic seizures (ES, n = 16) at our emergency department. sNfL, copeptin, and prolactin were measured within a few hours after the event in addition to standard clinical, neurophysiological, and laboratory assessment. All children were followed up for at least 1 year after presentation concerning recurrent seizures. Results Serum copeptin values were on average 4.1-fold higher in FS and 3.2-fold higher in ES compared with controls (both p < 0.01). Serum prolactin values were on average 1.3-fold higher in FS compared with controls ( p < 0.01) and without difference between ES and controls. There was no significant difference of mean sNfL values (95% CI) between all three groups, FS 21.7 pg/ml (19.6–23.9), ES 17.7 pg/ml (13.8–21.6), and controls 23.4 pg/ml (19.2–27.4). In multivariable analysis, age was the most important predictor of sNfL, followed by sex and C reactive protein. Neither the duration of seizures nor the time elapsed from seizure onset to blood sampling had an impact on sNfL. None of the three biomarkers were related to recurrent seizures. Significance Serum neurofilament light is not elevated during short recovery time after FS when compared with children presenting febrile infections without seizures. We demonstrate an age-dependent decrease of sNfL from early childhood until school age. In contrast to sNfL levels, copeptin and prolactin serum levels are elevated after FS.
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Affiliation(s)
- Katrina S Evers
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Melanie Hügli
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Sotirios Fouzas
- Paediatric Respiratory Unit and Department of Neonatology, University Hospital of Patras, Patras, Greece
| | - Severin Kasser
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Christian Pohl
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia
| | - Benjamin Stoecklin
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Wellmann
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Division of Neonatology, University Children's Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
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130
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Chen JR, Jin MF, Tang L, Liu YY, Ni H. Acute Phase Serum Leptin, Adiponectin, Interleukin-6, and Visfatin Are Altered in Chinese Children With Febrile Seizures: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2020; 11:531. [PMID: 33042001 PMCID: PMC7522506 DOI: 10.3389/fendo.2020.00531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Adipokines, including leptin, visfatin, adiponectin, and interleukin-6 (IL)-6, play multiple roles in the pathophysiology of epilepsy and febrile seizures (FS). We aimed to investigate the associations among plasma adipokines, mainly leptin, visfatin, adiponectin, or IL-6, and the prognosis of FS. This prospective cross-sectional study was conducted from January 2017 to December 2018 at the Wuxi Second People' Hospital China. The levels of serum leptin, visfatin, adiponectin, and IL-6 in 55 children with FS (FS group) were compared with 42 febrile children without seizure (FC group) and 48 healthy children (HC group) in an acute phase. The correlation with clinical indicators was determined by logistic regression analysis. Serum adiponectin and IL-6 levels were significantly higher in the FS group than in the FC and HC groups (p < 0.05), but there was no statistical difference between the FC and HC groups. In addition, logistic regression analysis showed that high concentrations of adiponectin and IL-6 were significantly associated with the occurrence of FS. For leptin and visfatin, they were significantly lower in the FS and FC groups than in the normal control group, but there was no statistical difference between the FS and FC groups. Our results suggest that higher plasma levels of IL-6 and adiponectin may serve as an additional biomarker in the early treatment or follow-up of the FS children.
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Affiliation(s)
- Jie-ru Chen
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
- Wuxi Second People's Hospital, Wuxi, China
| | - Mei-fang Jin
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Ling Tang
- Wuxi Second People's Hospital, Wuxi, China
| | - Yue-ying Liu
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Hong Ni
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
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131
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Alansari K, Barkat M, Mohamed AH, Al Jawala SA, Othman SA. Intramuscular Versus Buccal Midazolam for Pediatric Seizures: A Randomized Double-Blinded Trial. Pediatr Neurol 2020; 109:28-34. [PMID: 32387007 DOI: 10.1016/j.pediatrneurol.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 03/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND We compared the efficacy and safety of intramuscular with buccal midazolam as first-line treatment for active seizures in children brought to the emergency department. METHODS In a double-blind, double-dummy randomized trial, patients with an active seizure lasting more than five minutes received blinded treatments on arrival. We employed deferred consent. The proportion of patients with cessation of seizure within five minutes of drug administration was the primary efficacy outcome; proportions needing additional medication to control seizure, duration of seizure activity, and side effects were secondary outcomes. RESULTS We enrolled 150 children presenting with active seizure, age range 4.5 to 167.5 months. Cessation of seizure occurred in 61% of the intramuscular and 46% of the buccal treatment groups, (P = 0.07, difference 15.5%, 95% confidence interval for the difference -1.0 to 32.0%). Proportions requiring additional anti-seizure treatment were 39% in the intramuscular and 51% in the buccal groups. Mean duration of seizure activity after administration of study medication was 15.9 minutes (S.D. 28.7) in the intramuscular and 17.8 minutes (S.D. 27.5) in the buccal group. One patient in the intramuscular group developed respiratory depression and hypotension; there were no side effects attributed to investigational treatment in the buccal group. CONCLUSIONS Efficacy and safety of intramuscular midazolam as first-line treatment for pediatric seizures compare favorably to that of buccal midazolam.
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Affiliation(s)
- Khalid Alansari
- Department of Emergency Medicine, Sidra Medicine, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Magda Barkat
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - AbdelNasir H Mohamed
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Shahaza Alali Al Jawala
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Shadi Ahmad Othman
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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132
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Abstract
Factor X deficiency is a severe inherited coagulation disorder, which is characterized by severe systemic bleeding manifestations in affected individuals. It is a rare disorder with a frequency of around 1:1,000,000 in the general population. We present the case of an infant with factor X deficiency who presented with complex febrile seizure. Although febrile seizures are very common in children, a closer scrutiny leads to neuroimaging and finding of intracranial bleed. Hematologic and genetic investigations confirmed the diagnosis. A high index of suspicion should be maintained to diagnose uncommon bleeding disorders in children.
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133
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Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
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134
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Utility of ECGs in the pediatric emergency department for patients presenting with a seizure. Am J Emerg Med 2020; 38:1362-1366. [DOI: 10.1016/j.ajem.2019.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
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135
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Demographic and clinical characteristics of children who were hospitalized and followed due to seizures. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.773784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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136
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Takagi Y, Imamura T, Endo S, Hayashi K, Akiyama S, Ikuta Y, Kawaguchi T, Sumita T, Katori T, Hashino M, Saito S, Odagiri T, Oba K, Kuroda M, Kageyama T. Neurogenic pulmonary edema following febrile status epilepticus in a 22-month-old infant with multiple respiratory virus co-detection: a case report. BMC Infect Dis 2020; 20:388. [PMID: 32487032 PMCID: PMC7266127 DOI: 10.1186/s12879-020-05115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 05/24/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Neurogenic pulmonary edema is a rare but serious complication of febrile status epilepticus in children. Comprehensive screening for viral pathogens is seldomly performed in the work-up of febrile children. CASE PRESENTATION A 22-month-old girl presented with her first episode of febrile status epilepticus, after which she developed acute pulmonary edema and respiratory failure. After the termination of seizure activity, the patient was intubated and managed on mechanical ventilation in the emergency room. The resolution of respiratory failure, as well as the neurological recovery, was achieved 9 h after admission, and the patient was discharged 6 days after admission without any complications. Molecular biological diagnostic methods identified the presence of human coronavirus HKU1, influenza C virus, and human parainfluenza virus 2 from the patient's nasopharyngeal specimens. CONCLUSIONS Neurogenic pulmonary edema following febrile status epilepticus was suspected to be the etiology of our patient's acute pulmonary edema and respiratory failure. Timely seizure termination and rapid airway and respiratory intervention resulted in favorable outcomes of the patient. Molecular biological diagnostic methods identified three respiratory viruses; however, their relevance and association with clinical symptoms remain speculative.
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Affiliation(s)
- Yoshie Takagi
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
- Department of Emergency Medicine and Critical Care, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Takeaki Imamura
- Department of Emergency Medicine and Critical Care, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
- Department of Virology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, 980-8575, Japan
| | - Shota Endo
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Kenta Hayashi
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Satoka Akiyama
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Yoji Ikuta
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Takahiro Kawaguchi
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Tomoko Sumita
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Tatsuo Katori
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Masanori Hashino
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan
| | - Shinji Saito
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Takato Odagiri
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan
| | - Tsutomu Kageyama
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan.
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Ogino M, Kashiwagi M, Tanabe T, Oba C, Nomura S, Shimakawa S, Kidokoro H, Natsume J, Okumura A, Tamai H, Ashida A. Clinical findings in patients with febrile seizure after 5 years of age: A retrospective study. Brain Dev 2020; 42:449-456. [PMID: 32201092 DOI: 10.1016/j.braindev.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/04/2020] [Accepted: 02/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Febrile seizures (FSs) typically occur in infants and children between 6 and 60 months of age. Rarely, FS can occur in late childhood (late FS [LFS]; >5 years of age); however, the clinical features of LFS remain unclear. We aimed to clarify the clinical features of LFS. METHODS We retrospectively analyzed data from patients with LFS who visited Hirakata City Hospital between January 2004 and December 2014. We defined LFS as a seizure accompanied by fever (temperature ≥38 °C) occurring after 5 years of age, without a central nervous system infection. RESULTS A total of 505 patients (349 boys, 156 girls: 5-14 years old) were included. A history of FS before 60 months of age was observed in 319 of 460 patients (69.3%) with sufficient information about previous FS history among the 505 patients enrolled. LFS was more likely to occur in males (69.1%). Seizure duration was ≤15 min in 87.4% of cases. A family history of FS in first-degree relatives was observed in 103/327 cases (31.5%). Among LFS cases, 45% occurred at 5 years of age, and 92.1% experienced only one seizure after 5 years of age. The number of seizure episodes gradually lessened with age, decreasing drastically to 5.6% of cases older than 9 years. CONCLUSIONS Our findings suggest that sex differences, seizure duration, and family history were similar for LFS and FS. Over 90% patients with LFS experienced no recurrence after 5 years of age. Further study is needed to verify the recurrence rate of LFS.
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Affiliation(s)
- Motoko Ogino
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan; Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | | | - Takuya Tanabe
- Department of Child Neurology, Tanabe Children's Clinic, Osaka, Japan
| | - Chizu Oba
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | - Shohei Nomura
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | | | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
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Brugman J, Solomons RS, Lombard C, Redfern A, Du Plessis AM. Risk-Stratification of Children Presenting to Ambulatory Paediatrics with First-Onset Seizures: Should We Order an Urgent CT Brain? J Trop Pediatr 2020; 66:299-314. [PMID: 31625577 DOI: 10.1093/tropej/fmz071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A computed tomography (CT) brain scan is an often-utilised emergency department imaging modality to detect emergent intra-cranial pathology in a child with a first seizure. Identifying children at low risk of having a clinically significant intra-cranial abnormality could prevent unnecessary radiation exposure and contrast/sedation-related risks. OBJECTIVES To identify clinical variables which could predict clinically significant CT brain abnormalities and use recursive partitioning analysis to define a low-risk group of children in whom emergent CT brain can be deferred. METHODS Retrospective cross-sectional review of 468 children who underwent emergent CT brain after presenting to a low- and middle-income paediatric emergency department following first seizure. RESULTS In total 133/468 (28.4%) of CT brain scans had clinically significant abnormalities. Failure to return to neurological baseline and focal neurological deficit persisting >36 h had statistical significance in a multiple regression analysis. Recursive partitioning analysis, applied to a subgroup without suspected tuberculous meningitis (n = 414), classified 153 children aged between 6 months and 5 years, who had a normal neurological baseline, had returned to baseline post-seizure, and were not in status epilepticus, as non-clinically significant scans and 98% were correctly classified. CONCLUSION Our study re-inforces the American Academy of Neurology recommendation that children with persistent post-ictal abnormal neurological status and/or post-ictal focal deficit be prioritised for emergent CT brain. Having excluded children with suspected tuberculous meningitis, the remaining subgroup aged 6 months to 5 years presenting with a non-status first seizure, normal neurological baseline and return to baseline post-seizure, are at very low risk of having a clinically significant CT brain abnormality.
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Affiliation(s)
- Jaanri Brugman
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Regan Shane Solomons
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andrew Redfern
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anne-Marie Du Plessis
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
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Abstract
INTRODUCTION Febrile convulsion (FC) is the most common neurological disorder in childhood. The aim of this study was to determine the risk factors for recurrence and the development of epilepsy from the demographic data of these patients. METHODS A retrospective study was made of 680 patients with FC who presented to our hospital. Patients with only FC were defined as group 1 and those who developed epilepsy after FC as group 2. Comparisons were made between the 2 groups of the demographic parameters, parental consanguinity, familial history of FCs or epilepsy, criteria for starting prophylactic treatment, response to treatment, risk factors for recurrence, and results of electroencephalogram. RESULTS The study included a total of 680 patients comprising 399 males (59%) and 281 females (41%). A diagnosis of FC was made in 652 cases (95.8%, group 1), and epilepsy was diagnosed in 28 (4.2%, group 2). A positive familial history of FCs was determined statistically significantly higher in group 1. On the other hand, a history of pathological birth and parental consanguinity was found higher in group 2. Prophylactic treatment was administered to 89.3% of group 2 and 40.3% of group 1. CONCLUSIONS Febrile convulsions create fear and panic in the family and are a significant health problem in Turkey. The conclusion that has been reached is that the unnecessary administration of prophylactic treatment could be prevented with education of the families on the subject of fever and correct identification of patients at risk of developing epilepsy.
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140
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Adachi S, Inoue M, Kawakami I, Koga H. Short-term neurodevelopmental outcomes of focal febrile seizures. Brain Dev 2020; 42:342-347. [PMID: 32019687 DOI: 10.1016/j.braindev.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/06/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The effect of complex febrile seizures (FS), specifically focal FS, on long-term neurodevelopmental outcome is not well known. The aim of this study was to assess the association between complex FS and neurodevelopmental outcome. METHODS A single-center, retrospective, cohort study was performed. The study included 282 children aged 6-60 months who experienced FS. Of these, 61 (22%) experienced recurrent FS, 33 (12%) prolonged FS, and 17 (6%) focal FS. The effect of these complex FS on subsequent need for special neurodevelopmental support was investigated. The neurodevelopmental status after FS was evaluated by a questionnaire. RESULTS During a median follow-up period of 3 years post FS, 12 children (4.3%) required special neurodevelopmental support. Univariate analysis demonstrated a significant association between focal FS and the need for subsequent special neurodevelopmental support, as well as a correlation between prolonged FS and pre-existing neurodevelopmental abnormality. Multiple logistic regression analysis demonstrated that focal FS (odds ratio [OR]: 12.27; 95% confidence interval [CI]: 2.11-71.22) and pre-existing neurodevelopmental abnormality (OR: 262; 95% CI: 17-3944) were significantly associated with the need for subsequent special support. CONCLUSION An association was found between focal FS and subsequent neurodevelopmental impairment; therefore, close follow-up with particular attention to neurodevelopmental status is required for children who experience focal FS.
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Affiliation(s)
- Shunichi Adachi
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan
| | - Masataka Inoue
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan
| | - Isao Kawakami
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan
| | - Hiroshi Koga
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita 874-0011, Japan.
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141
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Guleria S, Kjaer SK, Duun-Henriksen AK, Christensen J, Soylu LÍ, Hargreave M, Jensen A. Risk of febrile seizures among children conceived following fertility treatment: A cohort study. Paediatr Perinat Epidemiol 2020; 34:114-121. [PMID: 32027053 DOI: 10.1111/ppe.12653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/29/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies have shown that fertility treatment in mothers is associated with neurological problems in children. However, knowledge about any association between maternal use of fertility treatment and febrile seizures in children is lacking. OBJECTIVE To determine whether maternal use of fertility treatment is associated with febrile seizures in children. METHODS All liveborn children in Denmark during 1996-2012 (n = 1 065 901) were linked with the Danish Infertility Cohort and the Danish national registers and were followed from one year of age until the first episode of a febrile seizure, death, emigration, loss to follow-up, or end of follow-up (December 2015). Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for potential confounders. RESULTS Approximately 16% children (n = 172 140) were conceived by infertile women, and approximately 3% (n = 34 082) were diagnosed with febrile seizures during follow-up. Compared with children conceived by fertile women, children conceived following any fertility treatment (HR 1.11, 95% CI 1.06, 1.16), following specific fertility treatment, for example IVF (HR 1.15, 95% CI 1.05, 1.25), ICSI (HR 1.20, 95% CI 1.10, 1.32), and following fertility drugs (HR 1.06, 95% CI 1.00, 1.11) had slight increase in risk of febrile seizures, after adjusting for calendar year of birth, parental age, education, parity status, and maternal smoking during pregnancy. The associations were unchanged when children conceived naturally by infertile women were used as the reference group. CONCLUSIONS Children conceived following fertility treatment had slightly increased relative risk for febrile seizures.
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Affiliation(s)
- Sonia Guleria
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.,Department of Neurology, Aarhus University, Aarhus C, Denmark
| | - Lív Í Soylu
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Sjaellands Universitetshospital, Kirurgisk Afdeling, Køge, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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142
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Guillou T, Carbajal R, Rambaud J, Titomanlio L, Pontual L, Biscardi S, Nissack‐Obiketeki G, Pellegrino B, Charara O, Angoulvant F, Denis J, Chalard F, Morel B, Loschi S, Chappuy H, Guedj R. Predictors of clinically urgent intracranial pathology at neuroimaging in children with complex febrile seizures: a retrospective cross-sectional study. Acta Paediatr 2020; 109:349-360. [PMID: 31310688 DOI: 10.1111/apa.14938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess the prevalence of clinically urgent intracranial pathology (CUIP) in children visiting the emergency department with a complex febrile seizure (CFS). METHODS Retrospective cohort review. We analysed the visits of patients for a CFS from January 2007 to December 2011 in seven paediatric emergency departments. Our main outcomes were the proportions of CUIP diagnosed between day 0 and 1 and within 30 days after the index visit. RESULTS From 1 183 487 visits, 839 were for a CFS and 130 (15.5%) of these had a neuroimaging performed within 30 days (CT scan for 75 visits [8.9%], MRI for 30 visits [3.6%] and both for 25 visits [3.0%]). Three CUIP were diagnosed between day 0 and 1 (0.4% [CI-95%: 0.1-1.3]), 5 within 30 days after the index visit (0.7% [CI-95%: 0.2-1.7]) but none among the 630 visits of children presenting with a normal neurological clinical examination (0% [95% CI: 0.0-0.7]), nor among the 468 presenting only with multiple seizure (0% [95% CI: 0.0-1.0]). CONCLUSION In children with a CFS, CUIP is rare event in the subgroup of children with a normal neurological clinical examination and in those with brief generalised multiple seizures.
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Affiliation(s)
- Tifenn Guillou
- Pediatric Emergency Department Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital Paris France
| | - Ricardo Carbajal
- Pediatric Emergency Department Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital Paris France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy INSERM UMR 1153 Paris Descartes University Paris France
- Pierre and Marie Curie Medical School Pierre and Marie Curie University, Paris VI Paris France
| | - Jérome Rambaud
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris Armand Trousseau Hospital Paris France
| | - Luigi Titomanlio
- Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris Robert Debré Hospital Paris France
| | - Loic Pontual
- Pediatric Department Jean Verdier Hospital Bondy France
| | - Sandra Biscardi
- Pediatric Emergency Department Centre Hospitalier Intercommunal de Créteil Créteil France
| | | | | | - Oussama Charara
- Pediatric Department Versailles Hospital Le Chesnay Cedex France
| | - François Angoulvant
- Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris Necker‐Enfants Malades Hospital Paris France
| | - Julien Denis
- Pediatric Emergency Department Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital Paris France
| | - Francois Chalard
- Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris Armand Trousseau Hospital Paris France
| | - Baptiste Morel
- Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris Armand Trousseau Hospital Paris France
| | - Solène Loschi
- Pediatric Emergency Department Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital Paris France
| | - Hélène Chappuy
- Pediatric Emergency Department Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital Paris France
- Pierre and Marie Curie Medical School Pierre and Marie Curie University, Paris VI Paris France
| | - Romain Guedj
- Pediatric Emergency Department Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital Paris France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy INSERM UMR 1153 Paris Descartes University Paris France
- Pierre and Marie Curie Medical School Pierre and Marie Curie University, Paris VI Paris France
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143
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Change in the strategy for prophylactic diazepam use for febrile seizures and the impact on seizure recurrence within 24 h. Seizure 2020; 75:70-74. [DOI: 10.1016/j.seizure.2019.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/22/2022] Open
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144
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Tanaka M, Natsume J, Hamano SI, Iyoda K, Kanemura H, Kubota M, Mimaki M, Niijima SI, Tanabe T, Yoshinaga H, Kojimahara N, Komaki H, Sugai K, Fukuda T, Maegaki Y, Sugie H. The effect of the guidelines for management of febrile seizures 2015 on clinical practices: Nationwide survey in Japan. Brain Dev 2020; 42:28-34. [PMID: 31604594 DOI: 10.1016/j.braindev.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/02/2019] [Accepted: 08/26/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of guidelines for management of febrile seizures on the clinical practice, we conducted a nationwide survey in Japan. METHODS The Japanese guidelines for management of febrile seizures 2015 (GL2015) was released in 2015. In 2016, a questionnaire was sent to all 512 certified hospitals (3 pediatricians each) of the Japan Pediatric Society and all 47 prefecture Pediatric Associations (10 private pediatricians each) in Japan asking about management policies for febrile seizures (FSs) during 2013-2014 and 2016. The questionnaires were about the following procedures: (1) lumbar punctures, blood examinations, and diazepam suppositories for children after a first simple FS at emergency departments; and (2) prophylactic diazepam during febrile illnesses in children with two or three past simple FSs, with no known predictors of recurrence. RESULTS A total of 1327 pediatricians (66.2%) answered the questionnaire. Numbers of pediatricians performing lumbar punctures and blood examinations, and giving diazepam suppositories after a first simple FS were less in 2016 than in 2013-2014 (1.2% and 2.0%, 53.1% and 61.3%, and 36.7% and 51.9%, respectively). Pediatricians recommending prophylactic diazepam for children with two and three FSs decreased from 45.7% and 82.4% in 2013-2014 to 31.0% and 65.0% in 2016, respectively. CONCLUSION GL2015 had an effect on the clinical practices of pediatricians. On the other hand, 65% recommended prophylactic diazepam to children with three simple FSs even though GL2015 did not recommend use of diazepam based on number of previous FS. Anxiety about frequent seizures may affect pediatricians' clinical practice.
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Affiliation(s)
- Masaharu Tanaka
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shin-Ichiro Hamano
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Kuniaki Iyoda
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Fukuyama Support Center of Development and Care for Children, Fukuyama, Japan
| | - Hideaki Kanemura
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masaya Kubota
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Masakazu Mimaki
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Niijima
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takuya Tanabe
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Tanabe Children's Clinic, Osaka, Japan
| | - Harumi Yoshinaga
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Child Neurology, Okayama University Graduate Schools of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Noriko Kojimahara
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirofumi Komaki
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenji Sugai
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tokiko Fukuda
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Maegaki
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Division of Child Neurology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hideo Sugie
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Faculty of Health and Medical Sciences, Tokoha University Hamamatsu Campus, Hamamatsu, Japan
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145
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Sharawat I, Panda P. Relationship between serum sodium levels and febrile seizure recurrence in children. J Pediatr Neurosci 2020; 15:345-346. [PMID: 33531969 PMCID: PMC7847092 DOI: 10.4103/jpn.jpn_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/05/2022] Open
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Thébault-Dagher F, Deguire F, Knoth IS, Lafontaine MP, Barlaam F, Côté V, Agbogba K, Lippé S. Prolonged and unprolonged complex febrile seizures differently affect frontal theta brain activity. Epilepsy Res 2020; 159:106217. [DOI: 10.1016/j.eplepsyres.2019.106217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 01/29/2023]
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Barghout MS, Al-Shahawy AK, El Amrousy DM, Darwish AH. Comparison Between Efficacy of Melatonin and Diazepam for Prevention of Recurrent Simple Febrile Seizures: A Randomized Clinical Trial. Pediatr Neurol 2019; 101:33-38. [PMID: 31521449 DOI: 10.1016/j.pediatrneurol.2019.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/06/2019] [Accepted: 01/11/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We evaluated the efficacy and safety of oral melatonin compared with oral diazepam for prevention of recurrent simple febrile seizures. METHODS This prospective randomized clinical trial included 60 children aged six to 50 months with recurrent simple febrile seizures who attended the pediatric neurology clinic in Tanta University Hospital. Children were randomly allocated into two groups: the first group (30 children) received oral melatonin 0.3 mg/kg/8 hours, whereas the other group (30 children) received oral diazepam 1 mg/kg/day divided into three doses. Both melatonin and diazepam were given only during the febrile illness, started at the onset of the fever for 48 to 72 hours. Patients were followed up for six months. The primary outcome was recurrence of febrile seizures and the secondary outcome was occurrence of adverse effect related to melatonin or diazepam. RESULTS The recurrence rate of febrile seizures was 17% (5/30) in the melatonin group and 37% (11/30) in the diazepam group. There was no significant difference between the two groups (P = 0.08) (95% confidence interval -0.025 to 0.42). Both melatonin and diazepam have significantly reduced recurrence of febrile seizures (P < 0.001). Adverse effects were reported in 13.3% and 23.3% of the children taking melatonin and diazepam, respectively. No serious side effects were reported with melatonin use. Sedation and dizziness were the main side effects reported in children receiving oral diazepam. CONCLUSIONS Our data suggest that melatonin, administered at the onset of a febrile illness, may effectively reduce the likelihood of recurrent simple febrile seizures. No serious side effects were encountered.
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Affiliation(s)
- Mohammad Sami Barghout
- Faculty of Medicine, Department of Pediatrics, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Azza Kamal Al-Shahawy
- Faculty of Medicine, Department of Pediatrics, Pediatric Neurology Unit, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Doaa Mohamed El Amrousy
- Faculty of Medicine, Department of Pediatrics, Pediatric Cardiology Unit, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Amira Hamed Darwish
- Faculty of Medicine, Department of Pediatrics, Pediatric Neurology Unit, Tanta University Hospital, Tanta University, Tanta, Egypt.
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148
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Mitsuda N, Hosokawa T, Eitoku M, Fujieda M, Suganuma N. Breastfeeding and risk of febrile seizures in infants: The Japan Environment and Children's Study. Brain Dev 2019; 41:839-847. [PMID: 31324349 DOI: 10.1016/j.braindev.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/14/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our study was conducted to examine the association between breastfeeding and febrile seizures (FS) in the first year of life. METHODS We used data from a birth cohort study, the Japan Environment and Children's Study (JECS). In a self-administered questionnaire, we asked participants the duration of breastfeeding and whether their children were diagnosed as having FS during their first 12 months. We estimated the association of duration and exclusiveness of breastfeeding with the FS by using multiple logistic regression analysis. RESULTS Of 84,082 children, 995 (1.2%) were diagnosed as having FS by the age of 12 months. The prevalence of FS was higher in children who were breastfed for shorter duration. Multiple logistic regression analysis showed that, compared with children breastfed for less than 1 month, those breastfed for 4-6 months and 7-12 months had lower risks of FS (adjusted odds ratio [aOR], 0.65 [95% confidence interval {CI}, 0.42-0.99]; aOR, 0.66 [95% CI: 0.45-0.96], respectively). Moreover, compared with infants who received both breast milk and formula milk for 6 months, infants who were breastfed exclusively for 6 months had lower risk of FS (aOR: 0.78 [95% CI: 0.64-0.95]). CONCLUSIONS Our results suggest that breastfeeding has a protective effect against FS in the first year of life.
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Affiliation(s)
- Naomi Mitsuda
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan.
| | | | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
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149
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Jang HN, Yoon HS, Lee EH. Prospective case control study of iron deficiency and the risk of febrile seizures in children in South Korea. BMC Pediatr 2019; 19:309. [PMID: 31484495 PMCID: PMC6724315 DOI: 10.1186/s12887-019-1675-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Febrile seizures are the most common type of seizure in the first 5 years of life, and many factors that increase seizure risk have been identified. This study was performed to examine the association between iron status and febrile seizures in children in South Korea. Methods A prospective unmatched case control study was performed in 63 cases of febrile seizures and 65 controls with febrile illness but no seizures. Results Serum iron, plasma ferritin, and transferrin saturation were significantly lower in children with febrile seizures compared to the controls. Iron deficiency, defined as ferritin < 30 ng/mL, was more prevalent in the febrile seizure group (49.2%) than in the control group (16.9%). Serum iron < 22 ng/dL (odds ratio 3.42, 95% confidence interval [CI] 1.31–8.9, P = 0.012) and ferritin < 30 ng/mL (odds ratio 6.18, 95% CI 2.32–16.42, P < 0.001) were associated with increased risk of developing febrile seizures in multivariate logistic regression analysis. Conclusion These observations suggest that iron deficiency prior to development of anemia may increase risk of febrile seizures.
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Affiliation(s)
- Han Na Jang
- Department of Pediatrics, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea
| | - Hoi Soo Yoon
- Department of Pediatrics, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea
| | - Eun Hye Lee
- Department of Pediatrics, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea.
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150
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Cokyaman T. Febril nöbetler: Ateş sonrası nöbet zamansal sıralamasının bir önemi var mıdır? FAMILY PRACTICE AND PALLIATIVE CARE 2019. [DOI: 10.22391/fppc.491220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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