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Riccò M, Cascio A, Corrado S, Bottazzoli M, Marchesi F, Gili R, Giuri PG, Gori D, Manzoni P. Occurrence of Central Nervous System Complications of Respiratory Syncytial Virus Infections: A Systematic Review with Meta-Analysis. EPIDEMIOLOGIA 2024; 5:421-455. [PMID: 39051211 PMCID: PMC11270441 DOI: 10.3390/epidemiologia5030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
An increasing base of evidence suggests that respiratory syncytial virus (RSV) infections may be associated with neurological complications. In accord with the PRISMA statement, we performed a systematic review and meta-analysis on the occurrence of encephalitis and encephalopathy associated with documented RSV infections. PubMed, Embase, and Scopus databases were searched for eligible observational studies published up to 10 April 2024. Raw data included the occurrence of RSV infections among cases of encephalitis and/or encephalopathy and cases of encephalitis and/or encephalopathy among series of RSV infections. Data were pooled in a random effects model. Case reports were also collected, and their data pooled as a cumulative series. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 15 studies for a total of 7719 RSV infections and 1631 cases of encephalitis were analyzed. Moreover, 27 case reports and case series were retrieved, for a total of 84 individual cases of encephalitis/encephalopathy occurring during a documented RSV infection. A pooled prevalence of 2.20 cases of encephalitis/encephalopathy per 100 RSV cases (I2 = 99%) was calculated, while a prevalence of RSV infections among cases of encephalitis/encephalopathy was estimated to 3.53 per 100 cases for studies on respiratory specimens (I2 = 48%) and 0.37 per cases on central nervous system (CNS) specimens (I2 = 0%). Detection of RSV within the CNS was relatively rare (17.86% of pooled case reports), being associated with male gender (adjusted odds ratio [aOR] 5.021, 95% confidence interval [95%CI] 1.104 to 22.831) and recovery with long-term sequelae (aOR 5.699, 95%CI 1.152; 28.183). Case fatality ratio was estimated to be 0.43 per 100 cases on observational studies and 10.71% in case reports, a difference likely due to publication bias. In summary, RSV represented a not frequent but notable cause of encephalitis/encephalopathy in adults and children. The paucity of available studies not only recommends a cautious appraisal of our results but stresses the clinical significance of future studies on incident cases of encephalitis and/or encephalopathy.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, “G D’Alessandro”, University of Palermo, AOUP P. Giaccone, 90127 Palermo, Italy;
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Renata Gili
- Department of Prevention, Turin Local Health Authority, 10125 Torino, Italy
| | | | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, 10125 Turin, Italy
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Vivisenco IC, Lescaie A, Dragomirescu A, Ioniță IC, Florescu I, Ciocea B, Grama AR, Crăciun MD, Chivu CD, Ulmeanu CE, Nițescu VG. Neurological Manifestations of Acute SARS-CoV-2 Infection in Pediatric Patients: A 3-Year Study on Differences between Pandemic Waves. Viruses 2024; 16:967. [PMID: 38932259 PMCID: PMC11209294 DOI: 10.3390/v16060967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
This study analyzed the neurological manifestation profiles of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across pandemic waves in pediatric patients. The study collected data on patients aged between 0 and 18 years, diagnosed with acute SARS-CoV-2 infection, admitted to a pediatric tertiary hospital between 1 March 2020 and 28 February 2023. This study included 1677 patients. Neurological manifestations were noted in 10% (n = 168) of patients with a median age of 3.2 years (interquartile range: 1-11.92). Neurological manifestations were significantly associated with the pandemic waves (p = 0.006) and age groups (p < 0.001). Seizures were noted in 4.2% of cases and reached an increasing frequency over time (p = 0.001), but were not associated with age groups. Febrile seizures accounted for the majority of seizures. Headache was reported in 2.6% of cases and had similar frequencies across the pandemic waves and age groups. Muscular involvement was noted in 2% of cases, reached a decreasing frequency over time (p < 0.001), and showed different frequencies among the age groups. Neurological manifestations of acute SARS-CoV-2 infection exhibit distinct patterns, depending on the pandemic wave and patient age group. The Wuhan and Omicron waves involved the nervous system more often than the other waves.
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Affiliation(s)
- Iolanda Cristina Vivisenco
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Andreea Lescaie
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Ana Dragomirescu
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Ioana Cătălina Ioniță
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Irina Florescu
- Department of Neurology, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (I.F.); (B.C.)
| | - Bogdan Ciocea
- Department of Neurology, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (I.F.); (B.C.)
| | - Andreea Rodica Grama
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Maria-Dorina Crăciun
- Department of Epidemiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (M.-D.C.); (C.-D.C.)
- Department of Infection Prevention and Control, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania
| | - Carmen-Daniela Chivu
- Department of Epidemiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (M.-D.C.); (C.-D.C.)
- Department of Infection Prevention and Control, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania
| | - Coriolan Emil Ulmeanu
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
| | - Viorela Gabriela Nițescu
- Discipline of Pediatrics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Plevnei Road, 010221 Bucharest, Romania; (I.C.V.); (A.R.G.); (C.E.U.); (V.G.N.)
- Department of Pediatrics, Grigore Alexandrescu Clinical Emergency Hospital for Children, 30-32 Iancu de Hunedoara Road, 011743 Bucharest, Romania; (A.D.); (I.C.I.)
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Ferretti A, Riva A, Fabrizio A, Bruni O, Capovilla G, Foiadelli T, Orsini A, Raucci U, Romeo A, Striano P, Parisi P. Best practices for the management of febrile seizures in children. Ital J Pediatr 2024; 50:95. [PMID: 38735928 PMCID: PMC11089695 DOI: 10.1186/s13052-024-01666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Febrile seizures (FS) are commonly perceived by healthcare professionals as a self-limited condition with a generally 'benign' nature. Nonetheless, they frequently lead to pediatric consultations, and their management can vary depending on the clinical context. For parents and caregivers, witnessing a seizure can be a distressing experience, significantly impacting their quality of life. In this review, we offer an in-depth exploration of FS management, therapeutic interventions, and prognostic factors, with the aim of providing support for physicians and enhancing communication with families. We conducted a comprehensive literature search using the PubMed and Web of Science databases, spanning the past 50 years. The search terms utilized included "febrile seizure," "complex febrile seizure," "simple febrile seizure," in conjunction with "children" or "infant." Only studies published in English or those presenting evidence-based data were included in our assessment. Additionally, we conducted a cross-reference search to identify any additional relevant data sources. Our thorough literature search resulted in a compilation of references, with carefully selected papers thoughtfully integrated into this review.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy.
| | - Antonella Riva
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alice Fabrizio
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Capovilla
- Child Neuropsychiatry Department, Epilepsy Center, Mantova, Italy
- C. Poma HospitalFondazione Poliambulanza, Brescia, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Romeo
- Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pasquale Striano
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
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Muniz MCR, Lima RV, Maia VQCC, Bezerra AM, Freire IF, Lima MCC, Matos YMT, Pontes LP, Cavalcante ANM. The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis. Eur J Pediatr 2024; 183:2049-2058. [PMID: 38456990 DOI: 10.1007/s00431-024-05501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67-1.04; I2 = 78%; Cochran's Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65-0.99; I2 = 70%; Cochran's Q = 0.02). Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts. What is Known: • Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight. • However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures. What is New: • When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures. • When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.
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Affiliation(s)
- Maria Carolina Rocha Muniz
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Rian Vilar Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil.
| | | | - Arthur Meneses Bezerra
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Isabela Franco Freire
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Manuela Cavalcante Coling Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Yuri Marques Teixeira Matos
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Letícia Pinheiro Pontes
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Ana Nery Melo Cavalcante
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
- PhD in Collective Health By the University of Fortaleza, Neonatologist Pediatrician at Dr. César Cals de Oliveira General Hospital, Fortaleza, Ceara, Brazil
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Castellazzi ML, La Vecchia A, Scali M, Agostoni C, Di Pietro G, Milani GP. Clinical and laboratory parameters associated with febrile seizure recurrence within the first 24 h: a ten-year cohort study. Front Pediatr 2024; 12:1373848. [PMID: 38500593 PMCID: PMC10944896 DOI: 10.3389/fped.2024.1373848] [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: 01/20/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction We assessed clinical and laboratory parameters associated with early recurrence of febrile seizure in patients presenting at the Emergency Department with a first episode. Methods Case series of patients admitted to the emergency department with the first episode of febrile seizure for ten consecutive years. Exclusion criteria were focal features and prolonged duration (>15 min). Results We included 693 patients, 284 (41%) female. Median age of 20 (IQR 15-27) months. Fifty-two (8%) patients had a recurrence within 24 h. At univariate analysis, patients with recurrent seizures had higher use of antipyretics (88% vs. 74%, P = 0.03, OR 2.6, 95% CI: 1.1-7.7), higher median maximal body temperature (39.3 °C, IQR 38.9-39.9, vs. 38.9, IQR 38.4-39.3, P < 0.001, OR 2.3, 95% CI: 1.5-2.6) and presented with a lower proportion of respiratory tract infections (54% vs. 70%, P = 0.02) compared to patients without recurrence. A maximal body temperature equal to or higher than 39 °C was associated with a higher recurrence (11% vs. 4%, P < 0.001, OR 2.9, 95% CI: 1.6-5.6). Hyponatremia was not associated with a risk of recurrence. The multivariate analysis confirmed a direct association with body temperature (OR 2.3, 95% CI: 1.5-3.7, P < 0.001), and an inverse association with respiratory tract infections (OR 0.4, 95% CI: 0.2-0.9, P = 0.01), while antipyretic use was not correlated (OR 1.9, 95% CI: 0.8-5.2, P = 0.2). Conclusions High body temperature and respiratory tract infections were (directly and inversely) associated with recurrences. Consideration of these conditions might help for anticipating the probability of recurrence.
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Affiliation(s)
- Massimo Luca Castellazzi
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adriano La Vecchia
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Martina Scali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Giada Di Pietro
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gregorio Paolo Milani
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
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Bakkannavar S, Faheem Y, Jaiswal A, Shergill K, Boppana K, Almansouri NE, Hamid P. Associative Patterns Between Iron Deficiency Anemia and Febrile Seizures in the Five to 60 Months Age Group: A Comprehensive Systematic Review. Cureus 2024; 16:e56470. [PMID: 38638769 PMCID: PMC11024880 DOI: 10.7759/cureus.56470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Febrile seizures (FS) are commonly seen in younger age groups. The cause of seizures is multifactorial, including viral illnesses, certain vaccines such as MMR (measles, mumps, rubella), family history of FS, and certain mineral deficiencies like zinc. Iron deficiency anemia (IDA) is the most common cause of anemia in children of the same age group. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This review aimed to investigate the correlation between IDA and fever convulsions. A systematic literature search was conducted using PubMed and Google Scholar databases for studies published between January 2013 and September 2023. The following keywords were used to search the articles: "children", "febrile seizures", and "iron deficiency anemia", using all possible combinations and using the word "and" between them. Following the inclusion and exclusion criteria application, we included 23 case-control studies written in the English language in this study. Quality assessment of studies was done using the Newcastle Ottawa Scale.
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Affiliation(s)
- Saloni Bakkannavar
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davanagere, IND
| | - Youmna Faheem
- Medicine, Ras Al Khaimah Medical & Health Sciences University, Ras Al Khaimah, ARE
- Medicine, New Medical Center Royal Hospital, Abu Dhabi, ARE
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amisha Jaiswal
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kainaat Shergill
- Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Maharishi Markandeshwar Institute of Medical Sciences & Research, Ambala, IND
| | - Kusalik Boppana
- Gastroenterology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Naiela E Almansouri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Shao L, Yu Y. Development of a prediction nomogram model of recurrent febrile seizures in pediatric children. Eur J Pediatr 2023; 182:4875-4888. [PMID: 37597045 DOI: 10.1007/s00431-023-05133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/21/2023]
Abstract
The purpose of this study is to develop a prediction nomogram of recurrent febrile seizures in pediatric children based on the identified predictors for developing recurrent febrile seizures. This is a retrospective observational study. The medical records of 320 febrile seizure-afflicted children admitted to Zhoushan Women and Children Hospital from March 2019 to January 2023 were retrospectively reviewed. Children were divided into the recurrent febrile seizures group and the non-recurrent febrile seizures group. The predictors of recurrent febrile seizures were identified by univariate and multivariate analyses. A prediction nomogram model was developed via R software. The performance of the nomogram was internally validated to assess the model's discrimination and consistency, and decision curve analysis was employed to assess clinical utility. There were 41 out of 320 cases that had recurrent febrile seizures during the observation period, with a 12.81% prevalence rate of recurrent febrile seizures. The predictors of recurrent febrile seizures were young age at the first febrile seizures, a family history of febrile seizures in a first-degree relative, diurnal variation of initial febrile seizures occurrence, gender, and a low level of C-reactive protein. The area under the receiver operating characteristic curve of the nomogram is 0.795 (95% confidence interval: 0.720-0.871). Calibration plots and the result of the Hosmer-Lemeshow test (P = 0.472) reveal satisfactory consistency. Decision curve analysis showed a significant net benefit of the nomogram. CONCLUSIONS The prediction nomogram model demonstrates good performance and clinical utility, which would be a convenient tool for the detection of children in pediatrics with high-risk recurrent febrile seizures. It is useful for pediatric medical staff to provide early medical interventions and family counseling. WHAT IS KNOWN • A proportion of children experience recurrences of febrile seizures. • Recognition of risk factors for recurrent FS in pediatrics would be useful for the prediction of risk probabilities and help provide tailored counseling and follow-up. WHAT IS NEW • A nomogram model is developed for risk prediction of recurrent febrile seizures in this study, which would be a convenient risk prediction tool in pediatrics. • The predictor of diurnal variation of recurrent febrile seizures is with new ideas.
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Affiliation(s)
- Lingling Shao
- The Department of Pediatric Ward, Zhoushan Women and Children Hospital, No. 238 Renmin North Road, Dinghai District, Zhoushan, 316000, Zhejiang, China
| | - Youna Yu
- The Department of Pediatric Ward, Zhoushan Women and Children Hospital, No. 238 Renmin North Road, Dinghai District, Zhoushan, 316000, Zhejiang, China.
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Biltz S, Speltz L. Febrile Seizures. Pediatr Ann 2023; 52:e388-e393. [PMID: 37820706 DOI: 10.3928/19382359-20230829-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Febrile seizures (FSs) are the most common cause of pediatric seizures. They are defined as seizures in children age 6 months to 5 years with a temperature higher than 100.4°F, although they are more common at higher temperatures. A family history of FS is the most common risk factor. FSs are classified into three types (simple, complex, or febrile status epilepticus) based on duration and quality, with simple FSs accounting for many cases. Most FSs persist for less than 10 minutes and are self-limiting. Approximately one-third of patients will have recurrence of FSs. Safe and effective prophylaxis for FS has yet to be identified. Most patients will not have any long-term sequelae, although there is an increased risk of epilepsy, particularly for those with febrile status epilepticus. FSs are associated with caregiver anxiety, "fever phobia," and high health care use, emphasizing the importance of education and reassurance for both the provider and family. [Pediatr Ann. 2023;52(10):e388-e393.].
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Cappellari AM, Mariani S, Bruschi G. Febrile seizures and convulsions with mild gastroenteritis: age-dependent acute symptomatic seizures. Front Pediatr 2023; 11:1151770. [PMID: 37534200 PMCID: PMC10390780 DOI: 10.3389/fped.2023.1151770] [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: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Background Febrile seizures (FS) and benign convulsions in children with mild gastroenteritis (CwG) are acute symptomatic seizures, transiently occurring in infants and young children, probably related to the immaturity of the brain. Our paper aims to review the literature data on patients with FS and CwG. Methods A review of series of patients with FS and CwG was performed by literature search on PubMed January 1960 to October 2022. Several parameters were considered, including epidemiology, pathophysiology, clinical features, electroencephalographic findings and other diagnostic studies, and treatment. Results FS and CwG share an age-dependent course, but they show significant differences in the pathophysiology, clinical features, diagnostic studies, and treatment. Conclusion Acute symptomatic seizures include seizures that are caused by acute structural brain pathologies, such as stroke, as well as seizures that are provoked by a reversible factor, such as hyponatraemia, although the two groups should be not equated. Furthermore, FS and CwG should be set apart as "age-dependent acute symptomatic seizures", reinforcing the concept of their self-limited course over a certain period.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Mariani
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
| | - Gaia Bruschi
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
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10
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Tewari BP, Harshad PA, Singh M, Joshi NB, Joshi PG. Pilocarpine-induced acute seizure causes rapid area-specific astrogliosis and alters purinergic signaling in rat hippocampus. Brain Res 2023:148444. [PMID: 37290610 DOI: 10.1016/j.brainres.2023.148444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
The progressive nature of acquired epilepsy warrants a thorough examination of acute changes that occur immediately after an epileptogenic insult to better understand the cellular and molecular mechanisms that trigger epileptogenesis. Astrocytes are important regulators of neuronal functions and emerging evidence suggests an involvement of astrocytic purinergic signaling in the etiology of acquired epilepsies. However, how astrocytic purinergic signaling responds immediately after an acute seizure or an epileptogenic insult to impact epileptogenesis is not well studied. In the present study, we report area-specific rapid onset of astrocytic changes in morphology, as well as in expression and functional activity of the purinergic signaling in the hippocampus that occur immediately after pilocarpine-induced stage 5 seizure. After 3 hours of stage 5 acute seizure, hippocampal astrocytes show increased intrinsic calcium activity in stratum radiatum as well as reactive astrogliosis in the stratum lacunosum moleculare and hilus regions of the hippocampus. Hilar astrocytes also upregulated the expression of P2Y1 and P2Y2 metabotropic purinergic receptors. Subsequently, P2Y1 exhibited a functional upregulation by showing a significantly higher intracellular calcium rise in ex-vivo hippocampal slices on P2Y1 activation. Our results suggest that hippocampal astrocytes undergo rapid area-specific morphological and functional changes immediately after the commencement of the seizure activity and purinergic receptors upregulation is one of the earliest changes in response to seizure activity. These changes can be considered acute astrocytic responses to seizure activity which can potentially drive the epileptogenesis and can be explored further to identify astrocyte-specific targets for seizure therapy.
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Affiliation(s)
- Bhanu P Tewari
- Department of Biophysics, National Institute of mental health and Neuroscience (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India.
| | - P A Harshad
- Department of Biophysics, National Institute of mental health and Neuroscience (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Mahendra Singh
- Department of Biophysics, National Institute of mental health and Neuroscience (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nanda B Joshi
- Department of Biophysics, National Institute of mental health and Neuroscience (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India
| | - Preeti G Joshi
- Department of Biophysics, National Institute of mental health and Neuroscience (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India.
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Respiratory Syncytial Virus: An Uncommon Cause of Febrile Seizures-Results from a Systematic Review and Meta-Analysis. Pediatr Rep 2022; 14:464-478. [PMID: 36412662 PMCID: PMC9680341 DOI: 10.3390/pediatric14040055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a highly contagious viral pathogen. In infants, it is usually listed among the main causes of medical referrals and hospitalizations, particularly among newborns, and a considerable base of evidence associates RSV infections and bronchiolitis with long-term neurological sequelae. We specifically performed a systematic review and meta-analysis in order to ascertain whether RSV infections may be associated with an increased risk for febrile seizures (FS) in infected infants. According to the PRISMA statement, Pubmed, Embase, and pre-print archive medRxiv.og were searched for eligible observational studies published up to 1 July 2022. Raw data included the incidence of FS among children admitted for influenza-like illness (ILI) and/or bronchiolitis, with a confirmed diagnosis of RSV or seasonal influenza virus (SIV) infection. Data were then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 11 studies including 6847 cases of RSV infections were retrieved, with a pooled prevalence of 29.975 cases of FS per 1000 RSV cases (I2 = 88.5%). The prevalence was not substantially greater in studies performed in pediatric intensive care units (53.817 per 1000 RSV cases vs. 23.552, p = 0.12). Higher occurrence of FS was reported from studies performed after 2010 (Risk Ratio [RR] 1.429, 95% Confidence Interval [95%CI] 1.049-1.948), and in China (RR 2.105, 95%CI 1.356-3.266) and South Africa (RR 1.722, 95%CI 1.060-2.824) than in Europe, while a lower occurrence was reported form the USA (RR 0.414, 95%CI 0.265-0.649). Eventually, FS were less likely reported from RSV cases compared to subjects affected by seasonal influenza (RR 0.402; 95%CI 0.228-0.708). Although RSV is often associated with high risk of neurological complications, substantially less cases of FS are reported than in SIV infections. However, the paucity of available studies recommends a cautious appraisal of aforementioned results.
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