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Yabe M, Fukuyama T, Motoki N, Toubou H, Hasegawa K, Shibazaki T, Tsukahara T, Nomiyama T. Hypertensive disorders of pregnancy increase the incidence of febrile seizures in offspring. Pediatr Res 2024; 96:223-229. [PMID: 38310196 DOI: 10.1038/s41390-024-03057-y] [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] [Received: 07/27/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Intrauterine exposure to hypertensive disorders of pregnancy (HDP) may increase the risk of neuropsychiatric disorders. This investigation examined for associations between maternal HDP and febrile seizures (FS) in offspring by the age of three years. METHODS The present cohort study analyzed data from the Japan Environment and Children's Study, a large national birth cohort. We included mother-child pairs recruited between January 2011 and March 2014. Information regarding maternal HDP, the presence of FS in offspring up to 3 years of age, and potential confounding factors were assessed using written questionnaires administered to mothers. RESULTS A total of 77,699 mother-child dyads were analyzed. The prevalence of FS was 8.4% in children without HDP exposure, 10.6% in those exposed to mild HDP, and 10.4% in those with severe HDP exposure. Among children with full-term birth, logistic regression analysis indicated that exposure to mild or severe HDP was significantly associated with a higher incidence of FS (adjusted odds ratio [95% confidence interval]: 1.27 [1.05-1.53] and 1.27 [0.90-1.78], respectively, P for trend = 0.008), compared with children without HDP exposure. CONCLUSION In children with full-term birth, intrauterine exposure to HDP was significantly associated with FS by the age of three years. IMPACT This study revealed a significant association between intrauterine exposure to hypertensive disorders of pregnancy (HDP) and the subsequent development of febrile seizures (FS) in offspring by three years. This increased incidence of FS by HDP was independent of preterm birth status. This is the first large nationwide birth cohort study showing the impact of intrauterine exposure to HDP on FS in early childhood.
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Affiliation(s)
- Manami Yabe
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuhiro Fukuyama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Noriko Motoki
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hirokazu Toubou
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kohei Hasegawa
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takumi Shibazaki
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruomi Tsukahara
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuo Nomiyama
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Leung JSC. Febrile Seizures: An Updated Narrative Review for Pediatric Ambulatory Care Providers. Curr Pediatr Rev 2024; 20:43-58. [PMID: 36043723 DOI: 10.2174/1573396318666220829121946] [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: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While generally self-limited, febrile seizures result in significant familial distress. Ambulatory pediatric care providers must be prepared to counsel families on the causes, risk factors, management principles, and prognosis of children with febrile seizures. OBJECTIVE To provide an updated, evidence-based review of febrile seizures focused on the needs of an ambulatory pediatric care provider. METHODS A narrative review of the literature prioritizing landmark articles, metanalyses, longitudinal population longitudinal cohort studies and national level guidelines. RESULTS Febrile seizures are aberrant physiological responses to fever in children caused by complex interactions of cytokine mediated neuroinflammation, environmental triggers, and genetic predisposition. Other than investigations to determine fever etiology, routine bloodwork, lumbar punctures, neuroimaging and electroencephalograms are low yield. The general prognosis is excellent, however, clinicians should be aware of long-term outcomes including: cognitive impairment with non-simple febrile seizures; neuropsychiatric associations; recurrent febrile seizure and epilepsy risk factors; and the association between complex febrile seizures and sudden unexpected death. Children with a high risk of recurrence, complex febrile seizures, limited access to care, or extreme parental anxiety may benefit from intermittent oral diazepam prophylaxis. CONCLUSION Clinicians should consider four management priorities: 1) terminating the seizure; 2) excluding critical differential diagnoses; 3) investigating fever etiology; and 4) providing adequate counselling to families. The clinical approach and prognosis of febrile seizure can be based on subtype. Children with non-simple (i.e. complex or febrile status epilepticus) febrile seizures require closer care than the vast majority of children with simple febrile seizures, who have excellent outcomes.
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Affiliation(s)
- James Sze-Chuck Leung
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Na JY, Cha JH, Moon JH, Lee H, Kim YJ, Cho Y. Protective Effect of Breastfeeding Against Febrile Seizure: A Nationwide Study in Korea. Pediatr Neurol 2023; 138:52-57. [PMID: 36395574 DOI: 10.1016/j.pediatrneurol.2022.10.005] [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: 05/13/2022] [Revised: 09/22/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breastfeeding is known to protect against febrile seizure (FS). Whether its impact continues throughout the childhood period is still controversial. Our objective was to investigate the protective effect of breastfeeding against FS stratified by age. METHODS We included children who participated in the National Health Screening Program for Infants and Children (NHSPIC) aged between four and six months between 2008 and 2014. Feeding type was confirmed based on the NHSPIC questionnaire, and data from the Korean National Health Insurance Service were used to determine FS cases during a five-year follow-up period. RESULTS Among the 1,791,335 children, the most prevalent feeding type was exclusive breastfeeding (EB) (42.3%). FS occurred most frequently in the exclusive formula feeding (EF) group (12.2%), followed by the partial breastfeeding (PB) (11.3%) and EB groups (10.7%). Compared with the EF group, the adjusted odds ratio for FS was 0.87 (95% confidence interval, 0.86 to 0.88, P < 0.001) and 0.93 (0.92 to 0.94, P < 0.001) in the EB and PB groups, respectively. The protective effect by age 2.5 years was significant in both the EB (0.85; 0.84 to 0.86, P < 0.001) and PB (0.92; 0.90 to 0.93, P < 0.001) groups. In contrast, the protective effect was not significant in the PB group and inconsistent in the EB group after 2.5 years. CONCLUSION Breastfeeding has a protective effect against FS in the most prevalent age period, from 0 to 2.5 years. Despite the limited effect after age 2.5 years, we support the current recommendation for prolonged breastfeeding to promote childhood health.
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Affiliation(s)
- Jae Yoon Na
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jong Ho Cha
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jin-Hwa Moon
- Department of Pediatrics, College of Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Yong Joo Kim
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
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4
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Tiwari A, Meshram RJ, Kumar Singh R. Febrile Seizures in Children: A Review. Cureus 2022; 14:e31509. [DOI: 10.7759/cureus.31509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
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Christensen KJ, Dreier JW, Skotte L, Feenstra B, Grove J, Børglum AD, Mitrovic M, Cotsapas C, Christensen J. Seasonal Variation and Risk of Febrile Seizures: A Danish Nationwide Cohort Study. Neuroepidemiology 2022; 56:138-146. [PMID: 35051933 PMCID: PMC9018567 DOI: 10.1159/000522065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/30/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Onset of febrile seizures varies with calendar season. However, it has not previously been assessed, how season of birth interacts with age and peak risk of febrile seizures, and whether season of birth correlates with the cumulative risk of febrile seizures at 5 years of age (i.e., when children are no longer of risk of febrile seizures). METHODS We identified all singleton children born in Denmark between 1977 and 2011 who were alive at 3 months of age (N = 2,103,232). We used the Danish Civil Registration System to identify age and sex of the children and the Danish National Patient Register to identify children hospitalized with febrile seizures from 3 months to 5 years of age. Follow-up ended on December 31, 2016, when all children had reached 5 years of age. RESULTS The relative risk of admission with a first febrile seizure varied with calendar month; in February (a winter month in Denmark), the risk was more than doubled (hazard ratio: 2.10 [95% confidence interval [CI]: 2.03-2.18]) compared with August (a summer month in Denmark). The age-specific incidence of a first febrile seizure by birth month identified the highest peak incidence of a first febrile seizure among children born in November (reaching a peak incidence of 350 first admissions with a febrile seizure per 100,000 person months at age 16 months) as compared to children born in July (reaching a peak incidence of 200 first admissions with a febrile seizure per 100,000 person months at age 16 months). However, the cumulative incidence of any admission with febrile seizures before 5 years was not correlated with season of birth (3.69% [95% CI: 3.64-3.74%] for winter births, 3.57% [95% CI: 3.52-3.62%] for spring births, 3.55% [95% CI: 3.50-3.59%] for summer births, and 3.64% [95% CI: 3.59-3.69%] for fall births). DISCUSSION/CONCLUSION The study found a significant seasonal variation in onset of the first febrile seizure and in the age-specific peak incidence of febrile seizures. However, there was no correlation between season of birth and cumulative incidence of febrile seizures at 5 years of age suggesting that children who are predisposed to febrile seizures will eventually go on to experience a febrile seizure regardless of season of birth.
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Affiliation(s)
- Kirstine J. Christensen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Denmark,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Julie W. Dreier
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Denmark
| | - Line Skotte
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jakob Grove
- Department of Biomedicine, Aarhus University, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Anders D. Børglum
- Department of Biomedicine, Aarhus University, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Mitja Mitrovic
- Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Chris Cotsapas
- Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Jakob Christensen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Denmark,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Christensen KJ, Dreier JW, Skotte L, Feenstra B, Grove J, Børglum A, Mitrovic M, Cotsapas C, Christensen J. Birth characteristics and risk of febrile seizures. Acta Neurol Scand 2021; 144:51-57. [PMID: 33822360 DOI: 10.1111/ane.13420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Febrile seizure is a common childhood disorder that affects 2-5% of all children, and is associated with later development of epilepsy and psychiatric disorders. This study determines how the incidence of febrile seizures correlates with birth characteristics, age, sex and brain development. METHODS This is a cohort study of all children born Denmark between 1977 and 2011 who were alive at 3 months of age (N = 2,103,232). The Danish National Patient Register was used to identify children with febrile seizures up to 5 years of age. Follow-up ended on 31 December 2016 when all cohort members had potentially reached 5 years of age. RESULTS In total, 75,593 (3.59%, 95% CI: 3.57-3.62%) were diagnosed with febrile seizures. Incidence peaked at 16.7 months of age (median: 16.7 months, interquartile range: 12.5-24.0). The 5-year cumulative incidence of febrile seizures increased with decreasing birth weight (<1500 g; 5.42% (95% CI: 4.98-5.88% vs. 3,000-4,000 g; 3.53% (95% CI: 3.50-3.56%)) and with decreasing gestational age at birth (31-32 weeks; 5.90% (95% CI: 5.40-6.44%) vs. 39-40 weeks; 3.56% (95% CI: 3.53-3.60)). Lower gestational age at birth was associated with higher age at onset of a first febrile seizure; an association that essentially disappeared when correcting for age from conception. CONCLUSIONS The risk of febrile seizures increased with decreasing birth weight and gestational age at birth. The association between low gestational age at birth and age at first febrile seizure suggests that onset of febrile seizures is associated with the stage of brain development.
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Affiliation(s)
- Kirstine J. Christensen
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Julie W. Dreier
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
| | - Line Skotte
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Bjarke Feenstra
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Jakob Grove
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Anders Børglum
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Mitja Mitrovic
- Department of Neurology Yale School of Medicine New Haven CT USA
| | - Chris Cotsapas
- Department of Neurology Yale School of Medicine New Haven CT USA
| | - Jakob Christensen
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
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Nishiyama M, Yamaguchi H, Ishida Y, Tomioka K, Takeda H, Nishimura N, Nozu K, Mishina H, Iijima K, Nagase H. Seizure prevalence in children aged up to 3 years: a longitudinal population-based cohort study in Japan. BMJ Open 2020; 10:e035977. [PMID: 32912975 PMCID: PMC7485243 DOI: 10.1136/bmjopen-2019-035977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of seizures/febrile seizures in children up to 3 years of age and examine the effects of gestational age at birth on the risk for febrile seizures. DESIGN Retrospective longitudinal population-based cohort study. SETTING Kobe City public health center, Kobe, Japan, from 2010 to 2018. PARTICIPANTS Children who underwent a medical check-up at 3 years of age. METHODS Information regarding seizures was collected from the parents of 96 014 children. We identified the occurrence of seizure/febrile seizure in 74 017 children, whose gestational ages at birth were noted. We conducted a multivariate analysis with the parameter, gestational age at birth, to analyse the risk of seizure. We also stratified the samples by sex and birth weight (<2500 g or not) and compared the prevalence of seizure between those with the term and late preterm births. RESULTS The prevalence of seizure was 12.1% (11.8%-12.3%), 13.2% (12.2%-14.4%), 14.6% (12.4%-17.7%) and 15.7% (10.5%-22.8%) in children born at 37-41, 34-36, 28-33 and 22-27 gestational weeks, respectively. The prevalence of febrile seizures was 9.0% (8.8%-9.2%), 10.5% (9.5%-11.5%), 11.8% (9.7%-14.5%) and 11.2% (6.9%-17.7%) in children born at 37-41, 34-36, 28-33 and 22-27 gestational weeks, respectively. Male was an independent risk factor for seizures (OR: 1.15, 95% CI 1.09 to 1.20; absolute risk increase 0.014, 95% CI 0.010 to 0.019) and febrile seizures (OR: 1.21, 95% CI 1.15 to 1.28; absolute risk increase 0.016, 95% CI 0.012 to 0.020), respectively. Late preterm birth was not associated with an increased risk of seizure/febrile seizure. CONCLUSIONS Although very preterm birth may increase the risk of seizure/febrile seizure, the risk associated with late preterm birth is considerably small and less than that associated with male.
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Affiliation(s)
- Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Takeda
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Nishimura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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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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Rolschau AH, Olesen AW, Obel C, Olsen J, Wu CS, Kofoed PE. Cerebral disorders in the first 7 years of life in children born post-term: a cohort study. BMC Pediatr 2020; 20:51. [PMID: 32013923 PMCID: PMC6996181 DOI: 10.1186/s12887-020-1950-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background To estimate the association between post-term delivery and risk of physical disabilities, mental disabilities, and seizures during the first 7 years of life. Methods Data from 57,884 singleton infants born alive in week 39–45 by mothers included in the Danish National Birth Cohort (1997 to 2004) were analyzed, of these 51,268 were born at term (39–41 + 6) and 6616 post-term (42 + 0–44 + 6). Information on clinical endpoints was obtained from an interview at 18 months of gestational age, from a 7-year questionnaire, and from the Danish National Patient Register. Logistic regression and Cox regression were used to estimate odds ratios and hazard rate ratios for the outcome obtained from the interview/questionnaire data and from the register-based data, respectively. Results We found no statistically significant increased risk of physical disabilities, mental disabilities, and epilepsy among children born post-term, though for most outcomes studied a tendency towards more adverse outcomes was seen. When children born late term (week 41) were compared to children born in week 42 or later the same tendency was found. Conclusion Post-term born children had a tendency to an excess risk of neurological disabilities as followed for up to 7 years of age.
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Affiliation(s)
- Anne Hald Rolschau
- Department of Gynecology and Obstetrics, Lillebaelt Hospital, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Pediatrics, Lillebaelt Hospital, Kolding Hospital, Sygehusvej 24, 6000, Kolding, Denmark
| | - Annette Wind Olesen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Obel
- Research Unit for Mental Public Health, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Chunsen S Wu
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research Unit on Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Poul-Erik Kofoed
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Department of Pediatrics, Lillebaelt Hospital, Kolding Hospital, Sygehusvej 24, 6000, Kolding, Denmark.
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10
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Baker MA, Jankosky C, Yih WK, Gruber S, Li L, Cocoros NM, Lipowicz H, Coronel-Moreno C, DeLuccia S, Lin ND, McMahill-Walraven CN, Menschik D, Selvan MS, Selvam N, Chen Tilney R, Zichittella L, Lee GM, Kawai AT. The risk of febrile seizures following influenza and 13-valent pneumococcal conjugate vaccines. Vaccine 2020; 38:2166-2171. [PMID: 32019703 DOI: 10.1016/j.vaccine.2020.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/04/2020] [Accepted: 01/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence on the risk of febrile seizures after inactivated influenza vaccine (IIV) and 13-valent pneumococcal conjugate vaccine (PCV13) is mixed. In the FDA-sponsored Sentinel Initiative, we examined risk of febrile seizures after IIV and PCV13 in children 6-23 months of age during the 2013-14 and 2014-15 influenza seasons. METHODS Using claims data and a self-controlled risk interval design, we compared the febrile seizure rate in a risk interval (0-1 days) versus control interval (14-20 days). In exploratory analyses, we assessed whether the effect of IIV was modified by concomitant PCV13 administration. RESULTS Adjusted for age, calendar time and concomitant administration of the other vaccine, the incidence rate ratio (IRR) for risk of febrile seizures following IIV was 1.12 (95% CI 0.80, 1.56) and following PCV13 was 1.80 (95% CI 1.29, 2.52). The attributable risk for febrile seizures following PCV13 ranged from 0.33 to 5.16 per 100,000 doses by week of age. The age and calendar-time adjusted IRR comparing exposed to unexposed time was numerically larger for concomitant IIV and PCV13 (IRR 2.80, 95% CI 1.63, 4.83), as compared to PCV13 without concomitant IIV (IRR 1.54, 95% CI 1.04, 2.28), and the IRR for IIV without concomitant PCV13 suggested no independent effects of IIV (IRR 0.94, 95% CI 0.63, 1.42). Taken together, this suggests a possible interaction between IIV and PCV13, though our study was not sufficiently powered to provide a precise estimate of the interaction. CONCLUSIONS We found an elevated risk of febrile seizures after PCV13 vaccine but not after IIV. The risk of febrile seizures after PCV13 is low compared to the overall risk in this population of children, and the risk should be interpreted in the context of the importance of preventing pneumococcal infections.
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Affiliation(s)
- Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | | | - W Katherine Yih
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Susan Gruber
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Lingling Li
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Hana Lipowicz
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Claudia Coronel-Moreno
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sandra DeLuccia
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | - David Menschik
- FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | | | | | - Rong Chen Tilney
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Lauren Zichittella
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Grace M Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Alison Tse Kawai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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11
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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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12
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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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Febrile seizures: Are they truly benign? Longitudinal analysis of risk factors and future risk of afebrile epileptic seizure based on the national sample cohort in South Korea, 2002–2013. Seizure 2019; 64:77-83. [DOI: 10.1016/j.seizure.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 11/20/2022] Open
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Chiang LM, Huang GS, Sun CC, Hsiao YL, Hui CK, Hu MH. Association of developing childhood epilepsy subsequent to febrile seizure: A population-based cohort study. Brain Dev 2018; 40:775-780. [PMID: 29801922 DOI: 10.1016/j.braindev.2018.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/15/2017] [Accepted: 05/09/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Epilepsy is an important neurological condition that frequently associated with neurobehavioral disorders in childhood. Our aim was to identify the risk of developing epilepsy subsequent to febrile seizure and the association between epilepsy risk factors and neurobehavioral disorders. SUBJECTS AND METHODS This longitudinal population-based cohort data included 952 patients with a febrile seizure diagnosis and 3808 age- and sex-matched controls. Participants were recruited for the study from 1996 to 2011, and all patients were followed up for maximum 12.34 years. RESULTS The association of epilepsy was significantly higher (18.76-fold) in individuals that experienced febrile seizure compared to controls. Further, of those individuals who experienced febrile seizure, the frequency of subsequent development of epilepsy was 2.15-fold greater in females, 4.846-fold greater in patients with recurrent febrile seizure, and 11.26-fold greater patients with comorbid autism. CONCLUSIONS Our study showed that being female, comorbid autism with febrile seizure and recurrent febrile seizure had an increased association with development of epilepsy. Increased recognition the association for epilepsy might be warranted in those febrile seizure children with certain characteristics.
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Affiliation(s)
- Lin-Mei Chiang
- Department of Pediatric, Keelung Branch, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Go-Shine Huang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Keelung Branch, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Li Hsiao
- Department of Medical Research and Development, Keelung Branch, Chang Gung Memorial Hospital, Taiwan
| | - Chung Kun Hui
- Department of Anesthesiology, Keelung Branch, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Hua Hu
- Division of Pediatric General Medicine, Chang Gung Memorial Hospital, LinKou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Sociodemographic risk factors for febrile seizures: A school-based study from Izmir, Turkey. Seizure 2018; 61:45-49. [PMID: 30081300 DOI: 10.1016/j.seizure.2018.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Despite the fact that socioeconomic and environmental factors of a population are changing over time, there are few studies focusing on the effects of sociodemographic factors on the prevalence of febrile seizures (FS). This study was designed to find out the prevalence of FS and to investigate the effect of socio-cultural and economic factors on this prevalence among the Turkish school children. METHODS A school-based, cross-sectional study was conducted in first and second-class children. Data were collected through a questionnaire from the parents who agreed to be involved in the study. The survey had questions about some socioeconomic and demographic features of the children and febrile seizure episodes. RESULTS 3806 children and parent pairs accepted to participate in the survey. Febrile seizure prevalence was 4.8%. It was found that the prevalence of FS was significantly associated with the chronic illnesses of a child that requires continuous medication, developmental delay of a child, NICU history, gestational hypertension history of a mother, and lower educational level of a mother. Recurrence of FS was observed in 32.9% of children. Children whose first FS was seen below the 39 °C had 1.9 times more recurrence risk. CONCLUSION FS prevalence rate has declined from 9.7% to 4.3% in our study population within ten years. It was thought that advancing healthcare systems in our country might be decreased the prevalence. Our study enabled us to find out sociodemographic risk factors of FS, but further studies are needed in order to confirm the effect of sociodemographic factors on FS prevalence.
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16
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Kasahara Y, Ikegaya Y, Koyama R. Neonatal Seizure Models to Study Epileptogenesis. Front Pharmacol 2018; 9:385. [PMID: 29720941 PMCID: PMC5915831 DOI: 10.3389/fphar.2018.00385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/04/2018] [Indexed: 12/11/2022] Open
Abstract
Current therapeutic strategies for epilepsy include anti-epileptic drugs and surgical treatments that are mainly focused on the suppression of existing seizures rather than the occurrence of the first spontaneous seizure. These symptomatic treatments help a certain proportion of patients, but these strategies are not intended to clarify the cellular and molecular mechanisms underlying the primary process of epilepsy development, i.e., epileptogenesis. Epileptogenic changes include reorganization of neural and glial circuits, resulting in the formation of an epileptogenic focus. To achieve the goal of developing “anti-epileptogenic” drugs, we need to clarify the step-by-step mechanisms underlying epileptogenesis for patients whose seizures are not controllable with existing “anti-epileptic” drugs. Epileptogenesis has been studied using animal models of neonatal seizures because such models are useful for studying the latent period before the occurrence of spontaneous seizures and the lowering of the seizure threshold. Further, neonatal seizure models are generally easy to handle and can be applied for in vitro studies because cells in the neonatal brain are suitable for culture. Here, we review two animal models of neonatal seizures for studying epileptogenesis and discuss their features, specifically focusing on hypoxia-ischemia (HI)-induced seizures and febrile seizures (FSs). Studying these models will contribute to identifying the potential therapeutic targets and biomarkers of epileptogenesis.
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Affiliation(s)
- Yuka Kasahara
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuji Ikegaya
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Ryuta Koyama
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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17
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Gontko-Romanowska K, Żaba Z, Panieński P, Steinborn B, Szemień M, Łukasik-Głębocka M, Ratajczak K, Chrobak A, Mitkowska J, Górny J. The assessment of risk factors for febrile seizures in children. Neurol Neurochir Pol 2017; 51:454-458. [PMID: 28803641 DOI: 10.1016/j.pjnns.2017.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 12/13/2016] [Accepted: 07/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the paper was to assess the risk factors of febrile seizures in children. METHODS The paper presents an analysis of a group of 176 children aged 6 months to 5 years who were admitted to A&E because of febrile seizures. RESULTS The analysed group of 176 children comprised 61.96% boys and 38.07% girls, and the average age equalled 23 months. Family history was significant in 9.66% of patients. A statistically significant difference was noticed between insignificant family history and the incidence of febrile seizures. In all the studied groups of children the factor that determined the incidence of febrile seizures was a sudden increase in the body temperature with an infection of the upper respiratory tract of several day's duration as another cause. Febrile seizure incident was most frequently associated with a sudden increase in the body temperature in 53.40% children. A statistically significant difference was observed between persisting fever and an increase thereof during the day. Yet another factor predisposing for febrile seizures incidence was an infection of the upper respiratory system that could be observed in 32.95% patients. The mean body temperature when the seizures occurred was 38.9°C. CONCLUSIONS A sudden increase in the body temperature within the first day of pyrexia predisposes for the incidence of febrile seizures and it was proved that it depends on how long fever persists during the day. The other factor triggering the seizures was an infection of the upper respiratory tract of several days' duration.
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Affiliation(s)
- Krystyna Gontko-Romanowska
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland; Specialised Health Care Centre for Mother and Child, Poznan, Poland.
| | - Zbigniew Żaba
- Specialised Health Care Centre for Mother and Child, Poznan, Poland
| | - Paweł Panieński
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland; Specialised Health Care Centre for Mother and Child, Poznan, Poland
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Szemień
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Krystian Ratajczak
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Chrobak
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Mitkowska
- Specialised Health Care Centre for Mother and Child, Poznan, Poland
| | - Jacek Górny
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
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18
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Gholipoor P, Saboory E, Ghazavi A, Kiyani A, Roshan-Milani S, Mohammadi S, Javanmardi E, Rasmi Y. Prenatal stress potentiates febrile seizure and leads to long-lasting increase in cortisol blood levels in children under 2years old. Epilepsy Behav 2017; 72:22-27. [PMID: 28570964 DOI: 10.1016/j.yebeh.2017.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/12/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
Neurological disorders can be exacerbated in an offspring that is exposed to stress prenatally. This study is aimed to investigate the severity of febrile seizures (FS) in the offspring under 2years old that were prenatally stressed. In this study, 158 children below 2years old with FS were selected. Information about convulsion including seizure lasting, recurrence of seizure, age of the first seizure and type of FS was gathered. Blood samples were obtained from the offspring to measure the cortisol blood levels. Questionnaire was filled in to evaluate the perceived stress and exposure or non-exposure to major stresses during pregnancy. Results of this study showed that both high Perceived Stress Scores (PSS) during pregnancy and exposure to major stresses during pregnancy significantly increased seizure duration and seizure intensity. Also, the appearance of complex FS was significantly higher in prenatally stressed children than the unexposed ones. Further, cortisol blood levels were significantly higher in prenatally stressed subjects. It can be concluded that both higher PSS and/or exposure to major stresses during pregnancy potentiate FS parameters and lead to long lasting increase in cortisol blood levels in the offspring.
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Affiliation(s)
- Peyman Gholipoor
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Ehsan Saboory
- Neurophysiology Research Center, Urmia University of Medical sciences, Urmia, Iran.
| | - Ahad Ghazavi
- Neurophysiology Research Center, Urmia University of Medical sciences, Urmia, Iran.
| | - Arezoo Kiyani
- Neurophysiology Research Center, Urmia University of Medical sciences, Urmia, Iran.
| | - Shiva Roshan-Milani
- Department of Physiology, Urmia University of Medical sciences, Urmia, Iran.
| | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical sciences, Urmia, Iran.
| | - Elmira Javanmardi
- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
| | - Yousef Rasmi
- Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Halsey NA, Talaat KR, Greenbaum A, Mensah E, Dudley MZ, Proveaux T, Salmon DA. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2016; 33 Suppl 5:F1-F67. [PMID: 26822822 DOI: 10.1016/j.vaccine.2015.10.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
Most influenza vaccines are generally safe, but influenza vaccines can cause rare serious adverse events. Some adverse events, such as fever and febrile seizures, are more common in children than adults. There can be differences in the safety of vaccines in different populations due to underlying differences in genetic predisposition to the adverse event. Live attenuated vaccines have not been studied adequately in children under 2 years of age to determine the risks of adverse events; more studies are needed to address this and several other priority safety issues with all influenza vaccines in children. All vaccines intended for use in children require safety testing in the target age group, especially in young children. Safety of one influenza vaccine in children should not be extrapolated to assumed safety of all influenza vaccines in children. The low rates of adverse events from influenza vaccines should not be a deterrent to the use of influenza vaccines because of the overwhelming evidence of the burden of disease due to influenza in children.
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Affiliation(s)
- Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Kawsar R Talaat
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adena Greenbaum
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eric Mensah
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina Proveaux
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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20
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Bauchau V, Van Holle L, Cohen C. Modelling Hospitalisation Ratios for Febrile Convulsions and Severe Varicella Under Combined Measles, Mumps, Rubella, and Varicella (MMRV-Priorix-Tetra™) Compared to Separate MMR + V Vaccination. Drug Saf 2016; 38:1095-102. [PMID: 26251259 PMCID: PMC4608986 DOI: 10.1007/s40264-015-0326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Measles, mumps, rubella, and varicella combination vaccines (MMRV) facilitate varicella vaccination uptake compared with separate administration of measles, mumps, and rubella vaccine (MMR) with varicella vaccine (V). However, the risk of developing febrile convulsions (FC) is higher in children vaccinated with MMRV. Objectives The aim was to demonstrate how to put the increased FC risk associated with MMRV into perspective by comparing it with the lower V-coverage risk associated with MMR + V. Methods FC and varicella burdens were measured by total numbers or duration of hospitalisations. A model, based on several assumptions and integrating parameters from heterogeneous data sources relevant to Germany, was developed to evaluate hospitalisation ratios (HRs; ratios between yearly numbers of varicella-related hospitalisation days prevented by MMRV and yearly numbers of FC-related hospitalisation days attributed to MMRV, both compared with MMR + V). A sensitivity analysis estimated HR under different scenarios beyond the German experience. Results For parameter values compatible with the German experience, where MMRV (Priorix-Tetra™, GSK, Belgium) was introduced in 2006, the model predicted that transitioning from MMR + V to MMRV would induce 225 vaccine-related FC hospitalisation days whilst preventing 1976 varicella-related hospitalisation days per year. The HR estimated by Monte Carlo simulations was 8.5 (95 % confidence interval: 1.99–25.22). A sensitivity analysis on two key parameters suggested that transitioning from MMR + V to MMRV would be favourable in situations where MMRV use would significantly impact varicella vaccination uptake. Conclusions MMRV use instead of MMR + V can substantially reduce the number of hospitalisation days, despite increased FC risk when MMRV is used as a first dose of measles-containing vaccine.
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Affiliation(s)
| | | | - Carine Cohen
- GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
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Tu YF, Wang LW, Wang ST, Yeh TF, Huang CC. Postnatal Steroids and Febrile Seizure Susceptibility in Preterm Children. Pediatrics 2016; 137:peds.2015-3404. [PMID: 27012746 DOI: 10.1542/peds.2015-3404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate risk factors, seizure characteristics, and outcomes of febrile seizure (FS) in children born very preterm. METHODS This study used a prospective registry data set of 844 preterm infants (birth weight <1500 g and gestational age <32 weeks) admitted to NICUs from 2001 to 2009 in southern Taiwan. We investigated the prevalence, risks, seizure patterns, and outcomes of FS in children aged 5 years. RESULTS Among 575 children (follow-up rate, 85.8%) followed up for 5 years, 35 (6.1%) developed FS. The FS and non-FS groups were comparable regarding their mean gestational age, birth weight, 5-minute Apgar score <6, and prenatal and postnatal complications. No difference was observed in the use of prenatal corticosteroids between the 2 groups. The FS group had a significantly higher rate of postnatal corticosteroid treatment than the non-FS group, even after adjusting for confounding factors (odds ratio, 5.4 [95% confidence interval, 1.9-15.8]; P = .006). No differences were observed in IQs or subsequent epilepsy rates between the 2 groups. Although no difference was observed in the age of FS onset or neurodevelopmental outcomes between the 2 groups, children with FS who received postnatal corticosteroid treatment had a significantly lower mean body temperature during the first FS attack compared with those who did not receive postnatal corticosteroid treatment (38.6 ± 0.4°C vs 39.2 ± 0.6°C; P = .034). CONCLUSIONS Children born very preterm have a higher rate of FS, and postnatal corticosteroid treatment was associated with FS susceptibility in these children.
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Affiliation(s)
- Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, Institute of Clinical Medicine, and
| | - Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; and Departments of Pediatrics, College of Medicine, and
| | - Shan-Tair Wang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsu-Fu Yeh
- Departments of Pediatrics, College of Medicine, and
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, Departments of Pediatrics, College of Medicine, and Department of Pediatrics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Cui W, Kobau R, Zack MM, Helmers S, Yeargin-Allsopp M. Seizures in Children and Adolescents Aged 6-17 Years - United States, 2010-2014. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1209-14. [PMID: 26540283 DOI: 10.15585/mmwr.mm6443a2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kawai AT, Martin D, Kulldorff M, Li L, Cole DV, McMahill-Walraven CN, Selvam N, Selvan MS, Lee GM. Febrile Seizures After 2010-2011 Trivalent Inactivated Influenza Vaccine. Pediatrics 2015; 136:e848-55. [PMID: 26371192 DOI: 10.1542/peds.2015-0635] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In the Post-Licensure Rapid Immunization Safety Monitoring Program, we examined risk of febrile seizures (FS) after trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) during the 2010-2011 influenza season, adjusted for concomitant diphtheria tetanus acellular pertussis-containing vaccines (DTaP). Assuming children would receive both vaccines, we examined whether same-day TIV and PCV13 vaccination was associated with greater FS risk when compared with separate-day vaccination. METHODS We used a self-controlled risk interval design, comparing the FS rate in a risk interval (0-1 days) versus control interval (14-20 days). Vaccinations were identified in claims and immunization registry data. FS were confirmed with medical records. RESULTS No statistically significant TIV-FS associations were found in unadjusted or adjusted models (incidence rate ratio [IRR] adjusted for age, seasonality, and concomitant PCV13 and DTaP: 1.36, 95% confidence interval [CI] 0.78 to 2.39). Adjusted for age and seasonality, PCV13 was significantly associated with FS (IRR 1.74, 95% CI 1.06 to 2.86), but not when further adjusting for concomitant TIV and DTaP (IRR 1.61, 95% CI 0.91 to 2.82). Same-day TIV and PCV13 vaccination was not associated with excess risk of FS when compared with separate-day vaccination (1.08 fewer FS per 100 000 with same day administration, 95% CI -5.68 to 6.09). CONCLUSIONS No statistically significant increased risk of FS was found for 2010-2011 TIV or PCV13, when adjusting for concomitant vaccines. Same-day TIV and PCV13 vaccination was not associated with more FS compared with separate-day vaccination.
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Affiliation(s)
- Alison Tse Kawai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts;
| | - David Martin
- US Food and Drug Administration Center for Biologics Evaluation and Research, Silver Spring, Maryland
| | - Martin Kulldorff
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Lingling Li
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David V Cole
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | | | - Mano S Selvan
- Comprehensive Health Insights, Humana Inc, Louisville, Kentucky; and
| | - Grace M Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
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Hoppenbrouwers T. Sudden infant death syndrome, sleep, and seizures. J Child Neurol 2015; 30:904-11. [PMID: 25300988 DOI: 10.1177/0883073814549243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/02/2014] [Indexed: 01/08/2023]
Abstract
benign febrile seizures seen in 7% of infants before 6 months play a role in the terminal pathway in a subset of sudden infant death syndrome victims. Supporting evidence: (1) lack of 5-hydroxitryptamine, one consistent finding in sudden infant death syndrome that Kinney et al coined a developmental serotonopathy, is consistent with risk for seizures. (2) Non-rapid eye movement sleep increasing during the age of highest risk for sudden infant death syndrome facilitates some seizures (seizure gate). (3) Sudden unexpected death in epilepsy is associated with severe hypoxemia and hypercapnia during postictal generalized electroencephalographic (EEG) suppression. In toddlers, sudden unexplained deaths are associated with hippocampal abnormalities and some seizures. (4) The sudden nature of both deaths warrants an exploration of similarities in the terminal pathway. Moreover, sudden infant death syndrome, febrile seizures, sudden unexplained death in childhood, and sudden unexpected death in epilepsy share some of the following risk factors: prone sleeping, infections, hyperthermia, preterm birth, male gender, maternal smoking, and mutations in genes that regulate sodium channels. State-of-the-art molecular studies can be exploited to test this hypothesis.
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Affiliation(s)
- Toke Hoppenbrouwers
- Division of Neonatal Medicine, University of Southern California, Los Angeles, CA, USA
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Storz C, Meindl M, Matuja W, Schmutzhard E, Winkler AS. Community-based prevalence and clinical characteristics of febrile seizures in Tanzania. Pediatr Res 2015; 77:591-6. [PMID: 25580743 DOI: 10.1038/pr.2015.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/15/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence of febrile seizures (FSs) and epilepsy are often reported to be higher in sub-Saharan Africa. Furthermore, several studies describe complex features of FSs as risk factors for the development of subsequent epilepsy. METHODS During the period from 2002 to 2004 door-to-door studies with supplementary data collection were conducted in three different areas of Tanzania, examining the prevalence of FSs in 7,790 children between the age of 2 mo and 7 y at the time of the interview. The information on the presence of FSs of 14,583 children, who at the time of the interview were younger than 15 y, was collected in order to describe reported seizures, if any. RESULTS Overall, 160 children between 2 mo and 7 y with a prevalence rate of 20.5/1,000 (95% confidence interval: 17.5-23.9/1,000) met the criteria for FSs. The average age at onset was 2.2 (SD: 1.8) y and ~42% had complex FSs. Respiratory tract infections and malaria were the most frequent concomitant diseases. CONCLUSION Our findings do not confirm the assumption of an increased prevalence of FSs in sub-Saharan Africa. However, the elevated number of complex FSs emphasizes the necessity of more reliable studies about FSs and its consequences.
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Affiliation(s)
- Corinna Storz
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Michael Meindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - 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
- 1] Department of Neurology, Technical University of Munich, Munich, Germany [2] Pediatric Ward, Haydom Lutheran Hospital, Mbulu, Tanzania
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Abstract
Febrile seizure (FS) is the most common seizure disorder of childhood, and occurs in an age-related manner. FS are classified into simple and complex. FS has a multifactorial inheritance, suggesting that both genetic and environmental factors are causative. Various animal models have elucidated the pathophysiological mechanisms of FS. Risk factors for a first FS are a family history of the disorder and a developmental delay. Risk factors for recurrent FS are a family history, age below 18 months at seizure onset, maximum temperature, and duration of fever. Risk factors for subsequent development of epilepsy are neurodevelopmental abnormality and complex FS. Clinicians evaluating children after a simple FS should concentrate on identifying the cause of the child's fever. Meningitis should be considered in the differential diagnosis for any febrile child. A simple FS does not usually require further evaluation such as ordering electroencephalography, neuroimaging, or other studies. Treatment is acute rescue therapy for prolonged FS. Antipyretics are not proven to reduce the recurrence risk for FS. Some evidence shows that both intermittent therapy with oral/rectal diazepam and continuous prophylaxis with oral phenobarbital or valproate are effective in reducing the risk of recurrence, but there is no evidence that these medications reduce the risk of subsequent epilepsy. Vaccine-induced FS is a rare event that does not lead to deleterious outcomes, but could affect patient and physician attitudes toward the safety of vaccination.
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Affiliation(s)
- Sajun Chung
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
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Tartof SY, Tseng HF, Liu AL, Qian L, Sy LS, Hechter RC, Michael Marcy S, Jacobsen SJ. Exploring the risk factors for vaccine-associated and non-vaccine associated febrile seizures in a large pediatric cohort. Vaccine 2014; 32:2574-81. [DOI: 10.1016/j.vaccine.2014.03.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/03/2014] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
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Abstract
Vaccine administration is the second leading cause of febrile seizures (FS). FS occurrence in children is a serious concern because it leads to public apprehension of vaccinations. This review discusses the clinical implications of FS, its potential link to vaccinations and its impact on official recommendations for vaccinations in children. Vaccines such as the pertussis antigen-containing vaccine, the measles-containing vaccine and the influenza vaccine have been linked to FS. However, FS events are very rare and are not usually associated with downstream complications or severe neurologic diseases. Considering their significant health benefits, vaccinations have not been restricted in the pediatric population. Nevertheless, vaccine-induced FS could be a problem, particularly in genetically predisposed children. Therefore, post-marketing surveillance studies are required to accurately assess the incidence of FS and identify individuals who are particularly susceptible to FS after vaccination.
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Affiliation(s)
- Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
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Taherya M, Ziaei Kajbaf T, Janahmadi N, Azizi Malamiri R, Beladi Musavi M. Serum zinc level in children with simple febrile convulsions. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 15:626-7. [PMID: 24396590 PMCID: PMC3871758 DOI: 10.5812/ircmj.4485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/23/2013] [Accepted: 06/14/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Mehri Taherya
- Department of Paediatrics, Abuzar Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Tahereh Ziaei Kajbaf
- Department of Paediatrics, Abuzar Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Nasrin Janahmadi
- Department of Paediatrics, Abuzar Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Reza Azizi Malamiri
- Department of Paediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Reza Azizi Malamiri, Department of Paediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel/Fax: +98-6113743063, E-mail:
| | - Maedeh Beladi Musavi
- Department of Paediatrics, Abuzar Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Pruna D, Balestri P, Zamponi N, Grosso S, Gobbi G, Romeo A, Franzoni E, Osti M, Capovilla G, Longhi R, Verrotti A. Epilepsy and vaccinations: Italian guidelines. Epilepsia 2013; 54 Suppl 7:13-22. [PMID: 24099052 DOI: 10.1111/epi.12306] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Reports of childhood epilepsies in temporal association with vaccination have had a great impact on the acceptance of vaccination programs by health care providers, but little is known about this possible temporal association and about the types of seizures following vaccinations. For these reasons the Italian League Against Epilepsy (LICE), in collaboration with other Italian scientific societies, has decided to generate Guidelines on Vaccinations and Epilepsy. The aim of Guidelines on Vaccinations and Epilepsy is to present recent unequivocal evidence from published reports on the possible relationship between vaccines and epilepsy in order to provide information about contraindications and risks of vaccinations in patients with epilepsy. The following main issues have been addressed: (1) whether contraindications to vaccinations exist in patients with febrile convulsions, epilepsy, and/or epileptic encephalopathies; and (2) whether any vaccinations can cause febrile seizures, epilepsy, and/or epileptic encephalopathies. Diphtheria-tetanus-pertussis (DTP) vaccination and measles, mumps, and rubella vaccination (MMR) increase significantly the risk of febrile seizures. Recent observations and data about the relationships between vaccination and epileptic encephalopathy show that some cases of apparent vaccine-induced encephalopathy could in fact be caused by an inherent genetic defect with no causal relationship with vaccination.
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Affiliation(s)
- Dario Pruna
- Epilepsy Unit, Child Neuropsychiatry Department, University Hospital, Cagliari, Italy
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31
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Winkler AS, Tluway A, Schmutzhard E. Febrile seizures in rural Tanzania: hospital-based incidence and clinical characteristics. J Trop Pediatr 2013; 59:298-304. [PMID: 23619600 DOI: 10.1093/tropej/fmt022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Febrile seizures may contribute to epilepsy later in life, but data in sub-Saharan Africa are scarce. We, therefore, conducted a hospital-based study on clinical characteristics of children with febrile seizures. METHODS Over 2 years, we screened all pediatric admissions of Haydom Lutheran Hospital, northern Tanzania, and recruited 197 children with febrile seizures. RESULTS The incidence of febrile seizures was 4% of all admitted children aged <10 years, with a mortality of almost 4%. The peak age at the first febrile seizure was 2 years. One of five children experienced repeated episodes, and the majority of children showed features of complex seizures. Approximately 20% of children had a positive family history of febrile seizures or epilepsy. CONCLUSION Febrile seizures represent a frequent cause for admission of children, bearing a rather high mortality. Most children exhibit complex febrile seizures, which may contribute to the development of epilepsy later in life.
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Affiliation(s)
- Andrea S Winkler
- Department of Neurology, Technical University of Munich, 81675 Munich, Germany.
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32
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Ohlraun S, Wollersheim T, Weiß C, Martus P, Weber-Carstens S, Schmitz D, Schuelke M. CARbon DIoxide for the treatment of Febrile seizures: rationale, feasibility, and design of the CARDIF-study. J Transl Med 2013; 11:157. [PMID: 23806032 PMCID: PMC3700755 DOI: 10.1186/1479-5876-11-157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/14/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 2-8% of all children aged between 6 months and 5 years have febrile seizures. Often these seizures cease spontaneously, however depending on different national guidelines, 20-40% of the patients would need therapeutic intervention. For seizures longer than 3-5 minutes application of rectal diazepam, buccal midazolam or sublingual lorazepam is recommended. Benzodiazepines may be ineffective in some patients or cause prolonged sedation and fatigue. Preclinical investigations in a rat model provided evidence that febrile seizures may be triggered by respiratory alkalosis, which was subsequently confirmed by a retrospective clinical observation. Further, individual therapeutic interventions demonstrated that a pCO2-elevation via re-breathing or inhalation of 5% CO2 instantly stopped the febrile seizures. Here, we present the protocol for an interventional clinical trial to test the hypothesis that the application of 5% CO2 is effective and safe to suppress febrile seizures in children. METHODS The CARDIF (CARbon DIoxide against Febrile seizures) trial is a monocentric, prospective, double-blind, placebo-controlled, randomized study. A total of 288 patients with a life history of at least one febrile seizure will be randomized to receive either carbogen (5% CO2 plus 95% O2) or placebo (100% O2). As recurrences of febrile seizures mainly occur at home, the study medication will be administered by the parents through a low-pressure can fitted with a respiratory mask. The primary outcome measure is the efficacy of carbogen to interrupt febrile seizures. As secondary outcome parameters we assess safety, practicability to use the can, quality of life, contentedness, anxiousness and mobility of the parents. PROSPECT The CARDIF trial has the potential to develop a new therapy for the suppression of febrile seizures by redressing the normal physiological state. This would offer an alternative to the currently suggested treatment with benzodiazepines. This study is an example of academic translational research from the study of animal physiology to a new therapy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01370044.
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Affiliation(s)
- Stephanie Ohlraun
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Weiß
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neuropediatrics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University, Tübingen, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dietmar Schmitz
- Neuroscience Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Schuelke
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neuropediatrics, Charité Universitätsmedizin Berlin, Berlin, Germany
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Miller JE, Pedersen LH, Vestergaard M, Olsen J. Maternal use of antibiotics and the risk of childhood febrile seizures: a Danish population-based cohort. PLoS One 2013; 8:e61148. [PMID: 23613800 PMCID: PMC3627381 DOI: 10.1371/journal.pone.0061148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 03/07/2013] [Indexed: 11/23/2022] Open
Abstract
Objective In a large population-based cohort in Denmark to examine if maternal use of antibiotics during pregnancy, as a marker of infection, increases the risk of febrile seizures in childhood in a large population-based cohort in Denmark. Methods All live-born singletons born in Denmark between January 1, 1996 and September 25, 2004 and who were alive on the 90th day of life were identified from the Danish National Birth Registry. Diagnoses of febrile seizures were obtained from the Danish National Hospital Register and maternal use of antibiotics was obtained from the National Register of Medicinal Product Statistics. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox proportional hazard regression models. Results We followed 551,518 singletons for up to 5 years and identified a total of 21,779 children with a diagnosis of febrile seizures. Slightly increased hazard ratios were observed among most exposure groups when compared to the unexposed group, ex. HR 1.08 95% CI: 1.05–1.11 for use of any systemic antibiotic during pregnancy. Conclusion We found weak associations between the use of pharmacologically different antibiotics during pregnancy and febrile seizures in early childhood which may indicate that some infections, or causes or effects of infections, during pregnancy could affect the fetal brain and induce susceptibility to febrile seizures.
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Affiliation(s)
- Jessica E Miller
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
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34
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Abstract
Seizures with fever that result from encephalitis or meningitis usually occur late in the course of febrile illness, and are focal and prolonged. Febrile seizures are by far the most common affecting 5% of the population, followed by posttraumatic seizures and those observed in the setting of a toxic, infectious, or metabolic encephalopathy. This chapter reviews the clinical presentation of the three most common forms, due to fever, trauma, and intoxication. Febrile seizures carry no cognitive or mortality risk. Recurrence risk is increased by young age, namely before 1 year of age. Febrile seizures that persist after the age of 6 years are usually part of the syndrome of Generalized epilepsy febrile seizures plus. These febrile seizures have a strong link with epilepsy since non-febrile seizures may occur later in the same patient and in other members of the same family with an autosomal dominant transmission. Complex febrile seizures, i.e., with focal or prolonged manifestations or followed by focal defect, are related to later mesial temporal epilepsy with hippocampal sclerosis; risk factors are seizure duration and brain malformation. Prophylactic treatment is usually not required in febrile seizures. Early onset of complex seizures is the main indication for AED prophylaxis. Early posttraumatic seizures, i.e., within the first week, are often focal and indicate brain trauma: contusion, hematoma, 24 hours amnesia, and depressed skull fracture are major factors of posttraumatic epilepsy. Prophylaxis with antiepileptic drugs is not effective. Various psychotropic drugs, including antiepileptics, may cause seizures.
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Affiliation(s)
- T Bast
- Epilepsy Centre Kork, Kehl, Germany.
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35
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Abstract
Febrile seizures are common and mostly benign. They are the most common cause of seizures in children less than five years of age. There are two categories of febrile seizures, simple and complex. Both the International League against Epilepsy and the National Institute of Health has published definitions on the classification of febrile seizures. Simple febrile seizures are mostly benign, but a prolonged (complex) febrile seizure can have long term consequences. Most children who have a febrile seizure have normal health and development after the event, but there is recent evidence that suggests a small subset of children that present with seizures and fever may have recurrent seizure or develop epilepsy. This review will give an overview of the definition of febrile seizures, epidemiology, evaluation, treatment, outcomes and recent research.
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Affiliation(s)
- DO Syndi Seinfeld
- Department of Neurology, Virginia Commonwealth University, Richmond, USA
| | - John M Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, USA
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36
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Abstract
Febrile seizures are a common emergency faced by general pediatricians. They are mostly self-limiting, isolated events with no sequelae in later life. A minority are more complex. In the acute stage, there are a small number of underlying etiologies that are important to recognize in order to determine the prognosis accurately and to optimize management. There has been a long-standing debate about the relationship of early febrile seizures to the later development of epilepsy. It is now clear that this risk differs for simple and complex febrile seizures: complex febrile seizures may herald the presentation of a number of epilepsy syndromes of which febrile and illness-related seizures are part of the phenotype. This review examines the existing knowledge on febrile seizures and the various clinical phenotypes to which they are linked.
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Affiliation(s)
- J Helen Cross
- UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, United Kingdom.
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37
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Tse A, Tseng HF, Greene SK, Vellozzi C, Lee GM. Signal identification and evaluation for risk of febrile seizures in children following trivalent inactivated influenza vaccine in the Vaccine Safety Datalink Project, 2010-2011. Vaccine 2012; 30:2024-31. [PMID: 22361304 DOI: 10.1016/j.vaccine.2012.01.027] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/12/2011] [Accepted: 01/06/2012] [Indexed: 11/28/2022]
Abstract
In fall 2010 in the southern hemisphere, an increased risk of febrile seizures was noted in young children in Australia in the 24 h after receipt of trivalent inactivated influenza vaccine (TIV) manufactured by CSL Biotherapies. Although the CSL TIV vaccine was not recommended for use in young children in the US, during the 2010-2011 influenza season near real-time surveillance was conducted for febrile seizures in the 0-1 days following first dose TIV in a cohort of 206,174 vaccinated children ages 6 through 59 months in the Vaccine Safety Datalink Project. On a weekly basis, surveillance was conducted with the primary approach of a self-controlled risk interval design and the secondary approach of a current vs. historical vaccinee design. Sequential statistical methods were employed to account for repeated analyses of accumulating data. Signals for seizures based on computerized data were identified in mid November 2010 using a current vs. historical design and in late December 2010 using a self-controlled risk interval design. Further signal evaluation was conducted with chart-confirmed febrile seizure cases using only data from the primary approach (i.e. self-controlled risk interval design). The magnitude of the incidence rate ratio and risk difference comparing risk of seizures in the 0-1 days vs. 14-20 days following TIV differed by receipt of concomitant 13-valent pneumococcal conjugate vaccine (PCV13). Among children 6-59 months of age, the incidence rate ratio (IRR) for TIV adjusted for concomitant PCV13 was 2.4 (95% CI 1.2, 4.7) while the IRR for PCV13 adjusted for concomitant TIV was 2.5 (95% CI 1.3, 4.7). The IRR for concomitant TIV and PCV13 was 5.9 (95% CI 3.1, 11.3). Risk difference estimates varied by age due to the varying baseline risk for seizures in young children, with the highest estimates occurring at 16 months (12.5 per 100,000 doses for TIV without concomitant PCV13, 13.7 per 100,000 doses for PCV13 without concomitant TIV, and 44.9 per 100,000 doses for concomitant TIV and PCV13) and the lowest estimates occurring at 59 months (1.1 per 100,000 doses for TIV without concomitant PCV13, 1.2 per 100,000 doses for PCV13 without concomitant TIV, and 4.0 per 100,000 doses for concomitant TIV and PCV13). Incidence rate ratio and risk difference estimates were lower for children receiving TIV without concomitant PCV13 or PCV13 without concomitant TIV. Because of the importance of preventing influenza and pneumococcal infections and associated complications, our findings should be placed in a benefit-risk framework to ensure that population health benefits are maximized.
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Affiliation(s)
- Alison Tse
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, United States
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Yuan Y. Methylmercury: a potential environmental risk factor contributing to epileptogenesis. Neurotoxicology 2012; 33:119-26. [PMID: 22206970 PMCID: PMC3285480 DOI: 10.1016/j.neuro.2011.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 12/12/2011] [Accepted: 12/14/2011] [Indexed: 12/29/2022]
Abstract
Epilepsy or seizure disorder is one of the most common neurological diseases in humans. Although genetic mutations in ion channels and receptors and some other risk factors such as brain injury are linked to epileptogenesis, the underlying cause for the majority of epilepsy cases remains unknown. Gene-environment interactions are thought to play a critical role in the etiology of epilepsy. Exposure to environmental chemicals is an important risk factor. Methylmercury (MeHg) is a prominent environmental neurotoxicant, which targets primarily the central nervous system (CNS). Patients or animals with acute or chronic MeHg poisoning often display epileptic seizures or show increased susceptibility to seizures, suggesting that MeHg exposure may be associated with epileptogenesis. This mini-review highlights the effects of MeHg exposure, especially developmental exposure, on the susceptibility of humans and animals to seizures, and discusses the potential role of low level MeHg exposure in epileptogenesis. This review also proposes that a preferential effect of MeHg on the inhibitory GABAergic system, leading to disinhibition of excitatory glutamatergic function, may be one of the potential mechanisms underlying MeHg-induced changes in seizure susceptibility.
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Affiliation(s)
- Yukun Yuan
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 48824, USA.
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Abstract
Research investigating the early programming of adult metabolic disease has in recent years provided much mechanistic insight into how the early environment impacts on long-term health. It includes studies addressing the roles of intrauterine nutrient availability, which is determined by maternal nutrition, maternal exposure to oxygen, toxic events, and infection; the placental interface; and also the early postnatal environment. This review will explore the epidemiological evidence for programming of metabolic disease and provide an overview of the various studies using animals to model metabolic phenotypic outcome. It will also discuss evidence for the proposed molecular mechanisms and the potential for intervention.
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Affiliation(s)
- Denise S Fernandez-Twinn
- Department of Clinical Biochemistry, University of Cambridge, Metabolic Research Laboratories, Institute of Metabolic Sciences, Addenbrooke's Hospital, Cambridge, United Kingdom.
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40
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Koyama R, Matsuki N. Novel etiological and therapeutic strategies for neurodiseases: mechanisms and consequences of febrile seizures: lessons from animal models. J Pharmacol Sci 2010; 113:14-22. [PMID: 20424387 DOI: 10.1254/jphs.09r19fm] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Febrile seizures (FS) are the most common type of convulsive events in infancy and childhood. Genetic and environmental elements have been suggested to contribute to FS. FS can be divided into simple and complex types, the former being benign, whereas it is controversial whether complex FS have an association with the development of temporal lobe epilepsy (TLE) in later life. In the hippocampus of TLE patients, several structural and functional alterations take place that render the region an epileptic foci. Thus, it is important to clarify the cellular and molecular changes in the hippocampus after FS and to determine whether they are epileptogenic. To achieve this goal, human studies are too limited because the sample tissues are only available from adult patients in the advanced and drug-resistant stages of the disease, masking the underlying etiology. These facts have inspired researchers to take advantage of well-established animal models of FS to answer the following questions: 1) How does hyperthermia induce FS? 2) Do FS induce neuroanatomical changes? 3) Do FS induce neurophysiological changes? 4) Do FS affect the behavior in later life? Here we introduce and discuss accumulating reports to answer these questions.
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Affiliation(s)
- Ryuta Koyama
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Japan.
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Schuchmann S, Vanhatalo S, Kaila K. Neurobiological and physiological mechanisms of fever-related epileptiform syndromes. Brain Dev 2009; 31:378-82. [PMID: 19201562 DOI: 10.1016/j.braindev.2008.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/30/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
Abstract
Febrile seizures (FS) are the most common type of convulsive events in children. FS have been extensively studied using animal models, where rat and mice pups are placed in a hyperthermic environment. Such work has largely focused on the consequences rather than on the mechanisms of experimental febrile seizures (eFS). We have recently shown that eFS are preceded by a dramatic rise in the rate of respiration. The consequent respiratory alkalosis affecting the brain and increasing neuronal excitability is a direct cause of the eFS [1]. If a similar mechanism contributes to human FS and other fever-related epileptiform syndromes, a number of factors operating at the molecular, cellular and systems level that have not been previously thought to be involved in their etiology must be considered. These include physiological and pathophysiological factors affecting CO(2) chemosensitivity as well as cellular and systemic mechanisms of acid-base regulation. Furthermore, a critical role for brain pH in FS points to novel types of susceptibility genes, which include genes coding pH-sensitive target proteins (e.g. neuronal ion channels) and pH-regulatory proteins. We will discuss these novel ideas and putative therapies based on them.
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Affiliation(s)
- Sebastian Schuchmann
- Department of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
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