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Chen H, Yu X, Chen Y, Wu H, Wu Z, Zhong J, Tang Z. Reversible splenial lesion syndrome in children: a retrospective study of 130 cases. Front Neurol 2023; 14:1241549. [PMID: 37731857 PMCID: PMC10507860 DOI: 10.3389/fneur.2023.1241549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Background Reversible splenial lesion syndrome (RESLES) is a new clinico-radiological syndrome. We retrospectively analyzed the clinical features of 130 children with RESLES in China, which is the largest case series available in the literature. Methods The clinical data of children diagnosed as RESLES in Jiangxi Provincial Children's Hospital between 2017 and 2023 were retrospectively analyzed. The 130 cases were divided into two groups: ≤ 3 years old group (group A) (n = 83) and > 3 years old group (group B) (n = 47). The chi-squared test or Fisher's test was used to evaluate the data. Results The vast majority of patients (127/130 cases, 97.7%) had prodromal symptoms of infection. Preceding infections of the gastrointestinal tract were statistically more significant in group A (60/83, 72.3%) than in group B (11/47, 23.4%) (P < 0.05). Preceding infections of the respiratory tract were statistically more significant in group B (33/47, 70.2%) than in group A (17/83, 20.5%) (P < 0.05). Seizures were statistically more significant in group A (82/83, 98.8%) than in group B (24/47,51.1%) (P < 0.05). The disturbance of consciousness and headache/dizziness were statistically more significant in group B (27/47, 57.4%; 37/47, 78.7%) than in group A (3/83, 3.6%; 1/83, 1.2%), respectively (P < 0.05). Convulsions with mild gastroenteritis (CwG) were statistically more significant in group A (50/83, 60.2%) than in group B (8/47, 17.0%) (P < 0.05). However, encephalitis/encephalopathy was statistically more significant in group B (20/47, 42.6%) than in group A (10/83, 12.0%) (P < 0.05). MRI showed cytotoxic edema in typical locations (RESLES type-1 limited to the splenium of the corpus callosum and RESLES type-2 spread to the entire corpus callosum, adjacent white matter, or both). There was full recovery of the lesions of MRI in all cases from 3 days to 50 days after the initial examinations. All the children showed normal neurodevelopment. Conclusion Infection was the most common cause of RESLES. Infections of the gastrointestinal tract are common in ≤ 3 years old children, while infections of the respiratory tract are common in >3 years old children. Younger patients are more likely to develop convulsions, and older children were more likely to have symptoms with disturbance of consciousness and headache/dizziness. RESLES has characteristic MRI manifestations and a good prognosis.
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Affiliation(s)
- Hui Chen
- Nanchang University, Nanchang, China
- Department of Neurology, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Xiongying Yu
- Department of Neurology, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Yong Chen
- Department of Neurology, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Huaping Wu
- Department of Neurology, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Zhuqiang Wu
- Department of Magnetic Resonance, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Jianmin Zhong
- Department of Neurology, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Zhenyu Tang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
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Shi K, Jiang D, Yang J, Li Y, Chen W, Li P. Clinical characteristics and follow-up of children with norovirus-associated benign convulsions with mild gastroenteritis. Epilepsia Open 2023; 8:1049-1053. [PMID: 37394877 PMCID: PMC10472357 DOI: 10.1002/epi4.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE Explore the clinical characteristics and prognosis of children with norovirus (NoV)-associated benign convulsions with mild gastroenteritis (CwG). METHODS We retrospectively analyzed the Clinical and laboratory data of children with NoV-associated CwG admitted to the emergency department of Guangzhou Children's Hospital between January 2019 and January 2020. And patients were followed up for 23-36 months. RESULTS There are 49 cases met the CwG criteria. Vomiting was the first symptom in 31 (63.3%) patients, and vomiting could be the main or the only gastrointestinal symptom. The mean frequency of seizures was 3.8 ± 2.4 episodes. Most patients (95.9%) experienced seizures that lasted for less than 5 min. Of the 43 (87.8%) cases followed up from 23 to 36 months, only one experienced recurrent convulsions (after rotavirus infection). SIGNIFICANCE NoV-associated CwG patients were prone to experiencing more convulsions. However, because most NoV-associated CwG patients had good prognosis, long-term use of anticonvulsants are unnecessary.
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Affiliation(s)
- Kaili Shi
- Department of NeurologyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Daoju Jiang
- Department of EmergencyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Jiehui Yang
- Department of NeurologyChildren's Hospital of Shanxi ProvinceTaiyuanChina
| | - Ying Li
- Department of NeurologyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Wenxiong Chen
- Department of NeurologyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Peiqing Li
- Department of EmergencyGuangzhou Women and Children's Medical CenterGuangzhouChina
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Cappellari AM, Mariani S, Bruschi G. Febrile seizures and convulsions with mild gastroenteritis: age-dependent acute symptomatic seizures. Front Pediatr 2023; 11:1151770. [PMID: 37534200 PMCID: PMC10390780 DOI: 10.3389/fped.2023.1151770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Background Febrile seizures (FS) and benign convulsions in children with mild gastroenteritis (CwG) are acute symptomatic seizures, transiently occurring in infants and young children, probably related to the immaturity of the brain. Our paper aims to review the literature data on patients with FS and CwG. Methods A review of series of patients with FS and CwG was performed by literature search on PubMed January 1960 to October 2022. Several parameters were considered, including epidemiology, pathophysiology, clinical features, electroencephalographic findings and other diagnostic studies, and treatment. Results FS and CwG share an age-dependent course, but they show significant differences in the pathophysiology, clinical features, diagnostic studies, and treatment. Conclusion Acute symptomatic seizures include seizures that are caused by acute structural brain pathologies, such as stroke, as well as seizures that are provoked by a reversible factor, such as hyponatraemia, although the two groups should be not equated. Furthermore, FS and CwG should be set apart as "age-dependent acute symptomatic seizures", reinforcing the concept of their self-limited course over a certain period.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Mariani
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
| | - Gaia Bruschi
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
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Zaki SA, Rashid A. Risk factors for recurrence of benign convulsions with mild gastroenteritis in children: A prospective cohort study. J Paediatr Child Health 2023; 59:404-406. [PMID: 36722443 DOI: 10.1111/jpc.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/20/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Syed Ahmed Zaki
- Department of Paediatrics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Asrar Rashid
- Paediatric Intensive Care Unit, NMC Royal hospital, Abu Dhabi, UAE
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Lakhan C, Badrie N, Ramsubhag A, Indar L. Direct outpatient cost per case of acute gastroenteritis in Trinidad and Tobago, 2021. J Food Prot 2023; 86:100009. [PMID: 36916592 DOI: 10.1016/j.jfp.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/28/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022]
Abstract
The burdens associated with acute gastroenteritis involve billions of dollars in expenses, coupled with significant morbidity and mortality globally. To reduce these burdens, health officials and policymakers require up-to-date data (health and economic) to request and allocate resources in guiding the development and implementation of preventative strategies. In 2021, the estimate for one case of acute gastroenteritis was calculated using multiple sources of data: the 2009 national health burden survey on acute gastroenteritis; a 2021 telephone survey of five major private hospitals; a 2021 telephone survey of 30 private pharmacies; and the 2021 Minimum Wages Act of Trinidad and Tobago. For each case of illness, an average cost of $1614 TTD ($238 USD) was estimated. For residents who sought private health care, the average GP visit cost was $500-$700 TTD ($73-$103 USD), while costs for medication prescribed ranged between $327 and $1166 TTD ($48-$172 USD). Productivity losses amounted to almost $21.7 million TTD ($3.2 million USD) for residents who took time off from work or required caregiving services. The overall annual cost was estimated to be $204 million TTD ($30.1 million USD) and, therefore, warrants measures by health officials to reduce the economic and social burdens of acute gastroenteritis in Trinidad and Tobago.
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Affiliation(s)
- Carelene Lakhan
- Department of Food Production, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Neela Badrie
- Department of Food Production, University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Adash Ramsubhag
- Department of Life Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Lisa Indar
- The Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
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Zha J, Chen Y, Yu X, Xie J, Yi Z, Chen H, Zhong J. Efficacy and safety of phenobarbital for benign convulsions with mild gastroenteritis: A prospective randomized controlled study. Medicine (Baltimore) 2022; 101:e31495. [PMID: 36550836 PMCID: PMC9771267 DOI: 10.1097/md.0000000000031495] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND previous studies have shown that phenobarbital (PB) is a effective and safe drug in the treatment of benign convulsions with mild gastroenteritis (CwG), but there is a lack of large sample prospective randomized controlled study of different doses. This study was a prospective randomized controlled study on the efficacy and safety of different doses of phenobarbital for CwG. There has been no similar study. METHODS One hundred twenty CwG cases were included in this study. All of them were hospitalized in the Department of Neurology of Jiangxi Provincial Children's Hospital from January 2019 to August 2021. They were randomly divided into 10 mg/kg single dose group (Group A, n = 60) and 5 mg/kg single dose group (Group B, n = 60). The criteria for judging the efficacy of PB in our study were there was no convulsion in the course of acute gastroenteritis within 2 weeks after using PB. RESULTS The effective rate was 93.33% in group A and 80.00% in group B. There was significant difference between the 2 groups (P < .05). Drowsiness was the most frequent adverse reaction. 14 cases in group A and 7 cases in group B had drowsiness. There was no significant difference between the 2 groups in the incidence of adverse events such as somnolence, ataxia, abnormal liver function, anemia, abnormal leukocyte, respiratory depression, cognitive impairment, rash, abnormal platelet and abnormal renal function (P > .05). All side reaction were transient. CONCLUSION it is suggested that PB 10 mg/kg intravenously should be used as soon as possible for CwG, which has high effectiveness and safety.
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Affiliation(s)
- Jian Zha
- Nanchang University, Nanchang, China
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Yong Chen
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Xiongying Yu
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Jihua Xie
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Zhaoshi Yi
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Hui Chen
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
- * Correspondence: Hui Chen and Jianmin Zhong, Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang 330006, China (e-mails: and )
| | - Jianmin Zhong
- Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang, China
- * Correspondence: Hui Chen and Jianmin Zhong, Department of Neurology, Jiangxi Provincial Children’s Hospital, Nanchang 330006, China (e-mails: and )
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A Comparative Study of Febrile Seizures and Febrile Convulsions Associated With Mild Gastroenteritis. Pediatr Neurol 2022; 135:1-3. [PMID: 35933805 DOI: 10.1016/j.pediatrneurol.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children presenting with complex febrile seizures (FS) have an increased risk of developing epilepsy. This study aimed to investigate the occurrence of complex seizures in children presenting with FS and those with both convulsions associated with mild gastroenteritis (CwG) and fever. METHODS Children admitted to our Pediatric Emergency Department between January 2017 and April 2019 with seizures were enrolled in this cross-sectional study. Patients were grouped according to the etiology as FS and febrile CwG. FS classification criteria of simple FS and complex FS was applied to both groups to allow a comparison between them. Prevalence ratios (PRs) of complex seizures, estimated through a log binomial model, were used to compare the occurrence of complex seizures between the two groups, using the FS group as reference category. RESULTS A total of 294 patients were enrolled: 231 with FS and 63 with febrile CwG. Complex seizures occurred in 31 patients with FS (13.4%) and 21 patients (33.3%) with febrile CwG. The PR of complex seizures was 2.48 (95% confidence interval, 1.54 to 4.01). CONCLUSIONS Children with febrile CwG showed a higher rate of complex seizures when compared with those with FS.
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Lee KY. Rotavirus infection-associated central nervous system complications: clinicoradiological features and potential mechanisms. Clin Exp Pediatr 2022; 65:483-493. [PMID: 35130429 PMCID: PMC9561191 DOI: 10.3345/cep.2021.01333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/22/2022] [Indexed: 11/27/2022] Open
Abstract
Despite the introduction of vaccines in 2006, rotavirus remains one of the most common causes of pediatric gastroenteritis worldwide. While many studies have conclusively shown that rotavirus infection causes gastroenteritis and is associated with various extraintestinal manifestations including central nervous system (CNS) complications, extraintestinal manifestations due to rotavirus infection have been relatively overlooked. Rotavirus infection-associated CNS complications are common in children and present with diverse clinicoradiological features. Rotavirus infection-associated CNS complications can be classified based on clinical features and brain magnetic resonance imaging findings, particularly lesion location on diffusion-weighted imaging. Common clinicoradiological features of rotavirus infection-associated CNS complications include: (1) benign convulsions with mild gastroenteritis; (2) acute encephalopathies/encephalitis, such as mild encephalopathy with a reversible splenial lesion, acute encephalopathy with biphasic seizures and late reduced diffusion, and acute necrotizing encephalopathy; (3) acute cerebellitis; and (4) neonatal rotavirus-associated leukoencephalopathy. The precise mechanism underlying the development of these complications remains unknown despite a number of clinical and laboratory studies. Here we review the diverse clinicoradiological features of rotavirus infection-associated CNS complications and propose a hypothesis of their pathophysiology.
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Affiliation(s)
- Kyung Yeon Lee
- Department of Pediatrics, Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Al-Beltagi M, Saeed NK. Epilepsy and the gut: Perpetrator or victim? World J Gastrointest Pathophysiol 2022; 13:143-156. [PMID: 36187601 PMCID: PMC9516455 DOI: 10.4291/wjgp.v13.i5.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/08/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
The brain and the gut are linked together with a complex, bi-path link known as the gut-brain axis through the central and enteric nervous systems. So, the brain directly affects and controls the gut through various neurocrine and endocrine processes, and the gut impacts the brain via different mechanisms. Epilepsy is a central nervous system (CNS) disorder with abnormal brain activity, causing repeated seizures due to a transient excessive or synchronous alteration in the brain’s electrical activity. Due to the strong relationship between the enteric and the CNS, gastrointestinal dysfunction may increase the risk of epilepsy. Meanwhile, about 2.5% of patients with epilepsy were misdiagnosed as having gastrointestinal disorders, especially in children below the age of one year. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy, in turn, affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of medications on the gut and the gut microbiota. Epilepsy with abdominal pain, a type of temporal lobe epilepsy, is an uncommon cause of abdominal pain. Epilepsy also can present with postictal states with gastrointestinal manifestations such as postictal hypersalivation, hyperphagia, or compulsive water drinking. At the same time, antiseizure medications have many gastrointestinal side effects. On the other hand, some antiseizure medications may improve some gastrointestinal diseases. Many gut manipulations were used successfully to manage epilepsy. Prebiotics, probiotics, synbiotics, postbiotics, a ketogenic diet, fecal microbiota transplantation, and vagus nerve stimulation were used successfully to treat some patients with epilepsy. Other manipulations, such as omental transposition, still need more studies. This narrative review will discuss the different ways the gut and epilepsy affect each other.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medica City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26612, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Busaiteen 15503, Muharraq, Bahrain
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Chen H, Li X, Wu H, Sun X, Che Y, Zha J, Wang R, Yu X, Chen Y, Zhong J. Case report: A novel de novo variant of SCN8A in a child with benign convulsions with mild gastroenteritis. Front Neurol 2022; 13:995513. [PMID: 36188413 PMCID: PMC9523015 DOI: 10.3389/fneur.2022.995513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
Abstract
Benign convulsions with mild gastroenteritis (CwG) is characterized by afebrile convulsions accompanied by mild gastroenteritis, and it can be considered after central nervous system infection, hypoglycemia, electrolyte disturbance, and moderate and severe dehydration are excluded. Previous studies have suggested that genetics may be involved in CWG. Herein, we reported a novel de novo variant of SCN8A in a child with CwG. This is the first report that SCN8A may be associated with CwG. Our report may provides evidence for the genetic etiology of CwG and expands the phenotypic and genetic spectrum of SCN8A-related disorders, which previously included severe developmental and epileptic encephalopathy (DEE) phenotype, benign epilepsy phenotype, spectrum of intermediate epilepsies, and patients with cognitive and/or behavioral disturbances without epilepsy. Phenotype of CwG has a good prognosis, and it does not require long-term antiepileptic therapy. Overtreatment should be avoided clinically. However, the conclusion needs to be further defined by long-term follow-up and similar clinical reports. In spite of this, our clinical observation provides possible evidence for future studies on the relationship between SCN8A and CwG.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yong Chen
- Department of Neurology, The Affiliated Children's Hospital of Nanchang University (Jiangxi Provincial Children's Hospital), Nanchang, China
| | - Jianmin Zhong
- Department of Neurology, The Affiliated Children's Hospital of Nanchang University (Jiangxi Provincial Children's Hospital), Nanchang, China
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Fang C, Fan W, Zhang C, Yang Y. Risk Factors for Benign Convulsions With Mild Gastroenteritis. Front Pediatr 2022; 10:925896. [PMID: 35844760 PMCID: PMC9277103 DOI: 10.3389/fped.2022.925896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the risk factors for benign convulsions with mild gastroenteritis (CwG) and provide a basis for the early identification and diagnosis. Method We selected children with CwG and acute gastroenteritis in the same period who attended the pediatric department of the Liyang People's Hospital from June 2018 to June 2021. A retrospective analysis of the general data, clinical characteristics, and laboratory test results of the two groups was performed. Finally, we conducted a multifactorial logistic regression analysis to derive the risk factors for CwG. Results A total of 82 children were included in the CwG and 93 children were included in the acute gastroenteritis group. Univariate analysis showed no significant differences in gender, age, vomiting, diarrhea, neutrophil, lymphocyte, hemoglobin, platelets, and serum calcium. Statistically significant differences were found in onset season, rotavirus, white blood cells, aspartate aminotransferase, alanine transaminase, serum sodium, and uric acid. Finally, multifactorial logistic regression analysis showed rotavirus (OR, 3.042, 95% CI, 1.116-8.289, p = 0.030), serum sodium (OR, 0.811, 95% CI, 0.684-0.962, p = 0.016) and uric acid (OR, 1.018, 95% CI, 1.012-1.024, p = 0.000) to be independent risk factors. Conclusion Characteristics of gastroenteritis symptoms such as vomiting and diarrhea cannot be used to predict the onset of CwG. Rotavirus is an independent risk factor for CwG, and decreased serum sodium and increased uric acid can be used as early warning indicators for CwG.
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Affiliation(s)
- Cuiyun Fang
- Department of Nursing, Liyang People's Hospital, Liyang, China
| | - Wei Fan
- Department of Pediatrics, Liyang People's Hospital, Liyang, China
| | - Chunsheng Zhang
- Department of Pediatrics, Liyang People's Hospital, Liyang, China
| | - Yi Yang
- Department of Pediatrics, Liyang People's Hospital, Liyang, China
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Iflah M, Kassem E, Rubinstein U, Goren S, Ephros M, Cohen D, Muhsen K. Convulsions in children hospitalized for acute gastroenteritis. Sci Rep 2021; 11:15874. [PMID: 34354134 PMCID: PMC8342430 DOI: 10.1038/s41598-021-95202-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022] Open
Abstract
The study aim was to examine possible correlates of convulsions in children hospitalized for acute gastroenteritis (AGE). Data collected in a prospective study of AGE hospitalizations in children aged 0-59 months in 3 hospitals in Israel during 2008-2015 were analyzed. Stool samples were tested for rotavirus using immunochromatography and stool culture was performed for the detection of Salmonella, Shigella and Campylobacter We compared clinical and demographic characteristics of children hospitalized for AGE who had convulsions (n = 68, cases) with children hospitalized for AGE without convulsions (n = 3505, controls). Age differed between children with and without convulsions (p = 0.005); the former were mostly toddlers aged 12-23 months (51%) compared to 30% of the control group. A higher percentage of cases tested positive for Shigella (11% vs. 4%, p = 0.002), the opposite was found for rotavirus (2% vs. 30% p < 0.001). A multivariable model showed that body temperature (OR 2.91 [95% CI 1.78-4.76], p < 0.001) and high blood glucose level (> 120 mg/dL) (OR 5.71 [95% CI 1.27-25.58] p = 0.023) were positively related to convulsions in children with AGE, while severe AGE (Vesikari score ≥ 11) was inversely related with convulsions (OR 0.09 [95% CI 0.03-0.24], p < 0.001). Conclusion: Elevated body temperature is associated with convulsions in children with AGE, but not severity of AGE, while hyperglycemia might reflect a neuroendocrine stress reaction to convulsions, AGE or both.
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Affiliation(s)
- Moti Iflah
- School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | - Sophy Goren
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Moshe Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel.
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Chen H, Chen Y, Zhong JM. Detection and diagnostic value of serum NSE and S100B protein levels in patients with seizures associated with mild gastroenteritis: A retrospective observational study. Medicine (Baltimore) 2020; 99:e23439. [PMID: 33235129 PMCID: PMC7710215 DOI: 10.1097/md.0000000000023439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Benign convulsions with mild gastroenteritis (CwG) and febrile seizures (FS) associated with mild gastroenteritis are 2 different diseases in the spectrum of seizures associated with mild gastroenteritis. However, specific and useful indicators for the identification of the 2 diseases are lacking. A retrospective analysis was performed to compare the serum neuronal-specific enolase (NSE) and S100B protein levels between patients with these 2 diseases to evaluate the value of NSE and S100B for differential diagnosis between these 2 diseases.The clinical data and NSE and S100B protein levels of 81 children with seizure-associated mild gastroenteritis were collected. According to the axillary temperature at the time of convulsions, all patients were classified into an afebrile seizure (AFS) group, hereafter called the CwG group (n = 46), and a febrile seizure group (FS group, n = 35).The serum NSE level was higher in the CwG group than in the FS group (14.046 (11.095, 19.266) pg/ml and 9.034 (7.158, 12.165) pg/ml, respectively, P < .001); however, the serum S100B protein levels in the CwG and the FS group were not significantly different (P > .05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for NSE was 0.806, P = .000, which was statistically significant. The Youden index was largest (0.605) for a serum NSE cut-off value of 10.460 pg/ml, which yielded a sensitivity and specificity of 89% and 71%, respectively, for prediction of a CwG diagnosis.NSE may contribute to the differential diagnosis of CwG and FS associated with mild gastroenteritis.
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Hao XS, Liang JM, Wu XM, Hao YP, Wang JT, Liu SY. Clinical characteristics, treatment, and long-term outcomes in children suffering from benign convulsions with mild gastroenteritis: a retrospective study. BMC Pediatr 2020; 20:516. [PMID: 33172428 PMCID: PMC7656682 DOI: 10.1186/s12887-020-02406-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign convulsions with mild gastroenteritis (BCWG) is a common condition in children in Asia and is generally not associated with pH or electrolyte imbalances. When BCWG is diagnosed, a lumbar puncture is usually recommended to rule out potential intracranial infections. This study examined the clinical characteristics of BCWG and evaluated the necessity of lumbar puncture. METHODS Medical records of children admitted to the First Hospital of Jilin University with BCWG between January 2018 and May 2019 were reviewed and analyzed. Children were stratified by rotavirus positivity or lumbar puncture status. Clinical characteristics and long-term outcomes were compared between groups. RESULTS A total of 51 children were included in the analyses (55.1% rotavirus [HRV] positive). The average age of convulsion onset was 21.12 ± 7.44 months, the male-to-female ratio was 1.8:1, and convulsions occurred primarily between October 2018 and April 2019. The main clinical presentations of BCWG were convulsions, vomiting, diarrhea, and fever. Convulsions occurred predominantly two days after diagnosis of gastroenteritis, were mainly generalized tonic-clonic with 88.2% of children having ≤ 3 convulsions per episode, and had a mean duration of 2.0 minutes (interquartile range [IQR]: 1.0, 3.0). Children with BCWG had mild metabolic acidosis (HCO3- 17.82 ± 3.63 mmol/L) with an elevated anion gap (AG; 20.98 ± 3.00 mmol/L), mild hyponatremia (134.56 ± 2.85 mmol/L), and slightly increased levels of creatine kinase myocardial band (CKMB). HRV + children had more severe acidosis and higher CKMB levels. Cerebrospinal fluid (CSF) samples collected via lumbar puncture were normal. No developmental abnormalities were noted as assessed by the Social Life Ability Scale. CONCLUSIONS BCWG is a situation-related seizure, with clinical presentations of tonic-clonic or focal convulsions and mild gastroenteritis (vomiting, diarrhea). Mild metabolic acidosis and hyponatremia may exist. The prognosis of the disease is favorable; lumbar puncture and long-term antiepileptics are unnecessary and should not be recommended.
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Affiliation(s)
- Xiao-Sheng Hao
- The First Hospital of Jilin University, 130021, Changchun, Jilin, China
| | - Jian-Min Liang
- The First Hospital of Jilin University, 130021, Changchun, Jilin, China
| | - Xue-Mei Wu
- The First Hospital of Jilin University, 130021, Changchun, Jilin, China
| | - Yun-Peng Hao
- The First Hospital of Jilin University, 130021, Changchun, Jilin, China
| | - Jiang-Tao Wang
- The First Hospital of Jilin University, 130021, Changchun, Jilin, China.
| | - Song-Yan Liu
- The China-Japan Union Hospital, 130033, Changchun, Jilin, China.
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Yoo SY, Kim DH, Lee Y, Lee GH, Ha DJ, Kwon YS. Serum Uric Acid as a Predictive Factor for Rotaviral or Noroviral Benign Convulsions with Mild Gastroenteritis. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2020.00143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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You SJ. Older Patients May Have More Frequent Seizures among Children Diagnosed as Benign Convulsions with Mild Gastroenteritis. Neuropediatrics 2020; 51:354-358. [PMID: 32016943 DOI: 10.1055/s-0040-1701442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Benign convulsions with mild gastroenteritis (CwG) is a condition that does not usually require treatment. However, when the patient experiences multiple seizures or prolonged seizures, anticonvulsant treatment may be required. We investigated this study to identify the factors that may influence on the number or duration of seizures at CwG. METHODS We retrospectively analyzed the medical records of CwG patients who were admitted to the Department of Pediatrics at Sanggye Paik Hospital. RESULTS A total of 105 children with CwG were enrolled. The mean age was 19.59 ± 7.09 months. The mean duration of seizure was 2.79 ± 5.51 minutes and mean number of seizure was 2.33 ± 1.70. Sixty-nine children had seizures less than twice, whereas 36 experienced three times or more. These groups differed significantly according to age in CwG (18.16 ± 7.08, vs. 22.33 ± 6.34 months, p < 0.05). When patients were divided into two groups based on age in CwG using a cut-off of 20 months, we found significant differences in seizure number (1.91 ± 1.27 vs. 3.11 ± 2.10, p < 0.05). There was also a positive correlation between patient age and frequency of seizures (R = 0.316, p = 0.001). Patients who received anticonvulsants were older (17.60 ± 6.87 vs. 22.04 ± 6.63 months, p < 0.05) and had more frequent (1.59 ± 1.37 vs. 3.26 ± 1.63, p < 0.05) and longer seizures (1.76 ± 2.75 vs. 4.07 ± 7.49 minutes, p < 0.05). CONCLUSION As the number of seizure in CwG was associated with age, treatment in older children may be required in acute stage.
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Affiliation(s)
- Su Jeong You
- Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
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17
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Spontaneous remission of infantile spasms following rotavirus gastroenteritis. Neurol Sci 2020; 42:253-257. [PMID: 32632632 DOI: 10.1007/s10072-020-04564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Epileptic seizures might be provoked and/or exacerbated by fever or viral infection in children with epilepsy. However, this is not true for infantile spasms; in this study, we report three cases with infantile spasms became seizure free within 2-5 days following rotavirus gastroenteritis without an exchange or addition of antiepileptic drugs, and hypsarrhythmia evolved to diffuse slow waves or localized spikes on electroencephalography. We propose that the probability regarding the mechanism of spontaneous mitigation is the suppression of immunopathological processes caused by infection, while the possibility of ketogenic effects of diarrhea and intestinal flora recombination after rotavirus gastroenteritis is unlikely. Further study may provide important information concerning the mechanism of seizure control and the applicability to treatment for infantile spasms.
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Shi K, Yang J, Wu Y, Han H, Guo J, Chen W. Risk factors for the recurrence of convulsions with mild gastroenteritis in children. Seizure 2020; 80:192-195. [PMID: 32619828 DOI: 10.1016/j.seizure.2020.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/20/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To identify risk factors for the recurrence of convulsions with mild gastroenteritis (CwG)1 in children. METHODS Altogether, 613 children with CwG admitted to Children's Hospital of Shanxi Province from January 2010 to December 2015 were selected, their clinical data were retrospectively analyzed, and patients were followed up for 4-10 years. Risk factors for the recurrence of CwG were analyzed based on the clinical characteristics of the children. RESULTS Relapse occurred in 35 patients (6.3 %). Recurrence occurred within 6 months after the first CwG in majority of the patients (80 %), and recurrence occurred once in most patients (91.4 %). Risk factors associated with CwG recurrence were age at first attack of ≤18 months (recurrence rates at ages ≤ and >18 months were 8.7 %, and 3.1 %, respectively; χ2 = 4.856, P = 0.028), and a history of convulsions in first-degree relatives (recurrence rates in first-degree relatives with and without a history of convulsion were 20 % and 6.2 %, respectively; χ2 = 5.501, P = 0.019). CONCLUSIONS Children with CwG have a possibility of recurrence. The risk of recurrence within 6 months of onset is high and such patients should be carefully observed. Furthermore, the age of onset of ≤18 months and history of convulsions in first-degree relatives are risks factors for CwG recurrence; therefore, these children should be closely followed up.
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Affiliation(s)
- Kaili Shi
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, China; Department of Neurology, Children's Hospital of Shanxi Province, Taiyuan, China.
| | - Jiehui Yang
- Department of Pediatrics, Shanxi Bethune Hospital, Taiyuan, China
| | - Yunhong Wu
- Department of Neurology, Children's Hospital of Shanxi Province, Taiyuan, China
| | - Hong Han
- Department of Neurology, Children's Hospital of Shanxi Province, Taiyuan, China
| | - Junxiu Guo
- Department of Neurology, Children's Hospital of Shanxi Province, Taiyuan, China
| | - Wenxiong Chen
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
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Kim YO. Benign Convulsions with Mild Gastroenteritis. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2019.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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20
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Lee JY, Ryu JM, Lee JS, Ko TS, Yum MS. Clinical Implications of Ketosis in Children with Benign Convulsions with Mild Gastroenteritis. J Clin Neurol 2020; 16:96-101. [PMID: 31942764 PMCID: PMC6974832 DOI: 10.3988/jcn.2020.16.1.96] [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] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose The pathophysiologic mechanisms underlying benign convulsions with mild gastroenteritis (CwG) in children remain unclear. We investigated the incidence of ketosis in CwG and whether this is related to seizures. Methods This retrospective study included children aged from 6 months to 6 years who visited our emergency department and were diagnosed as CwG between June 2015 and December 2018. The clinical and laboratory data were analyzed for these cases. Ketosis and severe ketosis were defined as blood β-hydroxybutyrate levels of ≥0.6 and ≥4.5 mmol/L, respectively. Results We enrolled 42 pediatric CwG patients aged 21.0±11.5 months (mean±SD) whose blood β-hydroxybutyrate level was 3.65±1.51 mmol/L. Ketosis was observed in 95.2% of these children, while 35.7% had severe ketosis. Compared to the non-severe-ketosis group (n=27), the severe-ketosis group (n=15) demonstrated significantly lower blood glucose levels (68.8 vs. 82.6 mg/dL, p=0.020) and sodium levels (134.2 vs. 135.6 mEq/L, p=0.018), and included a larger proportion of low-body-weight children (defined as adjusted weight <50th percentile for age and sex) (53.3% vs. 18.5%, p=0.019). However, the incidence of repetitive seizures (two or more during an illness period) did not differ between these groups. Moreover, severe ketosis was not associated with the risk of seizure recurrence in the emergency department. Conclusions Children with CwG are in a state of considerable ketosis. Severe ketosis in CwG may be associated with low blood glucose and sodium levels but does not reduce seizure recurrence.
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Affiliation(s)
- Jeong Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sung Ko
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Sun Yum
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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21
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Wu YZ, Liu YH, Tseng CM, Tseng YH, Chen TH. Comparison of Clinical Characteristics Between Febrile and Afebrile Seizures Associated With Acute Gastroenteritis in Childhood. Front Pediatr 2020; 8:167. [PMID: 32373562 PMCID: PMC7176810 DOI: 10.3389/fped.2020.00167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/24/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Acute gastroenteritis (AGE) accompanied by seizures is not a rare scenario in childhood. We investigated the clinical features of children with febrile or afebrile seizures during AGE and aimed to identify the impact of fever in this situation-related seizure. Methods: We retrospectively reviewed the medical charts of children admitted due to seizures associated with mild AGE between January 2008 and December 2017. These consecutive patients were divided into two groups: an "afebrile group" whose diagnosis was compatible with "benign convulsion with mild gastroenteritis (CwG)" and a "febrile group" who had a fever within 24 h of the onset of an AGE-related seizure. We compared the two groups' clinical and laboratory characteristics, electroencephalograms (EEG), neuroimaging, and outcomes. Results: Of the children suffering from AGE and seizures, 41 were afebrile and 30 were febrile, with a mean age of 32.2 ± 27.6 months. The gender, seizure semiology, frequency, duration of seizures, the time interval between AGE symptoms onset and first seizure, and levels of serum sodium, and hepatic enzymes were significantly different between the two groups. The most frequently identified enteropathogen was rotavirus (33%), especially in the male and febrile subjects. Afebrile patients had more EEG abnormalities initially, but all returned to normal later. All cases had an uneventful outcome. Of note, seizure clusters (≥2 episodes) occurred more frequently in the afebrile patients who had a duration of AGE symptoms lasting 2 days or more, or white blood cell counts ≥ 10,000/μL (p-values: 0.05 and 0.04, respectively). In comparison with seven similar studies, all showed more seizure clusters, partial seizures, and a shorter interval between AGE onset and seizures in afebrile patients than in febrile patients. Contrarily, afebrile patients had longer seizure duration and lower serum hepatic transaminases than febrile patients. Conclusion: Although fever partially influenced the clinical features of AGE-related seizures, febrile CwG might have pathophysiology distinctly different from that of febrile seizures. Comprehensive knowledge in discerning febrile and afebrile CwG can help to avoid unnecessary diagnostics tests, and anticonvulsants use.
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Affiliation(s)
- Yan-Zhang Wu
- Division of Pediatric Emergency, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Hua Liu
- Department of Emergency, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Ming Tseng
- Division of Pediatric Emergency, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Hao Tseng
- Division of Pediatric Emergency, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Heng Chen
- Division of Pediatric Emergency, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Ph.D. Program in Translational Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University and Academia Sinica, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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22
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Yoo IH, Kim W, Cho J, Kim H, Lim BC, Hwang H, Chae JH, Choi J, Kim KJ. Elevated Serum Uric Acid in Benign Convulsions with Mild Gastroenteritis in Children. J Clin Neurol 2019; 15:496-501. [PMID: 31591838 PMCID: PMC6785459 DOI: 10.3988/jcn.2019.15.4.496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 01/04/2023] Open
Abstract
Background and Purpose To identify whether serum uric acid levels are significantly higher in patients with benign convulsion associated with mild gastroenteritis (CwG) than in patients with acute gastroenteritis. Methods This retrospective study compared the serum levels of uric acid between CwG, acute gastroenteritis, and febrile seizure after correcting for the varying degree of mild dehydration using serum HCO3− levels. We also compared the serum uric acid levels between patients with CwG and febrile seizures in order to exclude the effect of seizures on uric acid. Results This study included 154 CwG patients (age range 0.73–3.19 years), 2,938 patients with acute gastroenteritis, and 154 patients with febrile seizure. The serum uric acid level was significantly higher in CwG patients than in patients with acute gastroenteritis [9.79±2.16 mg/dL vs. 6.04±2.3 mg/dL (mean±SD), p<0.001]. This difference was also significant after correcting for dehydration. The serum uric acid level was significantly higher in CwG patients than in dehydration-corrected acute gastroenteritis patients (9.79±2.16 mg/dL vs. 6.67±2.48 mg/dL, p<0.001). The serum uric acid level was not elevated in patients with febrile seizure. Conclusions We have confirmed that serum uric acid is elevated in CwG patients even after correcting for their dehydration status, and that this was not a postictal phenomenon. Highly elevated serum uric acid in CwG could be a useful clinical indicator of CwG in patients with acute gastroenteritis.
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Affiliation(s)
- Il Han Yoo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Woojoong Kim
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jaeso Cho
- Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul, Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Byung Chan Lim
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Hee Chae
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jieun Choi
- Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Ki Joong Kim
- Pediatric Clinical Neuroscience Center, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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Clinical features of campylobacter-associated benign convulsions with mild gastroenteritis compared with rotavirus convulsions. Seizure 2019; 70:20-24. [PMID: 31238195 DOI: 10.1016/j.seizure.2019.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/26/2019] [Accepted: 06/08/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of the present study was to compare the clinical features of campylobacter-associated benign convulsions with mild gastroenteritis (BCWG) with rotavirus-associated BCWG in China. METHODS The medical records of BCWG patients admitted to Children's Hospital of Jiangxi Province in China between January 2015 and January 2017 were reviewed in this retrospective study. RESULTS Ultimately, 318 patients were diagnosed with BCWG. Two hundred and two cases were tested for Campylobacter jejuni antigen, and seven (3.47%) were positive. A total of 248 cases were tested for rotavirus antigen, and 44 (17.74%) were positive. Campylobacter-associated BCWG occurred in summer and autumn. In contrast, rotavirus-associated BCWG mainly occurred in winter. In the campylobacter-associated BCWG group, five patients (71.43%) had two or more seizures. In one patient(14.29%), the seizure occurred on the first day of gastroenteritis; three patients (42.86%) had seizures on the second day, and three (42.86%) had seizures on the third day or later. Thirteen seizures were observed in the campylobacter-associated BCWG group; of these, 11 (84.62%) lasted less than 5 min, and 11 (84.62%) were generalized seizures. Phenobarbital (5 mg/kg/time) was effective in all 6 cases (100%) in which it was used. Other than the different seasonal distributions, the clinical features of campylobacter-associated BCWG and rotavirus-associated BCWG may be similar. CONCLUSIONS Campylobacter is one of the pathogens responsible for BCWG, especially in summer and autumn. Other than the different seasonal distributions, the clinical features of campylobacter-associated BCWG and rotavirus-associated BCWG may be similar.
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Khosroshahi N, Rahbarimanesh A, Boroujeni FA, Eskandarizadeh Z, Zoham MH. Afebrile Benign Convulsion Associated With Mild Gastroenteritis: A Cohort Study in a Tertiary Children Hospital. Child Neurol Open 2018; 5:2329048X18773498. [PMID: 29881767 PMCID: PMC5987894 DOI: 10.1177/2329048x18773498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Benign convulsion with mild gastroenteritis is a new clinical entity that occurs in children who are otherwise healthy. Method: This cohort study held among patients with afebrile convulsion and accompanying gastroenteritis in a tertiary children hospital during a 2-year period. Demographic and clinical data were analyzed. Neurodevelopmental milestones were observed during a follow-up period of 12 to 24 months. Results: Twenty-five patients aged 3 to 48 months with female predominance were enrolled. Ninety-three percent of cases experienced generalized tonic-clonic seizures. One-third of seizures occurred in clusters. Primary laboratory findings and electroencephalography were normal except for 3 with few epileptic waves. During the follow-up period, no seizure recurrence happened. Long-term antiepileptic treatment was unnecessary. Conclusion: Afebrile convulsion accompanying mild gastroenteritis is a convulsive disorder with reassuring prognosis. Due to its benign course, comprehensive neurodiagnostic evaluation and long-term antiepileptic drugs are usually avoidable.
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Affiliation(s)
- Nahid Khosroshahi
- Department of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Rahbarimanesh
- Department of Pediatric Infectious Disease, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Asadi Boroujeni
- Department of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Eskandarizadeh
- Department of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojdeh Habibi Zoham
- Department of Pediatric Intensive Care Unit, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Mojdeh Habibi Zoham, MD, Department of Pediatric Intensive Care Unit, Bahrami Children Hospital, Tehran University of Medical Sciences, Imam Hossein Square, Damavand Avenue, Tehran, Iran.
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Clinical outcome of recurrent afebrile seizures in children with benign convulsions associated with mild gastroenteritis. Seizure 2018; 60:110-114. [PMID: 29935410 DOI: 10.1016/j.seizure.2018.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the clinical outcome and evolution of recurrent afebrile seizures in children initially diagnosed with benign convulsions associated with mild gastroenteritis (CwG). METHODS We reviewed and analyzed the medical records of 37 patients who were diagnosed as CwG at onset, followed by recurrent afebrile seizures and followed up for at least 24 months. RESULTS The follow-up period ranged from 2 to 7 years (median, 40.1 months).Three patterns of recurrent afebrile seizures were recorded: afebrile seizures associated with gastrointestinal infection (AS-GI, n = 25), afebrile seizures associated with non-gastrointestinal infection (AS-nGI, n = 9), and unprovoked seizures (US, n = 3). Twenty eight patients (75.7%) had a second episode within 6 months after the first seizures. Five cases (13.5%) suffered three episodes of afebrile seizures. Seizure characteristics of the three patterns were similar, manifesting as clustered seizures in the majority. Focal epileptic activities in interictal EEG were found in 3 cases (9.4%) at onset, 10 cases (28.6%) at the second episode, respectively. Six patients were prescribed anti-epileptic drugs with apparently good responses. During at least 2 years' follow-up, all the cases showed normal psychomotor development. Only one patient was diagnosed with epilepsy. CONCLUSIONS All the recurrent afebrile seizures initially diagnosed as CwG, irrespective of the kinds and frequency of relapses, showed favorable prognoses. CwG maybe falls within the category of situation-related seizures, rather than epilepsy.
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26
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Ku JK, Heo YJ, Lee KS, Lee BL. Clinical Findings and Neurologic Outcome in Neonatal Encephalopathy With White Matter Injury Accompanied by Rotavirus. J Child Neurol 2018; 33:297-305. [PMID: 29433417 DOI: 10.1177/0883073817753290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to elucidate the clinical characteristics and neurodevelopmental outcomes in neonatal encephalopathy with characteristic white matter injury as compared with other injury patterns on magnetic resonance diffusion-weighted imaging. We conducted a retrospective study comparing clinical and laboratory findings, and neurologic outcomes between 17 newborns with diffuse lesions in the periventricular white matter and white matter tract (group I) and 22 newborns with other patterns (group II). Stool samples indicated that 16 neonates (94.1%) in group I were rotavirus-positive, whereas none in group II had rotavirus infection. Significantly lower calcium levels were found in group I than in group II ( P < .001). Moreover, a more favorable neurodevelopmental outcome was observed in group I than in group II. This study suggests that characteristic white matter injury in neonatal encephalopathy may be related to decreased calcium levels induced by rotavirus, and may have a better neurodevelopmental prognosis than other causes.
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Affiliation(s)
- Jae Kyun Ku
- 1 Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Young Jin Heo
- 2 Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Keun Soo Lee
- 3 Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Bo Lyun Lee
- 1 Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Xue CC, Liang YF, Pan GQ, Li CC. [Benign infantile convulsions associated with mild gastroenteritis: a clinical analysis and follow-up study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:1191-1195. [PMID: 29132468 PMCID: PMC7389322 DOI: 10.7499/j.issn.1008-8830.2017.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the clinical features and prognosis of benign infantile convulsions associated with mild gastroenteritis (BICE). METHODS A retrospective analysis was performed for the clinical data of 436 children with BICE, and among these children, 206 were followed up for 1.5 to 7 years. Some parents were invited to complete the Weiss Functional Defect Scale to evaluate the long-term social function. RESULTS The peak age of onset of BICE was 13-24 months, and BICE had a higher prevalence rate in September to February of the following year. Convulsions mainly manifested as generalized tonic-clonic seizures, which often occurred within 24 hours after disease onset and lasted for less than 5 minutes each time. Sometimes they occurred in clusters. During the follow-up of 206 children, only one had epileptiform discharge, and the other children had normal electroencephalographic results. The parents of all the 206 children thought their children had normal intelligence and had no marked changes in character. Based on the Weiss Functional Defect Scale completed by the parents of some BICE children, there was no significant difference in the long-term social function between BICE children and healthy children matched by age and sex. CONCLUSIONS BICE mainly occurs in children aged 1-2 years, with the manifestation of transient generalized seizures in most children and cluster seizures in some children. BICE seldom progresses to epilepsy and has good prognosis.
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Affiliation(s)
- Chao-Chao Xue
- Department of Pediatrics, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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Kim GH, Byeon JH, Lee DY, Jeong HJ, Eun BL. Norovirus in benign convulsions with mild gastroenteritis. Ital J Pediatr 2016; 42:94. [PMID: 27809881 PMCID: PMC5096325 DOI: 10.1186/s13052-016-0303-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/15/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Benign convulsions with gastroenteritis (CwG) are defined as afebrile convulsions accompanying symptoms of gastroenteritis without evidence of laboratory derangement. Although the main pathogen has been known as rotavirus, since the introduction of rotavirus vaccine, associated viruses with CwG may have changed. Thus, we evaluated the viral association of CwG for patients admitting for recent 2.5 years. METHODS All patients hospitalized for CwG between November 2012 and May 2015 were included in our study. Stool specimens were tested with reverse transcription polymerase chain reaction for detecting norovirus and astrovirus and with enzyme immunoassay for rotavirus and enteric adenovirus. Clinical data was gathered via chart review. RESULTS Fifty patients were included. Except four patients who failed to collect stool samples, 46 patients were tested. Causative diarrheal viruses were detected in 38 patients and they were 29 norovirus, four rotavirus, four adenovirus, and one astrovirus. Norovirus was commonly identified during the months of November and December. No difference of the clinical characteristics and laboratory value was noted according to the number of seizure episodes. CONCLUSIONS Norovirus is a common pathogen in CwG. Understanding the viral associations can facilitate recognition of CwG.
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Affiliation(s)
- Gun-Ha Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea
| | - Jung Hye Byeon
- Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea
| | - Deog-Yong Lee
- Division of Enteric Diseases, Center for Infectious Disease, National Institute of Health, Korea Center for Disease Control & Prevention (CDC-Korea), Chungcheongbuk-do, South Korea
| | - Hyun Ju Jeong
- Division of Enteric Diseases, Center for Infectious Disease, National Institute of Health, Korea Center for Disease Control & Prevention (CDC-Korea), Chungcheongbuk-do, South Korea
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea. .,Department of Pediatrics, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Zuberi SM. Editorial note. Eur J Paediatr Neurol 2016; 20:689. [PMID: 27502120 DOI: 10.1016/j.ejpn.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sameer M Zuberi
- Royal Hospital for Children, Glasgow, G51 4TF, United Kingdom.
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