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Ferretti A, Riva A, Fabrizio A, Bruni O, Capovilla G, Foiadelli T, Orsini A, Raucci U, Romeo A, Striano P, Parisi P. Best practices for the management of febrile seizures in children. Ital J Pediatr 2024; 50:95. [PMID: 38735928 PMCID: PMC11089695 DOI: 10.1186/s13052-024-01666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Febrile seizures (FS) are commonly perceived by healthcare professionals as a self-limited condition with a generally 'benign' nature. Nonetheless, they frequently lead to pediatric consultations, and their management can vary depending on the clinical context. For parents and caregivers, witnessing a seizure can be a distressing experience, significantly impacting their quality of life. In this review, we offer an in-depth exploration of FS management, therapeutic interventions, and prognostic factors, with the aim of providing support for physicians and enhancing communication with families. We conducted a comprehensive literature search using the PubMed and Web of Science databases, spanning the past 50 years. The search terms utilized included "febrile seizure," "complex febrile seizure," "simple febrile seizure," in conjunction with "children" or "infant." Only studies published in English or those presenting evidence-based data were included in our assessment. Additionally, we conducted a cross-reference search to identify any additional relevant data sources. Our thorough literature search resulted in a compilation of references, with carefully selected papers thoughtfully integrated into this review.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy.
| | - Antonella Riva
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alice Fabrizio
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Capovilla
- Child Neuropsychiatry Department, Epilepsy Center, Mantova, Italy
- C. Poma HospitalFondazione Poliambulanza, Brescia, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Romeo
- Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pasquale Striano
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
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Falsaperla R, Marino S, Vitaliti G, Bonadies A, Marino SD, Pavone P, Romano C, Savoia F, Calì C, Ruggieri M, Lubrano R, Tipo V. Simple febrile seizures: new cut off for the duration of the crises. Acta Neurol Belg 2023:10.1007/s13760-023-02211-3. [PMID: 36829088 DOI: 10.1007/s13760-023-02211-3] [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: 08/15/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Our study aimed to identify a new cut-off for febrile seizure (FS) with a good prognosis, thereby replacing the 15 min described in the standard definition of simple febrile seizure (SFS). METHODS Our study was a retrospective observational study (from January 2018 to December 2018) on children admitted to the Pediatric emergency room of the Santobono-Pausilipon Hospital, Naples, Italy, Pediatric Unit of Latina, Rome, Italy, and Policlinico-Vittorio-Emanuele University Hospital, Catania, Italy, for fever, which developed SFS during the hospitalization. All included patients had their seizures classified as SFS according to the international criteria for epilepsy. We assumed a duration cut-off, and we analyzed the EEG results, neurological follow-up at 12 months, and the recurrence of the febrile seizures the following year. Then, with another calculation, we identify an optimal cut-off of 6 min. Finally, we divided the population into two groups: children with seizures having a duration greater than or less than 6 min. RESULTS We found that the population with FS with a duration greater than 6 min presented EEG alteration at follow-up visits, neurological disorders, and a recurrence of FS during the following year. CONCLUSIONS We suggest to introduce a new cut-off for the duration of FS that better represents the benign nature of a simple febrile event.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy.,Unit of Intensive Care and Neonatology, University Hospital "Rodolico - San Marco", PO "San Marco", Catania, Italy
| | - Silvia Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy.
| | - Giovanna Vitaliti
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Anna Bonadies
- Department of Pediatric, AORN Santobono Pausilipon, Naples, Italy
| | - Simona Domenica Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital "Rodolico - San Marco", PO "Rodolico", Catania, Italy
| | - Catia Romano
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Fabio Savoia
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, AORN "Santobono-Pausilipon Children's Hospital", Naples, Italy
| | - Camilla Calì
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, AORN "Santobono-Pausilipon Children's Hospital", Naples, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Riccardo Lubrano
- Department of Paediatrics, University of Rome "La Sapienza", Rome, Italy
| | - Vincenzo Tipo
- Department of Pediatric, AORN Santobono Pausilipon, Naples, Italy
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3
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Practices of pediatric emergency physicians on the first febrile and afebrile seizures: a research in European Pediatric Emergency Medicine Survey Study. Eur J Emerg Med 2022; 29:455-457. [DOI: 10.1097/mej.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Henry C, Cockburn C, Simpson MH, Budd S, Wang C, Dinov D. The baseline risk of multiple febrile seizures in the same febrile illness: a meta-analysis. Eur J Pediatr 2022; 181:2201-2213. [PMID: 35292852 PMCID: PMC9468602 DOI: 10.1007/s00431-022-04431-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 02/02/2023]
Abstract
The baseline risk for multiple febrile seizures within the same febrile illness is largely unknown. Estimates range from 5 to 30%. Imprecise estimates can lead to incorrectly powering studies investigating the management of febrile seizures. To estimate the risk of multiple febrile seizures in the same febrile illness, we systematically reviewed and conducted a meta-analysis of studies from January 2000 to December 2021 that contained data for the number of children for both simple and complex febrile seizures in the same febrile illness. We searched MEDLINE, EMBASE, and Web of Science for randomized, quasi-randomized, prospective, and retrospective trials that involved children with febrile seizures. A total of 23,131 febrile illnesses with febrile seizures met the inclusion criteria. The estimated baseline risk of multiple febrile seizures in the same febrile illness was 17% (95% CI, 16-19%). However, the 30 cohorts that included both admitted and non-admitted patients had a lower percentage of multiple FSs within the same illness (14%; 95% CI, 12-15%) than the 30 cohorts that enrolled only admitted patients (20%; 95% CI, 16-25%). CONCLUSION Researchers can use estimates in this paper to design future studies. Taking into the account the substantial heterogeneity between countries and studies, clinicians could cautiously use our estimates in their clinical assessment and be better able to set parental expectations about a child's chances of having another febrile seizure during the current illness. TRIAL REGISTRATION PROSPERO CRD42020191784. Registered July 18, 2020. WHAT IS KNOWN • There is renewed interest in the diagnostic workup and prophylactic treatment of febrile seizures to prevent repeat seizures in the same febrile illness. • There is a lack of accurate estimates of the baseline risk for multiple febrile seizures in the same illness to properly design studies investigating management. WHAT IS NEW • This study provides the most robust estimates for the baseline risk for multiple febrile seizures in the same illness.
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Affiliation(s)
- Christopher Henry
- Department of Neurology, Children's Hospital of Richmond, VCU Health System, Richmond, VA, USA.
| | - Chelsea Cockburn
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Pediatrics, Children's Hospital of Pittsburgh, UPMC, Pittsburgh, PA, USA
| | - Mary Helen Simpson
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Pediatrics, Golisano Children's Hospital, URMC, Rochester, NY, USA
| | - Serenity Budd
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Chen Wang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Darina Dinov
- Department of Neurology, Children's Hospital of Richmond, VCU Health System, Richmond, VA, USA
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Tarhani F, Nezami A, Heidari G, Dalvand N. Factors associated with febrile seizures among children. Ann Med Surg (Lond) 2022; 75:103360. [PMID: 35198190 PMCID: PMC8850670 DOI: 10.1016/j.amsu.2022.103360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 01/16/2023] Open
Affiliation(s)
- Fariba Tarhani
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Alireza Nezami
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ghobad Heidari
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- Corresponding author. Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Niloufar Dalvand
- Student of Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Pavone P, Pappalardo XG, Parano E, Falsaperla R, Marino SD, Fink JK, Ruggieri M. Fever-Associated Seizures or Epilepsy: An Overview of Old and Recent Literature Acquisitions. Front Pediatr 2022; 10:858945. [PMID: 35529330 PMCID: PMC9070101 DOI: 10.3389/fped.2022.858945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
In addition to central nervous system infections, seizures and fever may occur together in several neurological disorders. Formerly, based on the clinical features and prognostic evolution, the co-association of seizure and fever included classical febrile seizures (FS) divided into simple, complex, and prolonged FS (also called febrile status epilepticus). Later, this group of disorders has been progressively indicated, with a more inclusive term, as "fever-associated seizures or epilepsy" (FASE) that encompasses: (a) FS divided into simple, complex, and prolonged FS; (b) FS plus; (c) severe myoclonic epilepsy in infancy (Dravet syndrome); (d) genetic epilepsy with FS plus; and (e) febrile infection-related epilepsy syndrome (FIRES). Among the FASE disorders, simple FS, the most common and benign condition, is rarely associated with subsequent epileptic seizures. The correlation of FS with epilepsy and other neurological disorders is highly variable. The pathogenesis of FASE is unclear but immunological and genetic factors play a relevant role and the disorders belonging to the FASE group show to have an underlying common clinical, immunological, and genetic pathway. In this study, we have reviewed and analyzed the clinical data of each of the heterogeneous group of disorders belonging to FASE.
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Affiliation(s)
- Piero Pavone
- Unit of Clinical Pediatrics, AOU "Policlinico", PO "G. Rodolico", University of Catania, Catania, Italy
| | - Xena Giada Pappalardo
- Unit of Catania, National Council of Research, Institute for Research and Biomedical Innovation (IRIB), Catania, Italy.,Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Enrico Parano
- Unit of Catania, National Council of Research, Institute for Research and Biomedical Innovation (IRIB), Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - John Kane Fink
- Department of Neurology and Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI, United States
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico", PO "G. Rodolico", Catania, Italy
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Salmi H, Oulasvirta J, Rahiala E, Kuisma M, Lääperi M, Harve H. Out-of-Hospital Seizures in Children: A Population-Based Study. Pediatr Emerg Care 2021; 37:e1274-e1277. [PMID: 31977765 DOI: 10.1097/pec.0000000000002001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Seizures seem to represent a frequent cause for pediatric emergency medical (EM) and emergency room (ER) contacts, but few population-based data are available. Our aim was to study the incidence, prehospital and ER treatment, and outcomes of pediatric seizures necessitating out-of-hospital care. METHODS We studied the out-of-hospital evaluation procedures, ER treatment, diagnostics and 2-year prognosis of all cases of pediatric (0-16 years) seizures encountered by the emergency medical services (EMS) in Helsinki, Finland, in 2012 (population 603,968, pediatric population 92,742); 251 patients were encountered by the EMS, of which 220 seen at the ER. RESULTS The yearly incidence of pediatric seizures necessitating EMS activation was 2.8/1000 in the pediatric population. Febrile seizures were responsible for 97 (44.1%) of the cases transported to the ER. Only a minority of patients required advanced life support measures out-of-hospital or complex diagnostics in the ER. Still, of the 220 patients seen at ER, 68 (30.9%) were hospitalized, and 106 (48.2%) had follow-up contacts scheduled. CONCLUSIONS Pediatric seizures were a common cause for EM and ER contacts. Advanced life support measures were seldom needed, and the prognosis was good, but seizures still required considerable resources. They often resulted in urgent EM dispatch and transport, hospitalization, follow-up visits, new medication, and complementary studies. This emphasizes the role the EMS plays in recognizing and terminating pediatric seizures and in referring these children to appropriate care.
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Affiliation(s)
| | - Jelena Oulasvirta
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine
| | | | - Markku Kuisma
- Emergency Medical Services, Department of Emergency Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mitja Lääperi
- Emergency Medical Services, Department of Emergency Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heini Harve
- Emergency Medical Services, Department of Emergency Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Kubota J, Higurashi N, Hirano D, Okabe S, Yamauchi K, Kimura R, Numata H, Suzuki T, Kakegawa D, Ito A, Hamano SI. Body temperature predicts recurrent febrile seizures in the same febrile illness. Brain Dev 2021; 43:768-774. [PMID: 33775463 DOI: 10.1016/j.braindev.2021.03.002] [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: 11/13/2020] [Revised: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of recurrent febrile seizures during the same febrile illness (RFS) is 14-24%. A pilot study found that body temperature and male sex were predictors of RFS. This study sought to validate body temperature as a predictor of RFS, calculate the optimal cut-off body temperature for predicting RFS, and identify the other predictors of RFS. METHODS This prospective cohort study enrolled children with febrile seizures aged 6-60 months who visited the emergency department at Atsugi City Hospital, Japan, between March 1, 2019, and February 29, 2020. Children who had multiple seizures, diazepam administration before the emergency department visit, seizures lasting >15 min, underlying diseases, or who could not be followed up were excluded. The optimal cut-off body temperature was determined using a receiver-operating characteristic curve. RESULTS A total of 109 children were enrolled, of whom 13 (11.9%) had RFS. A lower body temperature was significantly associated with RFS (P = 0.02). The optimal cut-off body temperature for predicting RFS was 39.2 °C. Children with RFS also had significantly lower C-reactive protein and blood glucose levels (P = 0.01 and 0.047, respectively), but none of the other factors considered were significantly associated with RFS. CONCLUSIONS This large prospective study confirmed that body temperature is a predictor of RFS. The optimal cut-off body temperature for predicting RFS was 39.2 °C. Low C-reactive protein level and blood glucose level might be predictors of RFS, but this needs to be confirmed in prospective multicenter studies.
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Affiliation(s)
- Jun Kubota
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
| | - Norimichi Higurashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shiro Okabe
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Kento Yamauchi
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Rena Kimura
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruka Numata
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Kakegawa
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Ito
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
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Barco TL, Kuchenbuch M, Garcelon N, Neuraz A, Nabbout R. Improving early diagnosis of rare diseases using Natural Language Processing in unstructured medical records: an illustration from Dravet syndrome. Orphanet J Rare Dis 2021; 16:309. [PMID: 34256808 PMCID: PMC8278630 DOI: 10.1186/s13023-021-01936-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background The growing use of Electronic Health Records (EHRs) is promoting the application of data mining in health-care. A promising use of big data in this field is to develop models to support early diagnosis and to establish natural history. Dravet Syndrome (DS) is a rare developmental and epileptic encephalopathy that commonly initiates in the first year of life with febrile seizures (FS). Age at diagnosis is often delayed after 2 years, as it is difficult to differentiate DS at onset from FS. We aimed to explore if some clinical terms (concepts) are significantly more used in the electronic narrative medical reports of individuals with DS before the age of 2 years compared to those of individuals with FS. These concepts would allow an earlier detection of patients with DS resulting in an earlier orientation toward expert centers that can provide early diagnosis and care. Methods Data were collected from the Necker Enfants Malades Hospital using a document-based data warehouse, Dr Warehouse, which employs Natural Language Processing, a computer technology consisting in processing written information. Using Unified Medical Language System Meta-thesaurus, phenotype concepts can be recognized in medical reports. We selected individuals with DS (DS Cohort) and individuals with FS (FS Cohort) with confirmed diagnosis after the age of 4 years. A phenome-wide analysis was performed evaluating the statistical associations between the phenotypes of DS and FS, based on concepts found in the reports produced before 2 years and using a series of logistic regressions. Results We found significative higher representation of concepts related to seizures’ phenotypes distinguishing DS from FS in the first phases, namely the major recurrence of complex febrile convulsions (long-lasting and/or with focal signs) and other seizure-types. Some typical early onset non-seizure concepts also emerged, in relation to neurodevelopment and gait disorders. Conclusions Narrative medical reports of individuals younger than 2 years with FS contain specific concepts linked to DS diagnosis, which can be automatically detected by software exploiting NLP. This approach could represent an innovative and sustainable methodology to decrease time of diagnosis of DS and could be transposed to other rare diseases.
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Affiliation(s)
- Tommaso Lo Barco
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Centre de Référence Épilepsies Rares, Member of ERN EPICARE, Université de Paris, Paris, France.,Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Mathieu Kuchenbuch
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Centre de Référence Épilepsies Rares, Member of ERN EPICARE, Université de Paris, Paris, France.,Imagine Institute, INSERM, UMR 1163, Université de Paris, 75015, Paris, France
| | - Nicolas Garcelon
- Imagine Institute, INSERM, UMR 1163, Université de Paris, 75015, Paris, France
| | - Antoine Neuraz
- Université de Paris, Paris, France.,INSERM, UMR1138, Centre de Recherche Des Cordeliers, Paris, France.,Department of Medical Informatics, University Hospital Necker-Enfants Malades, APHP, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Centre de Référence Épilepsies Rares, Member of ERN EPICARE, Université de Paris, Paris, France. .,Imagine Institute, INSERM, UMR 1163, Université de Paris, 75015, Paris, France. .,Université de Paris, Paris, France.
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Han JY, Han SB. Seizures Related to Influenza in Pediatric Patients: A Comparison with Seizures Associated with Other Respiratory Viral Infections. J Clin Med 2021; 10:jcm10143088. [PMID: 34300253 PMCID: PMC8303985 DOI: 10.3390/jcm10143088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 01/27/2023] Open
Abstract
Although febrile seizures are the most common neurological complications of influenza, there are few studies comparing seizure characteristics and outcomes between patients with influenza and those with other respiratory virus (RV) infections. Medical records of pediatric patients presenting with seizures accompanied by fever, in whom RV infections were identified, were retrospectively reviewed to compare the characteristics and outcomes of seizures with fever due to influenza (n = 97) to those due to other RV infections (n = 113). Patients with influenza were older than those with other RV infections (p < 0.001), and 22.7% of them were aged ≥5 years. Seizure characteristics of complex febrile seizures were observed more frequently in patients with other RV infections than in those with influenza; however, the frequency of epilepsy was comparable between the two groups. For patients with influenza, children aged <5 years and those aged ≥5 years showed similar seizure characteristics and outcomes. Further neurological evaluations should not be based solely on patient age in children with influenza who experience late-onset seizures at ≥5 years of age. Long-term sequelae should be further investigated in these patients.
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Affiliation(s)
- Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-42-220-9218
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Ogino M, Kashiwagi M, Tanabe T, Oba C, Nomura S, Shimakawa S, Kidokoro H, Natsume J, Okumura A, Tamai H, Ashida A. Clinical findings in patients with febrile seizure after 5 years of age: A retrospective study. Brain Dev 2020; 42:449-456. [PMID: 32201092 DOI: 10.1016/j.braindev.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/04/2020] [Accepted: 02/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Febrile seizures (FSs) typically occur in infants and children between 6 and 60 months of age. Rarely, FS can occur in late childhood (late FS [LFS]; >5 years of age); however, the clinical features of LFS remain unclear. We aimed to clarify the clinical features of LFS. METHODS We retrospectively analyzed data from patients with LFS who visited Hirakata City Hospital between January 2004 and December 2014. We defined LFS as a seizure accompanied by fever (temperature ≥38 °C) occurring after 5 years of age, without a central nervous system infection. RESULTS A total of 505 patients (349 boys, 156 girls: 5-14 years old) were included. A history of FS before 60 months of age was observed in 319 of 460 patients (69.3%) with sufficient information about previous FS history among the 505 patients enrolled. LFS was more likely to occur in males (69.1%). Seizure duration was ≤15 min in 87.4% of cases. A family history of FS in first-degree relatives was observed in 103/327 cases (31.5%). Among LFS cases, 45% occurred at 5 years of age, and 92.1% experienced only one seizure after 5 years of age. The number of seizure episodes gradually lessened with age, decreasing drastically to 5.6% of cases older than 9 years. CONCLUSIONS Our findings suggest that sex differences, seizure duration, and family history were similar for LFS and FS. Over 90% patients with LFS experienced no recurrence after 5 years of age. Further study is needed to verify the recurrence rate of LFS.
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Affiliation(s)
- Motoko Ogino
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan; Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | | | - Takuya Tanabe
- Department of Child Neurology, Tanabe Children's Clinic, Osaka, Japan
| | - Chizu Oba
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | - Shohei Nomura
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | | | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
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Kubota J, Higurashi N, Hirano D, Isono H, Numata H, Suzuki T, Kakegawa D, Ito A, Yoshihashi M, Ito T, Hamano SI. Predictors of recurrent febrile seizures during the same febrile illness in children with febrile seizures. J Neurol Sci 2020; 411:116682. [PMID: 31972348 DOI: 10.1016/j.jns.2020.116682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/22/2019] [Accepted: 01/11/2020] [Indexed: 11/29/2022]
Abstract
Febrile seizures (FS) are common in childhood. Of children who experience an FS, 14-24% experience recurrence within 24 h, during the same febrile illness (RFS). The aim of this pilot study was to identify the predictors of RFS among children who experience FS. We conducted a retrospective cohort study of children aged 6-60 months, who visited the emergency department (ED) at Atsugi City Hospital in Japan for treatment of an FS between December 1, 2018 and February 28, 2019. Exclusion criteria included multiple seizures before visiting the ED, diazepam administration before visiting the ED or on departure, seizures lasting >15 min, underlying diseases such as epilepsy, and absence of laboratory test results. The primary outcome was RFS. Fifty-one patients fulfilled the inclusion criteria, of whom nine (17.6%) had RFS. The incidence of RFS was significantly higher in children with a body temperature ≤ 39.8 °C during the ED visit (P = .01). The combination of male sex and a body temperature ≤ 39.8 °C had a sensitivity, specificity and negative predictive value of 88.9%, 76.2%, and 97.0%, respectively. In conclusion, the incidence of RFS was 17.6%. The major predictors of RFS were male sex and a body temperature ≤ 39.8 °C.
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Affiliation(s)
- Jun Kubota
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
| | - Norimichi Higurashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirotaka Isono
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruka Numata
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Kakegawa
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Ito
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Yoshihashi
- Department of Pediatrics, Kanagawa Rehabilitation Center, Kanagawa, Japan
| | - Takeru Ito
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
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13
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Caffarelli C, Santamaria F, Mastrorilli C, Santoro A, Iovane B, Petraroli M, Gaeta V, Di Pinto R, Borrelli M, Bernasconi S, Corsello G. Report on advances for pediatricians in 2018: allergy, cardiology, critical care, endocrinology, hereditary metabolic diseases, gastroenterology, infectious diseases, neonatology, nutrition, respiratory tract disorders and surgery. Ital J Pediatr 2019; 45:126. [PMID: 31619283 PMCID: PMC6796402 DOI: 10.1186/s13052-019-0727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022] Open
Abstract
This review reported notable advances in pediatrics that have been published in 2018. We have highlighted progresses in allergy, cardiology, critical care, endocrinology, hereditary metabolic diseases, gastroenterology, infectious diseases, neonatology, nutrition, respiratory tract disorders and surgery. Many studies have informed on epidemiologic observations. Promising outcomes in prevention, diagnosis and treatment have been reported. We think that advances realized in 2018 can now be utilized to ameliorate patient care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carla Mastrorilli
- UO Pediatria e Pronto Soccorso, Azienda Ospedaliero-Universitaria Consorziale Policlinico Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Brunella Iovane
- UOC Pediatria Generale e d'Urgenza, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Maddalena Petraroli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Valeria Gaeta
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Rosita Di Pinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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14
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Epidemiology and Resource Utilization of Simple Febrile Seizure-associated Hospitalizations in the United States, 2003-2012. J Neurosurg Anesthesiol 2019; 31:144-150. [PMID: 30767940 DOI: 10.1097/ana.0000000000000546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Simple febrile seizure (SFS) affects 2% to 4% of children under 6 years of age. The purpose of this study is to examine the epidemiologic patterns and resource utilization of SFS-associated hospitalizations in children aged younger than 6 years of age in the United States. MATERIALS AND METHODS This study is a serial, retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Databases for the years 2003, 2006, 2009, and 2012. SFS-associated hospitalizations were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code 780.31. We calculated the proportion of hospitalizations in pediatric patients under 6 years of age due to SFS and all other nonbirth causes, the rate of SFS-associated hospitalizations per 100,000 population, the mean length of stay and inflation-adjusted hospital costs of SFS-associated hospitalizations, as well as patient demographics and hospital characteristics. RESULTS From 2003 to 2012, the weighted proportion of hospitalizations due to SFS declined from 0.83% to 0.41% (P<0.01) and the annual rate of SFS-associated hospitalizations per 100,000 population decreased from 48.0 to 18.7 (P<0.01). However, use of computed tomography, electroencephalogram, and lumbar puncture in SFS-associated hospitalizations decreased significantly (all P<0.001), but the utilization rate of magnetic resonance imaging remained stable (P=0.53). The mean length of stay for SFS-associated hospitalizations decreased from 2.03 days in 2003 to 1.74 days in 2012, and the mean hospital costs (exclusive of professional payment) decreased from $3830 in 2003 to $3223 in 2012 (both P<0.001). CONCLUSIONS SFS-associated hospitalizations and resource utilization in children under 6 years of age have decreased markedly in the United States, probably due to improved clinical adherence to the practice parameters set forth by the American Academy of Pediatrics for managing patients with SFS.
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Management of Pediatric Febrile Seizures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102232. [PMID: 30321985 PMCID: PMC6210946 DOI: 10.3390/ijerph15102232] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/21/2023]
Abstract
Febrile seizures (FS), events associated with a fever in the absence of an intracranial infection, hypoglycaemia, or an acute electrolyte imbalance, occur in children between six months and six years of age. FS are the most common type of convulsions in children. FS can be extremely frightening for parents, even if they are generally harmless for children, making it important to address parental anxiety in the most sensitive manner. The aim of this review was to focus on the management of FS in the pediatric age. An analysis of the literature showed that most children with FS have an excellent prognosis, and few develop long-term health problems. The diagnosis of FS is clinical, and it is important to exclude intracranial infections, in particular after a complex FS. Management consists of symptom control and treating the cause of the fever. Parents and caregivers are often distressed and frightened after a FS occurs and need to be appropriately informed and guided on the management of their child’s fever by healthcare professionals. Due to the inappropriate use of diagnostic tests and treatments, it is extremely important to improve the knowledge of pediatricians and neurologists on FS management and to standardize the diagnostic and therapeutic work-up.
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16
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Pavone P, Corsello G, Ruggieri M, Marino S, Marino S, Falsaperla R. Benign and severe early-life seizures: a round in the first year of life. Ital J Pediatr 2018; 44:54. [PMID: 29764460 PMCID: PMC5952424 DOI: 10.1186/s13052-018-0491-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/18/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND At the onset, differentiation between abnormal non-epileptic movements, and epileptic seizures presenting in early life is difficult as is clinical diagnosis and prognostic evaluation of the various seizure disorders presenting at this age. Seizures starting in the first year of life including the neonatal period might have a favorable course, such as in infants presenting with benign familial neonatal epilepsy, febrile seizures simplex or acute symptomatic seizures. However, in some cases, the onset of seizures at birth or in the first months of life have a dramatic evolution with severe cerebral impairment. Seizure disorders starting in early life include the "epileptic encephalopathies", a group of conditions characterized by drug resistant seizures, delayed developmental skills, and intellective disability. This group of disorders includes early infantile epileptic encephalopathy also known as Ohtahara syndrome, early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, infantile spasms syndrome (also known as West syndrome), severe myoclonic epilepsy in infancy (also known as Dravet syndrome) and, myoclonic encephalopathies in non-progressive disorder. Here we report on seizures manifesting in the first year of life including the neonatal period. Conditions with a benign course, and those with severe evolution are presented. At this early age, clinical identification of seizures, distinction of each of these disorders, type of treatment and prognosis is particularly challenging. The aim of this report is to present the clinical manifestations of each of these disorders and provide an updated review of the conditions associated with seizures in the first year of life.
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Affiliation(s)
- Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, A.U.O. Vittorio Emanuele-Policlinico of Catania, Via Santa Sofia 78, 95100, Catania, Italy.
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, A.U.O. Vittorio Emanuele-Policlinico of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| | - Silvia Marino
- University-Hospital 'Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Simona Marino
- University-Hospital 'Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- University-Hospital 'Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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