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Kim JS, Woo H, Kim WS, Sung WY. Clinical Profile and Predictors of Recurrent Simple Febrile Seizure. Pediatr Neurol 2024; 156:4-9. [PMID: 38677048 DOI: 10.1016/j.pediatrneurol.2024.04.001] [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: 09/18/2023] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Recurrent simple febrile seizure (SFS) refers to febrile seizure (FS) that recurs within 24 hours. Patients with recurrent SFS often undergo unnecessary neurodiagnostic tests. To address this, we compared the clinical characteristics of recurrent SFS with those of SFS and investigated the risk factors associated with recurrent SFS. METHODS We retrospectively reviewed electronic medical records of patients aged six to 60 months who had been hospitalized for FS at two training hospitals between January 2016 and December 2019. The primary outcome was a comparison of the clinical features of patients with SFS and recurrent SFS. Additionally, the risk factors associated with seizure recurrence within 24 hours were evaluated. RESULTS Three quarters (n = 191, 75.2%) of the 254 enrolled patients experienced a single seizure episode during the febrile illness period. The remaining 63 patients (24.8%) were diagnosed with recurrent SFS. Significant differences between SFS and recurrent SFS were observed in the history of recurrent SFS, time from fever onset to seizure, and body temperature on hospital arrival. Multiple logistic regression analysis revealed that a history of previous recurrent SFS (odds ratio [OR] 10.161) and a body temperature below 39°C on arrival (OR 2.377) were significantly associated with early seizure recurrence. CONCLUSIONS This study highlights that early FS recurrence is common and has a self-limiting clinical course similar to that of SFS. We recommend close monitoring of the patient for six to eight hours when a history of early recurrence is present or if the seizure occurs at a low body temperature.
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Affiliation(s)
- Jon Soo Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyewon Woo
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Won Seop Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea.
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Castellazzi ML, La Vecchia A, Scali M, Agostoni C, Di Pietro G, Milani GP. Clinical and laboratory parameters associated with febrile seizure recurrence within the first 24 h: a ten-year cohort study. Front Pediatr 2024; 12:1373848. [PMID: 38500593 PMCID: PMC10944896 DOI: 10.3389/fped.2024.1373848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction We assessed clinical and laboratory parameters associated with early recurrence of febrile seizure in patients presenting at the Emergency Department with a first episode. Methods Case series of patients admitted to the emergency department with the first episode of febrile seizure for ten consecutive years. Exclusion criteria were focal features and prolonged duration (>15 min). Results We included 693 patients, 284 (41%) female. Median age of 20 (IQR 15-27) months. Fifty-two (8%) patients had a recurrence within 24 h. At univariate analysis, patients with recurrent seizures had higher use of antipyretics (88% vs. 74%, P = 0.03, OR 2.6, 95% CI: 1.1-7.7), higher median maximal body temperature (39.3 °C, IQR 38.9-39.9, vs. 38.9, IQR 38.4-39.3, P < 0.001, OR 2.3, 95% CI: 1.5-2.6) and presented with a lower proportion of respiratory tract infections (54% vs. 70%, P = 0.02) compared to patients without recurrence. A maximal body temperature equal to or higher than 39 °C was associated with a higher recurrence (11% vs. 4%, P < 0.001, OR 2.9, 95% CI: 1.6-5.6). Hyponatremia was not associated with a risk of recurrence. The multivariate analysis confirmed a direct association with body temperature (OR 2.3, 95% CI: 1.5-3.7, P < 0.001), and an inverse association with respiratory tract infections (OR 0.4, 95% CI: 0.2-0.9, P = 0.01), while antipyretic use was not correlated (OR 1.9, 95% CI: 0.8-5.2, P = 0.2). Conclusions High body temperature and respiratory tract infections were (directly and inversely) associated with recurrences. Consideration of these conditions might help for anticipating the probability of recurrence.
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Affiliation(s)
- Massimo Luca Castellazzi
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adriano La Vecchia
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Martina Scali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Giada Di Pietro
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gregorio Paolo Milani
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
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Papež J, Labounek R, Jabandžiev P, Česká K, Slabá K, Ošlejšková H, Aulická Š, Nestrašil I. Multivariate linear mixture models for the prediction of febrile seizure risk and recurrence: a prospective case-control study. Sci Rep 2023; 13:17372. [PMID: 37833343 PMCID: PMC10576023 DOI: 10.1038/s41598-023-43599-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Our goal was to identify highly accurate empirical models for the prediction of the risk of febrile seizure (FS) and FS recurrence. In a prospective, three-arm, case-control study, we enrolled 162 children (age 25.8 ± 17.1 months old, 71 females). Participants formed one case group (patients with FS) and two control groups (febrile patients without seizures and healthy controls). The impact of blood iron status, peak body temperature, and participants' demographics on FS risk and recurrence was investigated with univariate and multivariate statistics. Serum iron concentration, iron saturation, and unsaturated iron-binding capacity differed between the three investigated groups (pFWE < 0.05). These serum analytes were key variables in the design of novel multivariate linear mixture models. The models classified FS risk with higher accuracy than univariate approaches. The designed bi-linear classifier achieved a sensitivity/specificity of 82%/89% and was closest to the gold-standard classifier. A multivariate model assessing FS recurrence provided a difference (pFWE < 0.05) with a separating sensitivity/specificity of 72%/69%. Iron deficiency, height percentile, and age were significant FS risk factors. In addition, height percentile and hemoglobin concentration were linked to FS recurrence. Novel multivariate models utilizing blood iron status and demographic variables predicted FS risk and recurrence among infants and young children with fever.
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Affiliation(s)
- Jan Papež
- Department of Pediatrics, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic
| | - René Labounek
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Masonic Institute for the Developing Brain, 2025 East River Parkway, Minneapolis, MN, 55414, USA
| | - Petr Jabandžiev
- Department of Pediatrics, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
| | - Katarína Česká
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic
| | - Kateřina Slabá
- Department of Pediatrics, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
| | - Hana Ošlejšková
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic
| | - Štefania Aulická
- Department of Pediatric Neurology, Faculty of Medicine and University Hospital, Masaryk University, Černopolní 9, Brno, 612 00, Czech Republic.
- Ondrej Slaby Research Group, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
| | - Igor Nestrašil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Masonic Institute for the Developing Brain, 2025 East River Parkway, Minneapolis, MN, 55414, USA.
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Erdede Ö, Sarı E, Uyur E, Sezer Yamanel RG. Comprehensive Evaluation of Inflammatory Biomarkers and Osmolarity to Distinguish Simple and Complex Febrile Seizures in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1594. [PMID: 37892257 PMCID: PMC10605422 DOI: 10.3390/children10101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
With limited sample sizes and varying study outcomes regarding complete blood count (CBC)-associated biomarkers and their febrile seizure (FS) classification, along with limited research on osmolarity, this study aims to evaluate CBC-associated biomarkers, including osmolarity, for a comprehensive view of their diagnostic value. This single-center retrospective study used data from 364 children (aged 5-60 months) diagnosed with FS. The patients were categorized into simple FS (n = 221) and complex FS (n = 143) groups. CBC and biochemical tests, including sodium, potassium, chloride, glucose, blood urea nitrogen, and C-reactive protein levels, were evaluated. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio, and osmolarity were calculated and compared between FS types and the number of seizures. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive utility of these markers. Inflammatory markers, including NLR, were ineffective in predicting FS types. Complex FS cases exhibited a significantly lower osmolarity than simple FS cases. The area under the ROC curve for osmolarity to distinguish complex FS was 0.754, while other markers did not reach the desired threshold of 0.700. Including osmolarity in the classification of FS has clinical applicability. Physicians may consider osmolarity as an additional tool to aid in clinical decision-making.
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Affiliation(s)
- Özlem Erdede
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
| | - Erdal Sarı
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
| | - Emek Uyur
- Department of Pediatric Neurology, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey;
| | - Rabia Gönül Sezer Yamanel
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
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Zhang M, Kou L, Qin Y, Chen J, Bai D, Zhao L, Lin H, Jiang G. A bibliometric analysis of the recent advances in diazepam from 2012 to 2021. Front Pharmacol 2022; 13:1042594. [DOI: 10.3389/fphar.2022.1042594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Diazepam is a classic benzodiazepine drug that has been widely used for disorders such as anxiety, sleep disorders, and epilepsy, over the past 59 years. The study of diazepam has always been an important research topic. However, there are few bibliometric analyses or systematic studies in this field. This study undertook bibliometric and visual analysis to ascertain the current status of diazepam research, and to identify research hotspots and trends in the past 10 years, to better understand future developments in basic and clinical research.Methods: Articles and reviews of diazepam were retrieved from the Web of Science core collection. Using CiteSpace, VOSviewer, and Scimago Graphica software, countries, institutions, authors, journals, references, and keywords in the field were visually analyzed.Results: A total of 3,870 publications were included. Diazepam-related literature had high volumes of publications and citations. The majority of publications were from the USA and China. The highest number of publications and co-citations, among the authors, was by James M Cook. Epilepsia and the Latin American Journal of Pharmacy were the journals with the most publications on diazepam and Epilepsia was the most frequently cited journal. Through a comprehensive analysis of keywords and references, we found that current research on diazepam has focused on its mechanism of action, application in disease, pharmacokinetics, risk, assessment, and management of use, status epilepticus, gamma-aminobutyric acid receptors (GABAR), intranasal formulation, gephyrin, and that ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) is the current research hotspot.Conclusion: Research on diazepam is flourishing. We identified research hotspots and trends in diazepam research using bibliometric and visual analytic methods. The clinical applications, mechanisms of action, pharmacokinetics, and assessment and management of the use of diazepam are the focus of current research and the development trend of future research.
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Tanaka M, Wang Q, Morikawa Y, Tsukamoto J, Sammori H, Takehira K, Yano M, Miyama S, Fujita S, Narita K, Kishibe S, Kawaguchi Morikawa E, Suzuki S, Hataya H. Efficacy, safety, and economic impact of diazepam suppositories with as-needed acetaminophen for prevention of seizure recurrence during the same fever episode in children with suspected simple febrile seizures. Epilepsia 2022; 63:1704-1713. [PMID: 35485955 DOI: 10.1111/epi.17271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy, safety, and economic impact of diazepam suppositories with as-needed acetaminophen in comparison with as-needed acetaminophen alone for prevention of seizure recurrence during the same fever episode in suspected pediatric simple febrile seizures (SFS). METHODS This single-center, prospective, observational study was conducted from July 29, 2019 to February 15, 2021 at a children's hospital. Children aged 6 months to 60 months presenting to the emergency department with suspected SFS were included. Participants receiving both diazepam suppositories and as-needed acetaminophen were compared with those receiving as-needed acetaminophen alone. The primary outcome was seizure recurrence during the same fever episode. The secondary outcomes included the incidence of central nervous system (CNS) pathologies, adverse events, and medical costs. RESULTS Of the 316 participants, 228 (72.2%) had their first febrile seizure. Diazepam (0.3-0.5 mg/kg for up to two doses) was administered to 88/316 patients (27.8%). The outcomes were available for 306 patients. The recurrence rate was 3.5% (3/85) in the patients receiving diazepam with as-needed acetaminophen and 12.2% (27/221) in the patients receiving as-needed acetaminophen alone (relative risk: 0.29 [95% CI: 0.09-0.93]; P=0.03). The adjusted odds ratio of diazepam administration against recurrence was 0.23 (95% CI: 0.07-0.78; P=0.02). None of the patients had a CNS pathology. No severe adverse events occurred although mild ataxia was observed significantly more often in the patients receiving diazepam and as-needed acetaminophen (29.4% vs 18.7%, P=0.04). The median medical cost was US Dollars 199 (IQR: 86-244) for the group receiving both medications and US Dollars 202 (IQR: 114-242) for the group receiving as-needed acetaminophen alone. SIGNIFICANCE Compared with as-needed acetaminophen alone, diazepam with as-needed acetaminophen may reduce seizure recurrence more during the same fever episode without severe adverse events or additional costs in children with suspected SFS.
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Affiliation(s)
- Miki Tanaka
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Qianzhi Wang
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Junya Tsukamoto
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroaki Sammori
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Ken Takehira
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Mizuki Yano
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satoshi Miyama
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Saki Fujita
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kazutoshi Narita
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shun Kishibe
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Emi Kawaguchi Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satoko Suzuki
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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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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