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Leung JSC. Febrile Seizures: An Updated Narrative Review for Pediatric Ambulatory Care Providers. Curr Pediatr Rev 2024; 20:43-58. [PMID: 36043723 DOI: 10.2174/1573396318666220829121946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While generally self-limited, febrile seizures result in significant familial distress. Ambulatory pediatric care providers must be prepared to counsel families on the causes, risk factors, management principles, and prognosis of children with febrile seizures. OBJECTIVE To provide an updated, evidence-based review of febrile seizures focused on the needs of an ambulatory pediatric care provider. METHODS A narrative review of the literature prioritizing landmark articles, metanalyses, longitudinal population longitudinal cohort studies and national level guidelines. RESULTS Febrile seizures are aberrant physiological responses to fever in children caused by complex interactions of cytokine mediated neuroinflammation, environmental triggers, and genetic predisposition. Other than investigations to determine fever etiology, routine bloodwork, lumbar punctures, neuroimaging and electroencephalograms are low yield. The general prognosis is excellent, however, clinicians should be aware of long-term outcomes including: cognitive impairment with non-simple febrile seizures; neuropsychiatric associations; recurrent febrile seizure and epilepsy risk factors; and the association between complex febrile seizures and sudden unexpected death. Children with a high risk of recurrence, complex febrile seizures, limited access to care, or extreme parental anxiety may benefit from intermittent oral diazepam prophylaxis. CONCLUSION Clinicians should consider four management priorities: 1) terminating the seizure; 2) excluding critical differential diagnoses; 3) investigating fever etiology; and 4) providing adequate counselling to families. The clinical approach and prognosis of febrile seizure can be based on subtype. Children with non-simple (i.e. complex or febrile status epilepticus) febrile seizures require closer care than the vast majority of children with simple febrile seizures, who have excellent outcomes.
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Affiliation(s)
- James Sze-Chuck Leung
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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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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Yang JH, Villegas R, Khanna S, Kaswick J, Coufal NG, Crawford J, Harvey H. The Utility of Infectious and Neurodiagnostic Testing in Children With Complex Febrile Seizures Requiring Mechanical Ventilation. J Child Neurol 2021; 36:735-742. [PMID: 33754870 DOI: 10.1177/08830738211000507] [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] [Indexed: 11/15/2022]
Abstract
A retrospective cohort analysis was performed on 79 consecutive patients between 6 months and 5 years admitted to a tertiary hospital with a diagnosis of complex febrile seizures requiring mechanical ventilation from 2011 to 2017 to determine the utility of infectious and neurologic diagnostics. Intubation was used as a proxy for severity of illness. The overall intensive care unit stay was short (95% intubated <24 hours, 88% admitted <3 days). No life-threatening infections were identified, and none required surgical interventions. Electroencephalogram (EEG) was obtained on 43%, 26% of which were abnormal. Sixty-six percent of patients were discharged on rescue benzodiazepine and 20% with maintenance antiseizure medications. Duration of follow-up averaged 4 years (range 1 month to 9 years); 8 patients (10%) were subsequently diagnosed with epilepsy. Our findings suggest that extensive diagnostic evaluations may not be necessary for children with complex febrile seizures requiring mechanical ventilation although the role of EEG is less understood.
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Affiliation(s)
- Jennifer H Yang
- Department of Neurosciences, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Richard Villegas
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Sandeep Khanna
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Julie Kaswick
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Nicole G Coufal
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - John Crawford
- Department of Neurosciences, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Helen Harvey
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
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黄 金, 王 华. [Dynamic change of hippocampal volume in children with recurrent febrile seizures]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:350-355. [PMID: 33840406 PMCID: PMC8050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the change and significance of hippocampal volume (HCV) in children with recurrent febrile seizures. METHODS A retrospective analysis was performed on the medical data and examination results of 34 children with recurrent febrile seizures who underwent two magnetic resonance plain scans of the head and the hippocampus from January 1, 2013 to September 30, 2019. According to the follow-up time, they were divided into the first follow-up group and the second follow-up group. According to prognosis, they were divided into a febrile seizure group, a non-febrile group and an epilepsy group. The change in HCV was analyzed and compared. RESULTS Total HCV was positively correlated with age (rs=0.683, P < 0.05). The second follow-up group had a significantly larger total HCV than the first follow-up group (P < 0.05). For both groups, preschool children (≥ 3 years old) had significantly larger total HCV, left HCV, and right HCV than those at an age of < 3 years (P < 0.05). For both groups, the children with persistent seizures had significantly lower average annual increment (ΔV) of total HCV, left HCV, and right HCV than those without persistent seizures (P < 0.05). There was no significant difference in ΔV of total HCV, left HCV, and right HCV among the febrile seizure, non-febrile seizure and epilepsy groups (P > 0.05). CONCLUSIONS HCV gradually increases with age in children with recurrent febrile seizures. Persistent seizures may damage the development of the hippocampus.
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Affiliation(s)
- 金影 黄
- />中国医科大学附属盛京医院小儿内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - 华 王
- />中国医科大学附属盛京医院小儿内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
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黄 金, 王 华. [Dynamic change of hippocampal volume in children with recurrent febrile seizures]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:350-355. [PMID: 33840406 PMCID: PMC8050554 DOI: 10.7499/j.issn.1008-8830.2012156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the change and significance of hippocampal volume (HCV) in children with recurrent febrile seizures. METHODS A retrospective analysis was performed on the medical data and examination results of 34 children with recurrent febrile seizures who underwent two magnetic resonance plain scans of the head and the hippocampus from January 1, 2013 to September 30, 2019. According to the follow-up time, they were divided into the first follow-up group and the second follow-up group. According to prognosis, they were divided into a febrile seizure group, a non-febrile group and an epilepsy group. The change in HCV was analyzed and compared. RESULTS Total HCV was positively correlated with age (rs=0.683, P < 0.05). The second follow-up group had a significantly larger total HCV than the first follow-up group (P < 0.05). For both groups, preschool children (≥ 3 years old) had significantly larger total HCV, left HCV, and right HCV than those at an age of < 3 years (P < 0.05). For both groups, the children with persistent seizures had significantly lower average annual increment (ΔV) of total HCV, left HCV, and right HCV than those without persistent seizures (P < 0.05). There was no significant difference in ΔV of total HCV, left HCV, and right HCV among the febrile seizure, non-febrile seizure and epilepsy groups (P > 0.05). CONCLUSIONS HCV gradually increases with age in children with recurrent febrile seizures. Persistent seizures may damage the development of the hippocampus.
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Affiliation(s)
- 金影 黄
- />中国医科大学附属盛京医院小儿内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - 华 王
- />中国医科大学附属盛京医院小儿内科, 辽宁沈阳 110004Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Abstract
Context Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are neurological emergencies with considerable mortality and morbidity. In this paper, we provide an overview of causes, evaluation, treatment, and consequences of RSE and SRSE, reflecting the lack of high-quality evidence to inform therapeutic approach. Sources This is a narrative review based on personal practice and experience. Nevertheless, we searched MEDLINE (using PubMed and OvidSP vendors) and Cochrane central register of controlled trials, using appropriate keywords to incorporate recent evidence. Results Refractory status epilepticus is commonly defined as an acute convulsive seizure that fails to respond to two or more anti-seizure medications including at least one nonbenzodiazepine drug. Super-refractory status epilepticus is a status epilepticus that continues for ≥24 hours despite anesthetic treatment, or recurs on an attempted wean of the anesthetic regimen. Both can occur in patients known to have epilepsy or de novo, with increasing recognition of autoimmune and genetic causes. Electroencephalography monitoring is essential to monitor treatment response in refractory/super-refractory status epilepticus, and to diagnose non-convulsive status epilepticus. The mainstay of treatment for these disorders includes anesthetic infusions, primarily midazolam, ketamine, and pentobarbital. Dietary, immunological, and surgical treatments are viable in selected patients. Management is challenging due to multiple acute complications and long-term adverse consequences. Conclusions We have provided a synopsis of best practices for diagnosis and management of refractory/superrefractory status epilepticus and highlighted the lack of sufficient high-quality evidence to drive decision making, ending with a brief foray into avenues for future research.
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Affiliation(s)
- Debopam Samanta
- Child Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lisa Garrity
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; USA. Correspondence to: Dr Ravindra Arya, Division of Neurology, Cincinnati Children's Hospital Medical Center, MLC 2015, 3333 Burnet Avenue, Cincinnati, Ohio, 45229 USA.
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Wang T, Wang J, Ma Y, Zhou H, Ding D, Li C, Du X, Jiang YH, Wang Y, Long S, Li S, Lu G, Chen W, Zhou Y, Zhou S, Wang Y. High genetic burden in 163 Chinese children with status epilepticus. Seizure 2020; 84:40-46. [PMID: 33278787 DOI: 10.1016/j.seizure.2020.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This study aimed to investigate the genetic aetiology in Chinese children diagnosed with status epilepticus (SE). METHODS Next-generation sequencing, copy number variation (CNV) analysis, and other genetic testing methods were conducted for children with SE lacking an identifiable non-genetic aetiology. Furthermore, the phenotype and molecular data of patients with SE were retrospectively analysed. RESULTS Among children with SE lacking an identifiable non-genetic aetiology, 73 out of 163 children (44.8 %) were found to have causative variants associated with SE including 66 monogenic mutations in 22 genes and 7 CNVs. Based on the American College of Medical Genetics and Genomics scoring system, the monogenic variants included 64 pathogenic/likely pathogenic and 2 uncertain significance variants. SCN1A gene mutations (n = 32) were the most common cause, followed by TSC2 (n = 5), CACNA1A (n = 5), SCN2A (n = 4), SCN9A (n = 2) and DEPDC5 (n = 2) gene mutations. Sixteen mutations were identified in single genes. Furthermore, 51 (77.3 %) monogenic mutations were de novo. Age at SE onset < 1 year (odds ratio [OR] = 2.70, 95 % confidence interval [CI]: 1.25-5.83, p = 0.012) and co-morbidity of intellectual disability (OR = 3.36, 95 %CI: 1.61-6.99, p = 0.001) were independently associated with pathogenic genetic variants. CONCLUSION This study identified genetic aetiology in 44.8 % of patients with SE, which indicates a high burden of genetic aetiology among children with SE in China. Our findings highlight the importance for genetic testing of children with SE that lacks an identifiable non-genetic aetiology.
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Affiliation(s)
- Tianqi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Ji Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yu Ma
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Hao Zhou
- Department of Pediatrics, Guizhou Provincial People's Hospital, Medical College of Guizhou University, Guiyang, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunpei Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaonan Du
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yong-Hui Jiang
- Department of Genetics, Yale University School of Medicine, New Haven, United States
| | - Yi Wang
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shasha Long
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuang Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Weiming Chen
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China.
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Abstract
Whether genetic factors contribute to acquired epilepsies has long been controversial. Supporters observe that, among individuals exposed to seemingly the same brain insult, only a minority develops unprovoked seizures. Yet, only in relatively recent years have studies started to build a case for genetic contributions. Here, we appraise this emerging evidence, by providing a critical review of studies published in the field.
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Affiliation(s)
- Piero Perucca
- Department of Neuroscience, Central Clinical School, 161666Monash University, Melbourne, Victoria, Australia.,Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Ingrid E Scheffer
- Department of Medicine, 2281Epilepsy Research Centre, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,The Florey Neuroscience and Murdoch Children's Research Institutes, Melbourne, Victoria, Australia
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Kipnis PA, Sullivan BJ, Kadam SD. Sex-Dependent Signaling Pathways Underlying Seizure Susceptibility and the Role of Chloride Cotransporters. Cells 2019; 8:cells8050448. [PMID: 31085988 PMCID: PMC6562404 DOI: 10.3390/cells8050448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/04/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022] Open
Abstract
Seizure incidence, severity, and antiseizure medication (ASM) efficacy varies between males and females. Differences in sex-dependent signaling pathways that determine network excitability may be responsible. The identification and validation of sex-dependent molecular mechanisms that influence seizure susceptibility is an emerging focus of neuroscience research. The electroneutral cation-chloride cotransporters (CCCs) of the SLC12A gene family utilize Na+-K+-ATPase generated electrochemical gradients to transport chloride into or out of neurons. CCCs regulate neuronal chloride gradients, cell volume, and have a strong influence over the electrical response to the inhibitory neurotransmitter GABA. Acquired or genetic causes of CCCs dysfunction have been linked to seizures during early postnatal development, epileptogenesis, and refractoriness to ASMs. A growing number of studies suggest that the developmental expression of CCCs, such as KCC2, is sex-dependent. This review will summarize the reports of sexual dimorphism in epileptology while focusing on the role of chloride cotransporters and their associated modulators that can influence seizure susceptibility.
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Affiliation(s)
- Pavel A Kipnis
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD 21205, USA.
| | - Brennan J Sullivan
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD 21205, USA.
| | - Shilpa D Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD 21205, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Risk Factors of Febrile Status Epilepticus. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:57-63. [PMID: 30598673 PMCID: PMC6296694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/25/2017] [Accepted: 01/15/2018] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to investigate the risk factors of febrile status epilepticus (FSE) in children. MATERIALS & METHODS This analytic case-control study was conducted on all patients' records with first febrile seizure (FS) admitted to 17 Shahrivar Hospital, Rasht, Iran during 2007-2014. Cases were children aged 6 to 60 months with FSE and controls were children with complex and simple FS. Data were gathered using a checklist including age, sex, type of milk consuming during first year, temperature, the interval between fever and seizure, family history of epilepsy and febrile seizure, and prematurity. Data were analyzed using Chi-square in SPSS 19. RESULTS Overall, 756 patients with FS participated including 39 patients with FSE, 194 complex febrile seizure (CFC) and 523 simple febrile seizure (SFC). Most of the patients (57.8%) experienced seizure with low-grade fever (<39 °C). The mean age in SFC group was significantly higher than FSE patients (P<0.05). A significant relation was noted between groups regarding body temperature during seizure (P=0.006), family history of FS (0.029), family history of epilepsy (P=0.042) and the premature birth (P=0.023). Significant relation was noted between FSE and CFC groups regarding body temperature during seizure (P=0.004), family history of FS (0.011), family history of epilepsy (P=0.037), and the premature birth (P=0.025) between FSE and CFC groups. CONCLUSION Considering risk factors of FSE including low body temperature, lower age, family history of FS and epilepsy, and premature birth is mandatory.
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Moshé SL. The 2017 Sachs Lecture: Kindling Knowledge in Epilepsy. Pediatr Neurol 2018; 85:5-12. [PMID: 29958806 DOI: 10.1016/j.pediatrneurol.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Solomon L Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Albert Einstein College of Medicine, Bronx, New York; Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Albert Einstein College of Medicine, Bronx, New York; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
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12
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Gallentine WB, Shinnar S, Hesdorffer DC, Epstein L, Nordli DR, Lewis DV, Frank LM, Seinfeld S, Shinnar RC, Cornett K, Liu B, Moshé SL, Sun S. Plasma cytokines associated with febrile status epilepticus in children: A potential biomarker for acute hippocampal injury. Epilepsia 2017; 58:1102-1111. [PMID: 28448686 DOI: 10.1111/epi.13750] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Our aim was to explore the association between plasma cytokines and febrile status epilepticus (FSE) in children, as well as their potential as biomarkers of acute hippocampal injury. METHODS Analysis was performed on residual samples of children with FSE (n = 33) as part of the Consequences of Prolonged Febrile Seizures in Childhood study (FEBSTAT) and compared to children with fever (n = 17). Magnetic resonance imaging (MRI) was obtained as part of FEBSTAT within 72 h of FSE. Cytokine levels and ratios of antiinflammatory versus proinflammatory cytokines in children with and without hippocampal T2 hyperintensity were assessed as biomarkers of acute hippocampal injury after FSE. RESULTS Levels of interleukin (IL)-8 and epidermal growth factor (EGF) were significantly elevated after FSE in comparison to controls. IL-1β levels trended higher and IL-1RA trended lower following FSE, but did not reach statistical significance. Children with FSE were found to have significantly lower ratios of IL-1RA/IL-1β and IL-1RA/IL-8. Specific levels of any one individual cytokine were not associated with FSE. However, lower ratios of IL-1RA/IL-1β, IL-1RA/1L-6, and IL-1RA/ IL-8 were all associated with FSE. IL-6 and IL-8 levels were significantly higher and ratios of IL-1RA/IL-6 and IL-1RA/IL-8 were significantly lower in children with T2 hippocampal hyperintensity on MRI after FSE in comparison to those without hippocampal signal abnormalities. Neither individual cytokine levels nor ratios of IL-1RA/IL-1β or IL-1RA/IL-8 were predictive of MRI changes. However, a lower ratio of IL-1RA/IL-6 was strongly predictive (odds ratio [OR] 21.5, 95% confidence interval [CI] 1.17-393) of hippocampal T2 hyperintensity after FSE. SIGNIFICANCE Our data support involvement of the IL-1 cytokine system, IL-6, and IL-8 in FSE in children. The identification of the IL-1RA/IL-6 ratio as a potential biomarker of acute hippocampal injury following FSE is the most significant finding. If replicated in another study, the IL-1RA/IL-6 ratio could represent a serologic biomarker that offers rapid identification of patients at risk for ultimately developing mesial temporal lobe epilepsy (MTLE).
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Affiliation(s)
- William B Gallentine
- Department of Pediatrics (Neurology), Duke Children's Hospital, Durham, North Carolina, U.S.A
| | - Shlomo Shinnar
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Dale C Hesdorffer
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, New York, U.S.A
| | - Leon Epstein
- Department of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Douglas R Nordli
- Department of Pediatrics (Neurology), Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Darrell V Lewis
- Department of Pediatrics (Neurology), Duke Children's Hospital, Durham, North Carolina, U.S.A
| | - L Matthew Frank
- Department of Neurology, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Syndi Seinfeld
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Ruth C Shinnar
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Karen Cornett
- Department of Pediatrics (Neurology), Duke Children's Hospital, Durham, North Carolina, U.S.A
| | - Binyi Liu
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, New York, U.S.A
| | - Solomon L Moshé
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Shumei Sun
- Department of Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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McClelland AC, Gomes WA, Shinnar S, Hesdorffer DC, Bagiella E, Lewis DV, Bello JA, Chan S, MacFall J, Chen M, Pellock JM, Nordli DR, Frank LM, Moshé SL, Shinnar RC, Sun S. Quantitative Evaluation of Medial Temporal Lobe Morphology in Children with Febrile Status Epilepticus: Results of the FEBSTAT Study. AJNR Am J Neuroradiol 2016; 37:2356-2362. [PMID: 27633809 PMCID: PMC5161621 DOI: 10.3174/ajnr.a4919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The pathogenesis of febrile status epilepticus is poorly understood, but prior studies have suggested an association with temporal lobe abnormalities, including hippocampal malrotation. We used a quantitative morphometric method to assess the association between temporal lobe morphology and febrile status epilepticus. MATERIALS AND METHODS Brain MR imaging was performed in children presenting with febrile status epilepticus and control subjects as part of the Consequences of Prolonged Febrile Seizures in Childhood study. Medial temporal lobe morphologic parameters were measured manually, including the distance of the hippocampus from the midline, hippocampal height:width ratio, hippocampal angle, collateral sulcus angle, and width of the temporal horn. RESULTS Temporal lobe morphologic parameters were correlated with the presence of visual hippocampal malrotation; the strongest association was with left temporal horn width (P < .001; adjusted OR, 10.59). Multiple morphologic parameters correlated with febrile status epilepticus, encompassing both the right and left sides. This association was statistically strongest in the right temporal lobe, whereas hippocampal malrotation was almost exclusively left-sided in this cohort. The association between temporal lobe measurements and febrile status epilepticus persisted when the analysis was restricted to cases with visually normal imaging findings without hippocampal malrotation or other visually apparent abnormalities. CONCLUSIONS Several component morphologic features of hippocampal malrotation are independently associated with febrile status epilepticus, even when complete hippocampal malrotation is absent. Unexpectedly, this association predominantly involves the right temporal lobe. These findings suggest that a spectrum of bilateral temporal lobe anomalies are associated with febrile status epilepticus in children. Hippocampal malrotation may represent a visually apparent subset of this spectrum.
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Affiliation(s)
| | - W A Gomes
- From Departments of Radiology (A.C.M., W.A.G., J.A.B.)
| | - S Shinnar
- Neurology (S. Shinnar, S.L.M., R.C.S.)
- Pediatrics (S. Shinnar, S.L.M.)
- Epidemiology and Population Health (S. Shinnar)
| | | | - E Bagiella
- Department of Health Evidence and Policy (E.B.), Mount Sinai School of Medicine, New York, New York
| | - D V Lewis
- Departments of Pediatrics (Neurology) (D.V.L.)
| | - J A Bello
- From Departments of Radiology (A.C.M., W.A.G., J.A.B.)
| | - S Chan
- Radiology (S.C.), Gertrude H. Sergievsky Center, Columbia University, New York, New York
| | - J MacFall
- Radiology (J.M.), Duke University Medical Center, Durham, North Carolina
| | - M Chen
- Departments of Epidemiology (D.C.H., M.C.)
| | | | - D R Nordli
- Department of Neurology (D.R.N.), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - L M Frank
- Department of Neurology (L.M.F.), Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia
| | - S L Moshé
- Neurology (S. Shinnar, S.L.M., R.C.S.)
- Pediatrics (S. Shinnar, S.L.M.)
- Neuroscience (S.L.M.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - S Sun
- Biostatistics (S. Sun), Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia
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오준석, Kim Hyo Jeong, 최준식. Interleukin-1β and Interleukin-1 Receptor Antagonist Levels in Children with Febrile Seizures. ACTA ACUST UNITED AC 2016. [DOI: 10.26815/jkcns.2016.24.3.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Hesdorffer DC, Shinnar S, Lax DN, Pellock JM, Nordli DR, Seinfeld S, Gallentine W, Frank LM, Lewis DV, Shinnar RC, Bello JA, Chan S, Epstein LG, Moshé SL, Liu B, Sun S. Risk factors for subsequent febrile seizures in the FEBSTAT study. Epilepsia 2016; 57:1042-7. [PMID: 27265870 DOI: 10.1111/epi.13418] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify risk and risk factors for developing a subsequent febrile seizure (FS) in children with a first febrile status epilepticus (FSE) compared to a first simple febrile seizure (SFS). To identify home use of rescue medications for subsequent FS. METHODS Cases included a first FS that was FSE drawn from FEBSTAT and Columbia cohorts. Controls were a first SFS. Cases and controls were classified according to established FEBSTAT protocols. Cumulative risk for subsequent FS over a 5-year period was compared in FSE versus SFS, and Cox proportional hazards regression was conducted. Separate analysis examined subsequent FS within FSE. The use of rescue medications at home was assessed for subsequent FS. RESULTS Risk for a subsequent FSE was significantly increased in FSE versus SFS. Any magnetic resonance imaging (MRI) abnormality increased the risk 3.4-fold (p < 0.05), adjusting for age at first FS and FSE and in analyses restricted to children whose first FS was FSE (any MRI abnormality hazard ratio [HR] 2.9, p < 0.05). The risk for a second FS of any type or of subsequent FS lasting >10 min over the 5-year follow-up did not differ in FSE versus SFS. Rectal diazepam was administered at home to 5 (23.8%) of 21 children with subsequent FS lasting ≥10 min. SIGNIFICANCE Compared to controls, FSE was associated with an increased risk for subsequent FSE, suggesting the propensity of children with an initial prolonged seizure to experience a prolonged recurrence. Any baseline MRI abnormality increased the recurrence risk when FSE was compared to SFS and when FSE was studied alone. A minority of children with a subsequent FS lasting 10 min or longer were treated with rectal diazepam at home, despite receiving prescriptions after the first FSE. This indicates the need to further improve the education of clinicians and parents in order to prevent subsequent FSE.
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Affiliation(s)
- Dale C Hesdorffer
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, New York, U.S.A
| | - Shlomo Shinnar
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Daniel N Lax
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - John M Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Douglas R Nordli
- Department of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, U.S.A
| | - Syndi Seinfeld
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - William Gallentine
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, U.S.A
| | - L Matthew Frank
- Department of Neurology, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Darrell V Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Ruth C Shinnar
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Jacqueline A Bello
- Department Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Stephen Chan
- Department of Radiology, Columbia University, New York, New York, U.S.A
| | - Leon G Epstein
- Department of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, U.S.A
| | - Solomon L Moshé
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Binyi Liu
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, New York, U.S.A
| | - Shumei Sun
- Department of Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of Risk Factors Associated with First Episode Febrile Seizure. J Clin Diagn Res 2016; 10:SC10-3. [PMID: 27437319 DOI: 10.7860/jcdr/2016/18635.7853] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Febrile seizure (FS) is the single most common type of seizure seen in children between 6 months to 5 years of age. The purpose of our study was to identify the risk factors associated with the first episode of febrile seizures, which would help in the better management and preventive measures in children at risk for FS episodes. AIM To evaluate the risk factors associated with the first episode of febrile seizures in Indian children. MATERIALS AND METHODS This was a hospital based, case control study. The purpose of this study was to identify the risk factors associated with the first FS episode in children. Seventy (70) children between age 6 months to 5 years with their first episode of FS were compared with 70 children with fever but without seizures based on various risk factors. RESULTS The mean age was 24.90±16.11 months in cases and 26.34±16.93 months in controls. Male: female ratio was 2:1. A positive family history was found in 31.4% of first degree and 11.4% in second degree relatives. Mean maximum temperature was 102.06±1.1°F and URI (upper respiratory infection) was most common cause of fever. Antenatal complication was significantly higher in the case group. RBC (Red Blood Cells) indices like lower mean haemoglobin, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Haemoglobin concentration) and higher RDW (Red Cell Distribution Width) values were seen in patients. Serum sodium, Serum calcium and random blood sugar values of the cases were significantly lower than those of controls (p<0.05). CONCLUSION Our study shows that male gender, family history of febrile seizures, peak body temperature, underlying cause of fever, antenatal complications, low serum calcium, sodium, blood sugar and microcytic hypochromic anaemia are the risk factors associated with the occurrence of first episode of febrile seizure and, thus, preventive measures in removing these risk factors could lead to a decrease in incidence of FS.
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Affiliation(s)
- Indar Kumar Sharawat
- Senior Resident, Department of Pediatric Medicine, VMMC and Safdarjung Hospital , New Delhi, India
| | - Jitender Singh
- Senior Resident, Department of Pediatric Medicine, SMS Medical College , Jaipur, India
| | - Lesa Dawman
- Senior Resident, Department of Pediatric Medicine, AIIMS , New Delhi, India
| | - Amitabh Singh
- Senior Resident, Department of Pediatric Medicine, AIIMS , New Delhi, India
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Febrile Seizures and Febrile Seizure Syndromes: An Updated Overview of Old and Current Knowledge. Neurol Res Int 2015; 2015:849341. [PMID: 26697219 PMCID: PMC4677235 DOI: 10.1155/2015/849341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 01/04/2023] Open
Abstract
Febrile seizures are the most common paroxysmal episode during childhood, affecting up to one in 10 children. They are a major cause of emergency facility visits and a source of family distress and anxiety. Their etiology and pathophysiological pathways are being understood better over time; however, there is still more to learn. Genetic predisposition is thought to be a major contributor. Febrile seizures have been historically classified as benign; however, many emerging febrile seizure syndromes behave differently. The way in which human knowledge has evolved over the years in regard to febrile seizures has not been dealt with in depth in the current literature, up to our current knowledge. This review serves as a documentary of how scientists have explored febrile seizures, elaborating on the journey of knowledge as far as etiology, clinical features, approach, and treatment strategies are concerned. Although this review cannot cover all clinical aspects related to febrile seizures at the textbook level, we believe it can function as a quick summary of the past and current sources of knowledge for all varieties of febrile seizure types and syndromes.
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18
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Wilmshurst JM, Gaillard WD, Vinayan KP, Tsuchida TN, Plouin P, Van Bogaert P, Carrizosa J, Elia M, Craiu D, Jovic NJ, Nordli D, Hirtz D, Wong V, Glauser T, Mizrahi EM, Cross JH. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia 2015; 56:1185-97. [PMID: 26122601 DOI: 10.1111/epi.13057] [Citation(s) in RCA: 253] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
Evidence-based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or "state of the art" interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video-EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile-onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide, valproate, bromide, and the ketogenic diet are possibly effective; and for Ohtahara syndrome, there is weak evidence that most antiepileptic drugs are poorly effective. For epileptic spasms, clinical suspicion remains central to the diagnosis and is supported by EEG, which ideally is prolonged (level C recommendation). Adrenocorticotropic hormone (ACTH) is preferred for short-term control of epileptic spasms (level B recommendation), oral steroids are probably effective in short-term control of spasms (level C recommendation), and a shorter interval from the onset of spasms to treatment initiation may improve long-term neurodevelopmental outcome (level C recommendation). The ketogenic diet is the treatment of choice for epilepsy related to glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency (expert opinion, level U recommendation). The identification of patients as potential candidates for epilepsy surgery should be part of standard practice at primary and secondary level care. Tertiary care facilities with experience in epilepsy surgery should undertake the screening for epilepsy surgical candidates (level U recommendation). There is insufficient evidence to conclude if there is benefit from vagus nerve stimulation (level U recommendation). The key recommendations are summarized into an executive summary. The full report is available as Supporting Information. This report provides a comprehensive foundation of an approach to infants with seizures, while identifying where there are inadequate data to support recommended practice, and where further data collection is needed to address these deficits.
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Affiliation(s)
- Jo M Wilmshurst
- Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - William D Gaillard
- Pediatrics and Neurology, Division Epilepsy and Neurophysiology, Comprehensive Pediatric Epilepsy Program, George Washington University, Washington, District of Columbia, U.S.A
| | | | - Tammy N Tsuchida
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia, U.S.A
| | - Perrine Plouin
- Clinical Neurophysiology Department, INSERM U663, Hospital for Sick Children, Paris, France
| | - Patrick Van Bogaert
- Paediatric Neurology, Department of Pediatrics, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jaime Carrizosa
- Pediatric Department Child Neurology Service, University of Antioquia, Medellín, Colombia
| | - Maurizio Elia
- Unit of Neurology and Clinical Neurophysiopathology, IRCCS Italy Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, EN, Italy
| | - Dana Craiu
- Department of Neurology, Pediatric Neurology, Psychiatry, Neurosurgery, "Carol Davila" University of Medicine Bucharest, Bucharest, Romania.,"Alexandru Obregia" Clinical Hospital, Bucharest, Romania
| | - Nebojsa J Jovic
- Neurology, Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Doug Nordli
- Epilepsy Center, Children's Memorial Hospital, Chicago, Illinois, U.S.A
| | - Deborah Hirtz
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, Maryland, U.S.A
| | - Virginia Wong
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Division of Paediatric Neurology/Developmental Behavioural Paediatrics/NeuroHabilitation, Duchess of Kent Children Hospital, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Tracy Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Eli M Mizrahi
- Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, Texas, U.S.A.,Section of Pediatric Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, U.S.A
| | - J Helen Cross
- Childhood Epilepsy, Paediatric Neurology, UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, NHS Foundation Trust, London, United Kingdom
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Spagnoli C, Cilio MR, Pavlidis E, Pisani F. Symptomatic neonatal seizures followed by febrile status epilepticus: the two-hit hypothesis for the subsequent development of epilepsy. J Child Neurol 2015; 30:615-8. [PMID: 24810087 DOI: 10.1177/0883073814533004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neonatal seizures have been associated with the later development of postneonatal epilepsy, mainly beginning within the first year of life. Mechanisms of epileptogenesis in the immature brain still need to be fully elucidated but a two-hit hypothesis, showing that an early insult heightens later susceptibility to seizure-induced brain damage, has been demonstrated in animal models. We describe 2 cases of preterm babies sustaining recurrent neonatal seizures in the context of a severe perinatal brain damage who presented with symptomatic epilepsy only after the occurrence of an episode of febrile status epilepticus. In the context of preexisting perinatal brain damage, febrile status epilepticus acted as a second hit for developing epilepsy, confirming animal evidence.
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Affiliation(s)
- Carlotta Spagnoli
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Parma, Italy
| | - Maria Roberta Cilio
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, University of California, San Francisco, CA, USA
| | - Elena Pavlidis
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Parma, Italy
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Parma, Italy
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21
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Perucca P, Camfield P, Camfield C. Does gender influence susceptibility and consequences of acquired epilepsies? Neurobiol Dis 2014; 72 Pt B:125-30. [DOI: 10.1016/j.nbd.2014.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022] Open
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Mastrangelo M, Midulla F, Moretti C. Actual insights into the clinical management of febrile seizures. Eur J Pediatr 2014; 173:977-82. [PMID: 24477659 DOI: 10.1007/s00431-014-2269-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Febrile seizures (FS) are a benign epileptic manifestation of infancy occurring between 3 months and 5 years of age and affecting an estimated 2-5 % of children. They have usually no important negative effects on motor and cognitive development. Simple FS (generalized seizures, lasting less than 10 min and single episodes during the same febrile event) have a benign prognosis in almost all cases and do not require an extensive diagnostic workup. In complex FS (focal semiology and lasting more than 10 min, more than one episode during the same febrile event), a more detailed clinical, electroencephalographic, laboratory, and neuroimaging evaluation is necessary because of a higher percentage of underlying detectable causes and a mildly higher risk for later development of epilepsy. Febrile status epilepticus is the most severe type of complex FS even if its morbidity and mortality is extremely low. Simple FS plus (more than one convulsive episode in 24 h) have the same benign prognosis of simple FS. Neither intermittent nor continuous prophylaxis is actually recommended both in simple and complex FS because its side effects outweigh its possible benefits. CONCLUSION This review summarizes recent developments into the clinical management of FS including a suggested algorithm for simple and complex FS, the concept of simple FS plus, the controversies about the relationships between FS and hippocampal sclerosis, the relationships between FS and complex syndrome such as Dravet syndrome, genetic epilepsy with FS plus or febrile infection-related epilepsy syndrome, and the results of recent epidemiologic studies on febrile status epilepticus.
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Affiliation(s)
- Mario Mastrangelo
- Division of Pediatric Neurology, Department of Pediatrics, Child Neurology and Psychiatry, "Sapienza" University of Rome, Via dei Sabelli 108, 00184, Rome, Italy,
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Akman O, Moshé SL, Galanopoulou AS. Sex-specific consequences of early life seizures. Neurobiol Dis 2014; 72 Pt B:153-66. [PMID: 24874547 DOI: 10.1016/j.nbd.2014.05.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/07/2014] [Accepted: 05/17/2014] [Indexed: 12/29/2022] Open
Abstract
Seizures are very common in the early periods of life and are often associated with poor neurologic outcome in humans. Animal studies have provided evidence that early life seizures may disrupt neuronal differentiation and connectivity, signaling pathways, and the function of various neuronal networks. There is growing experimental evidence that many signaling pathways, like GABAA receptor signaling, the cellular physiology and differentiation, or the functional maturation of certain brain regions, including those involved in seizure control, mature differently in males and females. However, most experimental studies of early life seizures have not directly investigated the importance of sex on the consequences of early life seizures. The sexual dimorphism of the developing brain raises the question that early seizures could have distinct effects in immature females and males that are subjected to seizures. We will first discuss the evidence for sex-specific features of the developing brain that could be involved in modifying the susceptibility and consequences of early life seizures. We will then review how sex-related biological factors could modify the age-specific consequences of induced seizures in the immature animals. These include signaling pathways (e.g., GABAA receptors), steroid hormones, growth factors. Overall, there are very few studies that have specifically addressed seizure outcomes in developing animals as a function of sex. The available literature indicates that a variety of outcomes (histopathological, behavioral, molecular, epileptogenesis) may be affected in a sex-, age-, region-specific manner after seizures during development. Obtaining a better understanding for the gender-related mechanisms underlying epileptogenesis and seizure comorbidities will be necessary to develop better gender and age appropriate therapies.
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Affiliation(s)
- Ozlem Akman
- Department of Physiology, Faculty of Medicine, Istanbul Bilim University, 34394 Istanbul, Turkey.
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Montefiore Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10461, USA; Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10461, USA; Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Montefiore Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10461, USA; Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10461, USA
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Wilmshurst JM, Berg AT, Lagae L, Newton CR, Cross JH. The challenges and innovations for therapy in children with epilepsy. Nat Rev Neurol 2014; 10:249-60. [PMID: 24709890 DOI: 10.1038/nrneurol.2014.58] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Major advances have been made in the diagnosis, evaluation and management of children with epilepsy over the past 15 years. There has been a marked increase in genetic diagnoses of a number of key childhood-onset epilepsy syndromes, such as Dravet syndrome, which has been linked to mutations in the SCN1A gene. The reorganization and reclassification of epilepsies, devised by the International League Against Epilepsy, has stimulated specialists to reassess their diagnostic practices; however, many studies have not addressed the global issues in treating children with epilepsy-specifically, the challenges of diagnosis through to optimal, and appropriate, therapeutic management. Also, Class I evidence-based data that are needed as a foundation for the development of treatment guidelines worldwide are lacking. Epilepsy is common, and the impact of this disease crosses age ranges and should be managed at all levels of care from community to quaternary care. In this Review, existing data and new therapeutic management approaches are discussed with the aim of highlighting the incidence of standard practices that may not be based on clinical evidence.
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Affiliation(s)
- Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch 7700, South Africa
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611, USA
| | - Lieven Lagae
- Department of Pediatric Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Charles R Newton
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, PO Box 230, Kilifi 80108, Kenya
| | - J Helen Cross
- UCL Institute of Child Health, 4/5 Long Yard, London WC1N 3LU, UK
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