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Cappellari AM, Mariani S, Bruschi G. Febrile seizures and convulsions with mild gastroenteritis: age-dependent acute symptomatic seizures. Front Pediatr 2023; 11:1151770. [PMID: 37534200 PMCID: PMC10390780 DOI: 10.3389/fped.2023.1151770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Background Febrile seizures (FS) and benign convulsions in children with mild gastroenteritis (CwG) are acute symptomatic seizures, transiently occurring in infants and young children, probably related to the immaturity of the brain. Our paper aims to review the literature data on patients with FS and CwG. Methods A review of series of patients with FS and CwG was performed by literature search on PubMed January 1960 to October 2022. Several parameters were considered, including epidemiology, pathophysiology, clinical features, electroencephalographic findings and other diagnostic studies, and treatment. Results FS and CwG share an age-dependent course, but they show significant differences in the pathophysiology, clinical features, diagnostic studies, and treatment. Conclusion Acute symptomatic seizures include seizures that are caused by acute structural brain pathologies, such as stroke, as well as seizures that are provoked by a reversible factor, such as hyponatraemia, although the two groups should be not equated. Furthermore, FS and CwG should be set apart as "age-dependent acute symptomatic seizures", reinforcing the concept of their self-limited course over a certain period.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Mariani
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
| | - Gaia Bruschi
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
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Lee YS, Lee GH, Kwon YS. Update on benign convulsions with mild gastroenteritis. Clin Exp Pediatr 2022; 65:469-475. [PMID: 34961297 PMCID: PMC9561189 DOI: 10.3345/cep.2021.00997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/15/2021] [Indexed: 12/16/2022] Open
Abstract
Benign convulsions with mild gastroenteritis (CwG) are characterized by afebrile convulsions associated with viral gastroenteritis in previously healthy infants and children. The main causative pathogens are rotavirus and norovirus. CwG occurs frequently in both East Asian and Western countries. The prevalence of CwG was reportedly not decreased by the introduction of rotavirus vaccines, and the prevalence of norovirus-associated CwG has been increasing annually. Convulsions in CwG are usually clustered, do not last longer than 5 minutes, and are mostly generalized. Laboratory diagnostics, electroencephalography (EEG), and imaging findings are usually normal. There is a probability of mild, transient abnormal findings on EEG or imaging limited to the acute disease phase. Although several reports have suggested that pathogens that affect the central nervous system through direct or indirect mechanisms could be related to the pathophysiology of CwG, its mechanism is not fully understood. Several antiepileptic drugs are effective during convulsions; however, long-term antiepileptic treatment is not required as CwG usually has a good prognosis.
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Affiliation(s)
- Yeong Seok Lee
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea
| | - Ga Hee Lee
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea
| | - Young Se Kwon
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea
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Lewis-Smith D, Galer PD, Balagura G, Kearney H, Ganesan S, Cosico M, O'Brien M, Vaidiswaran P, Krause R, Ellis CA, Thomas RH, Robinson PN, Helbig I. Modeling seizures in the Human Phenotype Ontology according to contemporary ILAE concepts makes big phenotypic data tractable. Epilepsia 2021; 62:1293-1305. [PMID: 33949685 PMCID: PMC8272408 DOI: 10.1111/epi.16908] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/19/2021] [Accepted: 04/01/2021] [Indexed: 01/08/2023]
Abstract
Objective: The clinical features of epilepsy determine how it is defined, which in turn guides management. Therefore, consideration of the fundamental clinical entities that comprise an epilepsy is essential in the study of causes, trajectories, and treatment responses. The Human Phenotype Ontology (HPO) is used widely in clinical and research genetics for concise communication and modeling of clinical features, allowing extracted data to be harmonized using logical inference. We sought to redesign the HPO seizure subontology to improve its consistency with current epileptological concepts, supporting the use of large clinical data sets in high-throughput clinical and research genomics. Methods: We created a new HPO seizure subontology based on the 2017 International League Against Epilepsy (ILAE) Operational Classification of Seizure Types, and integrated concepts of status epilepticus, febrile, reflex, and neonatal seizures at different levels of detail. We compared the HPO seizure subontology prior to, and following, our revision, according to the information that could be inferred about the seizures of 791 individuals from three independent cohorts: 2 previously published and 150 newly recruited individuals. Each cohort’s data were provided in a different format and harmonized using the two versions of the HPO. Results: The new seizure subontology increased the number of descriptive concepts for seizures 5-fold. The number of seizure descriptors that could be annotated to the cohort increased by 40% and the total amount of information about individuals’ seizures increased by 38%. The most important qualitative difference was the relationship of focal to bilateral tonic-clonic seizure to generalized-onset and focal-onset seizures.
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Affiliation(s)
- David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.,Department of Clinical Neurosciences, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Peter D Galer
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ganna Balagura
- Medical Genetics Unit, IRCSS Giannina Gaslini Institute, Genoa, Italy
| | - Hugh Kearney
- FutureNeuro the SFI Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Shiva Ganesan
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mahgenn Cosico
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Margaret O'Brien
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Priya Vaidiswaran
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Roland Krause
- Luxembourg Centre for Systems Biomedicine, Université du Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Colin A Ellis
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.,Department of Clinical Neurosciences, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.,Institute for Systems Genomics, University of Connecticut, Farmington, CT, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Yoo SY, Kim DH, Lee Y, Lee GH, Ha DJ, Kwon YS. Serum Uric Acid as a Predictive Factor for Rotaviral or Noroviral Benign Convulsions with Mild Gastroenteritis. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2020.00143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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You SJ. Older Patients May Have More Frequent Seizures among Children Diagnosed as Benign Convulsions with Mild Gastroenteritis. Neuropediatrics 2020; 51:354-358. [PMID: 32016943 DOI: 10.1055/s-0040-1701442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Benign convulsions with mild gastroenteritis (CwG) is a condition that does not usually require treatment. However, when the patient experiences multiple seizures or prolonged seizures, anticonvulsant treatment may be required. We investigated this study to identify the factors that may influence on the number or duration of seizures at CwG. METHODS We retrospectively analyzed the medical records of CwG patients who were admitted to the Department of Pediatrics at Sanggye Paik Hospital. RESULTS A total of 105 children with CwG were enrolled. The mean age was 19.59 ± 7.09 months. The mean duration of seizure was 2.79 ± 5.51 minutes and mean number of seizure was 2.33 ± 1.70. Sixty-nine children had seizures less than twice, whereas 36 experienced three times or more. These groups differed significantly according to age in CwG (18.16 ± 7.08, vs. 22.33 ± 6.34 months, p < 0.05). When patients were divided into two groups based on age in CwG using a cut-off of 20 months, we found significant differences in seizure number (1.91 ± 1.27 vs. 3.11 ± 2.10, p < 0.05). There was also a positive correlation between patient age and frequency of seizures (R = 0.316, p = 0.001). Patients who received anticonvulsants were older (17.60 ± 6.87 vs. 22.04 ± 6.63 months, p < 0.05) and had more frequent (1.59 ± 1.37 vs. 3.26 ± 1.63, p < 0.05) and longer seizures (1.76 ± 2.75 vs. 4.07 ± 7.49 minutes, p < 0.05). CONCLUSION As the number of seizure in CwG was associated with age, treatment in older children may be required in acute stage.
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Affiliation(s)
- Su Jeong You
- Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
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6
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Kim YO. Benign Convulsions with Mild Gastroenteritis. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2019.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kim BR, Choi GE, Kim YO, Kim MJ, Song ES, Woo YJ. Incidence and characteristics of norovirus-associated benign convulsions with mild gastroenteritis, in comparison with rotavirus ones. Brain Dev 2018; 40:699-706. [PMID: 29681427 DOI: 10.1016/j.braindev.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Rotavirus was detected in 40-50% of patients with benign convulsions with mild gastroenteritis (CwG) before the rotavirus vaccine was introduced in late 2000. However, the rate of rotavirus positivity has decreased since 2010 while the prevalence of norovirus has gradually increased. We investigated the incidence of norovirus-associated CwG during a recent 3-year period and additionally compared the characteristics of norovirus-associated CwG with those of rotavirus-associated CwG. METHODS The medical records of CwG patients admitted to our hospital between March 2014 and February 2017 were reviewed, including the results of stool virus tests. For comparing norovirus- and rotavirus-associated CwG, data obtained between March 2005 and February 2014 that included sufficient numbers of patients with rotavirus-associated CwG were additionally reviewed. Data were collected on clinical characteristics (age, sex, seasonal distribution, enteric symptoms, and the interval to seizure onset), seizure characteristics (frequency, duration, type, and electroencephalographic findings), and laboratory findings. RESULTS CwG was diagnosed in 42 patients during the 3-year study period. Stool viruses were checked in 40 (95.2%) patients and were detected in 32 (80.0%) patients. Norovirus genogroup II was detected in 27 (67.5%) of the 40 patients, rotavirus was detected in 3 patients, and adenovirus was detected in 2 patients. In total, 140 CwG patients were enrolled between March 2005 and February 2017. The patients with norovirus-associated CwG (N = 44) and rotavirus-associated CwG (N = 26) were aged 18.66 ± 5.57 and 19.31 ± 7.37 months (mean ± standard deviation), respectively (P > 0.05). Norovirus-associated CwG was less prevalent than rotavirus-associated CwG during spring (13.6% vs. 34.6%, P = 0.04), while the prevalence of both types of CwG peaked during winter (63.6% and 46.2%, respectively). Vomiting was more prevalent in norovirus- than rotavirus-associated CwG (97.7% vs. 80.8%, P = 0.02) and the interval between enteric symptom onset and seizure onset was shorter in norovirus-associated CwG (2.00 ± 1.06 vs. 2.58 ± 1.21 days, P = 0.04). Most cases in both groups had seizures that lasted for less than 5 min (95.5% vs. 92.3%). Clustered seizures seemed to occur more frequently in the norovirus group (79.5% vs. 57.7%), although with borderline significance (P = 0.05). Posterior slowing was observed more frequently in norovirus-associated CwG (34.9% vs. 11.5%, P = 0.03). CONCLUSION The most common viral pathogen of CwG was norovirus during the analyzed 3-year period, with an incidence of 67.5%. In comparison with rotavirus-associated CwG, norovirus-associated CwG was less frequent during spring, more frequently seen with vomiting, had a shorter interval from enteric symptom onset to seizure onset, and more frequently showed posterior slowing in electroencephalography.
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Affiliation(s)
- Bo Ram Kim
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonnam National University Childrens' Hospital, Gwangju, Republic of Korea
| | - Ga Eun Choi
- Department of Pediatrics, Chonnam National University Childrens' Hospital, Gwangju, Republic of Korea
| | - Young Ok Kim
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonnam National University Childrens' Hospital, Gwangju, Republic of Korea.
| | - Min Ji Kim
- Water and Foodborne Disease Division, Health and Environment Research Institute of Gwangju, Gwangju, Republic of Korea.
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonnam National University Childrens' Hospital, Gwangju, Republic of Korea.
| | - Young Jong Woo
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonnam National University Childrens' Hospital, Gwangju, Republic of Korea.
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Khosroshahi N, Rahbarimanesh A, Boroujeni FA, Eskandarizadeh Z, Zoham MH. Afebrile Benign Convulsion Associated With Mild Gastroenteritis: A Cohort Study in a Tertiary Children Hospital. Child Neurol Open 2018; 5:2329048X18773498. [PMID: 29881767 PMCID: PMC5987894 DOI: 10.1177/2329048x18773498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Benign convulsion with mild gastroenteritis is a new clinical entity that occurs in children who are otherwise healthy. Method: This cohort study held among patients with afebrile convulsion and accompanying gastroenteritis in a tertiary children hospital during a 2-year period. Demographic and clinical data were analyzed. Neurodevelopmental milestones were observed during a follow-up period of 12 to 24 months. Results: Twenty-five patients aged 3 to 48 months with female predominance were enrolled. Ninety-three percent of cases experienced generalized tonic-clonic seizures. One-third of seizures occurred in clusters. Primary laboratory findings and electroencephalography were normal except for 3 with few epileptic waves. During the follow-up period, no seizure recurrence happened. Long-term antiepileptic treatment was unnecessary. Conclusion: Afebrile convulsion accompanying mild gastroenteritis is a convulsive disorder with reassuring prognosis. Due to its benign course, comprehensive neurodiagnostic evaluation and long-term antiepileptic drugs are usually avoidable.
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Affiliation(s)
- Nahid Khosroshahi
- Department of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Rahbarimanesh
- Department of Pediatric Infectious Disease, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Asadi Boroujeni
- Department of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Eskandarizadeh
- Department of Pediatric Neurology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojdeh Habibi Zoham
- Department of Pediatric Intensive Care Unit, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Mojdeh Habibi Zoham, MD, Department of Pediatric Intensive Care Unit, Bahrami Children Hospital, Tehran University of Medical Sciences, Imam Hossein Square, Damavand Avenue, Tehran, Iran.
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Clinical outcome of recurrent afebrile seizures in children with benign convulsions associated with mild gastroenteritis. Seizure 2018; 60:110-114. [PMID: 29935410 DOI: 10.1016/j.seizure.2018.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the clinical outcome and evolution of recurrent afebrile seizures in children initially diagnosed with benign convulsions associated with mild gastroenteritis (CwG). METHODS We reviewed and analyzed the medical records of 37 patients who were diagnosed as CwG at onset, followed by recurrent afebrile seizures and followed up for at least 24 months. RESULTS The follow-up period ranged from 2 to 7 years (median, 40.1 months).Three patterns of recurrent afebrile seizures were recorded: afebrile seizures associated with gastrointestinal infection (AS-GI, n = 25), afebrile seizures associated with non-gastrointestinal infection (AS-nGI, n = 9), and unprovoked seizures (US, n = 3). Twenty eight patients (75.7%) had a second episode within 6 months after the first seizures. Five cases (13.5%) suffered three episodes of afebrile seizures. Seizure characteristics of the three patterns were similar, manifesting as clustered seizures in the majority. Focal epileptic activities in interictal EEG were found in 3 cases (9.4%) at onset, 10 cases (28.6%) at the second episode, respectively. Six patients were prescribed anti-epileptic drugs with apparently good responses. During at least 2 years' follow-up, all the cases showed normal psychomotor development. Only one patient was diagnosed with epilepsy. CONCLUSIONS All the recurrent afebrile seizures initially diagnosed as CwG, irrespective of the kinds and frequency of relapses, showed favorable prognoses. CwG maybe falls within the category of situation-related seizures, rather than epilepsy.
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Karampatsas K, Osborne L, Seah ML, Tong CYW, Prendergast AJ. Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PLoS One 2018; 13:e0194009. [PMID: 29565992 PMCID: PMC5863974 DOI: 10.1371/journal.pone.0194009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Rotavirus is the leading cause of acute gastroenteritis in children and is associated with neurological complications such as seizures and encephalopathy. The aim of this study was to investigate the presentation and complications of rotavirus compared to non-rotavirus gastroenteritis in UK children. Methods This was a retrospective, case-control, hospital-based study conducted at three sites in east London, UK. Cases were children aged 1 month to 16 years diagnosed with acute gastroenteritis between 1 June 2011 and 31 December 2013, in whom stool virology investigations confirmed presence of rotavirus by PCR. They were matched by age, gender and month of presentation to controls with rotavirus-negative gastroenteritis. Results Data were collected from 116 children (50 cases and 66 controls). Children with rotavirus gastroenteritis tended to present more frequently with metabolic acidosis (pH 7.30 vs 7.37, P = 0.011) and fever (74% versus 46%; P = 0.005) and were more likely to require hospitalisation compared to children with non-rotavirus gastroenteritis (93% versus 73%; P = 0.019). Neurological complications were the most common extra-intestinal manifestations, but did not differ significantly between children with rotavirus-positive gastroenteritis (RPG) and rotavirus-negative gastroenteritis (RNG) (24% versus 15%, respectively; P = 0.24). Encephalopathy occurred only in children with rotavirus infection (n = 3, 6%). Conclusion Rotavirus causes longer and more severe disease compared to other viral pathogens. Seizures and milder neurological signs were surprisingly common and associated with multiple pathogens, but encephalopathy occurred only in children with rotavirus gastroenteritis. Rotavirus vaccination may reduce seizures and presentation to hospital, but vaccines against other pathogens causing gastroenteritis are required.
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Affiliation(s)
- Konstantinos Karampatsas
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- * E-mail:
| | - Leanne Osborne
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - May-Li Seah
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Cheuk Y. W. Tong
- Department of Virology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Andrew J. Prendergast
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Hu MH, Lin KL, Wu CT, Chen SY, Huang GS. Clinical Characteristics and Risk Factors for Seizures Associated With Norovirus Gastroenteritis in Childhood. J Child Neurol 2017; 32:810-814. [PMID: 28482763 DOI: 10.1177/0883073817707302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Norovirus has become increasingly recognized as causing viral gastroenteritis in children. Few data are available on the characteristics of children admitted to pediatric emergency departments with norovirus gastroenteritis and accompanying seizures. Our aim in this study was to describe the clinical features of, and risk factors for, seizures accompanying norovirus gastroenteritis. We collected 6359 stool samples from patients with gastroenteritis, of whom 1444 (22.71%) had laboratory-confirmed norovirus gastroenteritis. Of all patients, 108 (7.48%) children exhibited norovirus gastroenteritis and seizures; 49 (45.4%) were febrile, and 59 (54.6%) afebrile. The mean patient age was 2.31 ± 2.12 years; most were <5 years of age (92.6%). The afebrile group had a significantly higher incidence of 2 or more seizures than the febrile subjects ( P = .004). Early recognition and prompt treatment of convulsions associated with norovirus gastroenteritis in children are important. Future studies might explore the long-term prognoses of these patients.
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Affiliation(s)
- Mei-Hua Hu
- 1 Department of General Pediatric, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- 3 Division of Pediatric Neurology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Teng Wu
- 1 Department of General Pediatric, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yen Chen
- 4 Division of Pediatric Gastroenterology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Go-Shine Huang
- 5 Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Castellazzi L, Principi N, Agostoni C, Esposito S. Benign convulsions in children with mild gastroenteritis. Eur J Paediatr Neurol 2016; 20:690-5. [PMID: 27292317 DOI: 10.1016/j.ejpn.2016.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Benign convulsions with mild gastroenteritis (CwG) is a clinical condition characterized by convulsions occurring in otherwise healthy children, usually in the absence of fever and in the presence of mild acute gastroenteritis. Until now, CwG had not been fully recognized as an epileptic syndrome, and several aspects of this condition are not clearly defined, especially its pathogenesis. METHODS The main aim of this paper is to discuss after the review of the literature what is known about CwG to facilitate its recognition and treatment. RESULTS CwG is a benign condition that has several clinical and prognostic similarities with febrile seizures. The disease occurs in infants and in children who are 1 month to 3 years old, during the winter and early spring when rotavirus and norovirus are circulating. In most cases, seizures follow gastrointestinal symptoms. In a minority of patients, the seizures and gastrointestinal symptoms occur before or simultaneously with the development of diarrhoea. Even if convulsions are mostly described as generalized tonic-clonic, the ictal recordings have always demonstrated a focal origin. Electroencephalography, lumbar punctures, and radiological examinations are not useful because they are normal in these patients; and when alterations are present, they disappear in a relatively short time. Only prolonged seizures, which are usually not common, require antiepileptic treatments in the acute phase. CONCLUSION Knowledge of CwG characteristics is essential for paediatricians to avoid useless hospitalization, examinations and, above all, drug administration, as the drugs have potential side effects.
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Affiliation(s)
- Luca Castellazzi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Medium Intensity Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Kikuchi K, Hamano SI, Higurashi N, Matsuura R, Suzuki K, Tanaka M, Minamitani M. Difficulty of Early Diagnosis and Requirement of Long-Term Follow-Up in Benign Infantile Seizures. Pediatr Neurol 2015; 53:157-62. [PMID: 26096618 DOI: 10.1016/j.pediatrneurol.2015.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/27/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated whether benign infantile seizures can be diagnosed in the acute phase. METHODS We retrospectively analyzed the medical records of 44 patients initially diagnosed with acute phase benign infantile seizures. All patients were followed for more than 12 months, and we reviewed patients' psychomotor development and presence or absence of seizure recurrence at the last visit. Patients were divided into the following three groups according to the final diagnosis: benign infantile seizures, benign infantile seizures associated with mild gastroenteritis, and non-benign infantile seizures. We defined benign infantile seizures associated with mild gastroenteritis and benign infantile seizures as those associated with normal psychomotor development and no seizure recurrence 3 months after onset of the first seizure, whereas non-benign infantile seizures were associated with delayed psychomotor development and/or seizure recurrence after 3 months of onset of the first seizure. We analyzed the clinical features in the acute phase and compared them between the groups. RESULTS The median age of seizure onset was 7.6 months. A final diagnosis of benign infantile seizures associated with mild gastroenteritis was made in three patients. In the remaining 41 patients, the final diagnosis was benign infantile seizures in 30 (73.2%) and non-benign infantile seizures in 11 (26.8%). In the non-benign infantile seizure group, intellectual disability was diagnosed in eight patients and seizure recurrence in six. There were no significant differences in clinical features between the groups in the acute phase, such as seizure type or seizure duration. CONCLUSION About 30% of patients initially diagnosed as having benign infantile seizures did not experience a benign clinical course. Our findings suggest that clinical features in the acute phase are not helpful for predicting benign outcomes in benign infantile seizures and that only long-term follow-up can discriminate benign infantile seizures from non-benign infantile seizures.
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Affiliation(s)
- Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, Saitama-city, Saitama, Japan; Department of Pediatrics, Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama-city, Saitama, Japan
| | - Norimichi Higurashi
- Department of Pediatrics, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Ryuki Matsuura
- Department of Pediatrics, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kotoko Suzuki
- Department of Pediatrics, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Manabu Tanaka
- Division of Neurology, Saitama Children's Medical Center, Saitama-city, Saitama, Japan
| | - Motoyuki Minamitani
- Division of Neurology, Saitama Children's Medical Center, Saitama-city, Saitama, Japan
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Park SH, Kim YO, Kim HK, Kim HS, Kim BY, Cheon KR, Kim MJ, Kim SH, Chung JK, Woo YJ. Incidence of benign convulsions with mild gastroenteritis after introduction of rotavirus vaccine. Brain Dev 2015; 37:625-30. [PMID: 25266417 DOI: 10.1016/j.braindev.2014.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/29/2014] [Accepted: 09/07/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Rotavirus was the most common virus in benign convulsions with mild gastroenteritis (CwG), with an incidence of 40-50%. As rotavirus gastroenteritis has decreased since introduction of rotavirus vaccine, we investigated the incidence of CwG and rotavirus positivity after introduction of the vaccine. METHODS We retrospectively reviewed the medical records of 987 patients aged between 3months and 3years who were admitted to the Chonnam National University Hospital between March 2005 and February 2014 due to their first seizures and enrolled 102 patients with CwG. The incidences of CwG among seizure patients and stool rotavirus positivity in CwG patients were compared between two periods: period I (March 2005-February 2010) and period II (March 2010-February 2014). Other viruses in stools were also reviewed. RESULTS The incidence of CwG were 8.47% (45 among 531 patients) in period I and 12.50% (57 among 456 patients) in period II (P=0.018). Stool rotavirus was checked in 85.29% (87 patients): 82.22% (37 patients) in period I and 87.72% (50 patients) in period II (P=0.166). The positivity of rotavirus was 40.54% (15 patients) in period I and 16.00% (8 patients) in period II (P=0.01). In the patients without rotavirus gastroenteritis, 30 patients were test for other viruses. Norovirus was the most common (56.67%, 17 patients) and was more frequent in period II than I (71.43% versus 22.22%, P=0.018). CONCLUSION After introduction of rotavirus vaccine, rotavirus-associated CwG has decreased but the incidence of CwG has increased due to an increase of norovirus.
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Affiliation(s)
- Sang Hyun Park
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea
| | - Young Ok Kim
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea.
| | - Han Kyul Kim
- Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea
| | - Ho Sung Kim
- Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea
| | - Byoung Young Kim
- Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea
| | - Kyeong Ryeol Cheon
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea
| | - Min Ji Kim
- Health and Environment Institute of Gwangju, Gwangju, Republic of Korea
| | - Sun Hee Kim
- Health and Environment Institute of Gwangju, Gwangju, Republic of Korea
| | - Jae Keun Chung
- Health and Environment Institute of Gwangju, Gwangju, Republic of Korea
| | - Young Jong Woo
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Pediatrics, Chonanm National University Hospital, Gwangju, Republic of Korea
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15
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Bozaykut A, Aksoy HU, Sezer RG, Polat M. Evaluation of clinical course and neurocognition in children with self-limited infantile epilepsy in a Turkish cohort study. J Child Neurol 2015; 30:314-9. [PMID: 24958006 DOI: 10.1177/0883073814538502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The outcome of children with self-limited infantile epilepsy was reported to be normal psychosocial and cognitive development as a characteristic criterion. We aimed to investigate the clinical course and neurocognitive outcome in children with self-limited infantile epilepsy in a Turkish cohort. The clinical course, electroencephalographic (EEG) characteristics, neuroimaging, treatment, and outcome of children with self-limited infantile epilepsy were retrospectively analyzed. All infants were reevaluated with the Denver Developmental Screening Test in addition to neurologic examination. Of 44 patients, self-limited familial infantile epilepsy was diagnosed in 8 infants (18.2%) and self-limited nonfamilial infantile epilepsy in 28 (63.6%). Interictal EEGs and neurologic examinations were normal in all cases. Fine motor and gross motor skills, language, adaptive personal/social skills were near-normal in all patients with self-limited familial infantile epilepsy. Delay in language parameters was observed in 2 infants with self-limited nonfamilial infantile epilepsy. Language skills should be thoroughly evaluated with detailed neurocognitive screening tests in patients with self-limited infantile epilepsy.
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Affiliation(s)
- Abdulkadir Bozaykut
- Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Halil Ural Aksoy
- Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Rabia Gönül Sezer
- Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Muzaffer Polat
- Celal Bayar University School of Medicine, Department of Pediatric Neurology, Manisa, Turkey
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16
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Ueda H, Tajiri H, Kimura S, Etani Y, Hosoi G, Maruyama T, Noma H, Kusumoto Y, Takano T, Baba Y, Nagai T. Clinical characteristics of seizures associated with viral gastroenteritis in children. Epilepsy Res 2014; 109:146-54. [PMID: 25524854 DOI: 10.1016/j.eplepsyres.2014.10.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/03/2014] [Accepted: 10/18/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We analyzed the clinical features of seizures during gastroenteritis in children by comparing the norovirus and rotavirus pathogen, and the impact of fever, if present, during the seizure episodes. METHODS Retrospective analysis was performed on 293 consecutive pediatric patients admitted with viral gastroenteritis to Osaka General Hospital between November 2007 and May 2009. Eighteen patients developed seizures, 12 of whom were positive for norovirus and six for rotavirus, as revealed by antigen detection. Of these 18 seizure patients, eight presented without fever (the aFS group) and 10 presented with febrile episodes (FS group). RESULTS Seizure patients in the rotavirus group (83%) were more likely to be febrile than those in the norovirus group (58%). Compared with the aFS group, 90% of patients in the FS group presented seizures at an early stage of gastroenteritis. The frequency of clustered seizures in the FS group was considerably higher than that of febrile seizures in general and was also as high as that of "convulsions with mild gastroenteritis (CwG)". All seizure patients, whether febrile or afebrile, presented with generalized tonic clonic seizures (GTCS), complex partial seizures (CPS), or both. Diazepam (DZP) was less effective and carbamazepine (CBZ) was completely effective for the cessation of seizures in the FS group, similar to the drug response observed in CwG. CONCLUSIONS The causative pathogen (norovirus or rotavirus) affected the frequency of febrile episodes during gastroenteritis, but fever had little effect on the clinical features of seizures. However, seizures occurred earlier during gastroenteritis in the FS group. On the whole, the clinical features of febrile seizures during viral gastroenteritis may closely resemble those of "convulsions with mild gastroenteritis" (CwG) than those of febrile seizures in general with respect to the frequency of clustered seizures and the antiepileptic drug responses and may have a pathogenic mechanism distinct from those of febrile seizures due to other causes.
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Affiliation(s)
- Hitoshi Ueda
- Ueda Heart Clinic, 5-303 1-3 Wakihamacho Chuo-ku Kobe city, Hyogo Prefecture 651-0072, Japan; Department of Pediatrics, Osaka General Medical Center, Japan.
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Japan
| | - Sadami Kimura
- Department of Pediatrics, Osaka General Medical Center, Japan; Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
| | - Yuri Etani
- Department of Pediatrics, Osaka General Medical Center, Japan; Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
| | - Gaku Hosoi
- Department of Pediatrics, Osaka General Medical Center, Japan; Gaku Child Outpatient Clinic, Japan
| | - Tomoko Maruyama
- Department of Pediatrics, Osaka General Medical Center, Japan
| | - Haruyoshi Noma
- Department of Pediatrics, Osaka General Medical Center, Japan
| | - Yoshio Kusumoto
- Department of Pediatrics, Osaka General Medical Center, Japan
| | - Tomoko Takano
- Department of Pediatrics, Osaka General Medical Center, Japan
| | - Yoshiko Baba
- Department of Pediatrics, Osaka General Medical Center, Japan; Mazda Hospital, Japan
| | - Toshizaburo Nagai
- Division of Child and Reproductive Health Course of Health Science, Osaka University Graduate School of Medicine, Japan
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17
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Verrotti A, Moavero R, Vigevano F, Cantonetti L, Guerra A, Spezia E, Tricarico A, Nanni G, Agostinelli S, Chiarelli F, Parisi P, Capovilla G, Beccaria F, Spalice A, Coppola G, Franzoni E, Gentile V, Casellato S, Veggiotti P, Malgesini S, Crichiutti G, Balestri P, Grosso S, Zamponi N, Incorpora G, Savasta S, Costa P, Pruna D, Cusmai R. Long-term follow-up in children with benign convulsions associated with gastroenteritis. Eur J Paediatr Neurol 2014; 18:572-7. [PMID: 24780603 DOI: 10.1016/j.ejpn.2014.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The outcome of benign convulsions associated with gastroenteritis (CwG) has generally been reported as being excellent. However, these data need to be confirmed in studies with longer follow-up evaluations. AIM To assess the long-term neurological outcome of a large sample of children presenting with CwG. METHODS We reviewed clinical features of 81 subjects presenting with CwG (1994-2010) from three different Italian centers with a follow-up period of at least 3 years. RESULTS Follow-up period ranged from 39 months to 15 years (mean 9.8 years). Neurological examination and cognitive level at the last evaluation were normal in all the patients. A mild attention deficit was detected in three cases (3.7%). Fourteen children (17.3%) received chronic anti-epileptic therapy. Interictal EEG abnormalities detected at onset in 20 patients (24.7%) reverted to normal. Transient EEG epileptiform abnormalities were detected in other three cases (3.7%), and a transient photosensitivity in one (1.2%). No recurrence of CwG was observed. Three patients (3.7%) presented with a febrile seizure and two (2.5%) with an unprovoked seizure, but none developed epilepsy. CONCLUSIONS The long-term evaluation of children with CwG confirms the excellent prognosis of this condition, with normal psychomotor development and low risk of relapse and of subsequent epilepsy.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Perugia, Perugia, Italy.
| | - Romina Moavero
- Systems Medicine Department, Child Neurology Unit, Tor Vergata University Hospital of Rome, Italy
| | - Federico Vigevano
- Neuroscience Department, Pediatric Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Laura Cantonetti
- Neuroscience Department, Pediatric Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Azzurra Guerra
- Pediatric Neurology, Azienda Policlinico Modena, Modena, Italy
| | | | | | - Giuliana Nanni
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | | | - Pasquale Parisi
- Chair of Pediatrics, II Faculty of Medicine, "La Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Capovilla
- Epilepsy Center, Department of Child Neuropsychiatry, C. Poma Hospital, Mantova, Italy
| | - Francesca Beccaria
- Epilepsy Center, Department of Child Neuropsychiatry, C. Poma Hospital, Mantova, Italy
| | - Alberto Spalice
- Department of Pediatrics, "La Sapienza" University of Rome, Italy
| | | | - Emilio Franzoni
- Department of Child Neuropsychiatry, University of Bologna, Bologna, Italy
| | - Valentina Gentile
- Department of Child Neuropsychiatry, University of Bologna, Bologna, Italy
| | | | - Pierangelo Veggiotti
- Department of Child Neuropsychiatry, Child EEG Unit, Foundation C. Mondino Institute of Neurology, Pavia, Italy
| | - Sara Malgesini
- Department of Child Neuropsychiatry, Child EEG Unit, Foundation C. Mondino Institute of Neurology, Pavia, Italy
| | | | | | | | - Nelia Zamponi
- Department of Child Neuropsychiatry, University of Ancona, Italy
| | | | | | - Paola Costa
- Department of Child Neuropsychiatry, IRCCS Burlo Garofalo, Trieste, Italy
| | - Dario Pruna
- Division of Child Neurology and Psychiatry, Azienda Ospedaliero-Universitaria Cagliari, Italy
| | - Raffaella Cusmai
- Neuroscience Department, Pediatric Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
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18
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Kang B, Kwon YS. Benign convulsion with mild gastroenteritis. KOREAN JOURNAL OF PEDIATRICS 2014; 57:304-9. [PMID: 25114690 PMCID: PMC4127392 DOI: 10.3345/kjp.2014.57.7.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/03/2014] [Indexed: 12/29/2022]
Abstract
Benign convulsion with mild gastroenteritis (CwG) is a type of afebrile seizure that occurs in children. CwG is defined as a convulsion in a previously healthy child with no known central nervous system infection or encephalopathy, accompanying mild diarrhea without fever, electrolyte imbalance, or moderate to severe dehydration. Convulsions in CwG are characterized by multiple brief episodes of generalized or focal seizures. Although the etiology and pathophysiology have yet to be fully explained, many pathogenic mechanisms have been proposed including the possibility of direct invasion of the central nervous system by a gastrointestinal virus such as rotavirus or the possibility of indirect influence by the production and effects of certain mediators. The electroencephalogram findings are benign and long-term antiepileptic treatment is typically not required. Long-term prognosis has been favorable with normal psychomotor development. This review provides a general overview of CwG with the goal of allowing physicians practicing in the field of pediatrics to better recognize this unique entity and, ultimately, to minimize unnecessary evaluation and treatment.
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Affiliation(s)
- Ben Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Se Kwon
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
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19
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Zhang T, Ma J, Gan X, Xiao N. Are afebrile seizures associated with minor infections a single seizure category? A hospital-based prospective cohort study on outcomes of first afebrile seizure in early childhood. Epilepsia 2014; 55:1001-8. [PMID: 24861704 DOI: 10.1111/epi.12651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore if afebrile seizures associated with minor infections are a single category of seizure, or a set of different kinds of seizures. METHODS We conducted this prospective cohort study on three kinds of first afebrile seizure: first afebrile seizure associated with gastrointestinal infection (AS-GI), first afebrile seizure associated with nongastrointestinal infection (AS-nGI), and first unprovoked seizure (US). The Kaplan-Meier estimate risks of recurrent seizures were analyzed and compared pairwise. The characteristics of recurrent seizures were also compared pairwise. RESULTS The Kaplan-Meier estimate risks of recurrent seizure at 2 years of the AS-GI, AS-nGI, and US groups were 6.9%, 23.7%, and 37.8%, respectively. The pairwise differences were significant between the AS-GI and US groups (p < 0.001) and between the AS-GI and AS-nGI groups (p = 0.001), but not significant between the US and AS-nGI groups (p = 0.066). Among unprovoked subsequent seizures in patients with recurrence, the pairwise differences were significant between the AS-GI and US groups (p < 0.001) and between the AS-GI and AS-nGI groups (p = 0.005), but not significant between the US and AS-nGI groups (p = 0.417). SIGNIFICANCE Afebrile seizures associated with minor infections are indeed of two distinguishable kinds: AS-GI, if free of risk factors such as a family history of epilepsy, had a better prognosis and should be categorized as an acute symptomatic seizure, whereas patients with first AS-nGI, like patients with first US, may have recurrent unprovoked seizures, which suggests this category's essential difference from AS-GI.
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Affiliation(s)
- Ting Zhang
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, Chongqing, China
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20
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Li T, Hong S, Peng X, Cheng M, Jiang L. Benign infantile convulsions associated with mild gastroenteritis: An electroclinical study of 34 patients. Seizure 2014; 23:16-9. [DOI: 10.1016/j.seizure.2013.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 11/29/2022] Open
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21
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Lee EH, Chung S. A comparative study of febrile and afebrile seizures associated with mild gastroenteritis. Brain Dev 2013; 35:636-40. [PMID: 23111347 DOI: 10.1016/j.braindev.2012.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/17/2012] [Accepted: 09/26/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Seizures associated with mild gastroenteritis have been increasingly reported. We analyzed the clinical characteristics of febrile and afebrile seizures associated with mild gastroenteritis, and attempted to determine the influence of fever in these two groups. METHODS We reviewed the medical records of 59 children presenting with seizures during a mild gastroenteritis episode. They were classified into an afebrile group (n=27) and a febrile group (n=32). We compared the age of onset, sex, seizure semiology, frequency, duration, family history, and prior history of seizures between the two groups. RESULTS The mean age, family history, seizure semiology, and frequency of seizures were not significantly different between the two groups. However, more patients in the afebrile group experienced ≥ 2 seizures/day than in the febrile group (63% vs. 38%, p=0.051). The febrile patients had a tendency of experiencing prolonged seizures lasting ≥ 5 min compared with the afebrile group (34% vs. 11%, p=0.063). Prior febrile seizures were noted in 5 of the 32 patients (15.6%) in the febrile group, while none of the 27 patients in the afebrile group had a history of prior seizures (p=0.056). CONCLUSIONS It seems that the presence of fever may influence the clinical characteristics of seizures associated with mild gastroenteritis. We suggest that afebrile seizures associated with gastroenteritis may be regarded as a distinct condition from those associated with fever, and it needs to be clarified by a further large sample study.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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22
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Kang B, Kim DH, Hong YJ, Son BK, Kim DW, Kwon YS. Comparison between febrile and afebrile seizures associated with mild rotavirus gastroenteritis. Seizure 2013; 22:560-4. [PMID: 23642407 DOI: 10.1016/j.seizure.2013.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/14/2013] [Accepted: 04/09/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We aimed on identifying the differences of febrile and afebrile seizures associated with mild rotavirus gastroenteritis (RVGE) in the pediatric population. METHOD Medical charts of pediatric patients who had been admitted between July 1999 and June 2011 due to RVGE were retrospectively reviewed. Subjects were ultimately divided into three groups; 'no seizure' (NS: patients without seizure), 'febrile seizure' (FS: patients with fever during seizure), 'afebrile seizure' (AFS: patients without fever during seizure). Comparisons between groups were carried out on demographic and clinical characteristics, laboratory test results, electroencephalogram findings, brain magnetic resonance imaging findings, antiepileptic treatment, and prognosis. RESULTS Among the 755 subjects who had been admitted due to mild rotavirus enteritis, 696 (90.3%) did not have any seizures, 17 (2.2%) had febrile seizures, 42 (5.5%) had afebrile seizures. The duration of gastrointestinal symptoms before the onset of seizures were significantly shorter in the FS group compared to the AFS group (1.3±0.8 vs. 2.8±1.0 days; p<0.0001). A single seizure attack was significantly higher in the AFS group (3.0±1.6 vs. 1.7±1.0 episodes; p=0.0003), and the frequency of seizures that were of focal type with or without secondary generalization were significantly higher in the AFS group (33.3% vs. 6.0%; p=0.0139). All patients among the FS and AFS group had not received further antiepileptic treatment after discharge, and none developed epilepsy during follow up period. CONCLUSION Despite some differences in seizure characteristics, both febrile and afebrile seizures associated with mild RVGE were mostly benign with a favorable prognosis.
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Affiliation(s)
- Ben Kang
- Department of Pediatrics, Inha University Hospital, 3-ga, Sinheung-dong, Jung-gu, Incheon, 400-711, Republic of Korea
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23
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Complications in hospitalized children with acute gastroenteritis caused by rotavirus: a retrospective analysis. Eur J Pediatr 2012; 171:337-45. [PMID: 21833497 DOI: 10.1007/s00431-011-1536-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED Acute gastroenteritis (AGE) caused by rotavirus (RV) is a common disease among infants and toddlers, often leading to hospitalization and, in resource-poor countries, to death. However, little is known on specific complications of severe RV-positive (RV+) AGE and on the clinical course in chronically ill children. This was a retrospective analysis of data for children <5 years of age hospitalized due to AGE during six rotavirus seasons in three large German pediatric hospitals. The primary study end point was the incidence and type of complications in RV+ versus RV-negative (RV-) cases. A total of 6,884 episodes of AGE in hospitalized children aged <5 years were included in this analysis. Of the 4,880 stools tested for RV, 2,118 (43.4%) were RV+. Hypernatremia was significantly more common in RV+ AGE (P < 0.001) and was associated with severe disease, need for intensive care treatment, and longer duration of hospitalization. Metabolic disorders, particularly hypoglycemia, were more common in RV+ AGE. In contrast, symptoms such as respiratory infections, neurological, and abdominal symptoms were more common in children with RV- AGE. CONCLUSIONS Hypernatremia is a specific complication of RV+ AGE. RV would therefore appear to be the cause of infant toxicosis, the traditional descriptive term for severe dehydration and clinical deterioration following AGE.
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24
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Espeche A, Cersosimo R, Caraballo RH. Benign infantile seizures and paroxysmal dyskinesia: A well-defined familial syndrome. Seizure 2011; 20:686-91. [DOI: 10.1016/j.seizure.2011.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 11/29/2022] Open
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25
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Vos MJ, Stam CJ, Ronner HE, Wolf NI. Epilepsy with central spikes provoked by fever with a benign disease course. Clin Neurophysiol 2011; 122:2110-2. [DOI: 10.1016/j.clinph.2011.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 03/07/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
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26
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Capovilla G, Verrotti A. Infantile convulsions in association with mild gastroenteritis: an emerging clinical condition. Eur J Neurol 2011; 18:203-204. [PMID: 20629719 DOI: 10.1111/j.1468-1331.2010.03140.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Capovilla
- Department of Child Neuropsychiatry, "C. Poma" Hospital, Mantova
| | - A Verrotti
- Department of Pediatrics, University of Chieti, Chieti, Italy (e-mail: )
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Durá-Travé T, Yoldi-Petri ME, Gallinas-Victoriano F, Molins-Castiella T. Infantile convulsions with mild gastroenteritis: a retrospective study of 25 patients. Eur J Neurol 2011; 18:273-278. [PMID: 20618844 DOI: 10.1111/j.1468-1331.2010.03120.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to analyze the epidemiologic, clinical, and evolutional characteristics in patients who presented convulsions with mild gastroenteritis (CwG) to facilitate the diagnosis in daily clinical practice. METHODS Twenty-five medical records of patients diagnosed with CwG were reviewed, and the epidemiological and clinical features, results of complementary studies, and evolutional data were collected. RESULTS Age of onset ranged between 12 and 24 months in 76% of patients. Female/male ratio was 2.6 (18 women and seven men). Seizures were mostly brief (<5 min) and apparently generalized, and often repetitive occurring in cluster (2.2 seizures per episode). One patient with status epilepticus was recorded. The average interval between the onset of gastroenteritis and seizures was 3.8 days, even though seizure preceded diarrhea in three cases. Mean rectal temperature at the moment of seizure was 37.1°C. Rotavirus antigen was positive in stool in 17 episodes (55.8%). There were no abnormalities in serum biochemistry tests and cerebrospinal fluid studies. Four patients showed anomalies in the interictal electroencephalogram. The period of follow-up was 4.2 years. Five patients (20%) experienced recurrences when suffering a new gastroenteritis episode. One patient developed epilepsy during the follow-up period. CONCLUSIONS CwG would constitute a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of patients relapse when suffering a new diarrhea episode.
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Affiliation(s)
- T Durá-Travé
- Pediatric Neurology Unit, Virgen del Camino Hospital, Pamplona, Spain
| | - M E Yoldi-Petri
- Pediatric Neurology Unit, Virgen del Camino Hospital, Pamplona, Spain
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Verrotti A, Nanni G, Agostinelli S, Parisi P, Capovilla G, Beccaria F, Iannetti P, Spalice A, Coppola G, Franzoni E, Gentile V, Casellato S, Veggiotti P, Malgesini S, Crichiutti G, Balestri P, Grosso S, Zamponi N, Incorpora G, Savasta S, Costa P, Pruna D, Chiarelli F. Benign convulsions associated with mild gastroenteritis: a multicenter clinical study. Epilepsy Res 2010; 93:107-14. [PMID: 21146369 DOI: 10.1016/j.eplepsyres.2010.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 10/26/2010] [Accepted: 11/14/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the clinical characteristics and the outcome of benign convulsions associated with mild gastroenteritis (CwG) in Italian children. METHODS We studied clinical and EEG features of 128 children with CwG who were hospitalized between January 2004 and February 2008 and then followed for at least 12 months in 14 Italian centers. RESULTS Age at onset ranged from 6 to 60 months. The seizures were generalized in 73 cases (57%), only focal in 16 (12.5%), and secondarily generalized in 39 (30.5%). The duration of the seizures was under 5 min in 97 patients (75.8%), between 5 and 30 min in 26 (20.3%), and longer than 30 min in 5 (3.9%). Seventy-three participants (57%) had 2 or more seizures, which recurred within 24-48 h. In the acute phase, antiepileptic drugs were used in 72 patients (56.3%). Although interictal abnormalities were present in EEG of 28 children (21.9%), these reverted to normal. During the follow up period, only 6 patients (4.7%) suffered from recurrence of CwG, 7 (5.5%) suffered from simple febrile seizures, and 3 (2.3%) developed epilepsy. CONCLUSIONS Recognition of CwG in children allows pediatricians to avoid extensive evaluations and continuous antiepileptic therapy and to reassure parents regarding the lack of long-term complications.
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Espeche AL, Caraballo RH. Benign infantile seizures associated with gastroenteritis and benign infantile seizures alone in the same patients: Related syndromes or coincidental entities? Epilepsy Res 2010; 92:249-52. [DOI: 10.1016/j.eplepsyres.2010.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 09/16/2010] [Accepted: 09/26/2010] [Indexed: 11/29/2022]
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