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Erdede Ö, Sarı E, Uyur E, Sezer Yamanel RG. Comprehensive Evaluation of Inflammatory Biomarkers and Osmolarity to Distinguish Simple and Complex Febrile Seizures in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1594. [PMID: 37892257 PMCID: PMC10605422 DOI: 10.3390/children10101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
With limited sample sizes and varying study outcomes regarding complete blood count (CBC)-associated biomarkers and their febrile seizure (FS) classification, along with limited research on osmolarity, this study aims to evaluate CBC-associated biomarkers, including osmolarity, for a comprehensive view of their diagnostic value. This single-center retrospective study used data from 364 children (aged 5-60 months) diagnosed with FS. The patients were categorized into simple FS (n = 221) and complex FS (n = 143) groups. CBC and biochemical tests, including sodium, potassium, chloride, glucose, blood urea nitrogen, and C-reactive protein levels, were evaluated. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio, and osmolarity were calculated and compared between FS types and the number of seizures. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive utility of these markers. Inflammatory markers, including NLR, were ineffective in predicting FS types. Complex FS cases exhibited a significantly lower osmolarity than simple FS cases. The area under the ROC curve for osmolarity to distinguish complex FS was 0.754, while other markers did not reach the desired threshold of 0.700. Including osmolarity in the classification of FS has clinical applicability. Physicians may consider osmolarity as an additional tool to aid in clinical decision-making.
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Affiliation(s)
- Özlem Erdede
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
| | - Erdal Sarı
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
| | - Emek Uyur
- Department of Pediatric Neurology, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey;
| | - Rabia Gönül Sezer Yamanel
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
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Kurt H, Demirkiran D. The effect of iron deficiency anaemia treatment on mean platelet volume. Ir J Med Sci 2023; 192:1763-1767. [PMID: 36380191 DOI: 10.1007/s11845-022-03221-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
AIM To determine the relationship between mean platelet volume (MPV) and treatment response of iron deficiency anaemia (IDA) with normal platelet count. Study further aimed to determine changing of platelet parameters treatment response of IDA. METHODS IDA patients (n = 124) and the control group (CG) (n = 124) who fulfilled the inclusion criteria were compared for MPV and platelet parameters. Patients with IDA were divided into two groups as partial and complete response. The partial response to treatment group (PRG) was accepted as haemoglobin level between 10 and 12 g/dL, mean corpuscular volume (MCV) below 80 fL, and ferritin below 15 ng/ml (n = 60). Complete response to treatment group (CRG) was the patients whose haemoglobin was above 12 g/dL, MCV is above 80 fL, and ferritin is above 15 ng/ml (n = 64). RESULTS The MPV levels of CG (8.81 ± 0.99), PRG (8.80 ± 1.09), and CRG (8.96 ± 0.96) were similar at the beginning of the study. In addition, MPV levels of PRG (8.84 ± 1.08) and CRG (8.96 ± 1.11) with IDA therapy were similar at the end of the study (p > 0.05). When IDA was treated, there was a decrease in plateletcrit, platelet distribution width (PDW), and platelet count from platelet parameters. There was a correlation between MPV level and platelet count in both PRG and CRG (r = - 0.506; p < 0.001), (r = - 0.499; p < 0.001). CONCLUSION There is no change in MPV levels before and after treatment when normal platelet count IDA is treated, but there is a decrease in platelet count and an increase in PDW.
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Affiliation(s)
- Hüseyin Kurt
- Department of Internal Medicine, University of Kocaeli Health Sciences, Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Davut Demirkiran
- Department of Internal Medicine, Medicabil Hospital, Bursa, Turkey
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Ibrahim Abdullah Mahmood, Ahmed Tahseen Muslim, Hussein Ghani Kaddoori. The utility of hematological indices in differentiation between general and focal onset epilepsy. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i1.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Epilepsy is one of the most common neurological disorders with mainly focal and generalized onset types. Discrimination between these types is of paramount importance because the prescription of antiepileptic drugs (AEDs) depends on such decimation. Currently this made mainly upon the medical history of the patient. The aim of the study is to evaluate the role of hematological indices in discrimination between focal and generalize onset epilepsy.
Patients and Methods: This cross-sectional study included a total of 100 patients with epilepsy (mean age 21.44±10.5, range 6-52, 67 males and 33 females). Blood samples were collected for the participant and complete blood count (CBC) was performed. Furthermore, serum concentration of K+ and Na+ was determined.
Results: There were 38 patients with generalized and 62 patients with focal onset epilepsy. In multivariate initial analysis, each of mean platelet volume (MPV) (odds ratio (OR)= 2.56, 95%CI=1.09-13.22, p= 0.046) and serum Na+ (OR= 3.85, 95%CI=1.13-13.19, p= 0.032) were significantly associated with generalized onset epilepsy. Furthermore, two AEDs: carbamazepine and valproic acid were also independently associated with generalized and local onset epilepsy, respectively.
Conclusion: These data indicate the possible utility of MPV in the discrimination between generalized and focal onset epilepsy. However, further studies are required for more reliable conclusions.
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Tang L, Chen JR. The Predictive Value of Hemocytometry Based on Peripheral Platelet-Related Parameters in Identifying the Causes of Febrile Seizures. J Inflamm Res 2021; 14:5381-5392. [PMID: 34703275 PMCID: PMC8536886 DOI: 10.2147/jir.s334165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/28/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To evaluate the outcome of platelet-related parameters in children with febrile seizures (FSs) and seek low-cost markers for the clinical prediction of FSs. Methods A total of 79 patients with FSs (the FS group) who were hospitalized in our hospital were selected. Eighty-two patients with fever and without seizures (the FC group) and 81 healthy patients without fever (the HC group) were selected. The results of whole blood cell analysis were retrospectively analyzed. Results The results of whole blood cell analysis showed that platelet (PLT) count, mean platelet volume (MPV), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and hematocrit (HCT) levels in the FS group were significantly lower than in the FC and HC groups (P < 0.05). The platelet-to-lymphocyte ratio (PLR) in the FS and FC groups was significantly higher than in the HC group (P < 0.05), but there was no statistical difference between the FS and FC groups (P > 0.05). The PLT count in the CFS group was significantly lower than in the SFS group (P < 0.05). The PDW of the CFS group was higher compared with the SFS group (P < 0.05). The PLT count and PLR of the relapsed group were lower than those of the non-relapsed group (P < 0.05). The conducted linear regression analysis showed that MCH, PLT, and MPV were closely related to the occurrence of FSs. The binary logistic model showed that MPV was the most important protective factor related to FSs. Conclusion PLT and MPV are closely related to the occurrence of FSs. PLT and PDW may be able to serve as simple yet effective laboratory indicators for distinguishing different types of FSs. Low PLR levels could be used to predict the risk of FS recurrence.
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Affiliation(s)
- Ling Tang
- Department of Clinical Laboratory, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, 214001, People's Republic of China
| | - Jie-Ru Chen
- Department of Paediatrics, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, 214001, People's Republic of China
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Maniu I, Costea R, Maniu G, Neamtu BM. Inflammatory Biomarkers in Febrile Seizure: A Comprehensive Bibliometric, Review and Visualization Analysis. Brain Sci 2021; 11:brainsci11081077. [PMID: 34439695 PMCID: PMC8394500 DOI: 10.3390/brainsci11081077] [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: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Inflammatory markers association with many diseases is the subject of many articles and reviews. This study presents a comprehensive bibliometric review and visualization analysis of inflammatory biomarkers (IB) in the context of febrile seizure (FS) patients. Methods: The study focused on IB in FS using (1) bibliometric analysis specific indicators and maps in order to analyze and present the network of authors, journals, universities, and countries, and (2) automated literature screening and unsupervised clustering approach for filtering and topic cluster identification. Results: We conducted a literature mining search on FS research, specifically IB in the context of FS, using the automated tools VOSviewer and Bibliometrix. Indices of the inflammatory response (in the context of febrile seizures) identified by the literature mining are (pro/anti-inflammatory) cytokines, such as interleukin IL-1β, IL-6, IL-8, I-10, IL-22, tumor necrosis factor (TNF-α), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT), and red blood cell distribution width (RDW). The resulted bibliometric maps and topic clusters offer a comprehensive overview, the status and leading trends on existing research of inflammatory biomarkers in FS. Conclusion: The analysis using bibliometrics and review with graphical presentations can be useful in investigating and (better) understanding the relationship between FS and IB.
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Affiliation(s)
- Ionela Maniu
- Research Center in Informatics and Information Technology, Mathematics and Informatics Department, Faculty of Sciences, Lucian Blaga University, 550025 Sibiu, Romania;
- Research Compartment, Pediatric Clinical Hospital, 550166 Sibiu, Romania;
- Correspondence: (I.M.); (B.M.N.)
| | - Raluca Costea
- Research Compartment, Pediatric Clinical Hospital, 550166 Sibiu, Romania;
- Pediatric Neurology Department, Pediatric Clinical Hospital, 550166 Sibiu, Romania
- Medical Department, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania
| | - George Maniu
- Research Center in Informatics and Information Technology, Mathematics and Informatics Department, Faculty of Sciences, Lucian Blaga University, 550025 Sibiu, Romania;
| | - Bogdan Mihai Neamtu
- Research Compartment, Pediatric Clinical Hospital, 550166 Sibiu, Romania;
- Clinical Department, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania
- Computer and Electrical Engineering Department, Faculty of Engineering, Lucian Blaga University, 550025 Sibiu, Romania
- Correspondence: (I.M.); (B.M.N.)
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Dilber B, Reis GP, Kolayli CC, Cansu A. The Role of Neutrophil-to-Lymphocyte Ratio, Red Blood Cell Distribution Width, and Mean Platelet Volume in Predicting Febrile Seizures and Differentiating Febrile Seizure Types. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1733904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), platelet count (PLT), and mean platelet volume (MPV)/platelet ratio (MPR) are commonly known inflammatory markers measured by a routine peripheral blood test that have been studied in patients with febrile seizures (FS) and may be useful for the classification of FS types. The aim of this study was to investigate the relationship between FS and inflammatory markers including MPR, RDW, and NLR and also to determine the diagnostic ability of these parameters to identify FS by comparing patients with and without FS, and by comparing patients with FS to their FS types (simple febrile seizure or complex febrile seizure [SFS or CFS]). The study included a total of 537 children aged 6 to 60 months who presented to the emergency service with FS. The FS group was divided into two subgroups based on the type of seizure, SFS, and CFS. MPR, NLR, and RDW predicted a 1.7 (odds ratio [OR], 95% confidence interval [CI]: 1.19–2.45), 1.94 (OR, 95% CI: 1.35–2.79), and 1.8 (OR, 95% CI: 1.25–2.59) times higher risk of FS, respectively. NLR and RDW predicted a 2.64 (OR, 95% CI: 1.17–4.85) and 2.34 (OR, 95% CI: 1.14–4.44) times higher risk of recurrent SFS, respectively. In patients with CFS, NLR ≥ 1.806 had a 3.64 times (OR, 95% CI: 1.83–7.21) and RDW ≥14.55 had a 3.34 times (OR, 95% CI: 1.67–6.65) higher risk of recurrent FS. The results indicated that MPV, NLR, and RDW differentiated not only SFS from CFS but also FS from fever without seizure. The increase in RDW and NLR values and their diagnostic values in patients with recurrent FS and the diagnostic value of these parameters in predicting CFS suggest that NLR and RDW could be effective, practical, and discriminative predictors of FS.
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Affiliation(s)
- Beril Dilber
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Gökçe P. Reis
- Department of Pediatric Hematology-Oncology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
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Zheng SF, Lin P, Lin ZY, Shang-Guan HC, Chen GR, Zhang YB, Lin YX, Kang DZ, Yao PS. Lower Serum Iron and Hemoglobin Levels are Associated with Acute Seizures in Patients with Ruptured Cerebral Aneurysms. Neurocrit Care 2020; 31:501-506. [PMID: 31161421 DOI: 10.1007/s12028-019-00746-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of the study is to investigate the value of serum iron and hemoglobin levels for predicting acute seizures following aneurysmal subarachnoid hemorrhage (aSAH). METHODS Clinical and laboratorial data from patients with ruptured intracranial aneurysms were collected in the retrospective study. Age, sex, symptom onset, history of diabetes and hypertension, history of coronary artery disease, temperature, Hunt-Hess grade, Fisher grade, aneurysm location, hemoglobin, serum potassium, sodium, calcium, phosphorus, and iron were collected. Acute seizures were determined as seizures within 1 week following aSAH. Propensity score matching (PSM) analyses were performed to correct imbalances in patient characteristics between seizure and non-seizure groups. RESULTS A total of 760 patients were included. Incidence of acute seizures following aSAH was 6.4%. In the univariate analysis, significant differences were detected in age, admission Hunt-Hess grade, Fisher grade, hemoglobin, serum sodium, and serum iron between seizure and non-seizure groups. In multivariate logistic regression model, lower serum iron was considered as a risk factor for acute seizures (OR 0.182, 95% CI 0.084-0.393, p = 0.000), as well as lower hemoglobin (OR 0.977, 95% CI 0.962-0.993, p = 0.004) and higher serum sodium (OR 1.072, 95% CI 1.003-1.145, p = 0.039). After PSM, there were no significant differences in age, admission Hunt-Hess grade, Fisher grade, and serum sodium between seizure and non-seizure groups. The matched seizure group had lower serum iron and hemoglobin levels compared with the matched non-seizure group (p < 0.05). The optimal cutoff value for serum iron and hemoglobin levels as a predictor of acute seizure after aSAH was determined as 9.9 mmol/L (sensitivity was 81.63% and the specificity was 65.40%) and 119 g/L (sensitivity was 63.27% and the specificity was 70.18%), respectively. CONCLUSIONS Serum iron and hemoglobin levels were inversely associated with a high risk of acute seizures following aSAH.
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Affiliation(s)
- Shu-Fa Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Peng Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Zhang-Ya Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Huang-Cheng Shang-Guan
- Department of Critical Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Rong Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Yi-Bin Zhang
- Department of Neurosurgery, Dehua County Hospital, Quanzhou, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China.
| | - Pei-Sen Yao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China.
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Wang DL, Lin P, Lin ZY, Zheng SF, Shang-Guan HC, Kang DZ, Chen GR, Zhang YB, Wen CS, Lin YX, Yao PS. Lower Hemoglobin Levels Are Associated with Acute Seizures in Patients with Ruptured Cerebral Aneurysms. World Neurosurg 2019; 127:e1237-e1241. [DOI: 10.1016/j.wneu.2019.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022]
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The role of Mean Platelet Volume/platelet count Ratio and Neutrophil to Lymphocyte Ratio on the risk of Febrile Seizure. Sci Rep 2018; 8:15123. [PMID: 30310107 PMCID: PMC6181908 DOI: 10.1038/s41598-018-33373-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/27/2018] [Indexed: 12/26/2022] Open
Abstract
Systemic inflammatory response has been implicated as a contributor to the onset of febrile seizures (FS). The four novel indices of the inflammatory response such as, neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT) ratio and red blood cell distribution width (RDW) have been investigated in FS susceptibility and FS types (simple febrile seizure and complex febrile seizure). However, the potential role of these inflammatory markers and MPV/PLT ratio (MPR) in Chinese children with FS has yet to be fully determined. This study investigated the relevance of NLR, MPV, PLT, MPR and RDW in febrile children with and without seizures. 249 children with FS and 249 age matched controls were included in this study. NLR and MPR were calculated from complete blood cell counts prior to therapy. Differences in age, gender and these inflammatory markers between the FS group and the control group were evaluated using the chi-square test, t-test or logistic regression analysis. Receiver Operating Characteristic (ROC) curve was used to determine the optimal cut-off value of NLR and MPR for FS risk. Interactions between NLR and MPR on the additive scale were calculated by using the relative excess risk due to interaction (RERI), the proportion attributable to interaction (AP), and the synergy index (S). It has been shown that the elevated NLR and MPR levels were associated with increased risk of FS. The optimal cut-off values of NLR and MPR for FS risk were 1.13 and 0.0335 with an area under the curve (AUC) of 0.768 and 0.689, respectively. Additionally, a significant synergistic interaction between NLR and MPR was found on an additive scale. The mean levels of MPV were lower and NLR levels were higher in complex febrile seizure (CFS) than simple febrile seizure (SFS), and the differences were statistically significant. ROC analysis showed that the optimal cut-off value for NLR was 2.549 with 65.9% sensitivity and 57.5% specificity. However, no statistically significant differences were found regarding average values of MPR and RDW between CFS and SFS. In conclusion, elevated NLR and MPR add evidence to the implication of white cells subsets in FS risk, and our results confirmed that NLR is an independent, albeit limited, predictor in differentiating between CFS and SFS. Moreover, NLR and MPR may have a synergistic effect that can influence the occurrence of FS.
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Rudy M, Mayer-Proschel M. Iron Deficiency Affects Seizure Susceptibility in a Time- and Sex-Specific Manner. ASN Neuro 2017; 9:1759091417746521. [PMID: 29243938 PMCID: PMC5734468 DOI: 10.1177/1759091417746521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Iron deficiency (ID) affects more than three billion people worldwide making it the most common micronutrient deficiency. ID is most prevalent during gestation and early life, which is of particular concern since its impact on the developing central nervous system is associated with an increased risk of a wide range of different psychiatric disorders later in life. The cause for this association is not known, but many of these same disorders are also associated with an imbalance between excitation and inhibition (E/I) within the brain. Based on this shared impairment, we asked whether ID could contribute to such an imbalance. Disruptions in the E/I balance can be uncovered by the brain’s response to seizure inducing insults. We therefore tested the seizure threshold under different nutritional models of ID. We found that mice which were postnatally exposed to ID (and were acutely ID) had a decreased seizure threshold and increased susceptibility to certain seizure types. In contrast, mice that were exposed to ID only during gestation had an increased seizure threshold and low seizure incidence. We suggest that exposure to ID during gestation might alter the cellular components that contribute to the establishment of a proper E/I balance later in life. In addition, our data highlight the importance of considering the window of vulnerability since gestational ID and postnatal ID have significantly different consequences on seizure probability.
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Affiliation(s)
- Michael Rudy
- 1 Department of Environmental Medicine, University of Rochester, NY, USA.,2 Department of Biomedical Genetics, University of Rochester, NY, USA
| | - Margot Mayer-Proschel
- 2 Department of Biomedical Genetics, University of Rochester, NY, USA.,3 Department of Neuroscience, University of Rochester, NY, USA
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Kwak BO, Kim K, Kim SN, Lee R. Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis. Seizure 2017; 52:27-34. [PMID: 28957722 DOI: 10.1016/j.seizure.2017.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/24/2017] [Accepted: 09/14/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The association between iron deficiency anemia (IDA) and febrile seizures (FS) during childhood is inconclusive due to inconsistent results reported in different studies. We performed a systematic review and meta-analysis to determine an association between IDA and FS in children. METHODS We searched PubMed, EMBASE, and Cochrane Library databases for studies published up to August 2015 using the following key words: ["iron deficiency" OR "iron status"] AND ["febrile seizure" OR "febrile convulsion"] AND ["pediatric" OR "infant" OR "child"]. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using standard meta-analysis techniques. Subgroup analysis also was performed. RESULTS A total of 17 studies enrolling 2416 children with FS and 2387 controls were included in the meta-analysis. The results indicated that IDA was significantly associated with FS (OR, 1.98; 95% CI, 1.26-3.13; P=0.003). Subgroup analyses evaluated the diagnostic indices for IDA including serum iron, plasma ferritin, and mean corpuscular volume (MCV). The results indicated that IDA diagnosed on the basis of plasma ferritin (OR, 3.78; 95% CI, 1.80-7.94; P<0.001) or MCV (OR, 2.08; 95% CI, 1.36-3.17; P=0.001) was modestly associated with FS, whereas IDA diagnosed on the basis of two serum iron studies was not associated with FS (OR, 0.57; 95% CI, 0.24-1.37; P=0.210). CONCLUSION The results of this meta-analysis suggest that IDA is associated with an increased risk of FS in children.
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Affiliation(s)
- Byung Ok Kwak
- Department of Microbiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyungmin Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Soo-Nyung Kim
- Department of Obstetrics and Gyneology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ran Lee
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul 05030, Republic of Korea.
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Papageorgiou V, Vargiami E, Kontopoulos E, Kardaras P, Economou M, Athanassiou-Mataxa M, Kirkham F, Zafeiriou DI. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol 2015; 19:591-6. [PMID: 26112262 DOI: 10.1016/j.ejpn.2015.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/03/2015] [Accepted: 05/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The relationship between iron status and febrile seizures has been examined in various settings, mainly in the Developing World, with conflicting results. The aim of this study was to investigate any association between iron deficiency and febrile seizures (FS) in European children aged 6-60 months. DESIGN Prospective, case-control study. SETTING Greek population in Thessaloniki. PATIENTS 50 patients with febrile seizures (cases) and 50 controls (children presenting with fever, without seizures). INTERVENTIONS None. MAIN OUTCOME MEASURES Haematologic parameters (haemoglobin concentration, haematocrit, mean corpuscular volume, red cell distribution width), plasma iron, total iron-binding capacity, plasma ferritin, transferrin saturation and soluble transferrin receptors were compared in cases and controls. RESULTS Plasma ferritin was lower (median [range]: 42.8 (3-285.7) vs 58.3 (21.4-195.3 ng/ml; p = 0.02) and Total Iron Binding Capacity (TIBC) higher (mean [Standard Deviation] 267 [58.9] vs 243 [58.45] μg/dl, p = 0.04) in cases than in controls. Results were similar for 12 complex FS cases (ferritin 30 (3-121 vs 89 (41.8-141.5ng/lL; TIBC 292.92 [68.0] vs 232.08 [36.27] μg/dL). Iron deficiency, defined as ferritin <30 ng/ml, was more frequent in cases (24%) than controls (4%; p = 0.004). Ferritin was lower and TIBC higher in 18 with previous seizures than in 32 with a first seizure although haemoglobin and mean cell haemoglobin concentration were higher. CONCLUSIONS European children with febrile seizures have lower Ferritin than those with fever alone, and iron deficiency, but not anaemia, is associated with recurrence. Iron status screening should be considered as routine for children presenting with or at high risk for febrile seizures.
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Affiliation(s)
- Valia Papageorgiou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Euthymia Vargiami
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Eleutherios Kontopoulos
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Panagiotis Kardaras
- 3rd Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Marina Economou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Miranta Athanassiou-Mataxa
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Fenella Kirkham
- Division of Clinical and Experimental Sciences, University of Southampton, UK; Neurosciences Unit, UCL Institute of Child Health, London, UK
| | - Dimitrios I Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece.
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Dai AI, Akcali A, Varan C, Demiryürek AT. Prevalence of resistant occipital lobe epilepsy associated with celiac disease in children. Childs Nerv Syst 2014; 30:1091-8. [PMID: 24566676 DOI: 10.1007/s00381-014-2387-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/11/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Celiac disease (CD) is a chronic, inflammatory autoimmune disorder caused by intolerance to ingested gluten. Increased frequency of CD has been reported in occipital lobe epilepsy. The aim of the present study is to investigate the frequency of CD among children followed up due to epilepsy and diagnosed with epileptic activity in the occipital lobe in at least one electroencephalography (EEG) test. METHODS For this research, 90 pediatric epilepsy patients with epileptic activity in the occipital lobe were enrolled in the study group, while the control group comprised of 100 healthy children. In addition to the EEG examination, tissue transglutaminase (tTG) antibody was determined on duodenal biopsy. RESULTS None of the healthy children in the control group was positive in terms of the tTG antibody test used to scan CD. In the group with epileptic activity in the occipital lobe, two patients out of 90 were tTG antibody positive. The seroprevalence was 1/45 (2.22 %) in this group. These two patients were diagnosed with CD based on the endoscopic duodenal biopsy. In these patients, the seizures were uncontrollable through monotherapy. CONCLUSIONS Our results showed that the prevalence of CD is observed to be higher than the normal population among the patients with occipital lobe epilepsy. This type of seizure disorder seems to be more resistant to monotherapy, compared with other types of occipital epilepsy. Therefore, screening for CD is recommended in children with resistant epileptic activity in the occipital lobe.
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Affiliation(s)
- Alper I Dai
- Department of Pediatric Neurology, Faculty of Medicine, University of Gaziantep, 27310, Gaziantep, Turkey,
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14
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Saghazadeh A, Gharedaghi M, Meysamie A, Bauer S, Rezaei N. Proinflammatory and anti-inflammatory cytokines in febrile seizures and epilepsy: systematic review and meta-analysis. Rev Neurosci 2014; 25:281-305. [DOI: 10.1515/revneuro-2013-0045] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 12/26/2013] [Indexed: 01/01/2023]
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Tombini M, Squitti R, Cacciapaglia F, Ventriglia M, Assenza G, Benvenga A, Pellegrino G, Campana C, Assenza F, Siotto M, Pacifici L, Afeltra A, Rossini P. Inflammation and iron metabolism in adult patients with epilepsy: Does a link exist? Epilepsy Res 2013; 107:244-52. [DOI: 10.1016/j.eplepsyres.2013.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 07/10/2013] [Accepted: 09/17/2013] [Indexed: 01/08/2023]
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Blaha M, Kostal M, Lanska M, Blaha V, Foralova I, Filip S, Kubisova M, Maly J. The decrease of mean platelet volume after extracorporeal LDL-cholesterol elimination. ATHEROSCLEROSIS SUPP 2013; 14:77-81. [PMID: 23357146 DOI: 10.1016/j.atherosclerosissup.2012.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Mean platelet volume is arousing increasing interest as a new independent cardiovascular risk factor. Large platelets are likely to be more reactive. If mean platelet volume would drop after LDL-lowering therapy, decreased MPV could be one of the markers of successful therapy. Therefore, we investigated mean platelet volume after extracorporeal LDL-cholesterol elimination. METHODS Mean platelet volume was investigated in patients with severe familial hypercholesterolemia long-term treated (3-12 years) by LDL-apheresis (immunoapheresis) or cascade filtration. Plasma was obtained by centrifugation. Adsorbers Lipopak 400 were used for immunoapheresis and filters Evaflux 4A were used for cascade filtration. 95 pair samples were measured (before and after the procedures) in a group of 12 patients--each patient 8 times in 4 years. RESULTS Mean platelet volume before the procedures was 10.891 fl, CI 10.25-11.53. Mean platelet volume after the procedures decreased--10.478 fl, CI 09.84-11.11. The difference is statistically significant (p = 0.036). Mean platelet volume did not correlate with age, sex, platelet count, duration of therapy. At the same time, we used rheohemapheresis in the therapy of 40 patients with age-related macular degeneration. But mean platelet volume was not changed. CONCLUSION Mean platelet volume is easily available and is often disregarded, and sometimes may suggest the need for a careful assessment in patients with familial hypercholesterolemia. Mean platelet volume could be one of the markers of therapeutic efficacy in patients with familial hypercholesterolemia treated by extracorporeal LDL-cholesterol elimination that is simple and inexpensive.
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Affiliation(s)
- M Blaha
- 2nd Department of Internal Medicine, Charles University School of Medicine and Teaching Hospital, Hradec Králové, Czech Republic.
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17
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Cozzi A, Santambrogio P, Privitera D, Broccoli V, Rotundo LI, Garavaglia B, Benz R, Altamura S, Goede JS, Muckenthaler MU, Levi S. Human L-ferritin deficiency is characterized by idiopathic generalized seizures and atypical restless leg syndrome. ACTA ACUST UNITED AC 2013; 210:1779-91. [PMID: 23940258 PMCID: PMC3754865 DOI: 10.1084/jem.20130315] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Human L-ferritin deficiency causes reduced cellular iron availability and increased ROS production with enhanced oxidized proteins, which results in idiopathic generalized seizures and atypical restless leg syndrome. The ubiquitously expressed iron storage protein ferritin plays a central role in maintaining cellular iron homeostasis. Cytosolic ferritins are composed of heavy (H) and light (L) subunits that co-assemble into a hollow spherical shell with an internal cavity where iron is stored. The ferroxidase activity of the ferritin H chain is critical to store iron in its Fe3+ oxidation state, while the L chain shows iron nucleation properties. We describe a unique case of a 23-yr-old female patient affected by a homozygous loss of function mutation in the L-ferritin gene, idiopathic generalized seizures, and atypical restless leg syndrome (RLS). We show that L chain ferritin is undetectable in primary fibroblasts from the patient, and thus ferritin consists only of H chains. Increased iron incorporation into the FtH homopolymer leads to reduced cellular iron availability, diminished levels of cytosolic catalase, SOD1 protein levels, enhanced ROS production and higher levels of oxidized proteins. Importantly, key phenotypic features observed in fibroblasts are also mirrored in reprogrammed neurons from the patient’s fibroblasts. Our results demonstrate for the first time the pathophysiological consequences of L-ferritin deficiency in a human and help to define the concept for a new disease entity hallmarked by idiopathic generalized seizure and atypical RLS.
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Affiliation(s)
- Anna Cozzi
- San Raffaele Scientific Institute, Division of Neuroscience and 2 University Vita-Salute San Raffaele, Milan, Italy
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Abstract
Seizures are a commonly encountered condition within the emergency department and, because of this, can engender complacency on the part of the physicians and staff. Unfortunately, there is significant associated morbidity and mortality with seizures, and they should never be regarded as routine. This point is particularly important with respect to seizures in pediatric patients. The aim of this review is to provide a current view of the various issues that make pediatric seizures unique and to help elucidate emergent evaluation and management strategies.
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MESH Headings
- Anticonvulsants/therapeutic use
- Child
- Child, Preschool
- Diagnosis, Differential
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/therapy
- Seizures/diagnosis
- Seizures/etiology
- Seizures/therapy
- Seizures, Febrile/diagnosis
- Seizures, Febrile/therapy
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Affiliation(s)
- Maneesha Agarwal
- Department of Emergency Medicine, Carolinas Medical Center, 3rd Floor Medical Education Building, 1000 Blythe Boulevard, Charlotte, NC 28203, USA
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