Association between iron status and febrile seizures in children

Multivariate linear mixture models for the prediction of febrile seizure risk and recurrence: a prospective case-control study

Our goal was to identify highly accurate empirical models for the prediction of the risk of febrile seizure (FS) and FS recurrence. In a prospective, three-arm, case-control study, we enrolled 162 children (age 25.8 ± 17.1 months old, 71 females). Participants formed one case group (patients with FS) and two control groups (febrile patients without seizures and healthy controls). The impact of blood iron status, peak body temperature, and participants' demographics on FS risk and recurrence was investigated with univariate and multivariate statistics. Serum iron concentration, iron saturation, and unsaturated iron-binding capacity differed between the three investigated groups (pFWE < 0.05). These serum analytes were key variables in the design of novel multivariate linear mixture models. The models classified FS risk with higher accuracy than univariate approaches. The designed bi-linear classifier achieved a sensitivity/specificity of 82%/89% and was closest to the gold-standard classifier. A multivariate model assessing FS recurrence provided a difference (pFWE < 0.05) with a separating sensitivity/specificity of 72%/69%. Iron deficiency, height percentile, and age were significant FS risk factors. In addition, height percentile and hemoglobin concentration were linked to FS recurrence. Novel multivariate models utilizing blood iron status and demographic variables predicted FS risk and recurrence among infants and young children with fever.

Anemia and Poor Iron Indices Are Associated With Susceptibility to Febrile Seizures in Children: A Systematic Review and Meta-analysis

INTRODUCTION

Febrile seizures are the most common type of seizure in children under the age of 5, and a number of risk factors for this condition have been identified. Several studies have examined the connection between iron deficiency anemia and febrile seizures in children, with inconsistent results. As a result, the authors sought to determine the precise link between iron deficiency anemia and its indices (mean corpuscular volume, serum iron, total iron-binding capacity, and ferritin) in conjunction to febrile seizures. Methods: A systematic literature search from several databases (PubMed, Europe PMC, ScienceDirect) was conducted from database inception until November 30, 2022. Studies were eligible if they investigated the relationship of the iron deficiency anemia and the aforementioned indices with the likelihood of febrile seizures. Results: This meta-analysis comprised 20 case-control studies with a total of 3856 participants. Our study revealed that iron deficiency anemia, low mean corpuscular volume, low serum iron, high total iron-binding capacity, and low ferritin were associated with the incremental risk of developing febrile seizures, with the odds ratios ranging from 1.24 to 1.59. Moreover, diagnostic test accuracy meta-analysis indicated that low serum ferritin level had the highest overall area under the curve value amid other iron deficiency anemia indices regarding our outcomes of interest. Conclusion: This study suggest that iron deficiency anemia and poor iron indices are associated with increased risk of febrile seizures in children.

Relationship between Febrile Seizures and Iron Deficiency Anemia in Children

BACKGROUND: The febrile seizure is the most common type of seizures occur in children under 5 years old and the peak age is 18 months, the temperature of body 38°C or more with no neurological infection or metabolic disorder. AIM: The aim of the present study is to found the association between iron deficiency anemia (IDA) and febrile seizure. METHODS: A case–control study has been carried out to determine the association between febrile convulsion and IDA. One hundred and twenty-two children with febrile seizure and 130 healthy babies include in study, period of study from May 2019 to December 2019 in Bunt Al Huda teaching hospital Nasiriyah, Dhi Qar, Iraq. The sociodemographic data are age of babies, weight, and gender. Diagnosis of febrile seizure done after details history and examination. Children aged 6 months–5 years presenting with febrile convulsion for cases and controls group of same age with fever but no convulsion. Both first and recurrent episodes of FC were included for cases. RESULTS: A case–control study of 122 children with seizures and 130 children without seizures, seizures babies have more weight than non-seizures, convulsion babies have low mean corpuscle volume than non-seizures, and seizures babies have low serum ferritin than non-seizures. There is a significant difference between mean serum ferritin of seizures and non-seizures babies, seizures babies have low serum ferritin than non-seizures. CONCLUSION: Serum ferritin also decreases more in babies with febrile seizure so IDA is occurring more in febrile seizure, and there is an association between iron supplements deficiency and febrile seizure.

Comorbidities in children with elevated periodic limb movement index during sleep

STUDY OBJECTIVES

Little is known about comorbidities in children who have elevated periodic limb movement index (PLMI) during overnight polysomnogram (PSG). The aim of this study is to identify comorbidities in children with elevated PLMI (PLMI > 5) versus children with PLMI < 5 presenting to a pediatric sleep center.

METHODS

This study was a retrospective review of all clinically indicated PSGs obtained consecutively from 3/2017-3/2019 at Seattle Children's Sleep Disorders Center. Data collected included demographics, clinical presentation, medications, medical history, family history specifically for restless legs syndrome (RLS), ferritin levels, and PSG metrics. Characteristics between those with (cases) elevated PLMI (AASM criteria) and without (controls) were summarized.

RESULTS

We identified 148 subjects with elevated PLMI (67% male, mean age 7.95 years, range 1-20), yielding a PLMI > 5 prevalence of 5%. There were 188 controls included (58% male, mean age 8.0 years, range 1-19). Neither sex (chi-square = 2.8, NS) nor age (Mann-Whitney U = 1339.5, NS) differed between groups. Case subjects had a higher prevalence of RLS, snoring, insomnia, mood disorders, behavioral problems, morning headaches, chronic kidney disease, epilepsy, and chronic heart disease. Similarly, the use of antidepressants, antipsychotics, antiseizure medication, and other medications was statistically more frequent in children with elevated PLMS. The prevalence of PLMI > 5 was 5% and the prevalence of periodic limb movement disorder (PLMD) was 0.3% in children referred to polysomnography. Ferritin levels did not differ.

CONCLUSIONS

We identified the prevalence of PLMD in a sleep medicine-referred population. We have also identified comorbidities and medications associated with elevated PLMI in children.No clinical trial.

Prospective case control study of iron deficiency and the risk of febrile seizures in children in South Korea

Background

Febrile seizures are the most common type of seizure in the first 5 years of life, and many factors that increase seizure risk have been identified. This study was performed to examine the association between iron status and febrile seizures in children in South Korea.

Methods

A prospective unmatched case control study was performed in 63 cases of febrile seizures and 65 controls with febrile illness but no seizures.

Results

Serum iron, plasma ferritin, and transferrin saturation were significantly lower in children with febrile seizures compared to the controls. Iron deficiency, defined as ferritin < 30 ng/mL, was more prevalent in the febrile seizure group (49.2%) than in the control group (16.9%). Serum iron < 22 ng/dL (odds ratio 3.42, 95% confidence interval [CI] 1.31–8.9, P = 0.012) and ferritin < 30 ng/mL (odds ratio 6.18, 95% CI 2.32–16.42, P < 0.001) were associated with increased risk of developing febrile seizures in multivariate logistic regression analysis.

Conclusion

These observations suggest that iron deficiency prior to development of anemia may increase risk of febrile seizures.

Iron Deficiency Affects Seizure Susceptibility in a Time- and Sex-Specific Manner

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.

Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis

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.

The Association Between Plasma Ferritin Level and Simple Febrile Seizures in Children

INTRODUCTION

We conducted this study to determine the role of iron deficiency (ID) as a risk factor for simple febrile seizure (SFS) in 6- to 60-month-old children.

MATERIALS AND METHODS

In this case-control study 100 children aged 6 to 60 months with febrile seizure (FS) (study group) and 100 febrile children without seizures (control group) admitted to Pediatric Departments of Kecioren Training and Research Hospital in between June 2014 and March 2015 were evaluated. Complete blood count, serum iron, plasma ferritin, and total iron binding capacity analyses were performed in children with FS and were compared with controls.

RESULTS

Ferritin level was significantly lower in the study group than controls (P<0.05). Compared with the onset of the study (first day), ferritin levels of the study group significantly decreased at the 10th day (P<0.05). At the onset, we were not able to determine ID in 18% of children because of fever.

CONCLUSIONS

There was a relationship between low plasma ferritin level and SFS. Low plasma ferritin level may be a risk factor for the development of SFS. For preventing the FS attacks, treatment of present ID and oral supplementary iron therapy should be initiated for children with SFS who have a low plasma ferritin.

Association between iron deficiency and febrile seizures

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.

Efficacy of zinc sulfate supplement on febrile seizure recurrence prevention in children with normal serum zinc level: A randomised clinical trial

OBJECTIVE

Serum zinc level might be related to pathogenesis of febrile seizure (FS). The purpose of this study was to evaluate efficacy and safety of oral zinc supplementation on FS recurrence prevention in non-zinc-deficient children.

MATERIALS AND METHODS

In a randomized clinical study, one hundred 18 to 60 mo old children with normal zinc level with first simple FS were referred to Shahid Sadoughi Hospital, Yazd, Iran from May 2012 to June 2013, were randomly assigned to two groups to receive 2 mg/kg/d zinc sulfate for six consecutive months or placebo as control group and were followed up for 1 y for FS recurrence.

RESULTS

41 girls and 59 boys with mean age of 2.47 ± 1.01 y were evaluated. Race, mean weight, height and body fat were similar in both groups. FS recurrence occurred in 19 children (38%) in the control group [95% confidence interval (CI): 19.45%-53.95%] and in 11 children (22%) in the zinc sulfate (95% CI: 57.47%-89.13%) groups, respectively; and the zinc group had lower FS recurrence (P = 0.03). The mean serum zinc level before intervention was lower in children with FS recurrence (72.43 ± 14.58 μg/dL versus 96.33 ± 12.69 μg/dL, P = 0.04). Gastrointestinal side effects (vomiting in five children, heartburn in two children and abdominal pain in one child) were seen in 16% of the zinc group and vomiting occurred in two children (4%) in control group and frequency of adverse events was similar in the two groups (P = 0.1).

CONCLUSION

Zinc supplementation should be considered as effective and safe in prevention of FS recurrence.

Risk of subsequent attention deficit-hyperactivity disorder in children with febrile seizures

OBJECTIVE

In this study, we obtained relevant data from a nationwide cohort database to investigate the risk of attention deficit-hyperactivity disorder (ADHD) in children with a history of febrile seizures (FS).

METHODS

We identified 1081 children with FS as the case cohort, and the date of diagnosis was used as an index date. Four controls were matched randomly with each case based on age, sex, urbanisation level, parents' occupation, and index date. We applied Cox's proportional hazards regression to estimate the HR and CI of FS-associated ADHD.

RESULTS

After 11 years of follow-up, the incidence of ADHD for the FS and control cohorts is 7.83 and 4.72 per 1000 person-years, respectively. The FS cohort was 1.66 times more at risk of ADHD occurrence (95% CI 1.27 to 2.18) than the control cohort. The risk of developing ADHD increased in conjunction with the frequency of FS-related visits.

CONCLUSIONS

FS may increase the risk of subsequent ADHD occurrence in children. Children who visited physicians for FS more than twice had a significantly higher cumulative incidence of ADHD.

Trace elements in febrile seizure compared to febrile children admitted to an academic hospital in iran, 2011

BACKGROUND AND AIM

Pathogenesis of Febrile Convulsion (FC) is unknown but some elements and genetic predispositions have been considered in the top list. This case-control study was designed to compare some trace elements in paediatrics who were admitted with FC and those in febrile ones without seizure attacks at an academic hospital in northeast of Iran.

MATERIAL AND METHODS

This case-control study was done from June 2010 to July 2011 on 160 paediatrics (6-months to 5-years old) who were diagnosed with FC and on 160 age-matched febrile children as control group. Data on the age, gender, past history of fever and convulsion, age at the first episode of seizure and family history of FC were gathered by using a designed checklist. Complete Blood Count (CBC), serum iron, Total Iron Binding Capacity (TIBC), zinc, magnesium and calcium were tested after taking informed consents from the parents. Serum levels of trace elements were measured by a photometric method. Independent t-test or non-parametric Mann-Whitney test were used to compare means between two groups.

RESULTS

There were no significant differences between the cases and controls with regards to the gender or age. TIBC and magnesium were lower in FC, but calcium, iron and zinc were higher in FC as compared to those in the other group (not significant).

CONCLUSIONS

So, it could be said that deficiency of trace elements was not significantly related to febrile convulsion in our study and it seemed that these tests were not necessary in FC cases. But further investigations on other trace elements are needed.