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VanDerhoef KF, Bergmann K, Kaila R, Shanley R, Louie JP. A Retrospective Report on Simple Febrile Seizure Management in a Pediatric Emergency Department. Clin Pediatr (Phila) 2024; 63:764-768. [PMID: 37497942 DOI: 10.1177/00099228231188607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To determine whether pediatric emergency medicine physicians are compliant with the 9-year-old simple febrile seizure guideline created by the American Academy of Pediatrics (AAP). METHODS A retrospective chart review of patients, ages 6 to 60 months, who presented to the emergency department between May 2011 and December 2019. Key variables abstracted were urine, blood, nasal viral swab, and radiographic results. RESULTS The retrospective cohort of 285 children met inclusion criteria. Among 285 children, 342 studies were performed with a median of 1.2 studies per patient. There were 77 urine cultures obtained with 6 bacterial pathogens. Nasal viral swabs were performed on 65 children with 9 positive results. Blood cultures were obtained for 28 children and none were positive. Chest radiographs were performed on 37 children with 4 showing pneumonia. CONCLUSION The study results reflect areas of opportunity to update guidelines with a focus to consider obtaining urine studies, viral sampling, and chest x-rays.
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Affiliation(s)
- Katlin F VanDerhoef
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kelly Bergmann
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Rahul Kaila
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Ryan Shanley
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Jeffrey P Louie
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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2
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Graham J, Ahmad FA, Bram S, Srinivasan M. Evaluating the Proportion of Low-Value Blood Cultures Obtained in a Pediatric Emergency Department. Pediatr Emerg Care 2024; 40:33-37. [PMID: 37523779 DOI: 10.1097/pec.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Existing literature suggests that for some pediatric conditions, blood cultures may be of low value in specific clinical circumstances. The goals of our study were to: 1) identify common pediatric illnesses and define criteria for low-value blood cultures in children aged from 91 days to 19 years, 2) apply these criteria retrospectively to identify the patients in our emergency department (ED) who had low-value blood cultures obtained, and 3) describe this cohort and assess the proportion of true bacteremia in low-value blood cultures. METHOD The study team reviewed the literature and developed consensus criteria to identify conditions in which blood cultures were of low value for our study population. The criteria were applied retrospectively to well-appearing patients aged from 91 days to 19 years, without a central venous catheter, and evaluated in our ED with a peripheral blood culture from June 2018 to April 2020. Children admitted to the intensive care/hematology-oncology/cardiology/pulmonary units, those transferred from our ED to an outside facility, who transferred to our ED due to a positive blood culture from an outside facility, and repeat visits of a patient within 30 days from a previous visit were excluded from the study. After chart review, children with fever for 7 days or more, who were unvaccinated, immunosuppressed, had implanted devices, had a complex medical history, or had provider concerns for bacteremia/sepsis were excluded. RESULTS The study population consisted of 1436 children. Children at risk for bacteremia (n = 718) were excluded. Four hundred twenty-four children had discharge diagnoses not included in our study. There were 294 (20.5%) patients who had low-value cultures per our study criteria. Nine children (9/294, 3.1%) had false-positive blood cultures, and three (3/294, 1.0%) had true-positive blood cultures. CONCLUSIONS We identified a cohort of patients in our ED with blood cultures obtained when available literature indicates they were of low value.
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Affiliation(s)
- John Graham
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Fahd A Ahmad
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Sarah Bram
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Mythili Srinivasan
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO
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Patel B, Shah MM, Suresh A, Patel PN, Patel P, Gandhi SK. Evaluation of Febrile Seizures: A Therapeutic Review of Current Modalities. Cureus 2023; 15:e50947. [PMID: 38249234 PMCID: PMC10800093 DOI: 10.7759/cureus.50947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
As benign as its nature is, a febrile seizure (FS) can be one of the most frightening experiences for parents to witness. It is a seizure that occurs in infants and children aged six months to five years, accompanied by a fever (with a temperature of at least 100.4°F or 38.0°C by any method), without any infection in the central nervous system. FS is typically benign and tends to resolve on its own. Overall, the risk of recurrence after an FS is high, so there is still a sizable knowledge discrepancy that needs to be addressed for better understanding and management of the disease. Thus, the objective of this review is to evaluate current therapeutic modalities available for FS and summarize recent recommendations on the management of this condition. On June 25, 2023, a review was undertaken using the Medical Subject Headings Tool (MeSH), and the following keywords yielded 867 results: seizures, febrile/drug therapy [Mesh] and seizures, and febrile/therapy [Mesh]. A total of 21 relevant articles were chosen for the research. Seizures were classified as simple and complex FS (CFS) based on clinical features. CFS usually results in recurrence. Certain investigations like computed tomography (CT) scans, magnetic resonance imaging (MRIs), and electroencephalography (EEG) are helpful, along with laboratory investigations, to rule out other causes of FS. After reviewing the current literature, we have tried to conclude whether the current pharmacotherapy is effective in treating FS.
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Affiliation(s)
- Brinda Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Ahmedabad, IND
| | - Mokshit M Shah
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Patan, IND
| | - Amrita Suresh
- Department of Pediatrics, Kasturba Medical College, Mangalore, IND
| | - Parag N Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Patan, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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Gould L, Delavale V, Plovnick C, Wisniewski T, Devinsky O. Are brief febrile seizures benign? A systematic review and narrative synthesis. Epilepsia 2023; 64:2539-2549. [PMID: 37466925 DOI: 10.1111/epi.17720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Abstract
Febrile seizures affect 2%-5% of U.S. children and are considered benign although associated with an increased risk of epilepsy and, rarely, with sudden unexplained death. We compared rates of mortality, neurodevelopmental disorders, and neuropathology in young children with simple and complex febrile seizures to healthy controls. We systematically reviewed studies of 3- to 72-month-old children with simple or complex febrile seizures ≤30 min. We searched studies with outcome measures on mortality, neurodevelopment, or neuropathology through July 18, 2022. Bias risk was assessed per study design. Each outcome measure was stratified by study design. PROSPERO registration is CRD42022361645. Twenty-six studies met criteria reporting mortality (11), neurodevelopment (11), and neuropathology (13), including 2665 children with febrile seizures and 1206 seizure-free controls. Study designs varied: 15 cohort, 2 cross-sectional, 3 case-control, 5 series, and 1 case report. Mortality outcomes showed stark contrasts. Six cohort studies following children after febrile seizure (n = 1348) reported no deaths, whereas four child death series and 1 case report identified 24.1% (108/449) deaths associated with simple (n = 104) and complex (n = 3) febrile seizures ≤30 min. Minor hippocampal histopathological anomalies were common in sudden deaths with or without febrile seizure history. Most electroencephalography (EEG) studies were normal. Neuroimaging studies suggested increased right hippocampal volumes. When present, neurodevelopmental problems usually preexisted febrile-seizure onset. Risk bias was medium or high in 95% (18/19) of cohort and case-control studies vs medium to low across remaining study designs. Research on outcomes after simple or brief complex febrile seizures is limited. Cohort studies suffered from inadequate sample size, bias risk, and limited follow-up durations to make valid conclusions on mortality, neurodevelopment, and neuropathology. Sudden death registries, focused on a very small percentage of all cases, strongly suggest that simple febrile seizures are associated with increased mortality. Although most children with febrile seizures have favorable outcomes, longer-term prospective studies are needed.
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Affiliation(s)
- Laura Gould
- Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Victoria Delavale
- Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Caitlin Plovnick
- Health Sciences Library, NYU Grossman School of Medicine, New York, New York, USA
| | - Thomas Wisniewski
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Department of Pathology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Center for Cognitive Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Department of Psychiatry, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, NYU Langone Health, New York, New York, USA
- Department of Neurology, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
- Department of Psychiatry, NYU Langone Health and NYU Grossman School of Medicine, New York, New York, USA
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Erdede Ö, Sarı E, Uyur E, Sezer Yamanel RG. Comprehensive Evaluation of Inflammatory Biomarkers and Osmolarity to Distinguish Simple and Complex Febrile Seizures in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1594. [PMID: 37892257 PMCID: PMC10605422 DOI: 10.3390/children10101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
With limited sample sizes and varying study outcomes regarding complete blood count (CBC)-associated biomarkers and their febrile seizure (FS) classification, along with limited research on osmolarity, this study aims to evaluate CBC-associated biomarkers, including osmolarity, for a comprehensive view of their diagnostic value. This single-center retrospective study used data from 364 children (aged 5-60 months) diagnosed with FS. The patients were categorized into simple FS (n = 221) and complex FS (n = 143) groups. CBC and biochemical tests, including sodium, potassium, chloride, glucose, blood urea nitrogen, and C-reactive protein levels, were evaluated. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio, and osmolarity were calculated and compared between FS types and the number of seizures. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive utility of these markers. Inflammatory markers, including NLR, were ineffective in predicting FS types. Complex FS cases exhibited a significantly lower osmolarity than simple FS cases. The area under the ROC curve for osmolarity to distinguish complex FS was 0.754, while other markers did not reach the desired threshold of 0.700. Including osmolarity in the classification of FS has clinical applicability. Physicians may consider osmolarity as an additional tool to aid in clinical decision-making.
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Affiliation(s)
- Özlem Erdede
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
| | - Erdal Sarı
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
| | - Emek Uyur
- Department of Pediatric Neurology, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey;
| | - Rabia Gönül Sezer Yamanel
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, University of Health Sciences, 34668 Istanbul, Turkey; (E.S.); (R.G.S.Y.)
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Wu H, Du K, Liang X, Fan H, Ba R, Yang J, Wang Y. Factors affecting the simple febrile seizures in COVID-19 children: a case-control study from China. Front Neurol 2023; 14:1193843. [PMID: 37693772 PMCID: PMC10485374 DOI: 10.3389/fneur.2023.1193843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The over-age phenomenon of simple febrile seizures (SFS) was found during the epidemic in COVID-19, but there was no clear explanation, especially in China. This study aimed to analyze the clinical and auxiliary examination features of SFS in children infected with the coronavirus disease 2019 (COVID-19). Methods In total, 78 patients with SFS in the Department of Pediatric and Neurology of Qujing First People's Hospital were enrolled and divided into the COVID-19-positive group (case group) and the COVID-19-negative group (control group). The clinical characteristics, auxiliary examinations, and risk factors were analyzed. Results There were significant differences in age stratification between the two groups. The proportion of children aged over 5 years old in the case group (47.4%) was higher than that of the control group (5%) (p < 0.0001). In terms of sex distribution, the proportion of males in the case group was higher than that in the control group (71.1% vs. 50%), but the difference was not statistically significant (p = 0.0678). For blood cell analysis, the values of white blood cells (WBC), lymphocytes (LY), and monocytes (MN) in the case group were significantly lower than those in the control group (p < 0.01). Serum electrolyte analysis showed the greatest difference in blood sodium. The proportion of hyponatremia in the case group was higher than that in the control group (36.8% vs. 17.5%), but the difference did not reach statistical significance (p = 0.0745). A multivariate logistic regression analysis showed that the history of FS was a independent protective factors for SFS in children with COVID-19 (OR = 0.115, p = 0.009), and age was an independent risk factor for SFS in children with COVID-19 (OR = 1.042, p = 0.001). Conclusion Age distribution, sex a previous history of FS and hyponatremia were different between children with and without COVID-19 in SFS. The history of FS was an independent protective factors for SFS in children with COVID-19.
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Affiliation(s)
- Haohao Wu
- Department of Neurology, Qujing First People's Hospital, Yunnan, Qujing, China
| | - Kang Du
- Department of Neurology, Qujing First People's Hospital, Yunnan, Qujing, China
| | - Xi Liang
- Department of Neurology, Qujing First People's Hospital, Yunnan, Qujing, China
| | - Huijuan Fan
- Department of Neurology, Qujing First People's Hospital, Yunnan, Qujing, China
| | - Ruiqiong Ba
- Department of Neurology, Qujing First People's Hospital, Yunnan, Qujing, China
| | - Junsu Yang
- Department of Neurology, Qujing First People's Hospital, Yunnan, Qujing, China
| | - Yue Wang
- Department of Paediatrics, Qujing First People's Hospital, Yunnan, Qujing, China
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Li S, Zhao Q, Sun J, Yan W, Wang J, Gao X, Li X, Ren C, Hao L. Association between high-mobility group box 1 levels and febrile seizures in children: a systematic review and meta-analysis. Sci Rep 2023; 13:3619. [PMID: 36869074 PMCID: PMC9983536 DOI: 10.1038/s41598-023-30713-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
The relationship between High-mobility group box 1 (HMGB1) and febrile seizures (FS) in children remains unclear. This study aimed to apply meta-analysis to reveal the correlation between HMGB1 levels and FS in children. Databases including PubMed, EMBASE, Web of science, Cochrane library, CNKI, SinoMed and WanFangData were searched for relevant studies. Pooled standard mean deviation and 95% confidence interval were calculated as effect size since the random-effects model was used when I2 > 50%. Meanwhile, between-study heterogeneity was determined by performing subgroup and sensitivity analyses. A total of 9 studies were finally included. Meta-analysis showed that the children with FS had significantly higher HMGB1 levels compared with healthy children and children with fever but no seizures (P<0.05). Additionally, subgroup analysis showed that the HMGB1 level in children with complex FS was higher than those with simple FS (P<0.05), and children with duration >15 min were higher than those with duration ≤15min (P<0.05). There were no statistical differences between children with or without a family history of FS (P>0.05). Finally, children with FS who converted to epilepsy exhibited higher HMGB1 levels than those who did not convert to epilepsy (P<0.05). The level of HMGB1 may be implicated in the prolongation, recurrence and development of FS in children. Thus, it was necessary to evaluate the precise concentrations of HMGB1 in FS patients and to further determine the various activities of HMGB1 during FS by well-designed, large-scale, and case-controlled trials.
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Affiliation(s)
- Shangbin Li
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qian Zhao
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingfei Sun
- Department of Pediatrics, Zhengding people's Hospital, Shijiazhuang, Hebei, China
| | - Weichen Yan
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie Wang
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiong Gao
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xueying Li
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Changjun Ren
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Ling Hao
- Department of Pediatrics, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Yang N, Chen YB, Zhang YF. The rearrangement of actin cytoskeleton in mossy fiber synapses in a model of experimental febrile seizures. Front Neurol 2023; 14:1107538. [PMID: 37181554 PMCID: PMC10170767 DOI: 10.3389/fneur.2023.1107538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background Experimental complex febrile seizures induce a persistent hippocampal hyperexcitability and an enhanced seizure susceptibility in adulthood. The rearrangement of filamentous actin (F-actin) enhances the excitability of hippocampus and contributes to epileptogenesis in epileptic models. However, the remodeling of F-actin after prolonged febrile seizures is to be determined. Methods Prolonged experimental febrile seizures were induced by hyperthermia on P10 and P14 rat pups. Changes of actin cytoskeleton in hippocampal subregions were examined at P60 and the neuronal cells and pre- /postsynaptic components were labeled. Results F-actin was increased significantly in the stratum lucidum of CA3 region in both HT + 10D and HT + 14D groups and further comparison between the two groups showed no significant difference. The abundance of ZNT3, the presynaptic marker of mossy fiber (MF)-CA3 synapses, increased significantly whereas the postsynaptic marker PSD95 did not change significantly. Overlapping area of F-actin and ZNT3 showed a significant increase in both HT+ groups. The results of cell counts showed no significant increase or decrease in the number of neurons in each area of hippocampus. Conclusion F-actin was significantly up-regulated in the stratum lucidum of CA3, corresponding to the increase of the presynaptic marker of MF-CA3 synapses after prolonged febrile seizures, which may enhance the excitatory output from the dentate gyrus to CA3 and contribute to the hippocampal hyperexcitability.
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Affiliation(s)
- Nuo Yang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Yin-Bo Chen
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Yan-Feng Zhang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
- *Correspondence: Yan-Feng Zhang,
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Guedj R, De Suremain N, Cavau A, Enault M, Carbajal R. Crises fébriles : mise au point pour le médecin aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les crises fébriles (CF), définies comme des crises d’épilepsie en contexte fébrile chez un enfant âgé entre six mois et cinq ans sans infection du système nerveux central affectent entre 2 et 5 % des enfants. Leur pronostic à long terme est excellent, n’exposant ni à un excès de mortalité ni à une diminution des compétences intellectuelles et comportementales. Poser le diagnostic de CF nécessite d’éliminer les autres causes de crises d’épilepsie en contexte fébrile, dont une méningite bactérienne et une méningoencéphalite herpétique. Cependant, le diagnostic de CF ne nécessite généralement aucun examen complémentaire sous réserve d’un interrogatoire et d’un examen clinique minutieux. L’indication des examens complémentaires pour identifier l’étiologie de la fièvre n’est pas modifiée par le fait que l’enfant ait présenté une CF. Bien qu’un tiers des enfants ayant eu une CF récidiveront au moins une fois avant l’âge de cinq ans, aucune mesure prophylactique (traitement antiépileptique, prise en charge agressive de la fièvre) n’est indiquée pour éviter ces récidives pour la quasi-totalité de ces enfants. Plusieurs facteurs de risque d’épilepsie sont à rechercher pour identifier les rares patients nécessitant un avis spécialisé sans urgence. Enfin, assister à un épisode de CF est une expérience très éprouvante pour les parents. Plusieurs messages clés doivent être délivrés aux parents avant le retour au domicile dans le but d’améliorer leur compréhension de l’épisode qui a eu lieu et de prévenir un syndrome posttraumatique ainsi que des modifications du comportement parental face à la fièvre.
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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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11
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Abstract
OBJECTIVES Fever of 39°C or higher and a white blood cell (WBC) count of 15,000/μL or greater are known predictors of occult bacteremia (OB). However, because of a decreasing prevalence of OB, WBC counts have become poor predictors of OB in populations of routinely immunized children. Thus, we aim to evaluate the clinical characteristics of OB in Japanese children and identify potential risk factors for OB. METHODS We conducted an observational study of children aged 3 to 36 months old with positive blood cultures for Streptococcus pneumoniae or Haemophilus influenzae at an emergency department in a tertiary care children's hospital between April 2002 and December 2015. Patients with significant underlying diseases, a proven source of infection, or toxic appearance, were excluded. RESULTS Positive blood cultures were recorded in 231 patients; of these, 110 were included in the study (S. pneumoniae, n = 102; H. influenzae, n = 8). Median age was 16 (3-34) months. Patients had a high median body temperature of 39.2 (interquartile range, 38.6-39.9) °C and median WBC of 21,120 (interquartile range, 16,408-24,242)/μL. A high rate of febrile seizures (58 patients, 53%) was observed, with complex febrile seizures accounting for 43% of the episodes. Frequency of febrile seizures was positively associated with age (P = 0.001). CONCLUSIONS Our study revealed a high rate of children presenting with febrile seizures, especially complex seizures, among children with OB in Japan. A further study is necessary to evaluate the role of febrile seizures as a predictor for OB.
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Upregulation of hippocampal synaptophysin, GFAP and mGluR3 in a pilocarpine rat model of epilepsy with history of prolonged febrile seizure. J Chem Neuroanat 2019; 100:101659. [DOI: 10.1016/j.jchemneu.2019.101659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/20/2019] [Accepted: 06/22/2019] [Indexed: 12/12/2022]
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Management of Pediatric Febrile Seizures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102232. [PMID: 30321985 PMCID: PMC6210946 DOI: 10.3390/ijerph15102232] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/21/2023]
Abstract
Febrile seizures (FS), events associated with a fever in the absence of an intracranial infection, hypoglycaemia, or an acute electrolyte imbalance, occur in children between six months and six years of age. FS are the most common type of convulsions in children. FS can be extremely frightening for parents, even if they are generally harmless for children, making it important to address parental anxiety in the most sensitive manner. The aim of this review was to focus on the management of FS in the pediatric age. An analysis of the literature showed that most children with FS have an excellent prognosis, and few develop long-term health problems. The diagnosis of FS is clinical, and it is important to exclude intracranial infections, in particular after a complex FS. Management consists of symptom control and treating the cause of the fever. Parents and caregivers are often distressed and frightened after a FS occurs and need to be appropriately informed and guided on the management of their child’s fever by healthcare professionals. Due to the inappropriate use of diagnostic tests and treatments, it is extremely important to improve the knowledge of pediatricians and neurologists on FS management and to standardize the diagnostic and therapeutic work-up.
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Hu LY, Shi XY, Li H, Zhang MN, Ma SF, Zou LP. Intermittent oral levetiracetam reduced recurrence of febrile seizure accompanied with epileptiform discharge: a pilot study. Ital J Pediatr 2018; 44:70. [PMID: 29907116 PMCID: PMC6003147 DOI: 10.1186/s13052-018-0507-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background In previous study, we have found intermittent oral levetiracetam (LEV) can effectively prevent recurrence of febrile seizure (FS). This study aimed to analyze the effects of the preventive on the patients with frequent FS accompanied with epileptiform discharge. Methods Patients with frequent FS were assigned to undergo Electroencephalogram (EEG). At the onset of fever, the patients who presented epileptiform discharge were orally administered with LEV with a dose of 15–30 mg/kg per day twice daily for 1 week, thereafter, the dosage was gradually reduced until totally discontinued in the second week. The seizure frequency associated with febrile events and FS recurrence rate during a 48-week follow-up were analyzed. Results among the 19 patients presented epileptiform discharge on EEG, 31.58% (6 of 19) had complex FS, 68.42% (13 of 19) had simple FS. Up to 57.89% (11 of 19) had a family history of seizure disorder and 36.84% (7 of 19) had a family history of FS in first-degree relatives. 42.11% (8 of 19) happened the first FS episode at the age < 18 months. 36.84% (7/19) presented generalized spikes, 63.16% (12/19) showed focal spikes. During the 48-week follow-up period, the patients experienced 26 febrile episodes, none of them presented seizure recurrence. Conclusion Intermittent oral LEV can prevent the seizure recurrence of FS accompanied with epileptiform discharge in 48-week. However, further randomized controlled trials should be conducted. Trial registration ChiCTR-IPR-15007241; Registered 1 January 2014 - Retrospectively registered.
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Affiliation(s)
- Lin-Yan Hu
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yu Shi
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hui Li
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng-Na Zhang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shu-Fang Ma
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, China.
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McDonald SA, Nijsten D, Bollaerts K, Bauwens J, Praet N, van der Sande M, Bauchau V, de Smedt T, Sturkenboom M, Hahné S. Methodology for computing the burden of disease of adverse events following immunization. Pharmacoepidemiol Drug Saf 2018; 27:724-730. [PMID: 29575242 PMCID: PMC6055877 DOI: 10.1002/pds.4419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/23/2018] [Accepted: 02/02/2018] [Indexed: 11/18/2022]
Abstract
Purpose Composite disease burden measures such as disability‐adjusted life‐years (DALY) have been widely used to quantify the population‐level health impact of disease or injury, but application has been limited for the estimation of the burden of adverse events following immunization. Our objective was to assess the feasibility of adapting the DALY approach for estimating adverse event burden. Methods We developed a practical methodological framework, explicitly describing all steps involved: acquisition of relative or absolute risks and background event incidence rates, selection of disability weights and durations, and computation of the years lived with disability (YLD) measure, with appropriate estimation of uncertainty. We present a worked example, in which YLD is computed for 3 recognized adverse reactions following 3 childhood vaccination types, based on background incidence rates and relative/absolute risks retrieved from the literature. Results YLD provided extra insight into the health impact of an adverse event over presentation of incidence rates only, as severity and duration are additionally incorporated. As well as providing guidance for the deployment of DALY methodology in the context of adverse events associated with vaccination, we also identified where data limitations potentially occur. Conclusions Burden of disease methodology can be applied to estimate the health burden of adverse events following vaccination in a systematic way. As with all burden of disease studies, interpretation of the estimates must consider the quality and accuracy of the data sources contributing to the DALY computation.
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Affiliation(s)
- Scott A. McDonald
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Danielle Nijsten
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | - Jorgen Bauwens
- University of Basel Children's HospitalBaselSwitzerland
- Brighton Collaboration FoundationBaselSwitzerland
| | | | - Marianne van der Sande
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
- Department Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | | | - Tom de Smedt
- P95 Pharmacovigilance and Epidemiology ServicesLeuvenBelgium
| | - Miriam Sturkenboom
- P95 Pharmacovigilance and Epidemiology ServicesLeuvenBelgium
- VACCINE.GRID FoundationBaselSwitzerland
| | - Susan Hahné
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
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Auvin S, Antonios M, Benoist G, Dommergues MA, Corrard F, Gajdos V, Gras Leguen C, Launay E, Salaün A, Titomanlio L, Vallée L, Milh M. Évaluation d’un enfant après une crise fébrile : focus sur trois problèmes de pratique clinique. Arch Pediatr 2017; 24:1137-1146. [DOI: 10.1016/j.arcped.2017.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
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Li XC, Lu LL, Wang JZ, Wang M, Gao Y, Lin YX, Han ZH. Clinical characteristics and electroencephalogram analysis of levetiracetam in the treatment of children with febrile seizure recurrence. Exp Ther Med 2017; 14:2015-2020. [PMID: 28962118 PMCID: PMC5609163 DOI: 10.3892/etm.2017.4738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/11/2017] [Indexed: 11/05/2022] Open
Abstract
Febrile seizure is the most common neurologic disorder in infants and children. This study aimed to elaborate safe and effective therapy for preventing FS recurrence by levetiracetam (LEV). A prospective study was performed in two groups of children, the no treatment group (n=51, 24.1±9.0 months) and the LEV treatment group (n=45, 23.3±8.9 months). The findings demonstrated that a significant difference (P<0.01) was observed between the no treatment group 51.0% (26/51) and LEV treatment group 15.5% (7/45) in terms of FS recurrence after 50 weeks. FS recurrence/fever episode was 12.4% (12/97) in the LEV treatment group and 51.8% (57/110) in the no treatment group. Furthermore, LEV administration significantly improved (P<0.001) epileptiform + nonspecific EEG abnormalities (17.8%; 8/45), as compared with the no treatment group (68.6%; 35/51). In conclusion, LEV could function as an effective therapeutic agent for the prevention of FS recurrence and reducing the frequency of fever episodes. Furthermore, LEV administration significantly improved nonspecific EEG abnormalities, which may be used as a clinical monitoring index for LEV treatment in patients with FS.
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Affiliation(s)
- Xue-Chao Li
- Department of Pediatrics, Maternal and Child Care Center of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Ling-Ling Lu
- Centers for Disease Control and Prevention of Qinhuangdao, Qinhuangdao, Hebei 066009, P.R. China
| | - Jian-Zhong Wang
- Department of Pediatrics, Maternal and Child Care Center of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Miao Wang
- Department of Pediatrics, Maternal and Child Care Center of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Yu Gao
- Department of Pediatrics, Maternal and Child Care Center of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Ye-Xin Lin
- Department of Children ICU, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhong-Hou Han
- Department of Pediatrics, Maternal and Child Care Center of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
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Multiplex polymerase chain reaction testing in pediatric inpatients with febrile seizures. J Pediatr 2016; 179:274-275. [PMID: 27562920 PMCID: PMC7131077 DOI: 10.1016/j.jpeds.2016.07.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/28/2016] [Indexed: 11/20/2022]
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19
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Bauchau V, Van Holle L, Cohen C. Modelling Hospitalisation Ratios for Febrile Convulsions and Severe Varicella Under Combined Measles, Mumps, Rubella, and Varicella (MMRV-Priorix-Tetra™) Compared to Separate MMR + V Vaccination. Drug Saf 2016; 38:1095-102. [PMID: 26251259 PMCID: PMC4608986 DOI: 10.1007/s40264-015-0326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Measles, mumps, rubella, and varicella combination vaccines (MMRV) facilitate varicella vaccination uptake compared with separate administration of measles, mumps, and rubella vaccine (MMR) with varicella vaccine (V). However, the risk of developing febrile convulsions (FC) is higher in children vaccinated with MMRV. Objectives The aim was to demonstrate how to put the increased FC risk associated with MMRV into perspective by comparing it with the lower V-coverage risk associated with MMR + V. Methods FC and varicella burdens were measured by total numbers or duration of hospitalisations. A model, based on several assumptions and integrating parameters from heterogeneous data sources relevant to Germany, was developed to evaluate hospitalisation ratios (HRs; ratios between yearly numbers of varicella-related hospitalisation days prevented by MMRV and yearly numbers of FC-related hospitalisation days attributed to MMRV, both compared with MMR + V). A sensitivity analysis estimated HR under different scenarios beyond the German experience. Results For parameter values compatible with the German experience, where MMRV (Priorix-Tetra™, GSK, Belgium) was introduced in 2006, the model predicted that transitioning from MMR + V to MMRV would induce 225 vaccine-related FC hospitalisation days whilst preventing 1976 varicella-related hospitalisation days per year. The HR estimated by Monte Carlo simulations was 8.5 (95 % confidence interval: 1.99–25.22). A sensitivity analysis on two key parameters suggested that transitioning from MMR + V to MMRV would be favourable in situations where MMRV use would significantly impact varicella vaccination uptake. Conclusions MMRV use instead of MMR + V can substantially reduce the number of hospitalisation days, despite increased FC risk when MMRV is used as a first dose of measles-containing vaccine.
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Affiliation(s)
| | | | - Carine Cohen
- GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
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Role of multiplex PCR analysis in children with febrile seizures. Wien Med Wochenschr 2016; 167:246-250. [PMID: 27324512 PMCID: PMC7088288 DOI: 10.1007/s10354-016-0462-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/10/2016] [Indexed: 11/07/2022]
Abstract
Background The aim of this study was to assess multiplex PCR analysis in detecting causative viruses in children with febrile seizures. Methods The study was a retrospective analysis comparing data from a pre-multiplex era (2009) with a period after the introduction of routine respiratory multiplex analysis (2010–2013) in children with febrile seizures. Results We included 200 children with febrile seizures (mean age: 29.5 ± 1.4.months; 104 male) in the study. In 2009, in 10 out of 49 (20 %) children, microbiology testing (bacterial/fungal) was positive compared with a rate of 74 out of 151 (49 %) children during 2010–2013 (p < 0.01). The rate of positive virological studies increased from 10 (20 %) in 2009 to 73 (48.3 %) in the period 2010–2013 (p < 0.01). Multiplex PCR analysis confirmed viral infections in 52 of 73 cases (71.2 %). Conclusion Routine multiplex PCR analysis fosters the detection of respiratory viruses in children with febrile seizure. The precise role of multiplex analysis in the management of these children awaits further clarification.
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Abstract
PURPOSE OF REVIEW The review describes current evidence on the evaluation of febrile seizures in the acute setting, the need for further outpatient assessment, and predictors regarding long-term outcomes of these patients. RECENT FINDINGS New evidence has been added in support of limited assessment and intervention: evidence on low utility of lumbar puncture, emergent neuroimaging, and follow-up electroencephalography, as well as low yield for antipyretic prophylaxis and intermittent use of antiepileptic drugs. Finally, there is growing evidence regarding the genetic basis of both febrile seizures and vaccine-related seizures/febrile seizures. SUMMARY Routine diagnostic testing for simple febrile seizures is being discouraged, and clear evidence-based guidelines regarding complex febrile seizures are lacking. Thus, clinical acumen remains the most important tool for identifying children with seizures who are candidates for a more elaborate diagnostic evaluation. Similarly, evidence and guidelines regarding candidates for an emergent out-of-hospital diazepam treatment are lacking.
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22
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Abstract
Febrile seizure (FS) is the most common seizure disorder of childhood, and occurs in an age-related manner. FS are classified into simple and complex. FS has a multifactorial inheritance, suggesting that both genetic and environmental factors are causative. Various animal models have elucidated the pathophysiological mechanisms of FS. Risk factors for a first FS are a family history of the disorder and a developmental delay. Risk factors for recurrent FS are a family history, age below 18 months at seizure onset, maximum temperature, and duration of fever. Risk factors for subsequent development of epilepsy are neurodevelopmental abnormality and complex FS. Clinicians evaluating children after a simple FS should concentrate on identifying the cause of the child's fever. Meningitis should be considered in the differential diagnosis for any febrile child. A simple FS does not usually require further evaluation such as ordering electroencephalography, neuroimaging, or other studies. Treatment is acute rescue therapy for prolonged FS. Antipyretics are not proven to reduce the recurrence risk for FS. Some evidence shows that both intermittent therapy with oral/rectal diazepam and continuous prophylaxis with oral phenobarbital or valproate are effective in reducing the risk of recurrence, but there is no evidence that these medications reduce the risk of subsequent epilepsy. Vaccine-induced FS is a rare event that does not lead to deleterious outcomes, but could affect patient and physician attitudes toward the safety of vaccination.
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Affiliation(s)
- Sajun Chung
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
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23
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Mastrangelo M, Midulla F, Moretti C. Actual insights into the clinical management of febrile seizures. Eur J Pediatr 2014; 173:977-82. [PMID: 24477659 DOI: 10.1007/s00431-014-2269-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Febrile seizures (FS) are a benign epileptic manifestation of infancy occurring between 3 months and 5 years of age and affecting an estimated 2-5 % of children. They have usually no important negative effects on motor and cognitive development. Simple FS (generalized seizures, lasting less than 10 min and single episodes during the same febrile event) have a benign prognosis in almost all cases and do not require an extensive diagnostic workup. In complex FS (focal semiology and lasting more than 10 min, more than one episode during the same febrile event), a more detailed clinical, electroencephalographic, laboratory, and neuroimaging evaluation is necessary because of a higher percentage of underlying detectable causes and a mildly higher risk for later development of epilepsy. Febrile status epilepticus is the most severe type of complex FS even if its morbidity and mortality is extremely low. Simple FS plus (more than one convulsive episode in 24 h) have the same benign prognosis of simple FS. Neither intermittent nor continuous prophylaxis is actually recommended both in simple and complex FS because its side effects outweigh its possible benefits. CONCLUSION This review summarizes recent developments into the clinical management of FS including a suggested algorithm for simple and complex FS, the concept of simple FS plus, the controversies about the relationships between FS and hippocampal sclerosis, the relationships between FS and complex syndrome such as Dravet syndrome, genetic epilepsy with FS plus or febrile infection-related epilepsy syndrome, and the results of recent epidemiologic studies on febrile status epilepticus.
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Affiliation(s)
- Mario Mastrangelo
- Division of Pediatric Neurology, Department of Pediatrics, Child Neurology and Psychiatry, "Sapienza" University of Rome, Via dei Sabelli 108, 00184, Rome, Italy,
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Hu LY, Zou LP, Zhong JM, Gao L, Zhao JB, Xiao N, Zhou H, Zhao M, Shi XY, Liu YJ, Ju J, Zhang WN, Yang XF, Kwan P. Febrile seizure recurrence reduced by intermittent oral levetiracetam. Ann Clin Transl Neurol 2014; 1:171-9. [PMID: 25356397 PMCID: PMC4184546 DOI: 10.1002/acn3.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/21/2013] [Accepted: 12/23/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Febrile seizure (FS) is the most common form of childhood seizure disorders. FS is perhaps one of the most frequent causes of admittance to pediatric emergency wards worldwide. We aimed to identify a new, safe, and effective therapy for preventing FS recurrence. METHODS A total of 115 children with a history of two or more episodes of FS were randomly assigned to levetiracetam (LEV) and control (LEV/control ratio = 2:1) groups. At the onset of fever, LEV group was orally administered with a dose of 15-30 mg/kg per day twice daily for 1 week. Thereafter, the dosage was gradually reduced until totally discontinued in the second week. The primary efficacy variable was seizure frequency associated with febrile events and FS recurrence rate (RR) during 48-week follow-up. The second outcome was the cost effectiveness of the two groups. RESULTS The intention-to-treat analysis showed that 78 children in LEV group experienced 148 febrile episodes. Among these 78 children, 11 experienced 15 FS recurrences. In control group, 37 children experienced 64 febrile episodes; among these 37 children, 19 experienced 32 FS recurrences. A significant difference was observed between two groups in FS RR and FS recurrence/fever episode. The cost of LEV group for the prevention of FS recurrence is lower than control group. During 48-week follow-up period, one patient in LEV group exhibited severe drowsiness. No other side effects were observed in the same patient and in other children. INTERPRETATION Intermittent oral LEV can effectively prevent FS recurrence and reduce wastage of medical resources.
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Affiliation(s)
- Lin-Yan Hu
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China ; Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China ; Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Jian-Min Zhong
- Department of Neurology, Jiang-Xi Children's Hospital Jiangxi, 330006, China
| | - Lei Gao
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Jian-Bo Zhao
- Department of Neurology, Beijing Children's Hospital Beijing, 100045, China
| | - Nong Xiao
- Department of Neurology, Children's Hospital of Chongqing Medical University Chongqing, 400014, China
| | - Hong Zhou
- The Beijing new century children's Hospital Beijing, 100045, China
| | - Meng Zhao
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Xiu-Yu Shi
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Yu-Jie Liu
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Jun Ju
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Wei-Na Zhang
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Xiao-Fan Yang
- Department of Pediatrics, Chinese PLA General Hospital Beijing, 100583, China
| | - Patrick Kwan
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne Melbourne, Australia ; Department of Medicine and Therapeutics, Chinese University of Hong Kong Hong Kong, China
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Paul SP, Chinthapalli R. Rational approach to management of febrile seizures. Indian J Pediatr 2013; 80:149-50. [PMID: 22766906 DOI: 10.1007/s12098-012-0843-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/20/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Siba Prosad Paul
- Department of Pediatrics, Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, UK.
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