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Leung JSC. Febrile Seizures: An Updated Narrative Review for Pediatric Ambulatory Care Providers. Curr Pediatr Rev 2024; 20:43-58. [PMID: 36043723 DOI: 10.2174/1573396318666220829121946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While generally self-limited, febrile seizures result in significant familial distress. Ambulatory pediatric care providers must be prepared to counsel families on the causes, risk factors, management principles, and prognosis of children with febrile seizures. OBJECTIVE To provide an updated, evidence-based review of febrile seizures focused on the needs of an ambulatory pediatric care provider. METHODS A narrative review of the literature prioritizing landmark articles, metanalyses, longitudinal population longitudinal cohort studies and national level guidelines. RESULTS Febrile seizures are aberrant physiological responses to fever in children caused by complex interactions of cytokine mediated neuroinflammation, environmental triggers, and genetic predisposition. Other than investigations to determine fever etiology, routine bloodwork, lumbar punctures, neuroimaging and electroencephalograms are low yield. The general prognosis is excellent, however, clinicians should be aware of long-term outcomes including: cognitive impairment with non-simple febrile seizures; neuropsychiatric associations; recurrent febrile seizure and epilepsy risk factors; and the association between complex febrile seizures and sudden unexpected death. Children with a high risk of recurrence, complex febrile seizures, limited access to care, or extreme parental anxiety may benefit from intermittent oral diazepam prophylaxis. CONCLUSION Clinicians should consider four management priorities: 1) terminating the seizure; 2) excluding critical differential diagnoses; 3) investigating fever etiology; and 4) providing adequate counselling to families. The clinical approach and prognosis of febrile seizure can be based on subtype. Children with non-simple (i.e. complex or febrile status epilepticus) febrile seizures require closer care than the vast majority of children with simple febrile seizures, who have excellent outcomes.
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Affiliation(s)
- James Sze-Chuck Leung
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Biltz S, Speltz L. Febrile Seizures. Pediatr Ann 2023; 52:e388-e393. [PMID: 37820706 DOI: 10.3928/19382359-20230829-03] [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: 10/13/2023]
Abstract
Febrile seizures (FSs) are the most common cause of pediatric seizures. They are defined as seizures in children age 6 months to 5 years with a temperature higher than 100.4°F, although they are more common at higher temperatures. A family history of FS is the most common risk factor. FSs are classified into three types (simple, complex, or febrile status epilepticus) based on duration and quality, with simple FSs accounting for many cases. Most FSs persist for less than 10 minutes and are self-limiting. Approximately one-third of patients will have recurrence of FSs. Safe and effective prophylaxis for FS has yet to be identified. Most patients will not have any long-term sequelae, although there is an increased risk of epilepsy, particularly for those with febrile status epilepticus. FSs are associated with caregiver anxiety, "fever phobia," and high health care use, emphasizing the importance of education and reassurance for both the provider and family. [Pediatr Ann. 2023;52(10):e388-e393.].
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Zhu Z, Chen L, Li K. Effect of nursing interventions based on the Kano model on symptom relief and parental psychological behavior in children with febrile seizures. Front Psychol 2023; 13:1067727. [PMID: 36743600 PMCID: PMC9889856 DOI: 10.3389/fpsyg.2022.1067727] [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: 10/12/2022] [Accepted: 11/28/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose To analyze the effect of nursing interventions based on the Kano model on symptom relief and parental psychological behavior in children with febrile seizures (FS). Methods A total of 104 children with FS and their corresponding families admitted to our hospital from January 2021 to April 2022 as the research object. All children were divided into 2 groups according to their nursing regimen during treatment. Children who received general nursing interventions were enrolled in the general group (n = 52) and children who received nursing interventions based on the Kano model were enrolled in the Kano group (n = 52). In this study, an investigation was first conducted to analyze the attributes of the caring care service needs of the families of children with FS. Then, we compared 4 aspects of symptom relief during the hospital stay of the 2 groups of children, including FS seizure frequency, time to cessation of convulsions, time to recovery of consciousness and time to fever reduction. The parent symptom questionnaire (PSQ) was used to assess the psychological behavior of the two groups of children during the hospital stay. The Chinese perceived stress scale (CPSS) and the symptom checklist 90 (SCL-90) were used to assess the psychological behavior of the two groups of their families during the children's hospitalization. Finally, a questionnaire was administered on the satisfaction of this nursing intervention. Results In terms of symptom relief, the children in the Kano group had less frequent of FS seizure than the general group, and the time to cessation of convulsions, time to recovery of consciousness and time to fever reduction were all earlier than in the genera group (p < 0.05). In terms of children's psychological behavior, the impulsivity-hyperactivity, anxiety, hyperactivity index and learning problems scores in the PSQ of the children in the Kano group were lower than those in the general group after the intervention (p < 0.05). In terms of family psychological behavior, the psychological behavioral problems of the families of the children in both groups improved after the intervention, and the CPSS scores of tension and dis-control, as well as the total SCL-90 score of the families of the children in the Kano group were lower than those of the general group (p < 0.05). In terms of family satisfaction, the Kano group was significantly better than the general group (p < 0.05). Conclusion The implementation of the nursing interventions based on the Kano model for children with FS was successful in dramatically reducing the clinical signs and symptoms of the children and meeting the psychological and behavioral needs of the children and their families.
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Affiliation(s)
- Zaiyun Zhu
- Department of Pediatrics, The Fourth Hospital of Changsha City, Changsha, China
| | - Liping Chen
- Disinfection Supply Center, The Fourth Hospital of Changsha City, Changsha, China
| | - Kai Li
- Department of Rehabilitation Pain, The Third Hospital of Changsha City, Changsha, China,*Correspondence: Kai Li,
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Remonde CG, Gonzales EL, Adil KJ, Jeon SJ, Shin CY. Augmented impulsive behavior in febrile seizure-induced mice. Toxicol Res 2023; 39:37-51. [PMID: 36726823 PMCID: PMC9839938 DOI: 10.1007/s43188-022-00145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/04/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
Febrile seizure (FS) is one of the most prevalent etiological events in childhood affecting 2-5% of children from 3 months to 5 years old. Debates on whether neurodevelopmental consequences rise in later life following a febrile seizure or not are still ongoing however there is limited evidence of its effect, especially in a laboratory setting. Moreover, the comparative study using both male and female animal models is sparse. To examine the effect of FS on the behavioral features of mice, both sexes of ICR mice were induced with hyperthermic seizures through exposure to an infrared heat lamp. The mice were divided into two groups, one receiving a single febrile seizure at postnatal day 11 (P11) and one receiving three FS at P11, P13, and P15. Starting at P30 the FS-induced mice were subjected to a series of behavioral tests. Mice with seizures showed no locomotor and motor coordination deficits, repetitive, and depressive-like behavior. However, the FS-induced mice showed impulsive-like behavior in both elevated plus maze and cliff avoidance tests, which is more prominent in male mice. A greater number of mice displayed impaired CAT in both males and females in the three-time FS-induced group compared to the single induction group. These results demonstrate that after induction of FS, male mice have a higher susceptibility to consequences of febrile seizure than female mice and recurrent febrile seizure has a higher chance of subsequent disorders associated with decreased anxiety and increased impulsivity. We confirmed the dysregulated expression of impulsivity-related genes such as 5-HT1A and tryptophan hydroxylase 2 from the prefrontal cortices of FS-induced mice implying that the 5-HT system would be one of the mechanisms underlying the increased impulsivity after FS. Taken together, these findings are useful in unveiling future discoveries about the effect of childhood febrile seizure and the mechanism behind it.
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Affiliation(s)
- Chilly Gay Remonde
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029 Republic of Korea
| | - Edson Luck Gonzales
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029 Republic of Korea
| | - Keremkleroo Jym Adil
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029 Republic of Korea
| | - Se Jin Jeon
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029 Republic of Korea
| | - Chan Young Shin
- School of Medicine and Center for Neuroscience Research, Konkuk University, Seoul, 05029 Republic of Korea
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Mohamed ZA, Tang C, Thokerunga E, Jimale AO, Fan J. Serum hypomagnesemia is associated with febrile seizures in young children. AIMS Neurosci 2022; 9:551-558. [PMID: 36660075 PMCID: PMC9826744 DOI: 10.3934/neuroscience.2022032] [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: 11/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Febrile seizures (FS) frequently manifest in children below 5 years of age. Although the exact etiology is still unknown, genetic predisposition, changes in neurotransmitter levels, and serum electrolyte imbalance are some of the known risk factors. This study examined the possible association between serum magnesium levels in children with FS compared to febrile children without seizures. Methods A retrospective case-control study was conducted from February 2019 to January 2021, recruiting 230 age and gender-matched cases and controls (115 each). Extracted data were analyzed using SPSS using an independent student's t-test, Chi-square test, and Pearson's correlation analysis. Results The mean serum magnesium levels were 0.93 ± 0.129 vs 0.97 ± 0.0961; p < 0.001, between cases and controls respectively. Similarly, hypomagnesemia (<0.85 mmol/L) was detected in 26.1% and 8.7% of the cases and controls, respectively; p < 0.001. A significant negative correlation was found between serum magnesium levels and the occurrence of febrile seizures; r = [-0.169], p < 0.05. Conclusion Serum magnesium was significantly low in febrile children with seizures compared to those without, and hypomagnesemia was associated with the occurrence of febrile seizures. These results portray hypomagnesemia as a possible risk factor for febrile seizure, and so should be validated in future large cohort studies so that guidelines are set for proper management of these children.
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Affiliation(s)
- Zakaria Ahmed Mohamed
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Chunjiao Tang
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Erick Thokerunga
- Department of Clinical Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ali Omar Jimale
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jingyi Fan
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan 430071, China,* Correspondence:
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Kadhem RH, Tarish AK. Relationship between Febrile Seizures and Iron Deficiency Anemia in Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Lolk K, Dreier JW, Sun Y, Christensen J. Perinatal adversities and risk of epilepsy after traumatic brain injury: A Danish nationwide cohort study. Acta Neurol Scand 2022; 145:721-729. [PMID: 35243615 PMCID: PMC9311430 DOI: 10.1111/ane.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
Objectives Traumatic brain injury (TBI) and perinatal adversities such as low gestational age at birth, low birth weight, low Apgar, and being born small for gestational age are well‐established risk factors for epilepsy. We examined whether perinatal adversities modified the risk of epilepsy after TBI in a nationwide cohort study of Danish singletons born from 1982 to 2011. Materials and Methods We categorized perinatal adversities as a composite measure of preterm delivery, low birth weight, low Apgar score, or being born small for gestational age. Cox regression and competing risk regression were used to estimate the risk of epilepsy after TBI according to such perinatal adversities. The study included 1,715,095 singletons (51.1% males). The mean age at end of follow‐up was 19.3 years (Interquartile range [IQR] = 12.1–26.3). During follow‐up, 85,636 persons (58.2% males) sustained a TBI and 18,064 developed epilepsy (50.7% males), of whom 1329 persons had a preceding TBI. Results The hazard ratio (HR) of epilepsy in persons with perinatal adversities was 1.19 (95% confidence interval [CI] 1.15–1.24), compared to persons without. The HR of epilepsy in persons with TBI was 2.31 (95% CI 2.18–2.45) compared to persons without TBI, but this risk was not modified by perinatal adversities (p = 0.2460). Conclusions Perinatal adversities and TBI both increased the risk of epilepsy, but the risk of epilepsy after TBI was not modified by these perinatal adversities.
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Affiliation(s)
- Kasper Lolk
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Centre for Integrated Register‐Based Research CIRRAU Aarhus University Aarhus Denmark
| | - Julie W. Dreier
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Centre for Integrated Register‐Based Research CIRRAU Aarhus University Aarhus Denmark
| | - Yuelian Sun
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Epidemiology Aarhus University Denmark
| | - Jakob Christensen
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
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Chen HY, Chang YH, Ding DC. The Negative Association between Breastfeeding Duration and Infant Febrile Seizure: A Retrospective Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095495. [PMID: 35564887 PMCID: PMC9105559 DOI: 10.3390/ijerph19095495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Two to five percent of infants and children experience febrile seizures (FS). Breastfeeding is beneficial to the health of mothers and children. Nevertheless, the benefits of breastfeeding in reducing FS remain unclear; thus, the present study aimed to evaluate this association. The case group was selected from 2010 to 2019, and the selected population was children younger than 5 years (i.e., children born from 2005−2019). The control group was selected from newborn infants at our hospital born between 2005 and 2019. Finally, 55 children with FS and 110 children in the control group were recruited. The results show longer breastfeeding duration is associated with an increased risk of FS (adjusted odds ratio: 1.06, 95% confidence interval: 1.01−1.11, p = 0.028). When comparing cases of FS with the control group, the percentage of inclusive breastfeeding over 12 months (32.7% vs. 9.1%, p = 0.017) and longer duration of exclusive breastfeeding were higher (10.86 ± 11.82 vs. 5.40 ± 7.17 months, p < 0.001). However, the comparison of the prevalence of FS between the different breastfeeding duration groups did not reach statistical significance. In conclusion, our study showed that a longer breastfeeding duration was associated with a higher risk of FS. Future large-scale studies evaluating the association between breastfeeding duration and febrile seizures are needed.
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Affiliation(s)
- Hsi-Yu Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien 970, Taiwan;
| | - Yu-Hsun Chang
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien 970, Taiwan
- Correspondence: (Y.-H.C.); (D.-C.D.); Tel.: +886-3-8561825 (ext. 12228) (Y.-H.C.); +886-3-8561825 (ext. 13383) (D.-C.D.)
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: (Y.-H.C.); (D.-C.D.); Tel.: +886-3-8561825 (ext. 12228) (Y.-H.C.); +886-3-8561825 (ext. 13383) (D.-C.D.)
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