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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics 2024; 154:e2024066855. [PMID: 38932719 DOI: 10.1542/peds.2024-066855] [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] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. J Am Coll Radiol 2024; 21:e37-e69. [PMID: 38944445 DOI: 10.1016/j.jacr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Schonfeld D, Gardner K, Willemsen MA, Ostrow O. Reducing unnecessary investigations in paediatric seizures in the emergency department. BMJ 2024; 385:e076814. [PMID: 38918034 DOI: 10.1136/bmj-2023-076814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- Deborah Schonfeld
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto
| | - Katie Gardner
- IWK Health, Halifax, Nova Scotia
- Department of Emergency Medicine, Dalhousie University, Halifax
| | - Michèl A Willemsen
- Amalia Children's Hospital, Nijmegen, Netherlands
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen
| | - Olivia Ostrow
- The Hospital for Sick Children, Toronto
- Department of Pediatrics, University of Toronto
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Corsello A, Marangoni MB, Macchi M, Cozzi L, Agostoni C, Milani GP, Dilena R. Febrile Seizures: A Systematic Review of Different Guidelines. Pediatr Neurol 2024; 155:141-148. [PMID: 38653182 DOI: 10.1016/j.pediatrneurol.2024.03.024] [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: 10/01/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Febrile seizures (FS) are the most common neurological disorder in pediatric age. FS affect 2% to 12% of children and result from a complex interplay of genetic and environmental factors. Effective management and unambiguous recommendations are crucial for allocating health care resources efficiently and ensuring cost-effectiveness in treating FS. METHODS This systematic review compares existing guidelines to provide insights into FS management. Seven guidelines published between 1991 and 2021, from Japan, United Kingdom, United States, Mexico, India, and Italy, were included. Data extraction covered definitions, diagnostic criteria, hospital admission criteria, diagnostic tests, management, and prophylaxis recommendations. RESULTS Hospital admission criteria varied but typically included age <18 months and complex FS. Neuroimaging and lumbar puncture recommendations varied, with most guidelines suggesting limited use. Pharmacologic prophylaxis was generally discouraged for simple FS but considered only for high-risk cases, due to the benign nature of FS and the potential side effects of antiseizure medications. CONCLUSIONS Guidelines on FS exhibit similarities and differences, highlighting the need for standardized management and improved parental education to enhance clinical outcomes and reduce economic and social costs associated with FS. Future research should focus on creating updated international guidelines and ensuring their practical implementation.
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Affiliation(s)
- Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | | | - Marina Macchi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Laura Cozzi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Struttura Complessa Pediatria, Presidio Ospedaliero Magenta, ASST Ovest Milanese, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
| | - Gregorio Paolo Milani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy
| | - Robertino Dilena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuropathophysiology Unit, Milan, Italy.
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Jiang Z, Fang C, Peng F, Fan W. Comparison of clinical characteristics and disease burden of febrile seizures in children with and without COVID-19. BMC Pediatr 2024; 24:329. [PMID: 38741083 DOI: 10.1186/s12887-024-04821-z] [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: 11/06/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Febrile seizures (FS) are the most common seizure disorder in children and a common neurologic complication in children with coronavirus disease 2019 (COVID-19). This study aimed to identify differences in clinical characteristics and disease burden between FS with and without COVID-19. MATERIALS AND METHODS We conducted a retrospective analysis of medical data at our hospital from December 2019 to July 2023, focusing on hospitalized patients under the age of 14 diagnosed with FS who underwent COVID-19 polymerase chain reaction (PCR) testing. Descriptive statistics and analysis of variance were employed to compare the COVID-19 and non-COVID-19 groups in terms of clinical characteristics and disease burden. RESULTS A total of 514 patients were included, with 106 testing positive for COVID-19 and 408 testing negative. Patients with COVID-19 were older (34.87 ± 6.16 vs. 28.61 ± 11.35 months, P < 0.001) and had a higher proportion of males (79.2% vs. 62.3%, P = 0.001). The COVID-19 group had longer seizure durations (4.57 ± 4.38 vs. 3.22 ± 2.91 min, P = 0.006) and more complex FS (25.5% vs. 15.9%, P = 0.022). Laboratory tests showed lower lymphocyte counts in the COVID-19 group (1.87 ± 1.48 vs. 2.75 ± 1.51 × 103/µL, P < 0.001) and higher creatine kinase levels (158.49 ± 82.89 vs. 110.89 ± 56.11 U/L, P < 0.001). No significant differences were found in hospital costs, length of hospitalization, and intensive care unit admissions. CONCLUSION Clinicians should be knowledgeable about the distinct clinical characteristics of FS in children with COVID-19. Despite distinct features, the prognosis remains favorable and does not require excessive intervention. Ongoing monitoring and research are needed to fully understand the impact of COVID-19 on FS and optimize management strategies.
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Affiliation(s)
- Zhongli Jiang
- Department of Pediatrics, Liyang People's Hospital, Liyang, China
| | - Cuiyun Fang
- Department of Nursing, Liyang People's Hospital, Liyang, China
| | - Fengyimei Peng
- Department of Pediatrics, Liyang People's Hospital, Liyang, China
| | - Wei Fan
- Department of Pediatrics, Liyang People's Hospital, Liyang, China.
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Ferretti A, Riva A, Fabrizio A, Bruni O, Capovilla G, Foiadelli T, Orsini A, Raucci U, Romeo A, Striano P, Parisi P. Best practices for the management of febrile seizures in children. Ital J Pediatr 2024; 50:95. [PMID: 38735928 PMCID: PMC11089695 DOI: 10.1186/s13052-024-01666-1] [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: 01/19/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Febrile seizures (FS) are commonly perceived by healthcare professionals as a self-limited condition with a generally 'benign' nature. Nonetheless, they frequently lead to pediatric consultations, and their management can vary depending on the clinical context. For parents and caregivers, witnessing a seizure can be a distressing experience, significantly impacting their quality of life. In this review, we offer an in-depth exploration of FS management, therapeutic interventions, and prognostic factors, with the aim of providing support for physicians and enhancing communication with families. We conducted a comprehensive literature search using the PubMed and Web of Science databases, spanning the past 50 years. The search terms utilized included "febrile seizure," "complex febrile seizure," "simple febrile seizure," in conjunction with "children" or "infant." Only studies published in English or those presenting evidence-based data were included in our assessment. Additionally, we conducted a cross-reference search to identify any additional relevant data sources. Our thorough literature search resulted in a compilation of references, with carefully selected papers thoughtfully integrated into this review.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy.
| | - Antonella Riva
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alice Fabrizio
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Capovilla
- Child Neuropsychiatry Department, Epilepsy Center, Mantova, Italy
- C. Poma HospitalFondazione Poliambulanza, Brescia, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Romeo
- Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pasquale Striano
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
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Tang CM, Kuo CY, Yen CW, Lin JJ, Hsieh YC, Hsia SH, Chan OW, Lee EP, Hung PC, Wang HS, Lin KL, Chiu CH. Predicting factors for acute encephalopathy in febrile seizure children with SARS-CoV-2 omicron variant: a retrospective study. BMC Pediatr 2024; 24:211. [PMID: 38528535 DOI: 10.1186/s12887-024-04699-x] [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: 11/01/2023] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND SARS-CoV-2 posed a threat to children during the early phase of Omicron wave because many patients presented with febrile seizures. The study aimed to investigate predicting factors for acute encephalopathy of children infected by SARS-CoV-2 Omicron variant presenting with febrile seizures. METHODS The retrospective study analyzed data from pediatric patients who visited the emergency department of Chang Gung Memorial Hospital in Taiwan between April and July 2022. We specifically focused on children with COVID-19 who presented with febrile seizures, collecting demographic, clinical, and laboratory data at the pediatric emergency department, as well as final discharge diagnoses. Subsequently, we conducted a comparative analysis of the clinical and laboratory characteristics between patients diagnosed with acute encephalopathy and those with other causes of febrile seizures. RESULTS Overall, 10,878 children were included, of which 260 patients presented with febrile seizures. Among them, 116 individuals tested positive for SARS-CoV-2 and of them, 14 subsequently developed acute encephalopathy (12%). Those with acute encephalopathy displayed distinctive features, including older age (5.1 vs. 2.6 years old), longer fever duration preceding the first seizure (1.6 vs. 0.9 days), cluster seizure (50% vs. 16.7%), status epilepticus (50% vs. 13.7%) and occurrences of bradycardia (26.8% vs. 0%) and hypotension (14.3% vs. 0%) in the encephalopathy group. Besides, the laboratory findings in the encephalopathy group are characterized by hyperglycemia (mean (95% CI) 146 mg/dL (95% CI 109-157) vs. 108 mg/dL (95% CI 103-114) and metabolic acidosis (mean (95% CI) pH 7.29(95% CI 7.22-7.36) vs. 7.39 (95%CI 7.37-7.41)). CONCLUSIONS In pediatric patients with COVID-19-related febrile seizures, the occurrence of seizures beyond the first day of fever, bradycardia, clustered seizures, status epilepticus, hyperglycemia, and metabolic acidosis should raise concerns about acute encephalitis/encephalopathy. However, the highest body temperature and the severity of leukocytosis or C-reactive protein levels were not associated with poor outcomes.
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Affiliation(s)
- Ching-Min Tang
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Yen Kuo
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan
| | - Chen-Wei Yen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Oi-Wa Chan
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Cheng Hung
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan.
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Cheng-Hsun Chiu
- Division of Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Pediatric Infectious Diseases, Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Anastasopoulou S, Svensson E, Wickström R, Hertting O, Rinder MR, Bennet R, Eriksson M. Seizures in hospitalised paediatric patients with SARS-CoV-2 and comparison of severity with seizures in hospitalised paediatric patients with other respiratory viruses during the COVID-19 pandemic: a population-based cohort study. Arch Dis Child 2024; 109:152-157. [PMID: 37798081 PMCID: PMC10850622 DOI: 10.1136/archdischild-2023-325974] [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: 06/16/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To study seizures in patients hospitalised due to SARS-CoV-2 infection, and compare their severity with seizures in patients hospitalised due to other viral respiratory tract infections (RTIs). DESIGN Observational population-based cohort study. SETTING Northern Stockholm. PATIENTS Patients aged 1 month-18 years hospitalised due to SARS-CoV-2 with and without seizures, and patients of the same age hospitalised due to other viral RTIs with seizures, between 1 March 2020 and 30 June 2022. MAIN OUTCOME MEASURES The prevalence of seizures in hospitalised patients due to SARS-CoV-2, the evaluation of assumed predictors of seizures and the comparison of severity markers in patients with SARS-CoV-2 versus other RTIs. RESULTS 32 of 239 included patients (13.4%) admitted due to SARS-CoV-2 infection had seizures. Central nervous system (CNS) disease and the omicron period had significantly increased OR for seizures (OR: 5.12; CI: 2.06 to 12.72 and OR: 3.01; CI: 1.15 to 7.88, respectively). Seizures in patients with SARS-CoV-2 were more common in children older than 5 years (p=0.001), even in the absence of fever (p=0.007), as compared with other viral RTIs. The duration of hospitalisation was longer in patients with seizures due to other viral RTIs (p=0.023). There was no significant difference regarding severity markers of seizures between the two groups. CONCLUSIONS CNS disease and the omicron period were risk factors for seizures in patients with SARS-CoV-2, who were older than patients with other RTIs. The severity of seizures was comparable between the two groups; hospitalisation was however longer in patients with other RTIs.
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Affiliation(s)
- Stavroula Anastasopoulou
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Neurology Department, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Svensson
- Pediatric Neurology Department, Karolinska University Hospital, Stockholm, Sweden
| | - Ronny Wickström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Neurology Department, Karolinska University Hospital, Stockholm, Sweden
- Paediatric Neurology, Karolinska Institute, Stockholm, Sweden
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Emergencies and Infections Department, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Ryd Rinder
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Emergencies and Infections Department, Karolinska University Hospital, Stockholm, Sweden
| | - Rutger Bennet
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Emergencies and Infections Department, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Emergencies and Infections Department, Karolinska University Hospital, Stockholm, Sweden
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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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10
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De Wachter M, Schoonjans AS, Weckhuysen S, Van Schil K, Löfgren A, Meuwissen M, Jansen A, Ceulemans B. From diagnosis to treatment in genetic epilepsies: Implementation of precision medicine in real-world clinical practice. Eur J Paediatr Neurol 2024; 48:46-60. [PMID: 38039826 DOI: 10.1016/j.ejpn.2023.11.003] [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: 09/30/2022] [Revised: 07/20/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
The implementation of whole exome sequencing (WES) has had a major impact on the diagnostic yield of genetic testing in individuals with epilepsy. The identification of a genetic etiology paves the way to precision medicine: an individualized treatment approach, based on the disease pathophysiology. The aim of this retrospective cohort study was to: (1) determine the diagnostic yield of WES in a heterogeneous cohort of individuals with epilepsy referred for genetic testing in a real-world clinical setting, (2) investigate the influence of epilepsy characteristics on the diagnostic yield, (3) determine the theoretical yield of treatment changes based on genetic diagnosis and (4) explore the barriers to implementation of precision medicine. WES was performed in 247 individuals with epilepsy, aged between 7 months and 68 years. In 34/247 (14 %) a (likely) pathogenic variant was identified. In 7/34 (21 %) of these individuals the variant was found using a HPO-based filtering. Diagnostic yield was highest for individuals with an early onset of epilepsy (39 %) or in those with a developmental and epileptic encephalopathy (34 %). Precision medicine was a theoretical possibility in 20/34 (59 %) of the individuals with a (likely) pathogenic variant but implemented in only 11/34 (32 %). The major barrier to implementation of precision treatment was the limited availability or reimbursement of a given drug. These results confirm the potential impact of genetic analysis on treatment choices, but also highlight the hurdles to the implementation of precision medicine. To optimize precision medicine in real-world practice, additional endeavors are needed: unifying definitions of precision medicine, establishment of publicly accessible databases that include data on the functional effect of gene variants, increasing availability and reimbursement of precision therapeutics, and broadening access to innovative clinical trials.
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Affiliation(s)
- Matthias De Wachter
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium.
| | - An-Sofie Schoonjans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Sarah Weckhuysen
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium; Applied&Translational Neurogenomics Group, VIB-CMN, VIB, UAntwerpen, Universiteitsplein 1, 2610, Wilrijk, Belgium; Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Kristof Van Schil
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Ann Löfgren
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Marije Meuwissen
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Anna Jansen
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium; Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
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11
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Fang C, Zhou Y, Fan W, Zhang C, Yang Y. Clinical features of febrile seizures in children with COVID-19: an observational study from a tertiary care hospital in China. Front Pediatr 2023; 11:1290806. [PMID: 37868269 PMCID: PMC10587579 DOI: 10.3389/fped.2023.1290806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Background Febrile seizures are a common neurologic manifestation in children with coronavirus disease 2019 (COVID-19). Compared to seasonal respiratory viruses, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a pronounced neurological impact, with the result that febrile seizures with COVID-19 may exhibit unique clinical features. Materials and methods We conducted a retrospective study in a tertiary care hospital in China. We collected medical record information on febrile seizures with COVID-19, including demographic characteristics, clinical features, laboratory tests, and disease burden. Subsequently, the data were then analyzed descriptively. Results A total of 103 children diagnosed with febrile seizures and positive COVID-19 PCR results were included in our study. Among them, 81 (78.6%) were males and 22 (21.4%) were females. The age of onset of febrile seizures ranged from 14 to 57 months, with a mean age of 34.9 ± 6.24 months. Complex febrile seizures were observed in 34 (33%) cases. Antiseizure medications were administered to 24 (23.3%) patients. Laboratory tests showed a white blood cell count of (27.05 ± 8.20) × 103/µl, a neutrophil count of (20.09 ± 5.66) × 103/µl and a lymphocyte count of (6.44 ± 1.86) × 103/µl. A creatine kinase level was significantly elevated, with a mean value of (412.00 ± 158.96) U/L. The mean length of stay was 4.36 days. Twelve patients (11.7%) required intensive care services, but there were no deaths or patients remaining on antiseizure medications after discharge. Conclusion In the post-epidemic era of COVID-19, pediatric clinicians should be aware of the changing clinical features of febrile seizures associated with COVID-19. The average age of onset has increased, with a higher proportion of males. Length of stay and hospitalization costs did not increase significantly. The prognosis remained favorable, although a small number of children required intensive care services during the acute phase.
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Affiliation(s)
- Cuiyun Fang
- Department of Nursing, Liyang People’s Hospital, Liyang, China
| | - Yuan Zhou
- Department of Nursing, Liyang People’s Hospital, Liyang, China
| | - Wei Fan
- Department of Pediatrics, Liyang People’s Hospital, Liyang, China
| | - Chunsheng Zhang
- Department of Pediatrics, Liyang People’s Hospital, Liyang, China
| | - Yi Yang
- Department of Pediatrics, Liyang People’s Hospital, Liyang, China
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12
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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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13
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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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14
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Chen F, Feng F, You D, Guo Y, Yang S, Zhao T, Sun S, Wang L. A Prospective Observational Study of Children with FS-Associated Hospitalization: The Implication and Outcomes of Pathogen Detection in Cerebrospinal Fluid. Int J Gen Med 2023; 16:1891-1898. [PMID: 37223619 PMCID: PMC10202201 DOI: 10.2147/ijgm.s410337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
Background Febrile seizures (FS) are a common cause of paediatric emergencies, but research on their aetiology and epidemiology are limited. The aim of this study was to investigate the prevalence of central nervous system (CNS) pathogenic infections in patients with FS-associated hospitalization. Methods A prospective observational study was conducted in children under 16 years of age with FS-associated hospitalization. Demographic, clinical and laboratory data were recorded. Multiplex-PCR was performed on cerebrospinal fluid (CSF) samples for nine viruses, nine bacteria and one fungus. Results A total of 119 children were enrolled between June 2021 and June 2022. Of these, 83.2% had a final diagnosis of FS (69.7%) or FS plus (13.4%). In addition, epilepsy and encephalitis/meningitis were also found in 16.8% (20/119). Seven pathogens were identified from 9 CSF samples (7.6%), including viruses (EV, EBV, HHV-6) and bacteria (H. influenzae, S. pneumoniae, M. tuberculosis, S. putrefaciens). There were no significant clinical or laboratory differences between children who tested positive or negative for pathogens in the CSF, except for the presentation of herpes pharyngitis. Children with encephalitis/meningitis had longer hospital stays compared with those diagnosed with FS at discharge; abnormal EEG findings were significantly more common in patients with epilepsy. Conclusion FS-associated hospitalized children may have viral or bacterial intracranial infections. Pathogen testing of CSF is an important basis for timely antibiotic or antiviral therapy when clinical and laboratory findings make FS indistinguishable from other CNS disorders.
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Affiliation(s)
- Fang Chen
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Fan Feng
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Dianping You
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Yinghui Guo
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Shuo Yang
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Tong Zhao
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Suzhen Sun
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
| | - Le Wang
- Institute of Pediatric Research, Children’s Hospital of Hebei Province, Shijiazhuang, 050031, People’s Republic of China
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15
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Salleh H, Soon IS, Chong VH. Frequency and risk factors for febrile seizures during COVID-19 pandemic waves: an observational study. Eur J Pediatr 2023:10.1007/s00431-023-05021-0. [PMID: 37178360 PMCID: PMC10182340 DOI: 10.1007/s00431-023-05021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
Febrile seizures (FS) are well-known manifestations of viral illnesses. The purpose of this study is to assess the prevalence and factors associated with FS among pediatric patients with COVID-19 admitted to the National Isolation Centre in Brunei Darussalam. All pediatric patients (< 12 years) during the first (n = 12), second (n = 418), and third (n = 219) waves were included in the study. In Brunei, the first, second, and third waves were caused by the original SARS-CoV-2, Delta, and Omicron variants, respectively. Data was extracted from a prospective database and the national electronic health record system. Patients with and without FS were compared to identify any significant risk factors. FS were only encountered in the third wave (n = 29, 13%) giving an overall prevalence of 4.5%; 24 (83%) occurring in the typical age group for FS (≥ 6 months to < 6 years). Five cases (17%) occurred in children 6 years and older. Comparing patients in the third wave, univariate analyses showed typical age group, previous history of FS, family history of FS, higher temperature (> 38.6 °C), and fewer symptoms on presentation (3 or less) were associated with FS. On multivariate analyses, typical age group, family history of FS, and fewer reported symptoms remained significant (all p < 0.05). Conclusions: The overall prevalence of FS in COVID-19 patients is comparable to rates reported. However, in Brunei Darussalam, FS only occurred in the third wave that has been associated with Omicron variant. Younger age group, family history of FS, and fewer symptoms on presentation are correlated with risk of FS. What is Known: • Viral infections are the most common cause of FS in children. •Young age and a personal and family history of FS are correlated with the risk of FS. What is New: • There were high rates of FS (13%) among pediatric patients admitted with COVID-19 due to the Omicron variant but not with the original and Delta variants. • FS with COVID-19 were correlated with reporting fewer symptoms on presentation.
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Affiliation(s)
- Hafizah Salleh
- Department of Paediatrics, RIPAS Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam.
| | - Ing Shian Soon
- Department of Paediatrics, RIPAS Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam
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16
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Sourbron J, Auvin S, Arzimanoglou A, Cross JH, Hartmann H, Pressler R, Riney K, Sugai K, Wilmshurst JM, Yozawitz E, Lagae L. Medical treatment in infants and young children with epilepsy: Off-label use of antiseizure medications. Survey Report of ILAE Task Force Medical Therapies in Children. Epilepsia Open 2023; 8:77-89. [PMID: 36281833 PMCID: PMC9977757 DOI: 10.1002/epi4.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Antiseizure medications (ASMs) remain the mainstay of epilepsy treatment. These ASMs have mainly been tested in trials in adults with epilepsy, which subsequently led to market authorization (MA). For treatment of - especially young - children with epilepsy, several ASMs do not have a MA and guidelines are lacking, subsequently leading to "off-label" use of ASMs. Even though "off-label" ASM prescriptions for children could lead to more adverse events, it can be clinically appropriate and rational if the benefits outweigh the risks. This could be the case if "on-label" ASM, in mono- or polytherapy, fails to achieve adequate seizure control. METHODS The Medical Therapies Task Force of the International League Against Epilepsy (ILAE) Commission for Pediatrics performed a survey to study the current treatment practices in six classic, early life epilepsy scenarios. Our aim was not only to study first- and second-line treatment preferences but also to illustrate the use of "off-label" drugs in childhood epilepsies. RESULTS Our results reveal that several ASMs (e.g. topiramate, oxcarbazepine, benzodiazepines) are prescribed "off-label" in distinct scenarios of young children with epilepsy. In addition, recent scientific guidelines were not always adopted by several survey respondents, suggesting a potential knowledge gap. SIGNIFICANCE We report the relatively common use of "off-label" prescriptions that underlines the need for targeted and appropriately designed clinical trials, including younger patients, which will also result in the ability to generate evidence-based guidelines.
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Affiliation(s)
- Jo Sourbron
- Section Pediatric Neurology, Department of Development and Regeneration, University Hospital KU Leuven, Leuven, Belgium
| | - Stéphane Auvin
- A PHP, Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,INSERM NeuroDiderot, Université de Paris, Paris, France.,Institut Universitaire de France (IUF), Paris, France
| | - Alexis Arzimanoglou
- Epilepsy Department, Member of the ERN EpiCARE, Sant Joan de Déu Hospital, Barcelona, Spain.,Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Lyon, France
| | - J Helen Cross
- Great Ormond Street Hospital for Children, London, UK.,Programme of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ronit Pressler
- Great Ormond Street Hospital for Children, London, UK.,Programme of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Kate Riney
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Neurosciences Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Jo M Wilmshurst
- Department of Pediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology, Montefiore Medical Center, New York City, New York, USA
| | - Lieven Lagae
- Section Pediatric Neurology, Department of Development and Regeneration, University Hospital KU Leuven, Leuven, Belgium
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17
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Falsaperla R, Marino S, Vitaliti G, Bonadies A, Marino SD, Pavone P, Romano C, Savoia F, Calì C, Ruggieri M, Lubrano R, Tipo V. Simple febrile seizures: new cut off for the duration of the crises. Acta Neurol Belg 2023:10.1007/s13760-023-02211-3. [PMID: 36829088 DOI: 10.1007/s13760-023-02211-3] [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: 08/15/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Our study aimed to identify a new cut-off for febrile seizure (FS) with a good prognosis, thereby replacing the 15 min described in the standard definition of simple febrile seizure (SFS). METHODS Our study was a retrospective observational study (from January 2018 to December 2018) on children admitted to the Pediatric emergency room of the Santobono-Pausilipon Hospital, Naples, Italy, Pediatric Unit of Latina, Rome, Italy, and Policlinico-Vittorio-Emanuele University Hospital, Catania, Italy, for fever, which developed SFS during the hospitalization. All included patients had their seizures classified as SFS according to the international criteria for epilepsy. We assumed a duration cut-off, and we analyzed the EEG results, neurological follow-up at 12 months, and the recurrence of the febrile seizures the following year. Then, with another calculation, we identify an optimal cut-off of 6 min. Finally, we divided the population into two groups: children with seizures having a duration greater than or less than 6 min. RESULTS We found that the population with FS with a duration greater than 6 min presented EEG alteration at follow-up visits, neurological disorders, and a recurrence of FS during the following year. CONCLUSIONS We suggest to introduce a new cut-off for the duration of FS that better represents the benign nature of a simple febrile event.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy.,Unit of Intensive Care and Neonatology, University Hospital "Rodolico - San Marco", PO "San Marco", Catania, Italy
| | - Silvia Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy.
| | - Giovanna Vitaliti
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Anna Bonadies
- Department of Pediatric, AORN Santobono Pausilipon, Naples, Italy
| | - Simona Domenica Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital "Rodolico - San Marco", PO "Rodolico", Catania, Italy
| | - Catia Romano
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico - San Marco", PO "San Marco", Via A. Ciampi, 2, 95100, Catania, Italy
| | - Fabio Savoia
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, AORN "Santobono-Pausilipon Children's Hospital", Naples, Italy
| | - Camilla Calì
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, AORN "Santobono-Pausilipon Children's Hospital", Naples, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Riccardo Lubrano
- Department of Paediatrics, University of Rome "La Sapienza", Rome, Italy
| | - Vincenzo Tipo
- Department of Pediatric, AORN Santobono Pausilipon, Naples, Italy
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18
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Kim SS. Lumbar puncture or not: when does febrile seizure require a neurodiagnostic evaluation? Clin Exp Pediatr 2023; 66:68-69. [PMID: 36510656 PMCID: PMC9899556 DOI: 10.3345/cep.2022.01081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Seung Soo Kim
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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19
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Tanaka T, Yamaguchi H, Ishida Y, Tomioka K, Nishiyama M, Toyoshima D, Maruyama A, Takeda H, Kurosawa H, Tanaka R, Nozu K, Nagase H. Clinical and laboratory characteristics of complex febrile seizures in the acute phase: a case-series study in Japan. BMC Neurol 2023; 23:28. [PMID: 36653748 PMCID: PMC9847116 DOI: 10.1186/s12883-023-03051-7] [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: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with complex febrile seizures (CFS) often display abnormal laboratory results, unexpectedly prolonged seizures, and/or altered consciousness after admission. However, no standardized values have been established for the clinical and laboratory characteristics of CFS in the acute phase, making the management of CFS challenging. This study aimed to determine the clinical and laboratory characteristics of children with CFS during the acute phase. In particular, the duration of impaired consciousness and the detailed distribution of blood test values were focused. METHODS We retrospectively reviewed medical records of a consecutive pediatric cohort aged 6-60 months who were diagnosed with CFS and admitted to Kobe Children's Hospital between October 2002 and March 2017. During the study period, 486 seizure episodes with confirmed CFS were initially reviewed, with 317 seizure episodes included in the analysis. Detailed clinical and laboratory characteristics were summarized. RESULTS Among 317 seizure episodes (296 children with CFS), 302 required two or fewer anticonvulsants to be terminated. In 296 episodes showing convulsive seizures, median seizure duration was 30.5 min. The median time from onset to consciousness recovery was 175 min. Impaired consciousness lasting > 6, 8, and 12 h was observed in 13.9%, 7.6%, and 1.9% patients with CFS, respectively. Additionally, the distribution of aspartate aminotransferase, lactate dehydrogenase, creatinine, and glucose were clarified with 3, 10, 50, 90, and 97 percentile values. CONCLUSION This study detailed the clinical and laboratory findings of acute-phase CFS using the data of the largest 15-year consecutive cohort of children with CFS. These results provide important information for appropriate acute management of CFS.
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Affiliation(s)
- Tsukasa Tanaka
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroshi Yamaguchi
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Yusuke Ishida
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kazumi Tomioka
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Masahiro Nishiyama
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan ,grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Azusa Maruyama
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Hiroki Takeda
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroshi Kurosawa
- grid.415413.60000 0000 9074 6789Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- grid.415413.60000 0000 9074 6789Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kandai Nozu
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroaki Nagase
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
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20
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Practices of pediatric emergency physicians on the first febrile and afebrile seizures: a research in European Pediatric Emergency Medicine Survey Study. Eur J Emerg Med 2022; 29:455-457. [DOI: 10.1097/mej.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chang G, Blackstone M, McGuire JL. Race and the emergency department management of febrile seizures. Medicine (Baltimore) 2022; 101:e31315. [PMID: 36281195 PMCID: PMC9592322 DOI: 10.1097/md.0000000000031315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
To determine if racial disparities exist in the management of febrile seizures in a large pediatric emergency department (ED), We performed a retrospective cross-sectional analysis of children 6 months to 6 years-old who presented to the ED with a febrile seizure over a 4-year period. Multivariate logistic regression models were built to examine the association between race and the primary outcome of neuroimaging, and secondary outcomes of hospital admission and abortive anticonvulsant prescription at ED discharge. There were 980 ED visits during the study period. Overall, 4.0% of children underwent neuroimaging and 11.1% were admitted. Of the 871 children discharged from the ED, 9.4% were prescribed an abortive anticonvulsant. There were no differences by race in neuroimaging or hospital admission. However, black children were less likely to be prescribed abortive anticonvulsants (adjusted odds ratio [aOR] 0.47; 95% confidence interval [CI]: 0.23-0.96) compared to non-black peers, when adjusting for demographic and clinical confounders. Stratification by insurance revealed that this disparity existed in Medicaid-insured patients (aOR 0.33, 95% CI: 0.14-0.78) but not in privately-insured patients. We found no racial disparities in neuroimaging or hospital admission among ED patients with febrile seizures. We did find racial disparities in our secondary outcome of abortive anticonvulsant prescription, driven primarily by individuals on Medicaid insurance. This pattern of findings may reflect the lack of standardized recommendations regarding anticonvulsant prescription, in contrast to the guidelines issued for other ED management decisions. Further investigation into the potential for treatment guidelines to reduce racial disparities is needed.
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Affiliation(s)
- Gina Chang
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- * Correspondence: Gina Chang, Division of Neurology at The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA (e-mail: )
| | - Mercedes Blackstone
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer L McGuire
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Tekin E, Diler Durgut B, Akoğlu HA. Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1746429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractThe coronavirus disease 2019 pandemic has led to significant changes in hospital visits worldwide. The admission rates have remarkably decreased. This study investigates the characteristics of 104 patients (54 girls, 50 boys) who presented to our pediatric emergency department (ED) with seizures during the pandemic between May 2020 and May 2021. Regarding seizure type, 84 generalized and 20 focal seizures had occurred. Tonic, tonic–clonic, clonic, and hypomotor seizures were seen in descending order. Thirty-seven patients were diagnosed with epilepsy, and 32 patients with first afebrile, 25 first febrile, and 10 recurrent febrile seizures. No patients had acute symptomatic seizures. In 85 patients, the seizures had stopped before the ED visit; only one lasted >60 minutes. Benzodiazepines were administered as a first-line drug. Demographical features, electroencephalogram (EEG), and cranial imaging findings, laboratory test results, and distribution by month and by the hour of ED visit were analyzed. Study data was in accordance with the literature by seizure types, seizure management, and cranial imaging rates but differed by distribution in terms of month and the hour of ED visit. The EEG abnormality rate was higher among the first afebrile seizure cases. The number of patients with seizures was 69, that is, 0.3% of emergency admissions, for the 4 months of 2019 before the pandemic, and 104, that is, 0.4% of emergency admissions for the whole initial year of the pandemic thereafter. So, the number of patients with seizures had decreased, but their rate had increased, which could be attributed to a decrease in the number of nonurgent presentations to the ED during the pandemic.
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Affiliation(s)
- Emine Tekin
- Pediatric Neurology Division, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Betül Diler Durgut
- Pediatric Neurology Division, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Handan Ayhan Akoğlu
- Department of Pediatrics, Faculty of Medicine, Giresun University, Giresun, Turkey
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Eilbert W, Chan C. Febrile seizures: A review. J Am Coll Emerg Physicians Open 2022; 3:e12769. [PMID: 36016968 PMCID: PMC9396974 DOI: 10.1002/emp2.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 01/23/2023] Open
Abstract
Febrile seizures are common, occurring in up to 5% of children in the United States. Frequently perceived by caregivers as a life‐threatening event, febrile seizures are a common cause of emergency department visits. The concern for permanent neurologic sequelae and future epilepsy after febrile seizures has resulted in a significant amount of research on these topics. The development of childhood vaccines over the past several decades has led to a significant reduction in childhood bacterial meningitis. This in turn has led to a dramatic change in the evaluation and treatment of febrile seizures. In this review, the different types of febrile seizures as well as the evaluation and prognosis of each are discussed.
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Affiliation(s)
- Wesley Eilbert
- Department of Emergency Medicine College of Medicine University of Illinois at Chicago Chicago Illinois USA
| | - Chuck Chan
- Department of Emergency Medicine College of Medicine University of Illinois at Chicago Chicago Illinois USA
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24
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Risk factors for acute encephalitis and early seizure recurrence in complex febrile seizures. Eur J Pediatr 2022; 181:3103-3110. [PMID: 35713689 DOI: 10.1007/s00431-022-04529-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
The purpose of this study is to elucidate risk factors for central nervous system infection and early seizure recurrence in children with febrile seizures (FSs) and thus facilitate outpatient management of complex FS. This single-center, retrospective cohort study investigated 688 children (6-60 months old) with FSs in Japan during 2011-2021. We investigated the incidence and clinical manifestations of children with acute encephalitis or bacterial meningitis. Logistic regression modeling was used to examine risk factors for seizure recurrence within 24 h. Among children with recurrent FSs, the distribution of intervals between first and second FS was assessed. Among 145 children with complex FSs, 2 patients (1.4%) had acute viral encephalitis and none had bacterial meningitis. Acute encephalitis was found in 2 of 8 patients (25%) with FSs prolonged ≥30 min and 2 of 3 patients (67%) requiring ≥2 intravenous anticonvulsants to stop seizures. Seizure recurrence within 24 h was observed in 16% of participants and was independently associated with preceding use of diazepam and family history of FS. In 82% of patients with FS recurrence within 24 h, early recurrences occurred within 8 h of the first seizure. Conclusion: Patients with prolonged or refractory FSs are still indicated for hospital admission due to the risk of acute encephalitis. FS patients with a family history of FS may be managed safely by 8-h observation or single-dose rectal diazepam as prophylaxis against early recurrent seizure. What is Known: • Hospitalization has been recommended for children with complex febrile seizures due to the increased risk of central nervous infections. • Recent studies showed low incidences of bacterial meningitis (<1%) in children with complex febrile seizures in the presence of routine immunization. What is New: • Acute encephalitis was identified in 1.4% of children with complex febrile seizures, characterized by prolonged seizures ≥30 min and refractory seizures. • Early recurrent seizures may be safely managed by prophylactic diazepam or 8-h expectant observation.
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Rivas-García A, Ferrero-García-Loygorri C, Carrascón González-Pinto L, Mora-Capín AA, Lorente-Romero J, Vázquez-López P. Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department. Neurologia 2022; 37:317-324. [PMID: 31326213 DOI: 10.1016/j.nrl.2019.05.004] [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: 01/09/2019] [Revised: 04/25/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. MATERIAL AND METHODS We performed a retrospective cohort study including patients aged 0-16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. RESULTS We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). CONCLUSIONS The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.
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Henry C, Cockburn C, Simpson MH, Budd S, Wang C, Dinov D. The baseline risk of multiple febrile seizures in the same febrile illness: a meta-analysis. Eur J Pediatr 2022; 181:2201-2213. [PMID: 35292852 PMCID: PMC9468602 DOI: 10.1007/s00431-022-04431-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 02/02/2023]
Abstract
The baseline risk for multiple febrile seizures within the same febrile illness is largely unknown. Estimates range from 5 to 30%. Imprecise estimates can lead to incorrectly powering studies investigating the management of febrile seizures. To estimate the risk of multiple febrile seizures in the same febrile illness, we systematically reviewed and conducted a meta-analysis of studies from January 2000 to December 2021 that contained data for the number of children for both simple and complex febrile seizures in the same febrile illness. We searched MEDLINE, EMBASE, and Web of Science for randomized, quasi-randomized, prospective, and retrospective trials that involved children with febrile seizures. A total of 23,131 febrile illnesses with febrile seizures met the inclusion criteria. The estimated baseline risk of multiple febrile seizures in the same febrile illness was 17% (95% CI, 16-19%). However, the 30 cohorts that included both admitted and non-admitted patients had a lower percentage of multiple FSs within the same illness (14%; 95% CI, 12-15%) than the 30 cohorts that enrolled only admitted patients (20%; 95% CI, 16-25%). CONCLUSION Researchers can use estimates in this paper to design future studies. Taking into the account the substantial heterogeneity between countries and studies, clinicians could cautiously use our estimates in their clinical assessment and be better able to set parental expectations about a child's chances of having another febrile seizure during the current illness. TRIAL REGISTRATION PROSPERO CRD42020191784. Registered July 18, 2020. WHAT IS KNOWN • There is renewed interest in the diagnostic workup and prophylactic treatment of febrile seizures to prevent repeat seizures in the same febrile illness. • There is a lack of accurate estimates of the baseline risk for multiple febrile seizures in the same illness to properly design studies investigating management. WHAT IS NEW • This study provides the most robust estimates for the baseline risk for multiple febrile seizures in the same illness.
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Affiliation(s)
- Christopher Henry
- Department of Neurology, Children's Hospital of Richmond, VCU Health System, Richmond, VA, USA.
| | - Chelsea Cockburn
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Pediatrics, Children's Hospital of Pittsburgh, UPMC, Pittsburgh, PA, USA
| | - Mary Helen Simpson
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Pediatrics, Golisano Children's Hospital, URMC, Rochester, NY, USA
| | - Serenity Budd
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Chen Wang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Darina Dinov
- Department of Neurology, Children's Hospital of Richmond, VCU Health System, Richmond, VA, USA
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Jongruk P, Wiwattanadittakul N, Katanyuwong K, Sanguansermsri C. Risk factors of epilepsy in children with complex febrile seizures: A retrospective cohort study. Pediatr Int 2022; 64:e14926. [PMID: 34273200 DOI: 10.1111/ped.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 06/07/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Febrile seizures are the most common seizures in children. Children with complex febrile seizures have a higher risk of subsequent epilepsy compared with children with simple febrile seizures. Multiple risks factors for epilepsy, including focal status epilepticus, family history of epilepsy, neurodevelopmental abnormalities and abnormal electroencephalogram findings, have been found with inconsistent results. The aim of this study is to identify risk factors for developing epilepsy in children with complex febrile seizures. METHODS The study included 248 children aged 3-72-months, diagnosed with complex febrile seizures at Chiang Mai University Hospital. Demographic data, seizure characteristics, electroencephalogram and neuroimaging findings were identified, and assessed to establish whether they were risk factors for subsequent epilepsy. RESULTS Fifty-five patients (22.1%) had subsequent epilepsy. Using Cox regression-survival analysis, factors associated with epilepsy were prolonged seizures >15 min (P = 0.006; Hazard Ratio (HR): 2.475; 95% Confidence Interval (CI): 1.294-4.735), developmental delay (P = 0.019; HR: 4.476; 95% CI: 2.280-15.646), epileptiform discharges on electroencephalogram (P = 0.023; HR: 1.391; 95%CI: 1.174-1.876), and abnormal neuroimaging (computed tomography or magnetic resonance imaging; P = 0.028; HR: 1.355; 95% CI: 1.034-1.776). Age at onset, peak febrile temperature, duration between the onset of fever and the occurrence of seizure, recurrent seizures within 24 h, focal seizures, abnormal neurological exams and family history of febrile seizure or epilepsy were not associated with increased risk of subsequent epilepsy in this study. CONCLUSIONS Risk factors associated with increased risk of epilepsy in children with complex febrile seizures are prolonged seizures or febrile status epilepticus, developmental delay, electroencephalogram epileptiform discharges, and abnormal neuroimaging. Their presence would merit close clinical monitoring.
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Affiliation(s)
- Piyatida Jongruk
- Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Natrujee Wiwattanadittakul
- Neurology Division, Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Kamornwan Katanyuwong
- Neurology Division, Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Chinnuwat Sanguansermsri
- Neurology Division, Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand
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Tassi L, Specchio N, Mecarelli O, Tinuper P, Vigevano F, Perucca E. The 50th anniversary of the Italian League Against Epilepsy (Lega Italiana Contro l’Epilessia). Epilepsy Behav Rep 2022; 19:100553. [PMID: 35664663 PMCID: PMC9157453 DOI: 10.1016/j.ebr.2022.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
We describe the 50-year history of the Italian League Against Epilepsy (LICE). LICE promotes high-quality epilepsy care, education and research into epilepsy. LICE maintains close relations with ILAE and other professional societies.
This article was prepared to outline the article collection submitted on behalf of Lega Italiana Contro l’Epilepsia, or LICE, for the 50th anniversary of the founding of the ILAE Italian Chapter, and provides a brief summary of the history, with its landmark achievements and challenges. LICE is a multidisciplinary, inclusive, educational, informative and multifaceted organization. Initially in 1955 and then formally in 1972, LICE was born in Milano, with the mission to devote itself to people suffering with epilepsy and by promoting appropriate treatment and care, integration into society, to promote and pursue all kinds of activities designed to achieve those aims. The LICE is currently composed of more than 1000 members including neurologists, pediatric neurologists, neurosurgeons, neurophysiologists, and neuropsychologists who function throughout Italy dealing mainly or exclusively with the diagnosis and treatment of people with epilepsy.
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29
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Dimitrijevic S, Jekic B, Cvjeticanin S, Tucovic A, Filipovic T, Novaković I, Ivić B, Nikolic D. KCC2 rs2297201 Gene Polymorphism Might be a Predictive Genetic Marker of Febrile Seizures. ASN Neuro 2022; 14:17590914221093257. [PMID: 35414199 PMCID: PMC9016559 DOI: 10.1177/17590914221093257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Febrile seizures (FS) are the most common neurological
disease in childhood. The etiology of FS is the subject of numerous studies
including studies regarding genetic predisposition. Aim: The aim of
the study was to analyze the association of TRPV1 rs222747 and
KCC2 rs2297201 gene polymorphisms with the occurrence of
FS. Materials and Methods: The study included 112 patients
diagnosed with FS classified as simple febrile seizures (SFS) or complex febrile
seizures (CFS). We analyzed selected polymorphisms of KCC2 and
TRPV1 genes using the Real-time PCR method.
Results: The CT and TT genotypes of the rs2297201 polymorphism
of the KCC2 gene are significantly more common in the group of
children with FS than the control group (p = .002) as well as
the allele T of this polymorphism (p = .045). Additionally,
genotypes CT and TT of the rs2297201 polymorphism of the KCC2
gene were more frequent in the group of children with CFS compared to the
control group (p < .001). Different genotypes and alleles of
the rs222747 TRPV1 gene polymorphism were not associated with
the occurrence of febrile seizures or epilepsy, nor were associated with the
occurrence of a particular type of febrile seizure (p = .252).
Conclusion: These results indicate that the CT and TT
genotypes, as well as the T allele of rs2297201 polymorphism of the
KCC2 gene, could be a predisposing factor for the FS, as
well as the occurrence of CFS.
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Affiliation(s)
- Sanja Dimitrijevic
- Special Hospital for Cerebral Palsy and Developmental Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Biljana Jekic
- Institute of Human Genetics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Suzana Cvjeticanin
- Institute of Human Genetics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Tamara Filipovic
- Institute for Rehabilitation, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Novaković
- Institute of Human Genetics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bojana Ivić
- University Clinic for Gynecology and Obstetrics “Narodni front”, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dimitrije Nikolic
- University Children’s Hospital Tiršova, School of Medicine, University of Belgrade, Belgrade, Serbia
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Pavone P, Pappalardo XG, Parano E, Falsaperla R, Marino SD, Fink JK, Ruggieri M. Fever-Associated Seizures or Epilepsy: An Overview of Old and Recent Literature Acquisitions. Front Pediatr 2022; 10:858945. [PMID: 35529330 PMCID: PMC9070101 DOI: 10.3389/fped.2022.858945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
In addition to central nervous system infections, seizures and fever may occur together in several neurological disorders. Formerly, based on the clinical features and prognostic evolution, the co-association of seizure and fever included classical febrile seizures (FS) divided into simple, complex, and prolonged FS (also called febrile status epilepticus). Later, this group of disorders has been progressively indicated, with a more inclusive term, as "fever-associated seizures or epilepsy" (FASE) that encompasses: (a) FS divided into simple, complex, and prolonged FS; (b) FS plus; (c) severe myoclonic epilepsy in infancy (Dravet syndrome); (d) genetic epilepsy with FS plus; and (e) febrile infection-related epilepsy syndrome (FIRES). Among the FASE disorders, simple FS, the most common and benign condition, is rarely associated with subsequent epileptic seizures. The correlation of FS with epilepsy and other neurological disorders is highly variable. The pathogenesis of FASE is unclear but immunological and genetic factors play a relevant role and the disorders belonging to the FASE group show to have an underlying common clinical, immunological, and genetic pathway. In this study, we have reviewed and analyzed the clinical data of each of the heterogeneous group of disorders belonging to FASE.
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Affiliation(s)
- Piero Pavone
- Unit of Clinical Pediatrics, AOU "Policlinico", PO "G. Rodolico", University of Catania, Catania, Italy
| | - Xena Giada Pappalardo
- Unit of Catania, National Council of Research, Institute for Research and Biomedical Innovation (IRIB), Catania, Italy.,Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Enrico Parano
- Unit of Catania, National Council of Research, Institute for Research and Biomedical Innovation (IRIB), Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Simona Domenica Marino
- Unit of Pediatrics, Neonatology and Neonatal Intensive Care, and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - John Kane Fink
- Department of Neurology and Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI, United States
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico", PO "G. Rodolico", Catania, Italy
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31
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Chatterjee S, Ghosh R, Dubey S, Ray B. Moyamoya angiopathy masquerading as febrile seizures. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zaniani NR, Roohbakhsh A, Moghimi A, Mehri S. Protective effect of Toll-like receptor 4 antagonist on inflammation, EEG, and memory changes following febrile seizure in Wistar rats. Behav Brain Res 2021; 420:113723. [PMID: 34923024 DOI: 10.1016/j.bbr.2021.113723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/19/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022]
Abstract
Neuroinflammation and fever are the main triggers in febrile seizures (FS). Focusing on inflammatory pathways and anti-inflammatory drugs could compensate for the limitations of existing medications. The aim of this study is to evaluate the neuroprotective effect of specific antagonizing Toll-like receptor 4 (TLR4), as a prominent inflammatory axis, on the consequences of FS and adulthood using animal models. Complex FS was induced on 9-11 day old male rat pups using a heated chamber. TAK-242, as a specific TLR4 inhibitor, was injected intraperitoneally before seizure induction. Seizure threshold, duration, and spike number were measured by electrocorticography. The levels of inflammatory cytokines, TLR4 protein expression, and oxidative stress markers were detected by enzyme-linked immunosorbent assay, western blotting, malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) assessments in the cortex and hippocampus. Also, spatial and non-spatial memory were evaluated using the novel object recognition test (NORT) and double Y-maze test during adulthood. The results revealed that provoked inflammatory responses in neonate rats, after FS, were associated with the increase of the tumor necrosis factor alpha, interleukin-1β, and enhanced TLR4 protein expression. Meanwhile, based on performed behavioral tests, the inflammatory process was also involved in adulthood memory deficit. Pretreatment with TAK-242 reduced the inflammatory cytokines and TLR4 protein expression in the cortex and hippocampus of neonate rats and improvement in memory deficit in NORT and double Y-maze tasks. Also, pretreatment with TAK-242 elevated seizure threshold, SOD, and CAT activities, and decreased seizure duration and MDA level with no significant change in spike number. TAK-242 possibly controlled FS via inhibiting inflammation.
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Affiliation(s)
- Nosaibeh Riahi Zaniani
- Rayan Research Center for Neuroscience & Behavior, Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Iran
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moghimi
- Rayan Research Center for Neuroscience & Behavior, Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Iran.
| | - Soghra Mehri
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Kaushik JS, Sondhi V, Yoganathan S, Dubey R, Sharma S, Vinayan KP, Gupta P, Mittal R. Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures. Indian Pediatr 2021. [DOI: 10.1007/s13312-022-2497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Raghavan VR, Porter JJ, Neuman MI, Lyons TW. Trends in Management of Simple Febrile Seizures at US Children's Hospitals. Pediatrics 2021; 148:peds.2021-051517. [PMID: 34670823 DOI: 10.1542/peds.2021-051517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to measure trends in evaluation and management of children with simple febrile seizures (SFSs) before and after the American Academy of Pediatrics updated guidelines published in 2011. METHODS In this retrospective, cross-sectional analysis, we used the Pediatric Health Information System database comprising 49 tertiary care pediatric hospitals in the United States from 2005 to 2019. We included children aged 6 to 60 months with an emergency department visit for first SFS identified using codes from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases 10th Revision. RESULTS We identified 142 121 children (median age 21 months, 42.4% female) with an emergency department visit for SFS. A total of 49 668 (35.0%) children presented before and 92 453 (65.1%) after the guideline. The rate of lumbar puncture for all ages declined from 11.6% (95% confidence interval [CI], 10.8% to 12.4%) in 2005 to 0.6% (95% CI, 0.5% to 0.8%) in 2019 (P < .001). Similar reductions were noted in rates of head computed tomography (10.6% to 1.6%; P < .001), complete blood cell count (38.8% to 10.9%; P < .001), hospital admission (19.2% to 5.2%; P < .001), and mean costs ($1523 to $601; P < .001). Reductions in all outcomes began before, and continued after, the publication of the American Academy of Pediatrics guideline. There was no significant change in delayed diagnosis of bacterial meningitis (preperiod 2 of 49 668 [0.0040%; 95% CI, 0.00049% to 0.015%], postperiod 3 of 92 453 [0.0032%; 95% CI, 0.00066% to 0.0094%]; P = .99). CONCLUSIONS Diagnostic testing, hospital admission, and costs decreased over the study period, without a concomitant increase in delayed diagnosis of bacterial meningitis. These data suggest most children with SFSs can be safely managed without lumber puncture or other diagnostic testing.
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Affiliation(s)
- Vidya R Raghavan
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John J Porter
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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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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36
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Consensus statements on the information to deliver after a febrile seizure. Eur J Pediatr 2021; 180:2993-2999. [PMID: 33866403 DOI: 10.1007/s00431-021-04067-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
Febrile seizures (FS) are usually self-limiting and cause no morbidity. Nevertheless they represent very traumatic events for families. There is a need to identify key messages that reassure carers and help to prevent inappropriate, anxiety-driven behaviors associated with "fever phobia." No recommendations have been proposed to date regarding the content of such messages. Using a Delphi process, we have established a consensus regarding the information to be shared with families following a FS. Twenty physicians (child neurologists and pediatricians) from five European countries participated in a three-step Delphi process between May 2018 and October 2019. In the first step, each expert was asked to give 10 to 15 free statements about FS. In the second and third steps, statements were scored and selected according to the expert ranking of importance. A list of key messages for families has emerged from this process, which offer reassurance about FS based on epidemiology, underlying mechanisms, and the emergency management of FS should they recur. Interestingly, there was a high level of agreement between child neurologists and general pediatricians.Conclusion: We propose key messages to be communicated with families in the post-FS clinic setting. What is Known: • Febrile seizures (FS) are traumatic events for families. • No guidelines exist on what information to share with parents following a FS. What is New: • A Delphi process involving child neurologists and pediatricians provides consensual statement about information to deliver after a febrile seizure. • We propose key messages to be communicated with families in the post-FS clinic setting.
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Mitchell C, Chatterton Dickson L, Ramsay A, Mesalles-Naranjo O, Leonard P, Brand C, Mclellan A, Shetty J. Epidemiology and outcome of status epilepticus in children: a Scottish population cohort study. Dev Med Child Neurol 2021; 63:1075-1084. [PMID: 33929072 DOI: 10.1111/dmcn.14900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/25/2022]
Abstract
AIM To describe the epidemiology and outcomes of convulsive status epilepticus (CSE) since the introduction of buccal midazolam and the change in International League Against Epilepsy definition of CSE to include seizures of at least 5 minutes. METHOD All children presenting to paediatric emergency departments with CSE (2011-2017) in Lothian, Scotland, were identified. Data, collated from electronic health records, included patient demographics, clinical characteristics, acute seizure management, and adverse outcomes (for example admission to intensive care). RESULTS Six hundred and sixty-five children were admitted with CSE who had 1228 seizure episodes (381 males, 284 females; median age 3y 8mo; age range 0-20y 11mo). CSE accounted for 0.38% (95% confidence interval 0.34-0.42) of annual attendances at emergency departments. Annual prevalence was 0.8 per 1000 children aged 0 to 14 years. Thirty-four per cent of children had recurrent CSE. Sixty-nine per cent of seizures lasted 5 to 29 minutes (median duration 10min). Buccal midazolam was given to 30% of children with CSE and had no effect on need for ventilatory support. Seventy per cent of children with CSE required hospital admission. Four per cent resulted in adverse outcome and there were only two deaths. Recurrent seizures, longer duration, and unprovoked seizures increased the odds of adverse outcome. INTERPRETATION Adverse outcomes have decreased and the use of buccal midazolam is promising. Identifying high-risk groups provides an opportunity for early intervention. These data form the basis for an extensive evaluation of acute seizure management and monitoring long-term outcomes. What this paper adds The annual prevalence of convulsive status epilepticus in Lothian, Scotland, was 0.8 per 1000 children. There was a decrease in case-fatality proportion from 3-9% to 0.2%. Use of buccal midazolam has increased, with no increase in adverse outcomes.
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Affiliation(s)
- Clodagh Mitchell
- University of Edinburgh Medical School, Edinburgh, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Ailidh Ramsay
- University of Edinburgh Medical School, Edinburgh, UK
| | | | - Paul Leonard
- Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
| | - Celia Brand
- Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
| | - Ailsa Mclellan
- Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
| | - Jay Shetty
- University of Edinburgh Medical School, Edinburgh, UK.,Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK
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38
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Capan N. What is the role of electroencephalograms for children with complex febrile seizures? A Cochrane Review summary with commentary. Dev Med Child Neurol 2021; 63:1017-1018. [PMID: 34131907 DOI: 10.1111/dmcn.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nalan Capan
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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39
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Octavius GS, Virliani C, Juliansen A. Assessment of Parental Quality of Life in Febrile Seizures Using Pediatric Quality of Live Inventory Parental Report. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1733954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractFebrile seizure (FS) is the most common convulsive disorder in children with FS prevalence in Indonesia reaching 2 to 4% in 2008. Although this entity has a good prognosis, it often brings panic, fear, and anxiety to the parents. This seemingly benign condition might lead to changes in family structures resulting in adverse effects on the family's daily lives and affect their overall quality of life (QoL). This study evaluates the QoL of parents whose children have FS. A cross-sectional study done in 47 parents whose children had a FS between ages 1 and 4 years from January 2020 to May 2020 and who were evaluated at the Siloam General Hospital, Lippo Village. Parents were asked to fill in Pediatric Quality of Life Questionnaire parent proxy. Data normality was analyzed using the Shapiro–Wilk's test and the significant impact of parents' QoL using the chi-square and independent t-tests. From a total of 47 parents, 30 (63.8%) parents had children with simple FS and 17 (36.2%) parents had children with complex FS. Parents whose children were in the age group of 1 year to 1 year 11 months had the best mean score of 79.64 (12.17) compared with other age groups. In the subset of 3 to 4 years old, the daily activities domain was significantly affected (p-value = 0.3). Parents with a lower educational level had a higher mean score of 76.53 (14.42) than parents who had a higher educational level, with a total mean of 79.88 (11.85), particularly with the highest mean score of 100 in the communication domain. The occurrence of FSs in children affected their parents' QoL in almost all domains in the Pediatric Quality of Life Inventory questionnaire.
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Affiliation(s)
- Gilbert Sterling Octavius
- Department of Pediatrics, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia
| | - Cindy Virliani
- Department of Pediatrics, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia
| | - Andry Juliansen
- Department of Pediatrics, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia
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Dilber B, Reis GP, Kolayli CC, Cansu A. The Role of Neutrophil-to-Lymphocyte Ratio, Red Blood Cell Distribution Width, and Mean Platelet Volume in Predicting Febrile Seizures and Differentiating Febrile Seizure Types. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1733904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), platelet count (PLT), and mean platelet volume (MPV)/platelet ratio (MPR) are commonly known inflammatory markers measured by a routine peripheral blood test that have been studied in patients with febrile seizures (FS) and may be useful for the classification of FS types. The aim of this study was to investigate the relationship between FS and inflammatory markers including MPR, RDW, and NLR and also to determine the diagnostic ability of these parameters to identify FS by comparing patients with and without FS, and by comparing patients with FS to their FS types (simple febrile seizure or complex febrile seizure [SFS or CFS]). The study included a total of 537 children aged 6 to 60 months who presented to the emergency service with FS. The FS group was divided into two subgroups based on the type of seizure, SFS, and CFS. MPR, NLR, and RDW predicted a 1.7 (odds ratio [OR], 95% confidence interval [CI]: 1.19–2.45), 1.94 (OR, 95% CI: 1.35–2.79), and 1.8 (OR, 95% CI: 1.25–2.59) times higher risk of FS, respectively. NLR and RDW predicted a 2.64 (OR, 95% CI: 1.17–4.85) and 2.34 (OR, 95% CI: 1.14–4.44) times higher risk of recurrent SFS, respectively. In patients with CFS, NLR ≥ 1.806 had a 3.64 times (OR, 95% CI: 1.83–7.21) and RDW ≥14.55 had a 3.34 times (OR, 95% CI: 1.67–6.65) higher risk of recurrent FS. The results indicated that MPV, NLR, and RDW differentiated not only SFS from CFS but also FS from fever without seizure. The increase in RDW and NLR values and their diagnostic values in patients with recurrent FS and the diagnostic value of these parameters in predicting CFS suggest that NLR and RDW could be effective, practical, and discriminative predictors of FS.
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Affiliation(s)
- Beril Dilber
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Gökçe P. Reis
- Department of Pediatric Hematology-Oncology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
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Kubota J, Higurashi N, Hirano D, Okabe S, Yamauchi K, Kimura R, Numata H, Suzuki T, Kakegawa D, Ito A, Hamano SI. Body temperature predicts recurrent febrile seizures in the same febrile illness. Brain Dev 2021; 43:768-774. [PMID: 33775463 DOI: 10.1016/j.braindev.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of recurrent febrile seizures during the same febrile illness (RFS) is 14-24%. A pilot study found that body temperature and male sex were predictors of RFS. This study sought to validate body temperature as a predictor of RFS, calculate the optimal cut-off body temperature for predicting RFS, and identify the other predictors of RFS. METHODS This prospective cohort study enrolled children with febrile seizures aged 6-60 months who visited the emergency department at Atsugi City Hospital, Japan, between March 1, 2019, and February 29, 2020. Children who had multiple seizures, diazepam administration before the emergency department visit, seizures lasting >15 min, underlying diseases, or who could not be followed up were excluded. The optimal cut-off body temperature was determined using a receiver-operating characteristic curve. RESULTS A total of 109 children were enrolled, of whom 13 (11.9%) had RFS. A lower body temperature was significantly associated with RFS (P = 0.02). The optimal cut-off body temperature for predicting RFS was 39.2 °C. Children with RFS also had significantly lower C-reactive protein and blood glucose levels (P = 0.01 and 0.047, respectively), but none of the other factors considered were significantly associated with RFS. CONCLUSIONS This large prospective study confirmed that body temperature is a predictor of RFS. The optimal cut-off body temperature for predicting RFS was 39.2 °C. Low C-reactive protein level and blood glucose level might be predictors of RFS, but this needs to be confirmed in prospective multicenter studies.
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Affiliation(s)
- Jun Kubota
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
| | - Norimichi Higurashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shiro Okabe
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Kento Yamauchi
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Rena Kimura
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruka Numata
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Kakegawa
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Ito
- Department of Pediatrics, Atsugi City Hospital, Kanagawa, Japan; Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
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Esen FH, Secilmis Y, Dogan M, Tubas F, Esen A, Bayram A, Gökahmetoglu S, Ozturk MA. Influenza A as a Common Viral Cause of Complex Febrile Seizures. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1731408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Objective The most common childhood convulsive disorder happens to be febrile seizure (FS), which is an important health problem leading to economic burden and parental anxiety. Further investigation into the etiological causes of FS will guide us for appropriate measures during the follow-up period. The aim of study was to identify the percentage of viral and bacterial pathogens in the etiological causes of children with FS, and also if there is any difference between simple and complex FSs.
Methods This prospective study randomly enrolled 100 pediatric patients with FS between January 2017 and July 2017. Nasopharyngeal swabs were obtained from all children at presentation. The respiratory panel was performed with a multiplex real-time polymerase chain reaction method to detect the 21 most common viruses. A complete blood count, absolute neutrophil count, absolute lymphocyte count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, blood culture, throat culture, urine analyses, urinary culture, and stool tests analysis were performed in all the patients.
Results During the study period, at least one virus was detected in 87% of patients. Bacterial agents were detected in only 13% of patients. Coinfections of the viruses and bacterial pathogens were found in 24% of patients. The most frequently detected virus was influenza A (Inf A) (18%), followed by rhinovirus (12%). Coinfections of the viruses and bacterial pathogens, mixed viral infections, and Inf A were common in children who experienced complex FS. Inf A was detected in 16% of patients with simple FSs and 30% of patients with complex FSs and a significant difference between them (p < 0.01).
Conclusion The results of this study showed that respiratory viral and bacterial pathogens are important in the etiology of FS in children. It is considered that complex FSs may be triggered by Inf A. The fact is viral pathogens are very common; therefore, antibiotics must be carefully prescribed. These results also draw attention to the use of the quadrivalent influenza vaccine in the prevention of FS related to the flu.
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Affiliation(s)
| | - Yılmaz Secilmis
- Department of Pediatric Emergency, Erciyes University, Kayseri, Turkey
| | - Murat Dogan
- Department of Pediatric Emergency, City Hospital, Kayseri, Turkey
| | - Filiz Tubas
- Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Aydın Esen
- Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Ayse Bayram
- Department of Pediatric Neurology, Kayseri City Hospital, Kayseri, Turkey
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Hypocalcemia as a Cause of Complex Febrile Seizures in a Toddler. Case Rep Pediatr 2021; 2021:1798741. [PMID: 34336337 PMCID: PMC8294952 DOI: 10.1155/2021/1798741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
A 13-month-old boy had suffered three episodes of complex febrile seizures. At this admission, there were signs of hyperexcitability, such as Trousseau sign and QTc prolongation. A point of care blood gas analysis revealed severe hypocalcemia. Therefore, prior to administering intravenous calcium gluconate, we took blood samples to investigate the etiology of this hypocalcemia: magnesium, parathormone, and 25-hydroxyvitamin D. Since both parathormone and phosphate were significantly elevated and 25-hydroxyvitamin D was within the normal range, pseudohypoparathyroidism was diagnosed. After two years of follow-up, serum calcium had normalized in our patient under supplementation of vitamin D and calcium. He had been free of convulsions, although different febrile episodes had occurred.
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Kannikeswaran N, Sivaswamy L, Farooqi A, Sethuraman U. Children With Complex Febrile Seizures: Is Hospital Admission Necessary? Clin Pediatr (Phila) 2021; 60:363-369. [PMID: 34014115 DOI: 10.1177/00099228211017702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with complex febrile seizure (CFS) are often hospitalized for concerns for serious bacterial infection (SBI) or seizure recurrence. We describe the yield of diagnostic studies and seizure recurrence during hospitalization in CFS children. We performed a retrospective review of 372 visits in 350 developmentally normal children aged 6 to 60 months between 2011 and 2016 for CFS. Majority of patients were male (200; 57.1%), with a mean age of 19.8 ± 11.3 months. Active seizures were noted in 42 (11.3%), status epilepticus in 35 (9.4%) while 97 (26.1%) had a seizure in the pediatric emergency department. The distribution of SBI was as follows: bacteremia (3; 1.1%), urinary tract infection (7; 3.7%), pneumonia (15; 6.8%), and bacterial meningitis (0; 0%). Electroencephalography (EEG) abnormality was rare (7/158; 4.4%). Seizure recurrence during hospitalization was uncommon (19; 5.1%). Logistic regression analysis did not reveal any predictors for seizure recurrence. The seizure recurrence rate during hospitalization, EEG yield, and SBI incidence was low in children with CFS.
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Affiliation(s)
- Nirupama Kannikeswaran
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Usha Sethuraman
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
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45
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Octavius GS, Handoko TGH, Budiputri CL, Muljono MP, Juliansen A. Factors Predicting the Recurrence of Febrile Seizure in Siloam General Hospital: A Descriptive Analysis. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1731037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractFebrile seizure (FS) is one of the most common pediatric neurologic disorders, affecting 2 to 5% of children between 6 months and 5 years. In 2008 to 2010, almost half of children with FS in Indonesia experienced recurrences. Various factors have been related to potential predictors for FS recurrence. However, available data reported inconsistent results. Considering its high recurrence rate, this study aimed to determine and assess the factors predicting the recurrence of FS. A cross-sectional study was done in Siloam General Hospital, Lippo Village. The study period was from December 2018 to December 2019, and data were obtained through medical records. Out of 60 participants, 41.7% had recurrent FS. No administration of rectal diazepam before admission (odds ratio [OR] = 6.42; 95% confidence interval [CI]: 1.20–34.2, p = 0.027) was a predictive factor of recurrent FS, while female sex (OR = 0.23; 95% CI: 0.64–0.80, p = 0.025) and shorter duration of the first FS (OR = 0.21; 95% CI 0.06–0.69, p = 0.008) were protective factors of recurrent FS. Identification of factors predicting the recurrence of FS is a powerful tool for clinicians. This study showed that no administration of rectal diazepam before admission was correlated with the risk of FS recurrence, while shorter duration of FS and female sex were protective factors of recurrent FS.
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Affiliation(s)
- Gilbert S. Octavius
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Tan G. H. Handoko
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Charista L. Budiputri
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Michelle P. Muljono
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Andry Juliansen
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
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Rivas-García A, Ferrero-García-Loygorri C, Carrascón González-Pinto L, Mora-Capín A, Lorente-Romero J, Vázquez-López P. Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:317-324. [DOI: 10.1016/j.nrleng.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/20/2019] [Indexed: 10/21/2022] Open
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47
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Jain S, Santhosh A. Febrile Seizures: Evidence for Evolution of an Operational Strategy from an Armed Forces Referral Hospital. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:151-159. [PMID: 33790685 PMCID: PMC8007563 DOI: 10.2147/phmt.s294729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022]
Abstract
Purpose Current recommendations for 'Febrile seizures' management include emergency first aid and treatment along with intermittent prophylaxis. Evidence of practices, efficacy, side-effects, and complications should lead to refined and rational management strategies. Patients and Methods Study of cases referred and treated at a tertiary level hospital, providing referral services to a large state in India. Evidence sought for the research questions identified, these were (i) immediate treatment: First aid components and practices; response to drug treatment (ii) intermittent prophylaxis: effectiveness, compliance, and side-effects (iii) complications arising due to treatment side-effects: quantifying the number of cases of CNS infections missed as a result of alterations in consciousness levels due to benzodiazepines. Results A total of 85 febrile seizure cases were studied. Full correct "First Aid" was provided by only 13 parents. Total 35 cases (41.18%) had seizures lasting more than 05 minutes. Emergency treatment for these included rectal diazepam in 14 cases with 57.14% success in terminating seizure, and intranasal midazolam in 21 cases with 71.43% success. The cases with persisting seizures were managed as status epilepticus treatment algorithm. Intermittent prophylaxis prevented recurrence of seizures in 90%, however side-effects were reported in 36.36%. There was no case of CNS infection missed. Conclusion Safe and effective management strategy should include "Health education" for correct first aid and 'Protocols' for timely and correct emergency treatment by parents/pre-hospital teams/emergency duty doctors. Intermittent prophylaxis is effective but refinements needed to minimize side-effects. Vigilant clinical monitoring obviates the fear that treatment may mask CNS infection.
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Affiliation(s)
- Sunil Jain
- Department of Paediatrics, Command Hospital (Northern Command), Jammu & Kashmir, India
| | - Abhijith Santhosh
- Medical Officer, Emergency Department, Command Hospital (Northern Command), Jammu & Kashmir, India
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Müller RM, Herziger B, Jeschke S, Neininger MP, Bertsche T, Bertsche A. Knowledge of epilepsy among German pharmacists. Epilepsy Res 2021; 172:106587. [PMID: 33647738 DOI: 10.1016/j.eplepsyres.2021.106587] [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: 07/26/2020] [Revised: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PROBLEM Pharmacists can have a large impact on attitude, acceptance and adherence in patients with long-term conditions. They should be able to give appropriate advice. METHODS We invited pharmacists in Mecklenburg-Vorpommern and Saxony, Germany, to complete a questionnaire mainly containing multiple-choice-questions. RESULTS Overall, 238 pharmacists took part in the survey. 199 (84%) said they were insecure counselling people with epilepsy or had no experience at all. 205 (86%) rightly assumed a seizure can result in death. Concerning an acute seizure, administration of a rescue medication was considered as possible useful measure by 127 (53%) participants. Of the participants, 206 (87%) stated a physician should be consulted for every first afebrile seizure, 188 (79%) for every first febrile seizure. Exanthema as especially clinically relevant adverse drug event was rightly chosen for carbamazepine by 18 (8%) and for lamotrigine by 12 (5%) participants. 60 (25%) rightly chose liver toxicity for valproate. The increase of carbamazepine plasma concentration when adding erythromycin was chosen by 66 (28%) of pharmacists. 13 (5%) knew about the reduction of effectiveness of lamotrigine when adding hormonal contraceptives. For valproate, 201 (84%) stated that it is important to counsel patients concerning contraception. CONCLUSION Pharmacists are insecure counselling people with epilepsy. Some of them would not suggest to seek medical advice for every first seizure. This can lead to reduced patient safety. The adverse drug events of valproate are well known, important adverse drug events and interactions of other anticonvulsants are less present to the pharmacists and should be regularly addressed in training courses.
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Affiliation(s)
- R M Müller
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany.
| | - B Herziger
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany.
| | - S Jeschke
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany.
| | - M P Neininger
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany.
| | - T Bertsche
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany.
| | - A Bertsche
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany.
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Hautala M, Arvila J, Pokka T, Mikkonen K, Koskela U, Helander H, Glumoff V, Rantala H, Tapiainen T. Respiratory viruses and febrile response in children with febrile seizures: A cohort study and embedded case-control study. Seizure 2020; 84:69-77. [PMID: 33285363 DOI: 10.1016/j.seizure.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE There are limited data on the pathogen-related and host-related factors in the pathogenesis of febrile seizures (FS). We designed a controlled study to compare the role of different respiratory viruses and febrile response in FS. METHODS In a prospective cohort study of 1899 pediatric emergency room patients aged 6 months-6 years with a positive respiratory virus multiplex PCR, we identified 225 patients with FSs. We first compared the distribution of respiratory viruses in age-stratified patients with FSs with that in other patients. In an embedded case-control study, we compared the febrile response in patients with FSs with that in the controls matched for age, season and the same respiratory virus. RESULTS The relative risk for FS was the highest for coronavirus OC43, 229E, and NL63 infections [RR: 3.2, 95 % confidence interval (CI): 1.4-7.2) and influenza A and B [RR: 2.5, 95 % CI: 1.4-4.7] as compared to those with other respiratory viral infections. The patients with FSs had a stronger febrile response of 39.2 °C (difference: 0.8 °C, 95 % CI: 0.5-1.2) later during hospitalization after acute care than the controls matched for the same respiratory virus. CONCLUSIONS Influenza and coronaviruses caused relatively more FS-related emergency room visits than other respiratory viruses. Furthermore, the febrile response was stronger in the patients with FSs than in the controls matched for the same respiratory virus. The results suggest that the pathomechanism of FSs includes modifiable pathogen-related and host-related factors with possible potential in the prevention of FSs.
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MESH Headings
- Adenovirus Infections, Human/epidemiology
- Adenovirus Infections, Human/virology
- Case-Control Studies
- Child
- Child, Preschool
- Cohort Studies
- Coronavirus 229E, Human
- Coronavirus Infections/epidemiology
- Coronavirus Infections/virology
- Coronavirus NL63, Human
- Coronavirus OC43, Human
- Emergency Service, Hospital
- Enterovirus Infections/epidemiology
- Enterovirus Infections/virology
- Female
- Fever/physiopathology
- Finland/epidemiology
- Humans
- Infant
- Inflammation
- Influenza A virus
- Influenza B virus
- Influenza, Human/epidemiology
- Influenza, Human/virology
- Male
- Multiplex Polymerase Chain Reaction
- Paramyxoviridae Infections/epidemiology
- Paramyxoviridae Infections/virology
- Picornaviridae Infections/epidemiology
- Picornaviridae Infections/virology
- Prospective Studies
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Virus Infections/virology
- Respiratory Tract Infections/epidemiology
- Respiratory Tract Infections/physiopathology
- Respiratory Tract Infections/virology
- Rhinovirus
- Risk
- Seizures, Febrile/epidemiology
- Seizures, Febrile/virology
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Affiliation(s)
- Maria Hautala
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland.
| | - Jukka Arvila
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Kirsi Mikkonen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Epilepsia Helsinki, Division of Child neurology, Children's Hospital, and Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ulla Koskela
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Heli Helander
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Virpi Glumoff
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland
| | - Heikki Rantala
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Terhi Tapiainen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Biocenter Oulu, University of Oulu, Finland
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Abstract
BACKGROUND The terminology and classification of seizures and epilepsy has undergone multiple revisions in the last several decades, which can lead to confusion and miscommunication amongst physicians and researchers. In 2017, the International League Against Epilepsy (ILAE) revised the classification of both seizures and epilepsy types in an effort to use less ambiguous terminology. Over time, definitions for status epilepticus, febrile seizures, and neonatal seizures have also evolved, as has the delineation of various epilepsy syndromes by age. METHODS Review of the literature for old and new terminology and various epilepsy syndromes was accomplished using the PubMed database system. RESULTS In the following article, we review old terminology for classifying seizures and epilepsy as compared to the new (2017) ILAE guidelines. We discuss neonatal seizures, status epilepticus, febrile seizures, autoimmune epilepsy and various epilepsy syndromes by age of onset. CONCLUSION Adopting a classification system that uses plain language allows for more effective and efficient communication between individuals and across specialties. Definitions of various syndromes and seizure types have evolved over time and are reviewed.
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Affiliation(s)
- Shelley Varnado
- Department of Neurology, NYU Langone Health, 223 East 34th Street, New York, NY 10016, United States
| | - Dana Price
- Department of Neurology, NYU Langone Health, 223 East 34th Street, New York, NY 10016, United States.
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