Comparison of serum zinc levels measured by inductively coupled plasma mass spectrometry in preschool children with febrile and afebrile seizures

The long-term neurodevelopmental outcomes of febrile seizures and underlying mechanisms

Febrile seizures (FSs) are convulsions caused by a sudden increase in body temperature during a fever. FSs are one of the commonest presentations in young children, occurring in up to 4% of children between the ages of about 6 months and 5 years old. FSs not only endanger children's health, cause panic and anxiety to families, but also have many adverse consequences. Both clinical and animal studies show that FSs have detrimental effects on neurodevelopment, that cause attention deficit hyperactivity disorder (ADHD), increased susceptibility to epilepsy, hippocampal sclerosis and cognitive decline during adulthood. However, the mechanisms of FSs in developmental abnormalities and disease occurrence during adulthood have not been determined. This article provides an overview of the association of FSs with neurodevelopmental outcomes, outlining both the underlying mechanisms and the possible appropriate clinical biomarkers, from histological changes to cellular molecular mechanisms. The hippocampus is the brain region most significantly altered after FSs, but the motor cortex and subcortical white matter may also be involved in the development disorders induced by FSs. The occurrence of multiple diseases after FSs may share common mechanisms, and the long-term role of inflammation and γ-aminobutyric acid (GABA) system are currently well studied.

The position of geochemical variables as causal co-factors of diseases of unknown aetiology

Abstract

The term diseases of unknown aetiology (DUA) or idiopathic diseases is used to describe diseases that are of uncertain or unknown cause or origin. Among plausible geoenvironmental co-factors in causation of DUA, this article focusses on the entry of trace elements, including metals and metalloids into humans, and their involvement in humoral and cellular immune responses, representing potentially toxic agents with implications as co-factors for certain DUA. Several trace elements/metals/metalloids (micronutrients) play vital roles as co-factors for essential enzymes and antioxidant molecules, thus, conferring protection against disease. However, inborn errors of trace element/metal/metalloid metabolisms can occur to produce toxicity, such as when there are basic defects in the element transport mechanism. Ultimately, it is the amount of trace element, metal or metalloid that is taken up, its mode of accumulation in human tissues, and related geomedical attributes such as the chemical form and bioavailability that decisively determine whether the exerted effects are toxic or beneficial. Several case descriptions of DUA that are common worldwide are given to illustrate our knowledge so far of how trace element/metal/metalloid interactions in the immune system may engender its dysregulation and be implicated as causal co-factors of DUA.

Article highlights

The importance of a proper understanding of geochemical perturbations in human metabolisms is emphasisedIt is proferred that such an understanding would aid greatly in the decipherment of diseases of unknown aetiology (DUA)The thesis presented may pave the way towards better diagnosis and therapy of DUA.

A Comparison Between Serum Selenium Level in Febrile Children with or Without Seizure

The role of trace elements in febrile seizure (FS) was considered recently. The present study was performed evaluating the serum level of selenium in febrile children aged 6-60 months with and without seizure. A cross-sectional study was performed in Mashhad University of Medical Sciences, Mashhad, Iran. Sixty patients aged 6-60 months including 30 children with FS and 30 febrile children without seizure were included. Blood sample was taken, and the serum level of selenium was measured. Data was analyzed using SPSS software. Sixteen patients in FS group (53.3%) and 10 patients in febrile group (33.3%) were males with an average age of 25.21 ± 15.91 and 26.47 ± 17.61 months, respectively. There was no significant difference between groups in age and sex (p = 0.77 and p = 0.19, respectively). The serum level of selenium was 87.34 ± 8.23 and 89.63 ± 9.83 µg/L in FS and febrile groups, respectively. Difference was not significant (p = 0.33). In children aged less than 1 year, the serum level of selenium in FS and febrile group was 83.32 ± 6.2 µg/L and 82.55 ± 8.32 µg/L, respectively. Difference was not significant (p = 0.87). In children aged more than 1 year, the serum level of selenium in FS significantly was lower compared to febrile group (87.96 ± 8.42 µg/L and 93.17 ± 8.66 µg/L, respectively, p = 0.04). The serum level of selenium was lower in children aged more than 1 year with febrile seizure compared to febrile ones.

Zinc Status and Febrile Seizures: Results from a Cross-sectional Study

Objective  To estimate the serum zinc levels in children under the age of 5 years with febrile seizures and febrile children without seizures Materials and Methods  In this cross-sectional study from 2017 to 2018, 40 children with febrile seizures (simple and complex) were taken as cases. Forty age- and sex-matched febrile children without convulsions were recruited as controls. Serum zinc estimates were analyzed using a spectrophotometer (Biolis 50i-Autoanalyzer). Statistical Analysis  The demographic variables and serum zinc estimates were analyzed using the Mann-Whitney test. The odds ratio was used to calculate the association of zinc deficiency in febrile seizures; 5% level of significance was considered. Results  The mean serum concentrations of zinc in the cases and controls were 83.8 ± 33.1 μg/dL and 116.3 ± 30.3 μg/dL, respectively ( p = 0.002). Hypozincemia defined by "a serum zinc level of less than 63 μg/dL" was found in 12 (30%) cases and 2(5%) controls with an odds ratio of 8:1. Conclusion  Children with febrile seizures had significantly reduced concentrations of zinc in the serum.

Serum Zinc Level in Children with Febrile Seizure

OBJECTIVES

Febrile seizure (FS) is the most common type of seizure in children. FS is a genetic age-limited seizure, which only occurs with febrile illness. Today, it is known that genetic factors play a major role in the occurrence of FS. Nevertheless, some trace elements, such as zinc, may play an important role in the occurrence of FS. In this study, we investigated the serum level of zinc in patients with FS and febrile children without seizure (control group).

MATERIALS &METHODS

This prospective case-control study was conducted on 41 patients with simple and complex FS as the case group and 41 febrile children without seizure as the age- and sex-matched control group. The participants were admitted to Best Hospital of Hamadan, Iran between January 2013 and January 2014 . The children's age ranged from six months to five years. Serum zinc levels were measured by atomic absorption spectroscopy in these groups.

RESULTS

The mean serum zinc levels were 70.41±20.46 and 92.73±17.62 mcg/dL in the case and control groups, respectively (P=0.001). The results showed that the serum zinc level in children with FS was significantly lower than that of the control group.

CONCLUSION

Based on the present results, serum zinc level was lower in children with febrile seizure. However, further basic research is needed to examine the efficacy of zinc supplements in the prevention of FS.

Synaptic Zn2+ and febrile seizure susceptibility

Zn²⁺ , the second most prevalent trace element in the body, is essential for supporting a wide range of biological functions. While the majority of Zn²⁺ in the brain is protein-bound, a significant proportion of free Zn²⁺ is found co-localized with glutamate in synaptic vesicles and is released in an activity-dependent manner. Clinical studies have shown Zn²⁺ levels are significantly lower in blood and cerebrospinal fluid of children that suffer febrile seizures. Likewise, investigations in multiple animal models demonstrate that low levels of brain Zn²⁺ increase seizure susceptibility. Recent work provides human genetic evidence that disruption of brain Zn²⁺ homeostasis at the level of the synapse is associated with increased seizure susceptibility. In this review, we have explored the clinical, functional and genetic data supporting the view that low synaptic Zn²⁺ increases cellular excitability and febrile seizure susceptibility. Finally, the review focuses on the potential of therapeutic Zn²⁺ supplementation for at risk patients.

SerumTrace Elements in Febrile Seizure: A Case-Control Study

OBJECTIVE

Febrile seizure (FS) is one of the most common neurological problems during childhood.Pathogenesis of febrile convulsion is unknown. This study investigated some trace elements among children admitted with FS compared with thoseof febrile without seizure attacks.

MATERIALS & METHODS

This case-control study was conducted on48 children (6 months to 5 yrold) diagnosed with febrile seizure as the cases and 48 age-matched febrile children as the control group. Serum levels of magnesium, calcium, sodium, potassium, and serum zinc were measured. Statistical analysis was performed with SPSS (version 15) using Student t-test.

RESULTS

There were no significant differences between the cases and controls in terms of gender or age. The means of serum level of zinc, sodium, calcium and magnesium in the case group was lower than those of the control group. There was no significant difference onserum potassium mean level between the case and control groups.

CONCLUSION

Deficiency of trace elements was correlated significantly with febrile convulsion, while further investigations on trace elements are required.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Comparison of Serum Zinc Levels among Children with Simple Febrile Seizure and Control Group: A Systematic Review

OBJECTIVE

Several factors are involved in the etiology of febrile seizure (FS), among them is zinc (Zn), which has been discussed in various studies. The present systematic review compares Zn levels in children with FS and a control group.

MATERIALS & METHODS

We searched keywords of febrile seizure, febrile convulsion, children, childhood, fever, trace elements, risk factor, predisposing, zinc, Zn, and epilepsy in the following databases: SCOPUS, PubMed, and Google Scholar. The quality of research papers was assessed using a checklist. Data was extracted from primary studies based on demographic variables and amounts of Zn in case and control groups.

RESULTS

Twenty primary studies were entered in the present study. Of which, eighteen studies, reported that Zn serum levels were significantly lower in the case group (patients with FS) than the control group.

CONCLUSION

The present systematic review indicated that Zn is one factor for predicting FS. A low level of this element among children can be regarded as a contributing factor for FS, a conclusion with a high consensus among different studies carried out in different parts of the world.

Association between Iron Deficiency Anemia and Febrile Convulsion in 3- to 60-Month-Old Children: A Systematic Review and Meta-Analysis

Controversy exists regarding the association between Iron Deficiency Anemia (IDA), iron status, and Febrile Convulsion (FC) during childhood. In this article, a systematic review and meta-analysis is conducted in order to determine possible association and the degree of association between these statuses and FC. To identify all studies related to IDA and FC, various references such as MEDLINE (PubMed), Embase (OVID), Web of sciences (Thomson Reuters) and Google scholar were searched (up until 15 January 2013). Heterogeneity was assessed using the Q statistic, Tau(2), and I(2). Additionally, subgroup analyses were performed. The outcome of primary interest was the overall Odds Ratio (OR) of FC for IDA and standard mean differences (SMD) of ferritin level. In total, 21 articles were considered to assess the association between IDA and FC. Anemia was more prevalent among the FC patients compared with the controls and the overall OR was 1.52 (95% CI=1.03 to 2.25). In addition, the pooled OR for 17 studies performed in the populations with low and moderate prevalence of anemia was 2.04 (95% CI=1.46 to 2.85). Furthermore, 12 studies assessed the association between the ferritin level and FC. The overall SMD was -0.02 with a 95% CI of -0.09 to 0.06. Besides, the pooled SMD of ferritin was -0.57 (95% CI=-0.7 to -0.46) in 6 studies reporting no difference between the FC and the control group with respect to temperature. IDA was associated with a moderate increased risk of FC in children, particularly in the areas with low and moderate prevalence of anemia.

Is serum zinc associated with pancreatic beta cell function and insulin sensitivity in pre-diabetic and normal individuals? Findings from the Hunter Community Study

Aim

To determine if there is a difference in serum zinc concentration between normoglycaemic, pre-diabetic and type-2 diabetic groups and if this is associated with pancreatic beta cell function and insulin sensitivity in the former 2 groups.

Method

Cross sectional study of a random sample of older community-dwelling men and women in Newcastle, New South Wales, Australia. Beta cell function, insulin sensitivity and insulin resistance were calculated for normoglycaemic and prediabetes participants using the Homeostasis Model Assessment (HOMA-2) calculator.

Result

A total of 452 participants were recruited for this study. Approximately 33% (N = 149) had diabetes, 33% (N = 151) had prediabetes and 34% (N = 152) were normoglycaemic. Homeostasis Model Assessment (HOMA) parameters were found to be significantly different between normoglycaemic and prediabetes groups (p<0.001). In adjusted linear regression, higher serum zinc concentration was associated with increased insulin sensitivity (p = 0.01) in the prediabetic group. There was also a significant association between smoking and worse insulin sensitivity.

Conclusion

Higher serum zinc concentration is associated with increased insulin sensitivity. Longitudinal studies are required to determine if low serum zinc concentration plays a role in progression from pre-diabetes to diabetes.

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

BACKGROUND AND AIM

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Serum Zinc Level in Children Presenting with Febrile Seizures

OBJECTIVE

To determine the frequency of low serum zinc level in children presenting with febrile seizures at The Children's Hospital and the Institute of Child Health (CH/ICH) Multan.

METHODS

This is an observational cross sectional study conducted at the Department of Pediatric Medicine, The Children's Hospital and the Institute of Child Health, Multan from September 2010 to March 2011. Children (6 months to 6 years of age) presenting with febrile seizures who satisfied inclusion and exclusion criteria were enrolled for the study. Cause of fever was determined after detailed history, physical examination and relevant investigations. Four milliliters centrifuged blood sample was preserved in acid washed test tube. Separated serum was used to measure serum zinc level by employing Randox kit on auto-analyzer in all cases. The outcome variable (serum zinc level) was recorded on a predesigned proforma.

RESULTS

Out of 100 enrolled children, there were 66 (66%) male with male to female ratio of 1:0.52. Mean age of the children was 23.97±14.45 months. Upper respiratory tract infection was the most frequent cause of fever apparent in 24 children (24%) followed by tonsillitis 17 (17%), pneumonia 16 (16%), urinary tract infection 16 (16%), otitis media 15 (15%), and bronchiolitis 12 (12%). Frequency of low serum zinc level was 26% in children with febrile seizures.

CONCLUSION

Zinc deficiency could be a potential risk factor for febrile seizure in children.

Zinc status in febrile seizure: a case-control study

OBJECTIVE

Febrile seizure is the most common type of seizure in children. Their incidence is 2-5%. There are different hypotheses about relationship between neurotransmitters and trace elements (such as zinc) and febrile seizure. Zinc, as a major element of some enzymes, plays an important role in the central nervous system (CNS) and can affect some inhibitory mechanisms of CNS. The aim of the present study was to determine whether there were any changes in serum zinc level in children with febrile seizure in comparison with febrile children without seizure.

MATERIALS & METHODS

This case-control study was performed on 100 patients aged 6 months to 6 years. This study was conducted between January and August 2012, on 50 children with febrile seizures (case) and 50 febrile children without seizures (control), that were referred to Amirkola Children Hospital (a referral hospital in the north of Iran). Two groups were matched for age and sex. The serum zinc levels in the both groups were determined by atomic absorption spectrophotometry method.

RESULTS

The mean serum zinc level was 0.585±0.166 mg/L and 0.704±0.179 mg/L in the case group and the control group, respectively (p=0.001). The mean serum zinc level was significantly lower in the febrile seizure group compared to the control groups.

CONCLUSION

Our findings revealed that serum zinc level was significantly lower in children with simple febrile seizure in comparison with febrile children without seizure. It can emphasize the hypothesis that there is a relation between serum zinc level and febrile seizure in children.