Update on benign convulsions with mild gastroenteritis

Febrile seizures and convulsions with mild gastroenteritis: age-dependent acute symptomatic seizures

Background

Febrile seizures (FS) and benign convulsions in children with mild gastroenteritis (CwG) are acute symptomatic seizures, transiently occurring in infants and young children, probably related to the immaturity of the brain. Our paper aims to review the literature data on patients with FS and CwG.

Methods

A review of series of patients with FS and CwG was performed by literature search on PubMed January 1960 to October 2022. Several parameters were considered, including epidemiology, pathophysiology, clinical features, electroencephalographic findings and other diagnostic studies, and treatment.

Results

FS and CwG share an age-dependent course, but they show significant differences in the pathophysiology, clinical features, diagnostic studies, and treatment.

Conclusion

Acute symptomatic seizures include seizures that are caused by acute structural brain pathologies, such as stroke, as well as seizures that are provoked by a reversible factor, such as hyponatraemia, although the two groups should be not equated. Furthermore, FS and CwG should be set apart as "age-dependent acute symptomatic seizures", reinforcing the concept of their self-limited course over a certain period.

The retrospective data analysis on the pedigree of nervous system diseases in children

Nowadays, the development of diagnosis and treatment technology is constantly changing the pedigree and classification of nervous system diseases. Analyzing changes in earlier disease pedigrees can help us understand the changes involved in disease diagnosis from a macro perspective, as well as predict changes in later disease pedigrees and the direction of diagnosis and treatment. The inpatients of the neurology department from January 2012 to December 2020 in Hunan Children's Hospital were retrospectively analyzed. There were 36,777 patients enrolled in this study. The next analysis was based on factors like age, gender, length of stay (LoS), number of patients per month and per year (MNoP and ANoP, respectively), and average daily hospital cost (ADHE). To evaluate the characteristics of neurological diseases, we applied a series of statistical tools such as numerical characteristics, boxplots, density charts, one-way ANOVA, Kruskal-Wallis tests, time-series plots, and seasonally adjusted indices. The statistical analysis of neurological diseases led to the following conclusions: First, children having neurological illnesses are most likely to develop them between the ages of 4 and 8 years. Benign intracranial hypertension was the youngest mean age of onset among the various neurologic diseases, and most patients with bacterial intracranial infection were young children. Some diseases have a similar mean age of onset, such as seizures (gastroenteritis/diarrhea) and febrile convulsions. Second, women made up most patients with autoimmune diseases of the central nervous system. Treatment options for inherited metabolic encephalopathy and epilepsy are similar, but they differ significantly for viral intracranial infection. Some neurologic diseases were found to have seasonal variations; for example, infectious diseases of the central nervous system were shown to occur more commonly in the warm season, whereas, autoimmune diseases primarily appeared in the autumn and winter months. Additionally, the number of patients admitted to hospitals with intracranial infections and encephalopathy has dramatically dropped recently, but the number of patients with autoimmune diseases of the central nervous system and hereditary metabolic encephalopathy has been rising year over year. Finally, we discovered apparent polycentric distributions in various illnesses' density distributions. The study offered an epidemiological basis for common nervous system diseases, including evidence from age of onset, number of cases, and so on. The pedigree of nervous system diseases has significantly changed. The proportion of patients with neuroimmune diseases and genetic metabolic diseases is rising while the number of patients with infection-related diseases and uncertain diagnoses is decreasing. The existence of a disease multimodal model suggests that there is still a lack of understanding of many diseases' diagnosis and treatment, which needs to be improved further because accurate diagnosis aids in the formulation of individualized treatment plans and the allocation of medical resources; additionally, there is still a lack of effective treatment for most genetic diseases. The seasonal characteristics of nervous system diseases suggest the need for the improvement of sanitation, living conditions, and awareness of daily health care.

Epilepsy and the gut: Perpetrator or victim?

The brain and the gut are linked together with a complex, bi-path link known as the gut-brain axis through the central and enteric nervous systems. So, the brain directly affects and controls the gut through various neurocrine and endocrine processes, and the gut impacts the brain via different mechanisms. Epilepsy is a central nervous system (CNS) disorder with abnormal brain activity, causing repeated seizures due to a transient excessive or synchronous alteration in the brain’s electrical activity. Due to the strong relationship between the enteric and the CNS, gastrointestinal dysfunction may increase the risk of epilepsy. Meanwhile, about 2.5% of patients with epilepsy were misdiagnosed as having gastrointestinal disorders, especially in children below the age of one year. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy, in turn, affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of medications on the gut and the gut microbiota. Epilepsy with abdominal pain, a type of temporal lobe epilepsy, is an uncommon cause of abdominal pain. Epilepsy also can present with postictal states with gastrointestinal manifestations such as postictal hypersalivation, hyperphagia, or compulsive water drinking. At the same time, antiseizure medications have many gastrointestinal side effects. On the other hand, some antiseizure medications may improve some gastrointestinal diseases. Many gut manipulations were used successfully to manage epilepsy. Prebiotics, probiotics, synbiotics, postbiotics, a ketogenic diet, fecal microbiota transplantation, and vagus nerve stimulation were used successfully to treat some patients with epilepsy. Other manipulations, such as omental transposition, still need more studies. This narrative review will discuss the different ways the gut and epilepsy affect each other.

Epidemiology, Clinical Features, and Unusual Complications of Norovirus Infection in Taiwan: What We Know after Rotavirus Vaccines

Noroviruses (NoVs) are one of the emerging and rapidly spreading groups of pathogens threatening human health. A reduction in sporadic NoV infections was noted following the start of the COVID-19 pandemic, but the return of NoV gastroenteritis during the COVID-19 pandemic has been noted recently. Research in recent years has shown that different virus strains are associated with different clinical characteristics; moreover, there is a paucity of research into extraintestinal or unusual complications that may be associated with NoV. The genomic diversity of circulating NoVs is also complex and may vary significantly. Therefore, this short narrative review focuses on sharing the Taiwan experience of NoV infection including epidemiology, clinical features, and complications following suboptimal rotavirus immunization in Taiwan (after October 2006). We also highlight the unusual complications associated with NoV infections and the impacts of NoV infection during the COVID-19 pandemic in the literature for possible future research directions. To conclude, further research is needed to quantify the burden of NoV across the spectrum of disease severity in Taiwan. The evidence of the connection between NoV and the unusual complications is still lacking.