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Patel B, Shah MM, Suresh A, Patel PN, Patel P, Gandhi SK. Evaluation of Febrile Seizures: A Therapeutic Review of Current Modalities. Cureus 2023; 15:e50947. [PMID: 38249234 PMCID: PMC10800093 DOI: 10.7759/cureus.50947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
As benign as its nature is, a febrile seizure (FS) can be one of the most frightening experiences for parents to witness. It is a seizure that occurs in infants and children aged six months to five years, accompanied by a fever (with a temperature of at least 100.4°F or 38.0°C by any method), without any infection in the central nervous system. FS is typically benign and tends to resolve on its own. Overall, the risk of recurrence after an FS is high, so there is still a sizable knowledge discrepancy that needs to be addressed for better understanding and management of the disease. Thus, the objective of this review is to evaluate current therapeutic modalities available for FS and summarize recent recommendations on the management of this condition. On June 25, 2023, a review was undertaken using the Medical Subject Headings Tool (MeSH), and the following keywords yielded 867 results: seizures, febrile/drug therapy [Mesh] and seizures, and febrile/therapy [Mesh]. A total of 21 relevant articles were chosen for the research. Seizures were classified as simple and complex FS (CFS) based on clinical features. CFS usually results in recurrence. Certain investigations like computed tomography (CT) scans, magnetic resonance imaging (MRIs), and electroencephalography (EEG) are helpful, along with laboratory investigations, to rule out other causes of FS. After reviewing the current literature, we have tried to conclude whether the current pharmacotherapy is effective in treating FS.
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Affiliation(s)
- Brinda Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Ahmedabad, IND
| | - Mokshit M Shah
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Patan, IND
| | - Amrita Suresh
- Department of Pediatrics, Kasturba Medical College, Mangalore, IND
| | - Parag N Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Patan, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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Vishal V, Sachdeva A, Bhalla K, Dureja A, Tarte S. Exploring the Involvement of Cytokines in Pediatric Patients Afflicted by Simple Febrile Seizures: A Case-Control Study. Cureus 2023; 15:e48083. [PMID: 38046507 PMCID: PMC10689979 DOI: 10.7759/cureus.48083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
AIM Most children under six with seizures experience febrile seizures (FS), which occur with a temperature of 38°C or higher and no apparent infectious or metabolic causes. FS has a multifaceted etiology, involving genetic and environmental factors. This study aimed to explore the connection between the cytokine system (part of the immune system related to inflammation) and FS to uncover potential relationships. METHOD This research was carried out on 50 patients experiencing FS and 25 patients experiencing only fever served as cases and controls, respectively. The patient's blood was obtained under sterile circumstances from the antecubital/femoral vein as soon as feasible following the commencement of seizures. The complete hemogram analysis was done using the Mindray BC-5800 auto hematology analyzer (Mindray Medical International Limited, Shenzhen, China). RESULT The cases group had significantly higher interleukin-4 (IL-4) concentrations (292.85 pg/mL) than controls (81.04 pg/mL), indicating a statistically significant difference (p<0.05), respectively. In the current research, case participants had a significantly lower mean level of interleukin-6 (IL-6) than control participants. The average IL-6 concentration in cases was 28.00 pg/mL, whereas in controls was 93.09pg/mL. Patients with FS have an important function for the cytokine network to perform. CONCLUSION The findings showed a significant difference in cytokine concentrations between patients with FS and control subjects, highlighting a potential link between the cytokine system and FS. Additionally, lower levels of IL-6 in case participants suggest a complex role of cytokines in FS, emphasizing the importance of the cytokine network in this condition.
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Affiliation(s)
- Vaibhav Vishal
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Ashuma Sachdeva
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Kapil Bhalla
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Ankanksha Dureja
- Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Sagar Tarte
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Yang JH, Villegas R, Khanna S, Kaswick J, Coufal NG, Crawford J, Harvey H. The Utility of Infectious and Neurodiagnostic Testing in Children With Complex Febrile Seizures Requiring Mechanical Ventilation. J Child Neurol 2021; 36:735-742. [PMID: 33754870 DOI: 10.1177/08830738211000507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective cohort analysis was performed on 79 consecutive patients between 6 months and 5 years admitted to a tertiary hospital with a diagnosis of complex febrile seizures requiring mechanical ventilation from 2011 to 2017 to determine the utility of infectious and neurologic diagnostics. Intubation was used as a proxy for severity of illness. The overall intensive care unit stay was short (95% intubated <24 hours, 88% admitted <3 days). No life-threatening infections were identified, and none required surgical interventions. Electroencephalogram (EEG) was obtained on 43%, 26% of which were abnormal. Sixty-six percent of patients were discharged on rescue benzodiazepine and 20% with maintenance antiseizure medications. Duration of follow-up averaged 4 years (range 1 month to 9 years); 8 patients (10%) were subsequently diagnosed with epilepsy. Our findings suggest that extensive diagnostic evaluations may not be necessary for children with complex febrile seizures requiring mechanical ventilation although the role of EEG is less understood.
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Affiliation(s)
- Jennifer H Yang
- Department of Neurosciences, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Richard Villegas
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Sandeep Khanna
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Julie Kaswick
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Nicole G Coufal
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - John Crawford
- Department of Neurosciences, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
| | - Helen Harvey
- Department of Pediatrics, 8784University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
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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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Thiffault I, Atherton A, Heese BA, T Abdelmoity A, Pawar K, Farrow E, Zellmer L, Miller N, Soden S, Saunders C. Pathogenic variants in KPTN gene identified by clinical whole-genome sequencing. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a003970. [PMID: 32358097 PMCID: PMC7304362 DOI: 10.1101/mcs.a003970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/16/2020] [Indexed: 11/24/2022] Open
Abstract
Status epilepticus is not rare in critically ill intensive care unit patients, but its diagnosis is often delayed or missed. The mortality for convulsive status epilepticus is dependent on the underlying aetiologies and the age of the patients and thus varies from study to study. In this context, effective molecular diagnosis in a pediatric patient with a genetically heterogeneous phenotype is essential. Homozygous or compound heterozygous variants in KPTN have been recently associated with a syndrome typified by macrocephaly, neurodevelopmental delay, and seizures. We describe a comprehensive investigation of a 9-yr-old male patient who was admitted to the intensive care unit, with focal epilepsy, static encephalopathy, autism spectrum disorder, and macrocephaly of unknown etiology, who died of status epilepticus. Clinical whole-genome sequencing revealed compound heterozygous variants in the KPTN gene. The first variant is a previously characterized 18-bp in-frame duplication (c.714_731dup) in exon 8, resulting in the protein change p.Met241_Gln246dup. The second variant, c.394 + 1G > A, affects the splice junction of exon 3. These results are consistent with a diagnosis of autosomal recessive KPTN-related disease. This is the fourth clinical report for KPTN deficiency, providing further evidence of a wider range of severity.
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Affiliation(s)
- Isabelle Thiffault
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA
| | - Andrea Atherton
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA
| | - Bryce A Heese
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA
| | - Ahmed T Abdelmoity
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA
| | - Kailash Pawar
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA
| | - Emily Farrow
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA.,Department of Pediatrics, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA
| | - Lee Zellmer
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri 64108, USA
| | - Neil Miller
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri 64108, USA
| | - Sarah Soden
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA.,Department of Pediatrics, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA
| | - Carol Saunders
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, Missouri 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA
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Yamanaka G, Morichi S, Takamatsu T, Takahashi R, Watanabe Y, Ishida Y, Takeshita M, Morishita N, Kasuga A, Kanou K, Oana S, Suzuki S, Go S, Kashiwagi Y, Kawashima H. Granzyme A Participates in the Pathogenesis of Infection-Associated Acute Encephalopathy. J Child Neurol 2020; 35:208-214. [PMID: 31709864 DOI: 10.1177/0883073819886217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The present study aimed to determine whether granzymes are implicated in the pathogenesis of infection-associated acute encephalopathy (AE). METHODS We investigated granzyme and cytokine levels in the cerebrospinal fluid of patients with acute encephalopathy or complex febrile seizures (cFS). A total of 24 acute encephalopathy patients and 22 complex febrile seizures patients were included in the present study. Levels of granzymes A and B were measured using enzyme-linked immunosorbent assay, and levels of tumor necrosis factor α (TNF-α), interferon-γ (IFN-γ), interleukin 1β (IL-1β), IL-1 receptor antagonist (IL-1RA), IL-4, IL-6, IL-8, and IL-10 were assessed using the Bio-Plex suspension array system. RESULTS Cerebrospinal fluid levels of granzyme A were significantly higher, and those of TNF-α and IL-1RA were significantly lower in the AE group than in the cFS group; however, no significant differences in the levels of granzyme B, IFN-γ, IL-1β, IL-4, IL-6, IL-8, and IL-10 were observed between the 2 groups. In addition, no significant differences in granzyme A, granzyme B, or cytokine levels were observed between acute encephalopathy patients with and those without neurologic sequelae. CONCLUSIONS Our findings indicate the involvement of granzyme A in the pathogenesis of acute encephalopathy.
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Affiliation(s)
- Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Shinichiro Morichi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Tomoko Takamatsu
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Ryou Takahashi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Akiko Kasuga
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Kanako Kanou
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Singo Oana
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Shunsuke Suzuki
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Yasuyo Kashiwagi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Hisashi Kawashima
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Shinjuku, Tokyo, Japan
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Abstract
The predictive value of epileptiform discharges for subsequent epilepsy after febrile seizures was studied in 140 children: 72 children (51%) had simple febrile seizures and 68 children (49%) had complex febrile seizures. Electroencephalography (EEG) was performed in 103 children (74%), it was normal in 66 (47%) and with epileptiform patterns in 37 patients (26%). At follow-up in 2017, 10 children developed epilepsy, 1 had a single epileptic seizure, 9 of them had epileptiform EEGs. Of the patients with normal EEGs after complex febrile seizures, none developed epilepsy, and 92% of patients with normal EEGs after recurrent febrile seizures did not develop epilepsy. Therefore, patients with normal EEGs were unlikely to develop epilepsy. Fifteen percent of patients with complex and 31% of patients with recurrent febrile seizures and epileptiform EEGs developed epileptic seizures. The positive predictive value of epileptiform discharges was low in complex and twice as high in recurrent febrile seizures.
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Affiliation(s)
- Alja Kavčič
- 1 Faculty of Medicine, University of Ljubljana, Slovenia
| | - Zvonka Rener-Primec
- 1 Faculty of Medicine, University of Ljubljana, Slovenia.,2 Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Center Ljubljana, Slovenia
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Affiliation(s)
- Sheila M Hofert
- Department of Pediatrics, St Agnes Hospital, Baltimore, Maryland; and
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Abstract
OBJECTIVE Febrile seizures may contribute to epilepsy later in life, but data in sub-Saharan Africa are scarce. We, therefore, conducted a hospital-based study on clinical characteristics of children with febrile seizures. METHODS Over 2 years, we screened all pediatric admissions of Haydom Lutheran Hospital, northern Tanzania, and recruited 197 children with febrile seizures. RESULTS The incidence of febrile seizures was 4% of all admitted children aged <10 years, with a mortality of almost 4%. The peak age at the first febrile seizure was 2 years. One of five children experienced repeated episodes, and the majority of children showed features of complex seizures. Approximately 20% of children had a positive family history of febrile seizures or epilepsy. CONCLUSION Febrile seizures represent a frequent cause for admission of children, bearing a rather high mortality. Most children exhibit complex febrile seizures, which may contribute to the development of epilepsy later in life.
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Affiliation(s)
- Andrea S Winkler
- Department of Neurology, Technical University of Munich, 81675 Munich, Germany.
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