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Wang DS, Chung CH, Hsu WF, Chen SJ, Chu DM, Chien WC, Tzeng NS, Fan HC. Higher Risk of Psychiatric Disorders in Children With Febrile Seizures: A Nationwide Cohort Study in Taiwan. Pediatr Neurol 2024; 154:26-35. [PMID: 38458101 DOI: 10.1016/j.pediatrneurol.2024.02.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 01/05/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Febrile seizures occur commonly in children aged between six months and six years. A previous Danish study found a positive correlation between febrile seizures and the overall incidence of psychiatric disorders. This population-based nationwide observational study was conducted to investigate the association between febrile seizures and different psychiatric disorders in Taiwan and the associated risk factors. METHODS This cohort study used data from the National Health Insurance Research Database in Taiwan-a nationwide claims database covering >99% of the Taiwanese population. The study period was from January 2000 to December 2015; the overall median follow-up time was 11.04 ± 10.95 years. Overall, 2464 children with febrile seizures diagnosed between 2000 and 2015 met the inclusion criteria, and 7392 children without febrile seizures matched by index year, age, and sex were included in the control cohorts. Febrile seizures and psychiatric disorders were measured as the exposure and main outcomes, respectively. RESULTS Children with febrile seizures (n = 2463) were at a high risk of psychiatric disorders (adjusted hazard ratio, 4.70; 95% confidence interval [CI], 2.44 to 7.30; P < 0.001). The risk for anxiety was the highest (adjusted hazard ratio, 21.92; 95% CI, 11.40 to 34.05; P < 0.001). CONCLUSIONS When treating children with febrile seizures, particular attention should be paid to the symptoms of psychiatric disorders, as early referral may be beneficial for these children.
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Affiliation(s)
- Der-Shiun Wang
- Department of Pediatrics, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Wan-Fu Hsu
- Department of Pediatrics, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shyi-Jou Chen
- Department of Pediatrics, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan
| | - Der-Ming Chu
- Department of Pediatrics, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan; Student Counselling Center, National Defense Medical Center, Taipei, Taiwan
| | - Hueng-Chuen Fan
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan; Department of Pediatrics, Tung's Taichung Metro Harbor Hospital, Taichung, Taiwan; Department of Medical Research, Tung's Taichung Metro Harbor Hospital, Taichung, Taiwan; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
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Muniz MCR, Lima RV, Maia VQCC, Bezerra AM, Freire IF, Lima MCC, Matos YMT, Pontes LP, Cavalcante ANM. The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis. Eur J Pediatr 2024; 183:2049-2058. [PMID: 38456990 DOI: 10.1007/s00431-024-05501-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67-1.04; I2 = 78%; Cochran's Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65-0.99; I2 = 70%; Cochran's Q = 0.02). Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts. What is Known: • Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight. • However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures. What is New: • When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures. • When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.
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Affiliation(s)
- Maria Carolina Rocha Muniz
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Rian Vilar Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil.
| | | | - Arthur Meneses Bezerra
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Isabela Franco Freire
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Manuela Cavalcante Coling Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Yuri Marques Teixeira Matos
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Letícia Pinheiro Pontes
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Ana Nery Melo Cavalcante
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
- PhD in Collective Health By the University of Fortaleza, Neonatologist Pediatrician at Dr. César Cals de Oliveira General Hospital, Fortaleza, Ceara, Brazil
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Mao Y, Lin X, Wu Y, Lu J, Shen J, Zhong S, Jin X, Ma J. Additive interaction between birth asphyxia and febrile seizures on autism spectrum disorder: a population-based study. Mol Autism 2024; 15:17. [PMID: 38600595 PMCID: PMC11007945 DOI: 10.1186/s13229-024-00596-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that can significantly impact an individual's ability to socially integrate and adapt. It's crucial to identify key factors associated with ASD. Recent studies link both birth asphyxia (BA) and febrile seizures (FS) separately to higher ASD prevalence. However, investigations into the interplay of BA and FS and its relationship with ASD are yet to be conducted. The present study mainly focuses on exploring the interactive effect between BA and FS in the context of ASD. METHODS Utilizing a multi-stage stratified cluster sampling, we initially recruited 84,934 Shanghai children aged 3-12 years old from June 2014 to June 2015, ultimately including 74,251 post-exclusion criteria. A logistic regression model was conducted to estimate the interaction effect after controlling for pertinent covariates. The attributable proportion (AP), the relative excess risk due to interaction (RERI), the synergy index (SI), and multiplicative-scale interaction were computed to determine the interaction effect. RESULTS Among a total of 74,251 children, 192 (0.26%) were diagnosed with ASD. The adjusted odds ratio for ASD in children with BA alone was 3.82 (95% confidence interval [CI] 2.42-6.02), for FS alone 3.06 (95%CI 1.48-6.31), and for comorbid BA and FS 21.18 (95%CI 9.10-49.30), versus children without BA or FS. The additive interaction between BA and FS showed statistical significance (P < 0.001), whereas the multiplicative interaction was statistically insignificant (P > 0.05). LIMITATIONS This study can only demonstrate the relationship between the interaction of BA and FS with ASD but cannot prove causation. Animal brain experimentation is necessary to unravel its neural mechanisms. A larger sample size, ongoing monitoring, and detailed FS classification are needed for confirming BA-FS interaction in ASD. CONCLUSION In this extensive cross-sectional study, both BA and FS were significantly linked to ASD. The coexistence of these factors was associated with an additive increase in ASD prevalence, surpassing the cumulative risk of each individual factor.
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Affiliation(s)
- Yi Mao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xindi Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yuhan Wu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiayi Lu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Shaogen Zhong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xingming Jin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Kim JH, Yoon D, Lee H, Choe YJ, Shin JY. Neurological and immunological adverse events after pneumococcal conjugate vaccine in children using national immunization programme registry data. Int J Epidemiol 2024; 53:dyae010. [PMID: 38302750 DOI: 10.1093/ije/dyae010] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Despite the general consensus on the safety of pneumococcal conjugate vaccine (PCV), safety concerns unveiled during post-licensure surveillance need to be addressed. We investigated whether there is a transient increased risk following a three-dose series of pneumococcal conjugate vaccine (PCV) administered at 2, 4 and 6 months of age. METHODS This was a population-based cohort study using the Korea immunization registry data linked to nationwide administrative claims data. Self-controlled risk interval analysis was conducted for PCV recipients who had an outcome of interest within pre-defined risk and control intervals between 2018 and 2022. The outcomes were anaphylaxis, asthma, encephalopathy, febrile seizure, Kawasaki disease and thrombocytopenia. We used conditional Poisson regression model to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) comparing the outcomes in the risk and control intervals. RESULTS Of 1 114 096 PCV recipients, 8661 had outcomes either in the risk or control intervals. Their mean age at Dose 1 was 10.0 weeks, 58.3% were boys, and 85.3% received 13-valent PCV. PCV was not associated with an increased risk of any outcomes except for febrile seizure. There were 408 (56.0%) cases of febrile seizure in the risk interval, corresponding to an IRR of 1.27 (95% CI 1.10-1.47). CONCLUSIONS It is reassuring to note that there was no increased risk of the potential safety concerns following PCV administration. Despite the transient increased risk of febrile seizure, absolute numbers of cases were small. Febrile seizure is generally self-limiting with a good prognosis, and should not discourage parents or caregivers from vaccinating their children.
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Affiliation(s)
- Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Dongwon Yoon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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AlFulayyih SF, Al Baridi SS, Alomar SA, Alshammari AN, Uddin MS. Impact of Respiratory Viruses and SARS-CoV-2 on Febrile Seizures in Saudi Children: Insights into Etiologies, Gender, and Familial Associations. Med Sci Monit 2024; 30:e942478. [PMID: 38192092 PMCID: PMC10787381 DOI: 10.12659/msm.942478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Childhood febrile seizures occur between 5 months and 6 years of age in children without a previous history of seizure and are associated with high temperature in the absence of intracranial infection. This retrospective study identified 71 children aged 6 months to 5 years with febrile seizures between 2017 and 2021 at a single center in Saudi Arabia and aimed to identify an association between common respiratory virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MATERIAL AND METHODS Pediatric nasopharyngeal specimens were tested using a multiplex PCR respiratory panel detecting human coronaviruses (NL63, 229E, OC43, HKU1), influenza A/B, human adenovirus, parainfluenza viruses 1-4, respiratory syncytial virus, human metapneumovirus, rhinovirus/enterovirus, Middle East respiratory syndrome coronavirus, and, as of September 2021, SARS-CoV-2, confirmed using the Cepheid Xpert Xpress SARS-CoV2 RT-PCR kit. RESULTS In a cohort of 71 pediatric patients (median age, 19 months; 54.9% female), dominant pathogens included human rhinovirus/enterovirus (23.9%), influenza A/B (26.8%), and SARS-CoV-2 (14.1%). Concurrent infections were noted in 28.2%. Simple seizures occurred in 69%, and complex seizures in 31%. Females exhibited an 8.18-fold increased risk for complex seizures. Each additional fever day reduced complex seizure risk by 36%. Familial seizure history increased risk 8.76-fold. Human rhinovirus/enterovirus or parainfluenza infections inversely affected complex seizure likelihood compared with adenovirus. CONCLUSIONS In Saudi children with febrile seizures, distinct viral etiologies, sex, and familial links play pivotal roles. Given regional viral variations, region-tailored diagnostic and therapeutic strategies are paramount. A multicenter prospective cohort study is essential for comprehensive understanding.
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Affiliation(s)
- Saleh Fahad AlFulayyih
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
| | - Sarah Saleh Al Baridi
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
| | - Sara Amer Alomar
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
| | | | - Mohammed Shahab Uddin
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
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Kim AY, Na JH, Kang HY, Lee H, Lee YM. Effects of the coronavirus disease outbreak on the development of neurological disorders in children: A comparison of the incidence of febrile seizure and epilepsy using an interrupted time-series approach. J Infect Public Health 2024; 17:102-108. [PMID: 37995555 DOI: 10.1016/j.jiph.2023.10.042] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/26/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND With the outbreak of COVID-19, school closures and quarantines following social distancing have brought significant changes to children's lifestyles. Therefore, we aimed to compare the population-adjusted incidence of febrile seizures(FS) and epilepsy before and after the COVID-19 outbreak in Korea and to assess the effects of the COVID-19 outbreak on the incidence by region and age group. METHODS A retrospective cohort study was conducted using nationwide claims data and covid data from January 2019 to December 2020. The incidence of diseases and difference in incidence before (Jan 20 to Dec 30, 2019) and after (Jan 20 to Dec 30, 2020) the COVID-19 outbreak was measured using rate ratio. An Interrupted time series analysis was used to identify the effect of COVID-19 on trends of FS and epilepsy. Subgroup analysis by age, sex, insurance, and risk of coronavirus by area were conducted. RESULTS Following the onset of the pandemic, the number of newly diagnosed FS cases decreased sharply by 69 % (24,182 to 7238), whereas the incidence of epilepsy, increased to 1.02 times (30,286-29,312), when adjusted in proportion to the population. Notably, a greater decrease in the incidence of FS were found in the regions with high-risk of coronavirus. A result of segmented regression analysis proved the decrease was significant and made immediately after the pandemic started(p < 0.001). In contrast to the incidence of FS, that of epilepsy did not exhibit a significant month-to-month change during the baseline period, immediately after the pandemic started, and during the pandemic. CONCLUSIONS The COVID-19 outbreak and resulting social distancing measures reduced the incidence of febrile seizure immediately rather than gradually. Unlike in the case of acute febrile seizure, the COVID-19 pandemic had no effect on the incidence of chronic epilepsy.
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Affiliation(s)
- Ah-Young Kim
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea; Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 135-720, South Korea
| | - Ji-Hoon Na
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 135-720, South Korea
| | - Hye-Young Kang
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Hankil Lee
- College of Pharmacy, Ajou University, Suwon, South Korea.
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul 135-720, South Korea.
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Huang CW, Lin JJ, Kuo CY, Lin KL, Huang YC, Chiu CH, Chen YC, Chen CH, Hsieh YC. Risk factors of Omicron variant associated acute encephalitis/encephalopathy in children. J Microbiol Immunol Infect 2023; 56:1169-1177. [PMID: 37709632 DOI: 10.1016/j.jmii.2023.08.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Outbreak of Omicron BA.2 in Taiwan led to an increased number of acute encephalitis/encephalopathy cases in children and several fatal cases drew public attention. In pre-Omicron period, pediatric cases of COVID-19-associated acute encephalitis have been reported and during Omicron epidemic, febrile convulsions, encephalitis were mentioned more frequently. The outcome of patients with neurological complications was worse. However, few studies investigated the risk factors, pathophysiology and prognosis of COVID-19-associated encephalitis/encephalopathy. Here, we describe the presentation of pediatric cases of COVID-19-associated acute encephalitis/encephalopathy and explore the associated risk factors. METHODS Pediatric patients with confirmed SARS-CoV-2 infections were prospectively enrolled at admission at Chang Gung Memorial Hospital between April and August 2022. Patients were categorized into groups of acute encephalitis/encephalopathy, febrile convulsions or mild disease. Demographic descriptions, clinical manifestations and laboratory data were collected. RESULTS Of 288 acute COVID-19 patients, there were 38 (13.2%) acute encephalitis/encephalopathy, 40 (13.9%) febrile convulsions, and 210 (72.9%) mild disease. Among acute encephalitis/encephalopathy group, the mean age was 68.3 ± 45.0 months. The common neurological symptoms were lethargy (65.8%), seizures (52.6%), and impaired consciousness (34.2%). Over 3 years old (adjusted odds ratio [aOR]: 7.57, p < 0.001), absolute neutrophil count ≥3150/μL (aOR: 5.46, p = 0.008), and procalcitonin ≥0.5 ng/mL (aOR: 4.32, p = 0.021) were independent factors for acute encephalitis/encephalopathy. CONCLUSIONS Most cases of COVID-19-associated acute encephalitis/encephalopathy showed no evidence of direct viral invasion but associations with older age, increased peripheral neutrophil, and serum procalcitonin. These findings may imply the neutrophil-mediated systemic inflammatory response plays an important role on central nerve system, leading to cerebral dysfunction.
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Affiliation(s)
- Chong-Wei Huang
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Yen Kuo
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ching Chen
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Ho Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Shao L, Yu Y. Development of a prediction nomogram model of recurrent febrile seizures in pediatric children. Eur J Pediatr 2023; 182:4875-4888. [PMID: 37597045 DOI: 10.1007/s00431-023-05133-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/21/2023]
Abstract
The purpose of this study is to develop a prediction nomogram of recurrent febrile seizures in pediatric children based on the identified predictors for developing recurrent febrile seizures. This is a retrospective observational study. The medical records of 320 febrile seizure-afflicted children admitted to Zhoushan Women and Children Hospital from March 2019 to January 2023 were retrospectively reviewed. Children were divided into the recurrent febrile seizures group and the non-recurrent febrile seizures group. The predictors of recurrent febrile seizures were identified by univariate and multivariate analyses. A prediction nomogram model was developed via R software. The performance of the nomogram was internally validated to assess the model's discrimination and consistency, and decision curve analysis was employed to assess clinical utility. There were 41 out of 320 cases that had recurrent febrile seizures during the observation period, with a 12.81% prevalence rate of recurrent febrile seizures. The predictors of recurrent febrile seizures were young age at the first febrile seizures, a family history of febrile seizures in a first-degree relative, diurnal variation of initial febrile seizures occurrence, gender, and a low level of C-reactive protein. The area under the receiver operating characteristic curve of the nomogram is 0.795 (95% confidence interval: 0.720-0.871). Calibration plots and the result of the Hosmer-Lemeshow test (P = 0.472) reveal satisfactory consistency. Decision curve analysis showed a significant net benefit of the nomogram. CONCLUSIONS The prediction nomogram model demonstrates good performance and clinical utility, which would be a convenient tool for the detection of children in pediatrics with high-risk recurrent febrile seizures. It is useful for pediatric medical staff to provide early medical interventions and family counseling. WHAT IS KNOWN • A proportion of children experience recurrences of febrile seizures. • Recognition of risk factors for recurrent FS in pediatrics would be useful for the prediction of risk probabilities and help provide tailored counseling and follow-up. WHAT IS NEW • A nomogram model is developed for risk prediction of recurrent febrile seizures in this study, which would be a convenient risk prediction tool in pediatrics. • The predictor of diurnal variation of recurrent febrile seizures is with new ideas.
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Affiliation(s)
- Lingling Shao
- The Department of Pediatric Ward, Zhoushan Women and Children Hospital, No. 238 Renmin North Road, Dinghai District, Zhoushan, 316000, Zhejiang, China
| | - Youna Yu
- The Department of Pediatric Ward, Zhoushan Women and Children Hospital, No. 238 Renmin North Road, Dinghai District, Zhoushan, 316000, Zhejiang, China.
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Yang L, Sun L, Chu W, Zhu Y, Wu G. Study of the Impact of Air Pollution on Convulsions in Children: A Hospital-Based Retrospective Study in Hangzhou, China. Clin Pediatr (Phila) 2023; 62:1186-1192. [PMID: 36797840 DOI: 10.1177/00099228231154059] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND To investigate the relationship between the occurrence of convulsions in children and air pollution in Hangzhou. METHODS From January 1, 2018, to December 31, 2020, 775 children admitted with convulsion to the pediatric outpatient clinic of The Affiliated Hospital of Hangzhou Normal University (Hangzhou, China) were enrolled in this study. The clinical data and the corresponding weather data of the day in Hangzhou were collected and analyzed. Also, the monthly etiological classification of convulsions and the monthly average air data of Hangzhou were statistically analyzed. RESULTS The highest incidence of convulsion was observed in children 1 to 2 years old, and higher in boys than in girls. The top three main causes were febrile seizure, benign infantile convulsion with mild gastroenteritis, and epilepsy. Among the meteorological factors, the increase in the level of 2.5 micron particulate matter (PM 2.5) in the air per month led to an increase in the number of patients with febrile seizure, benign infantile convulsion with mild gastroenteritis, and epilepsy, where the increase of ozone in 8 hours (O3-8h) per month led to a decrease in the number of patients with such conditions. CONCLUSIONS PM2.5, PM10, and SO2 are the main meteorological factors affecting the occurrence of convulsions in children in Hangzhou, and PM2.5 and SO2 are risk factors. The increase in the level of PM2.5 in the air per month could increase occurrence of child convulsions, but the increase of O3-8h per month could decrease occurrence of child convulsions.
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Affiliation(s)
- Lin Yang
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - LiXia Sun
- Zhejiang University of Water Resources and Electric Power, Hangzhou, China
| | - Wei Chu
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - YaFei Zhu
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - GuangSheng Wu
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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Soti Khiabani M, Mohammadi MS, Ashrafi MR, Haider SB, Haider SI, Mahmoudi S, Mamishi S. Evaluation of patients presenting with febrile seizures in an Iranian referral hospital: emphasis on the frequency of meningitis and co-infections. BMC Pediatr 2023; 23:316. [PMID: 37349740 PMCID: PMC10288671 DOI: 10.1186/s12887-023-04120-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Febrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures. METHODS This retrospective cross-sectional study was conducted at the Children's Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients' data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases. The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated. RESULTS A total of 290 patients were referred to the Children's Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination. CONCLUSION Evaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure.
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Affiliation(s)
- Mahsa Soti Khiabani
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahya Sadat Mohammadi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Shima Mahmoudi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, , Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, I.R, Tehran, Iran.
- Biotechnology Centre, Silesian University of Technology, Gliwice, 44-100, Poland.
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, , Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, I.R, Tehran, Iran.
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Hanlon SM, Sim D, Schneider JG, Yang Z, Thompson SM. The Association Between COVID-19 and Febrile Seizure: A Retrospective Case-Control Study. Pediatr Emerg Care 2023; 39:360-363. [PMID: 37079552 PMCID: PMC10171097 DOI: 10.1097/pec.0000000000002935] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND/OBJECTIVE Throughout the pandemic, febrile seizures have resulted from infection secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The objective of this study is to determine if there is an increased association between COVID-19 and febrile seizures as compared with other causes of febrile seizures. METHODS This was a retrospective case control study. Data were collected from the National Institute of Health (NIH) supported National COVID Cohort Collaborative (N3C). Patients from 6 to 60 months who were tested for COVID-19 were included; cases were defined as COVID-19-positive patients whereas controls were defined as COVID-19-negative patients. Febrile seizures diagnosed within 48 hours of the COVID-19 test were considered to be associated with the test result. Patients were subjected to a stratified gender and date matching design followed by a logistic regression controlling for age and race. RESULTS During the study period, 27,692 patients were included. Of those, 6923 patients were COVID-19-positive, among which 189 had febrile seizures (2.7%). After logistic regression, the likelihood of having febrile seizures concurrently with COVID-19 as compared with other causes was 0.96 ( P = 0.949; confidence interval, 0.81, 1.14). CONCLUSIONS There were 2.7% of the patients with COVID-19 that were diagnosed with a febrile seizure. However, when subjected to a matched case control design with logistic regression controlling for confounding variables, there does not appear to be an increased risk of febrile seizures secondary to COVID-19 as compared with other causes.
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Affiliation(s)
| | - Don Sim
- Department of Internal Medicine and Pediatrics
| | - Jack G. Schneider
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine
| | - Ziyi Yang
- Department of Biostatistics, Indiana University-Purdue University Indianapolis
| | - Sean M. Thompson
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) omicron (B.1.1.529) variant reduced the risk of severe disease compared with the original strain and other variants, but it appeared to be highly infectious, which resulted in an exponential increase in confirmed cases in South Korea. As the number of confirmed cases increased, so did the number of pediatric patients' hospitalization. This study aims to evaluate the frequency and clinical features of febrile seizure associated with the COVID-19 omicron variant in children. METHODS We retrospectively reviewed the medical records of children aged under 18 years with febrile seizure who were tested for COVID-19 from February 2020 to April 2022 at Ajou University Hospital, South Korea. Based on the dominant variants, we divided the period into the pre-omicron (from February 2020 to December 2021) and omicron periods (from January 2022 to April 2022) and compared the clinical characteristics between the two. Also, we compared the clinical characteristics of febrile seizure between COVID-19 positive and negative group during the omicron period. RESULTS Among the 308 children, 211 patients (9.2 patients/months) and 97 patients (24.3 patients/months) were grouped into pre-omicron and omicron periods, respectively. Compared with the pre-omicron period, patients in the omicron period showed significantly higher mean age (pre-omicron vs. omicron, 22.0 vs. 28.0 months; P = 0.004) and COVID-19 positive results (pre-omicron vs. omicron, 0.5% vs. 62.9%; P < 0.001). As the COVID-19 confirmed cases in the omicron period increased, the number of COVID-19 associated febrile seizure also increased. In the omicron period, 61 children were confirmed to be positive for COVID-19, and COVID-19 positive group showed statistically significant higher mean age (positive vs. negative, 33.0 vs. 23.0 months; P = 0.003) and peak body temperature than the negative group (positive vs. negative, 39.1°C vs. 38.6°C; P = 0.030). Despite the lack of significance, COVID-19 positive group showed longer seizure time, multiple seizure episodes, and higher prevalence of complex febrile seizure. CONCLUSION The frequency of COVID-19 associated febrile seizure increased in the omicron periods. In addition, in this period, children with febrile seizure diagnosed with COVID-19 had a higher mean age and higher peak body temperature.
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Affiliation(s)
- Jaehyung Joung
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Heewon Yang
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yura Ko
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
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Casabona G, Berton O, Singh T, Knuf M, Bonanni P. Combined measles-mumps-rubella-varicella vaccine and febrile convulsions: the risk considered in the broad context. Expert Rev Vaccines 2023; 22:764-776. [PMID: 37642012 DOI: 10.1080/14760584.2023.2252065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/01/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Studies on quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccines have indicated a twofold increased relative risk of febrile convulsion (FC) after the first dose compared to MMR and V administered at the same medical visit (MMR+V). AREAS COVERED This narrative review contextualizes FC occurrence after the first MMRV vaccine dose from a clinical perspective and outlines approaches to attenuate FC occurrence post-vaccination. EXPERT OPINION While the relative FC risk increases after the first dose of MMRV compared to MMR+V vaccine in measles-naïve infants, the attributable risk is low versus the overall FC risk in the pediatric population triggered by other causes, like natural exposure to pathogens or routine vaccination. No increased risk of FC has been reported after MMRV co-administration with other routine vaccines compared to MMRV alone. Based on our findings and considering the MMRV vaccination benefits (fewer injections, higher coverage, better vaccination compliance), the overall benefit-risk profile of MMRV vaccine is considered to remain positive. Potential occurrence of FC in predisposed children (e.g. with personal/family history of FC) may be attenuated if they receive MMR+V instead of MMRV as the first dose. It is also important to monitor vaccinees for fever during the first 2 weeks post-vaccination.
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Affiliation(s)
| | | | | | - Markus Knuf
- Department for Pediatric and Adolescent Medicine, General Hospital Worms, General Hospital Worms, Worms, Germany
- Pediatric Infectious Diseases, University Medicine, Mainz, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chen HY, Chang YH, Ding DC. The Negative Association between Breastfeeding Duration and Infant Febrile Seizure: A Retrospective Case-Control Study. Int J Environ Res Public Health 2022; 19:ijerph19095495. [PMID: 35564887 PMCID: PMC9105559 DOI: 10.3390/ijerph19095495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Two to five percent of infants and children experience febrile seizures (FS). Breastfeeding is beneficial to the health of mothers and children. Nevertheless, the benefits of breastfeeding in reducing FS remain unclear; thus, the present study aimed to evaluate this association. The case group was selected from 2010 to 2019, and the selected population was children younger than 5 years (i.e., children born from 2005−2019). The control group was selected from newborn infants at our hospital born between 2005 and 2019. Finally, 55 children with FS and 110 children in the control group were recruited. The results show longer breastfeeding duration is associated with an increased risk of FS (adjusted odds ratio: 1.06, 95% confidence interval: 1.01−1.11, p = 0.028). When comparing cases of FS with the control group, the percentage of inclusive breastfeeding over 12 months (32.7% vs. 9.1%, p = 0.017) and longer duration of exclusive breastfeeding were higher (10.86 ± 11.82 vs. 5.40 ± 7.17 months, p < 0.001). However, the comparison of the prevalence of FS between the different breastfeeding duration groups did not reach statistical significance. In conclusion, our study showed that a longer breastfeeding duration was associated with a higher risk of FS. Future large-scale studies evaluating the association between breastfeeding duration and febrile seizures are needed.
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Affiliation(s)
- Hsi-Yu Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien 970, Taiwan;
| | - Yu-Hsun Chang
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien 970, Taiwan
- Correspondence: (Y.-H.C.); (D.-C.D.); Tel.: +886-3-8561825 (ext. 12228) (Y.-H.C.); +886-3-8561825 (ext. 13383) (D.-C.D.)
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: (Y.-H.C.); (D.-C.D.); Tel.: +886-3-8561825 (ext. 12228) (Y.-H.C.); +886-3-8561825 (ext. 13383) (D.-C.D.)
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Zerbo O, Modaressi S, Goddard K, Lewis E, Fireman B, Daley MF, Irving SA, Jackson LA, Donahue JG, Qian L, Getahun D, DeStefano F, McNeil MM, Klein NP. Safety of measles and pertussis-containing vaccines in children with autism spectrum disorders. Vaccine 2022; 40:2568-2573. [PMID: 35315325 PMCID: PMC10987202 DOI: 10.1016/j.vaccine.2022.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine whether children aged 4-7 years with a diagnosis of autism spectrum disorders (ASD) were at increased risk of fever, febrile seizures, or emergency department (ED) visits following measles- or pertussis-containing vaccines compared with children without ASD. METHODS The study included children born between 1995-2012, aged 4-7 years at vaccination, and members of six healthcare delivery systems within Vaccine Safety Datalink. We conducted self-controlled risk interval analyses comparing rates of outcomes in risk and control intervals within each group defined by ASD status, and then compared outcome rates between children with and without ASD, in risk and control intervals, by estimating difference-in-differences using logistic regressions. RESULTS The study included 14,947 children with ASD and 1,650,041 children without ASD. After measles- or pertussis-containing vaccination, there were no differences in association between children with and without ASD for fever (ratio of rate ratio for measles-containing vaccine = 1.07, 95% CI 0.58-1.96; for pertussis-containing vaccine = 1.16, 95% CI 0.63-2.15) or ED visits (ratio of rate ratio for measles-containing vaccine = 1.11, 95% CI 0.80-1.54; for pertussis-containing vaccine = 0.87, 95% CI 0.59-1.28). Febrile seizures were rare. Pertussis-containing vaccines were associated with small increased risk of febrile seizures in children without ASD. CONCLUSION Children with ASD were not at increased risk for fever or ED visits compared with children without ASD following measles- or pertussis-containing vaccines. These results may provide further reassurance that these vaccines are safe for all children, including those with ASD.
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States.
| | | | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | - Edwin Lewis
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Stephanie A Irving
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - James G Donahue
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, United States
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
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Poudel S, Adhikari S, Thapa R, Parajuli B, Regmi S, Kunwar P. Febrile Seizures among Children Admitted to the Department of Paediatrics of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:348-351. [PMID: 35633224 PMCID: PMC9252255 DOI: 10.31729/jnma.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Febrile seizure is the most common convulsive event in children younger than 60 months. Fever plays an important role in causing disturbances in fluid and electrolyte balance, also hyponatremia has been thought to enhance the susceptibility to seizures. The objective of this study is to find out the prevalence of febrile seizures among children admitted to the Department of Paediatrics of a tertiary care centre. Methods: A descriptive cross-sectional study among children admitted to the Department of Paediatrics was done at a tertiary care centre between December, 2020 to September, 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 077/078-098). A total of 1052 children were included in this study. A convenience sampling technique was used. Statistical Package for the Social Sciences version 25.0 was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 1052 children, the prevalence of febrile seizure was 100 (9.50%) (7.73-11.27 at 95% Confidence Interval). Among these 100 patients, 68 (68%) had simple febrile seizures while 32 (32%) had recurrent febrile seizures. Conclusions: The prevalence of febrile seizures was found to be higher than in other studies conducted in similar settings. This knowledge may be of practical value in advising parents or caregivers of the risk of a febrile seizure and its recurrence.
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Affiliation(s)
- Sumita Poudel
- Department of Paediatrics, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Sudhir Adhikari
- Department of Paediatrics, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Rohit Thapa
- Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Biraj Parajuli
- Department of Paediatrics, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Shanti Regmi
- Department of Paediatrics, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Prajjwal Kunwar
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Karmacharya Malla K, Gaire B. Association of Iron Deficiency Anemia with Febrile Seizure in Children in a Tertiary Care Hospital. J Nepal Health Res Counc 2021; 19:66-70. [PMID: 33934135 DOI: 10.33314/jnhrc.v19i1.3327] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Febrile seizure is the most common cause of seizure in children. Iron deficiency, by lowering seizure threshold, is proposed to be one of the risk factors for febrile seizure. Many studies have been done to determine the association of iron deficiency anemia with febrile seizure but the results are controversial. Hence, the present study was conducted to evaluate the association of iron deficiency anemia with febrile seizure in Nepalese children. METHODS A prospective age and sex matched case control study was performed in 68 cases of febrile seizures and 68 controls of febrile illness without seizure after calculating the sample size. The study was conducted from October 21, 2019 to October 20, 2020 in Pediatric ward and intensive care unit of College of Medical Sciences, Bharatpur, Nepal after obtaining ethical clearance from institutional review committee. Data entry was done in statistical packages for the social science version 20. RESULTS Mean of haematological parameters (haemoglobin and mean corpuscular volume) as well as mean of serum iron, ferritin and transferrin saturation were significantly less and total iron binding capacity was significantly high in cases as compared to controls (P <0.05). Iron deficiency anemia was significantly associated with cases (59.7%), with odds ratio of 2.5 (95% confidence interval =1.24 - 5.01) as compared to control (40.3%) (P <0.05). CONCLUSIONS Iron deficiency anemia may be considered one of the risk factors for febrile seizure in children. Hence, Children with febrile seizure should be investigated and treated for Iron deficiency anemia.
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Affiliation(s)
| | - Binod Gaire
- Department of Pediatrics, College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Jacoby P, Glover C, Damon C, Fathima P, Pillsbury A, Durrheim D, Gold MS, Leeb A, Snelling T. Timeliness of signal detection for adverse events following influenza vaccination in young children: a simulation case study. BMJ Open 2020; 10:e031851. [PMID: 32122906 PMCID: PMC7050305 DOI: 10.1136/bmjopen-2019-031851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine how soon after commencement of the seasonal influenza vaccination programme, the AusVaxSafety active vaccine safety surveillance system, currently in use across Australia, would have detected a safety signal had it been operating in 2010 when there was an unprecedented number of febrile seizures in young children associated with one specific influenza vaccine brand, Fluvax (CSL Biotherapies). DESIGN Simulation study. SETTING Western Australian vaccine influenza coverage and adverse event surveillance data. OUTCOME MEASURES Simulated solicited responses from caregivers who would have received an SMS survey about adverse events experienced following seasonal influenza vaccination of their children aged 6 months to <5 years. PARTICIPANTS None. RESULTS We estimated a >90% probability of a safety signal being detected by AusVaxSafety based on solicited reports for either fever or medical attendance at or before the week ending 28 March 2010, 3 weeks after the start of vaccine distribution. Suspension of the national paediatric influenza vaccination programme as a result of the passive adverse events surveillance operating at the time did not occur until 23 April 2010. CONCLUSIONS Active vaccine safety surveillance leading to rapid detection of a safety signal would likely have resulted in earlier suspension of Fluvax from the vaccination programme, prevention of many febrile convulsions and maintenance of public confidence in influenza vaccination for young children.
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Affiliation(s)
- Peter Jacoby
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Catherine Glover
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Chloe Damon
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - David Durrheim
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael S Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Alan Leeb
- SmartVax, c/o Illawarra Medical Centre, Ballajura, Western Australia, Australia
- Illawarra Medical Centre, Ballajura, Western Australia, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
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21
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Khazaei Z, Moradi G, Zahraei SM, Gouya MM, Goodarzi E, Yaghini F, Roshani D. The Comparison of the Adverse Events of Pentavalent Vaccine and DPT Vaccine in 2-6 Months Infants in Iran: A National Study. Ann Glob Health 2020; 86:11. [PMID: 32064229 PMCID: PMC7006586 DOI: 10.5334/aogh.2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Vaccination is the most remarkable intervention in public health and is an effective strategy in controlling infectious diseases among infants. Objectives The aim of this study was to compare the adverse events of Pentavalent vaccine and DPT vaccine in two- to six-month-old infants in Iran. Methods This is an analytical cross-sectional study in which healthy infants aged two to six months, having received DPT vaccine in 2013 and Pentavalent vaccine in 2015, were studied for any experienced adverse events related to these vaccines. Percentage, mean, standard deviation and chi-square tests were used to describe and analyze the data (p < 0.05). Findings The results showed that 10,464 and 17,561 adverse events, which were associated with DPT vaccine and Pentavalent vaccine respectively, were recorded in the infants who received these vaccines throughout Iran. Mazandaran, Qazvin and Golestan provinces reported the highest number of adverse events, respectively (15.74%, 11.25%, and 9.12%). Moreover, Pentavalent vaccine seemed to have more recorded adverse events compared to DPT, high fever had the highest record rate for DPT vaccine (47.4%) and mild localized complications was the highest for Pentavalent vaccines (31.68%). There was a significant relationship between the kind of vaccine and the type of reaction, adverse event categorization and the country that produced the vaccine (p < 0.05). Conclusion Severe localized adverse events including high fever, vomiting, diarrhea and restlessness seemed to be less in Pentavalent vaccine compared to DPT vaccine. Therefore, substituting Pentavalent vaccine for DPT vaccine in infants seems to reduce the adverse events among them.
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Affiliation(s)
- Zaher Khazaei
- Department of Public Health, School of Medicine, Dezful University of Medical Sciences, Dezful, IR
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, IR
| | - Seyed Mohsen Zahraei
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, IR
| | - Mohammad Mehdi Gouya
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, IR
| | - Elham Goodarzi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, IR
| | - Fateme Yaghini
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, IR
| | - Daem Roshani
- Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, IR
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22
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Kim SH, Shim HS, Kang SM, Park H, Jin MH, Lee JH. Are there effects of lunar cycle on pediatric febrile seizure?: A single-center retrospective study (2005-2018). Sci Total Environ 2019; 692:589-594. [PMID: 31539966 DOI: 10.1016/j.scitotenv.2019.07.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/25/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Several studies have reported an association between seizure and the lunar cycle; however, results are conflicting. Thus, we investigated whether emergency department (ED) visits due to febrile seizure (FS) or FS plus were affected by lunar cycle. METHODS We reviewed the medical records of patients who were admitted to the ED with a main diagnosis of FS or FS plus from January 1, 2005 to August 31, 2018 (13 years 8 months), a period of 4991 days with 169 lunar cycles. During that period, we collected weather data such as mean temperature, average atmospheric pressure (AP), and humidity according to lunar phase (new moon, first quarter, full moon, and third or last quarter). RESULTS A total of 1979 patients were identified. We found male predominant with a mean age of 2.62 ± 2.09 years. Acute pharyngotonsillitis was the most common cause of fever, generalized tonic-clonic seizure was the most common type of seizure, and the mean peak body temperature was 38.77 ± 0.81 °C. The lunar cycle did not affect the onset or frequency of FS after adjustment; however, several factors, including season, O3 and NO2 concentrations, and holidays, were associated with FS. CONCLUSION We did not find an association between lunar cycle and FS or FS plus. However, several factors, including season, O3, NO2, and holidays were associated with FS or FS plus.
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Affiliation(s)
- Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Haeng Seon Shim
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Su Mynn Kang
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyunho Park
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mi Hyeon Jin
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jun Hwa Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
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23
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Thébault-Dagher F, Lafontaine MP, Knoth IS, Deguire F, Sheppard E, Cook R, Lagacé M, Gravel J, Lupien S, Lippé S. Febrile seizures and increased stress sensitivity in children: How it relates to seizure characteristics. Epilepsy Behav 2019; 95:154-160. [PMID: 31059921 DOI: 10.1016/j.yebeh.2019.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/08/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies suggest that the relationship between seizures and stress starts early in life. However, evidence of long-term altered stress reactivity following early-life seizures is lacking. Our objectives were to assess alterations in stress hormone reactivity in children with past febrile seizures (FS) and investigate how these alterations relate to clinical characteristics. METHOD This case-control study compared a convenience sample of children with simple FS (n = 24), complex FS (n = 18), and matched healthy controls (n = 42). Stress was induced by electrode placement for an electroencephalography (EEG) exam. Salivary cortisol to stress, using three samples collected before and after the stressor, was compared between groups and sex. The relationship between stress reactivity and clinical characteristics (i.e., FS duration, age at first FS, time since the last FS) was investigated. RESULTS Cortisol reactivity to stress was significantly different depending on study groups, F(1, 78) = 6.415, p = 0.003, η2p = 0.141, but not sex nor was there a significant interaction between group and sex (p ≥ 0.581). Participants with simple FS showed higher cortisol reactivity to stress (M = 14.936, Standard deviation (SD) = 26.852) compared with those with complex FS (M = -4.663, SD = 18.649, p = 0.015) and controls (M = -3.817, SD = 18.907, p = 0.003). There was no significant difference between participants with complex FS and controls (p > 0.999). Stress reactivity was not linked to clinical characteristics. CONCLUSIONS Children with past simple FS showed greater changes in salivary cortisol following stress, suggesting enhanced stress sensitivity. As similar results were not found in a population with complex FS, our study shows that stress alterations are not caused by seizure severity. Future studies are needed to investigate whether stress sensitivity may be premorbid to simple FS and may contribute to simple FS incidence.
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Affiliation(s)
- Fanny Thébault-Dagher
- Department of Psychology, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; Centre de recherche en neuropsychologie et cognition, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
| | - Marc-Philippe Lafontaine
- Department of Psychology, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; Centre de recherche en neuropsychologie et cognition, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
| | - Inga Sophia Knoth
- CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada
| | - Florence Deguire
- Department of Psychology, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; Centre de recherche en neuropsychologie et cognition, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
| | - Emilie Sheppard
- Department of Psychology, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; Centre de recherche en neuropsychologie et cognition, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
| | - Ramona Cook
- CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
| | - Maryse Lagacé
- CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
| | - Jocelyn Gravel
- CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada
| | - Sonia Lupien
- Psychiatry Department, Université de Montréal, Roger-Gaudry Building, 2900 Edouard-Montpetit Boulevard, Montreal, Quebec, Canada; Center for Studies on Human Stress, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada.
| | - Sarah Lippé
- Department of Psychology, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; Centre de recherche en neuropsychologie et cognition, Université de Montréal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, Quebec, Canada; CHU Sainte-Justine Research Center, Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, Canada.
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Abstract
IMPORTANCE Sudden unexplained death in childhood (SUDC) is the fifth leading category of death among toddlers but remains underrecognized and inadequately studied. OBJECTIVE To assess the potential role of febrile seizures (FS) and other risk factors associated with SUDC and describe the epidemiology, mechanisms, and prevention of SUDC. DESIGN, SETTING, AND PARTICIPANTS This case series study reviewed 622 consecutive sudden child death cases aged 1 to 17 years from 2001 to 2017 from 18 countries. Data were collected from family members of children who died suddenly; these families voluntarily registered with the SUDC Foundation. Data analysis was conducted from November 2017 to February 2019. MAIN OUTCOME MEASURES Certified manner of death characterized as accident, natural, or undetermined. RESULTS A total of 391 families with decedents aged 1 to 6 years completed a comprehensive interview on medical and social histories, and circumstances of death with forensic evaluations revealing a cause of death (sudden explained death in childhood [SEDC]) or no cause of death (SUDC). Of these children, 231 (59.1%) were male, the mean (SD) age at death was 24.9 (12.8) months, and 104 (26.6%) had a history of FS. Compared with the general population FS prevalence (2%-5%), FS prevalence among SUDC (28.8%; 95% CI, 23.3%-34.2%) and SEDC (22.1%; 95% CI, 14.8%-29.3%) were elevated. The odds of death during sleep was 4.6-fold higher in SUDC than in SEDC cases (odds ratio, 4.61; 95% CI, 1.92-11.09; adjusted P = .008). The siblings of SUDC cases were followed up for 3144 life-years, and none died prematurely from SUDC. CONCLUSIONS AND RELEVANCE This analysis of the largest SUDC cohort confirmed an increased FS rate and found significantly increased rates of FS among SEDC. This study suggests that seizures may contribute to some SUDC and SEDC deaths. The risk of sudden death in a sibling was low. To develop and assess preventive strategies, population-based studies are needed to define the epidemiology and spectrum of risk factors and identify biomarkers of patients with FS at high risk of sudden death.
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Affiliation(s)
- Laura Gould Crandall
- Sudden Unexplained Death In Childhood Foundation, Roseland, New Jersey
- New York University School of Medicine, Comprehensive Epilepsy Center, New York
| | - Joyce H. Lee
- New York University School of Medicine, Comprehensive Epilepsy Center, New York
| | - Rebecca Stainman
- New York University School of Medicine, Comprehensive Epilepsy Center, New York
| | - Daniel Friedman
- New York University School of Medicine, Comprehensive Epilepsy Center, New York
| | - Orrin Devinsky
- New York University School of Medicine, Comprehensive Epilepsy Center, New York
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25
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Kamoun Feki F, Fendri Kriaa N, Kolsi D, Rabai A, Fakhfakh F, Charfi Triki C. Clinical and genetic aspect of 30 tunisian families with febrile seizures. Tunis Med 2019; 97:525-532. [PMID: 31729702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND FS are the most benign occasional seizures in childhood. Little is known about the long term follow up. Aim: To describe a long term follow-up of FS in Tunisian families. METHODS Field study was conducted for 30 patients with FS. We analyzed clinical phenotype of FS and associated afebrile seizures with genetic study. RESULTS We collected 107 individuals with febrile and / or afebrile seizures. Afebrile seizures were found in 28.3% of patients. The "FS" phenotype was found in 18 families (60%), "GEFS +" in 7 (23.33%), and idiopathic generalized epilepsy in 5 (16.66%). Sequencing analyses of SCN1A, SCN1B and GABRG2 genes revealed a novel SCN1B gene mutation in one family with FS and a known SCN1A mutation in GEFS+ family. CONCLUSION If FS are apparently isolated and infrequent, they occur most often in a family setting. The genetic studies remain difficult mainly because of the lack of phenotype-genotype correlation.
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Yokomichi H, Mochizuki M, Lee JJ, Kojima R, Yokoyama T, Yamagata Z. Incidence of hospitalisation for severe complications of influenza virus infection in Japanese patients between 2012 and 2016: a cross-sectional study using routinely collected administrative data. BMJ Open 2019; 9:e024687. [PMID: 30782739 PMCID: PMC6340484 DOI: 10.1136/bmjopen-2018-024687] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To calculate the incidence of hospitalisation due to acute respiratory failure, pneumonia, acute respiratory distress syndrome (ARDS), febrile seizures and encephalitis/encephalopathy among influenza-positive patients in Japan, where point-of-care tests are routinely used to diagnose influenza. DESIGN A cross-sectional study using routinely collected data. SETTING Japanese clinics and hospitals between 2012 and 2016. PARTICIPANTS Japanese patients aged 0-74 years diagnosed with influenza by a rapid test in employment-related health insurance records. PRIMARY OUTCOME MEASURES Incidence of hospitalisation per 100 000 influenza-positive episodes. RESULTS We included over 16 million influenza-positive episodes, 1.0% of whom were hospitalised. Of these, 3361 were acute respiratory failure, 27 253 pneumonia, 18 ARDS, 2603 febrile seizure and 159 encephalitis/encephalopathy. The percentage of hospitalisations by age was 2.96% of patients aged 0-1 years, 0.77% aged 2-5, 0.51% aged 6-12, 0.78% aged 13-18, 1.36% aged 19-44, 1.19% aged 45-64, and 2.21% aged 65-74. The incidence of hospitalisations from these five complications combined was highest in influenza-positive patients aged 0-1 years (943 per 100 000) compared with 307 in those aged 2-5 years and 271 in those aged 65-74 years. For pneumonia, the incidence was highest for influenza-positive patients aged 0-5 years and 65 years or more. There were statistically significant decreasing trends over the years in the incidence of all-cause hospitalisations, pneumonia and febrile seizures. CONCLUSIONS Japanese administrative data revealed that 1.0% of influenza-positive patients aged under 75 years were hospitalised. Male patients had a higher incidence of pulmonary complications and febrile seizures. Children aged 0-5 years and adults aged 65-74 years were at high risk of being admitted to hospital for pneumonia.
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Affiliation(s)
- Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Chuo City, Japan
| | - Mie Mochizuki
- Department of Pediatrics, University of Yamanashi, Chuo City, Japan
| | - Joseph Jonathan Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Reiji Kojima
- Department of Health Sciences, University of Yamanashi, Chuo City, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako City, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, University of Yamanashi, Chuo City, Japan
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Tsai JD, Mou CH, Chang HY, Li TC, Tsai HJ, Wei CC. Trend of subsequent epilepsy in children with recurrent febrile seizures: A retrospective matched cohort study. Seizure 2018; 61:164-169. [PMID: 30172997 DOI: 10.1016/j.seizure.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Trends of epilepsy in children were correlated with febrile seizure (FS) in a previous retrospective study. In the present study, the authors obtained relevant data from a nationwide cohort database to investigate trends in subsequent epilepsy in children with a history of recurrent FS. METHODS A total of 10,210 children with FS comprised the cohort. The diagnosis date was used as the index date. A comparison cohort was randomly matched with each case based on age, sex, urbanization level, parents' occupation, and index date. Cox proportional hazard regression was performed to estimate the hazard ratio and confidence interval of FS-associated epilepsy. RESULTS This retrospective cohort study included 7729 children with FS and a comparison cohort of 30,916 children. The incidence of epilepsy was 11.4-fold higher in the FS cohort than in the comparison cohort (5.67 vs. 0.49 per 1000 person-years, respectively). Compared with the comparison cohort, the epilepsy incidence rate ratio increased in children with admissions for FS, from 8.62 at 1 admission to 26.2 at ≥2 admissions (95% CI 6.80-10.9, and 19.78-34.8, respectively; p for trend < 0.0001). CONCLUSION FS may increase the risk for subsequent epilepsy in children. Recurrent FS increased the cumulative incidence of epilepsy.
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Affiliation(s)
- Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Paediatrics, Chung Shan Medical University and Hospital, Taichung, Taiwan
| | - Chih-Hsin Mou
- Institute of Clinical and Medical Science, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Henry J Tsai
- Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
| | - Chang-Ching Wei
- Children's Hospital, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
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García Peñas JJ. [Evaluation of a child with a first unprovoked seizure]. Medicina (B Aires) 2018; 78 Suppl 2:6-11. [PMID: 30199358] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Paroxysmal episodes are one of the most common neurological disorders in children. It is important to distinguish between paroxysmal non-epileptic events, symptomatic seizures, febrile seizures, and unprovoked seizures. Patient's history is the key to proper diagnosis in most of the cases. A single unprovoked seizure is a frequent phenomenon in the pediatric population. Studies of recurrence after a first unprovoked seizure show percentages between 23% and 96% over a median follow-up of two years. The aim of this study is to define how to evaluate the first unprovoked epileptic seizure in a child and to review the weight of the different recurrence risk factors. Several factors enable us to predict the recurrence risk after a first unprovoked seizure including family history of epilepsy, prior history of febrile seizures, age at onset, type of seizure, prolonged seizures at onset, multiple seizures in a single day, sleep state, neurological abnormalities, etiology, and abnormalities in the electroencephalogram. The most important of these risk factors are the etiology of the seizures and the evidence of epileptiform abnormalities in the electroencephalogram.
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Affiliation(s)
- Juan José García Peñas
- Unidad de Epilepsia, Sección de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España. E-mail:
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Gencpinar P, Yavuz H, Bozkurt Ö, Haspolat Ş, Duman Ö. The risk of subsequent epilepsy in children with febrile seizure after 5 years of age. Seizure 2017; 53:62-65. [PMID: 29127859 DOI: 10.1016/j.seizure.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 10/04/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Despite their age-dependent definition, febrile seizures (FS) may be observed in people of almost any age. The risk of developing unprovoked seizures after an FS is well defined. However, there are limited data about FS starting or persisting after 5 years of age. In the present study, we evaluated patients who developed FS after 5 years of age. METHOD Between 2010 and 2014, we prospectively enrolled all patients with FS. We collected demographic and clinical features, radiologic images, electroencephalograms (EEGs), and results of psychomotor development tests and treatment data of the patients. The patients were grouped into two groups. Group 1 consisted of patients who had the first FS after 5 years of age, and group 2 consisted of patients in whom FS persisted after 5 years of age. Fisher's exact test and Pearson's chi-square test were used to analyse the study data and derive conclusions. RESULTS Sixty-four patients were enrolled, and afebrile seizure was observed in 12 (18.8%) of them. Nine (14%) patients were diagnosed to have epilepsy in their follow-up examination. Subsequent epilepsy occurrence was independent of gender, mean age, medical history of the patient, family history of epilepsy, presence of afebrile seizure, type of seizure, type of FS, duration of seizure, semiology of seizure, peak fever and EEG and magnetic resonance imaging (MRI) findings in our total cohort. There were no statistical differences between the groups with regard to the occurrence of subsequent afebrile seizure or epilepsy (p>0.5). CONCLUSION Close follow-up is important in patients with FS after the age of 5 years. These seizures are generally benign, but tend to recur and increase the risk of development of epilepsy in the patient. Further studies with a larger cohort are warranted to clarify risk factors and incidence of epilepsy in these patients.
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Affiliation(s)
- Pinar Gencpinar
- Department of Pediatric Neurology, Izmir Katip Celebi University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hamdi Yavuz
- Department of Pediatrics, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Öznur Bozkurt
- Department of Pediatric Neurology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Şenay Haspolat
- Department of Pediatric Neurology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Özgür Duman
- Department of Pediatric Neurology, Akdeniz University, Faculty of Medicine, Antalya, Turkey.
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Abstract
BACKGROUND Febrile seizure is the most common convulsive event during childhood, but it is generally considered benign. OBJECTIVES To estimate the rate of epilepsy after first presentation of febrile seizure and to describe factors that can predispose children to have subsequent epilepsy after their first febrile seizure. DESIGN Retrospective chart review. SETTING A tertiary care center in Riyadh. PATIENTS AND METHODS All children whose first febrile seizure developed between 2009-2012, and who were admitted to the pediatric wards. MAIN OUTCOME MEASURES The rate of epilepsy and prognostic factors for epilepsy following first febrile seizure. RESULTS Of 109 febrile seizure patients, 6 (5.5%, 95% CI: 2.1% - 11.6%) were diagnosed with subsequent epilepsy 5 to 46 months after their first febrile seizure. The risk of having subsequent epilepsy was higher in children who were convulsing at a low-grade fever during their first febrile convulsion (P=.02). Moreover, delayed vaccination status (P=.03), prolonged duration of the first convulsion (P=.04), frequent febrile seizures (P=.01), and fever without documented infection (P=.03) during the first febrile convulsion were associated with epilepsy. CONCLUSION The rate of epilepsy following first febrile seizure in Saudi children is within the range of values reported in different populations. Although most childhood febrile seizures are self-limiting, careful observation is needed, particularly for children who exhibit factors associated with epilepsy. LIMITATIONS Conducted at a single center in Saudi Arabia, which may limit generalizability.
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Affiliation(s)
- Abdullah I Almojali
- Dr. Abdullah Ibrahim Almojali, College of Medicine, King Saud bin Abdulaziz University for Health Sciences,, PO Box 22490, Riyadh 11426, Saudi Arabia, T: +966-11-4299999, , http://orcid.org/0000-0003-4208-4196
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Kwak BO, Kim K, Kim SN, Lee R. Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis. Seizure 2017; 52:27-34. [PMID: 28957722 DOI: 10.1016/j.seizure.2017.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/24/2017] [Accepted: 09/14/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The association between iron deficiency anemia (IDA) and febrile seizures (FS) during childhood is inconclusive due to inconsistent results reported in different studies. We performed a systematic review and meta-analysis to determine an association between IDA and FS in children. METHODS We searched PubMed, EMBASE, and Cochrane Library databases for studies published up to August 2015 using the following key words: ["iron deficiency" OR "iron status"] AND ["febrile seizure" OR "febrile convulsion"] AND ["pediatric" OR "infant" OR "child"]. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using standard meta-analysis techniques. Subgroup analysis also was performed. RESULTS A total of 17 studies enrolling 2416 children with FS and 2387 controls were included in the meta-analysis. The results indicated that IDA was significantly associated with FS (OR, 1.98; 95% CI, 1.26-3.13; P=0.003). Subgroup analyses evaluated the diagnostic indices for IDA including serum iron, plasma ferritin, and mean corpuscular volume (MCV). The results indicated that IDA diagnosed on the basis of plasma ferritin (OR, 3.78; 95% CI, 1.80-7.94; P<0.001) or MCV (OR, 2.08; 95% CI, 1.36-3.17; P=0.001) was modestly associated with FS, whereas IDA diagnosed on the basis of two serum iron studies was not associated with FS (OR, 0.57; 95% CI, 0.24-1.37; P=0.210). CONCLUSION The results of this meta-analysis suggest that IDA is associated with an increased risk of FS in children.
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Affiliation(s)
- Byung Ok Kwak
- Department of Microbiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyungmin Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Soo-Nyung Kim
- Department of Obstetrics and Gyneology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ran Lee
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul 05030, Republic of Korea.
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Gontko-Romanowska K, Żaba Z, Panieński P, Steinborn B, Szemień M, Łukasik-Głębocka M, Ratajczak K, Chrobak A, Mitkowska J, Górny J. The assessment of risk factors for febrile seizures in children. Neurol Neurochir Pol 2017; 51:454-458. [PMID: 28803641 DOI: 10.1016/j.pjnns.2017.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 12/13/2016] [Accepted: 07/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the paper was to assess the risk factors of febrile seizures in children. METHODS The paper presents an analysis of a group of 176 children aged 6 months to 5 years who were admitted to A&E because of febrile seizures. RESULTS The analysed group of 176 children comprised 61.96% boys and 38.07% girls, and the average age equalled 23 months. Family history was significant in 9.66% of patients. A statistically significant difference was noticed between insignificant family history and the incidence of febrile seizures. In all the studied groups of children the factor that determined the incidence of febrile seizures was a sudden increase in the body temperature with an infection of the upper respiratory tract of several day's duration as another cause. Febrile seizure incident was most frequently associated with a sudden increase in the body temperature in 53.40% children. A statistically significant difference was observed between persisting fever and an increase thereof during the day. Yet another factor predisposing for febrile seizures incidence was an infection of the upper respiratory system that could be observed in 32.95% patients. The mean body temperature when the seizures occurred was 38.9°C. CONCLUSIONS A sudden increase in the body temperature within the first day of pyrexia predisposes for the incidence of febrile seizures and it was proved that it depends on how long fever persists during the day. The other factor triggering the seizures was an infection of the upper respiratory tract of several days' duration.
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Affiliation(s)
- Krystyna Gontko-Romanowska
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland; Specialised Health Care Centre for Mother and Child, Poznan, Poland.
| | - Zbigniew Żaba
- Specialised Health Care Centre for Mother and Child, Poznan, Poland
| | - Paweł Panieński
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland; Specialised Health Care Centre for Mother and Child, Poznan, Poland
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Szemień
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Krystian Ratajczak
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Adrian Chrobak
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Mitkowska
- Specialised Health Care Centre for Mother and Child, Poznan, Poland
| | - Jacek Górny
- Department of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Siddiqui HB, Haider N, Khan Z. Frequency of acute bacterial meningitis in children with first episode of febrile seizures. J PAK MED ASSOC 2017; 67:1054-1058. [PMID: 28770886] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the frequency of acute bacterial meningitis in children with first episode of febrile seizures. METHODS This cross-sectional study was conducted at the Polyclinic, Postgraduate Medical Institute, Islamabad, Pakistan, from December 2012 to August 2013, and comprised patients with first episode of fever and seizure. SPSS 10 was used for data analysis. RESULTS Of the157 patients, 12(7.6%) were diagnosed to have acute bacterial meningitis with 5(41.6%) in the age group of 6-12 months, 4(33.3%) in 13-18 months and 3(25%) in the age group of 19-60 months. CONCLUSIONS Clinicians evaluating children after a febrile seizure should direct their attention toward identifying the cause of the child's fever.
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Affiliation(s)
| | - Nighat Haider
- Consultant Pediatrician, Shifa International Hospital, Pakistan
| | - Zarmast Khan
- Pediatrics, Shifa College of Medicine, Islamabad, Pakistan
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Aziz KT, Ahmed N, Nagi AG. Iron Deficiency Anaemia As Risk Factor For Simple Febrile Seizures: A Case Control Study. J Ayub Med Coll Abbottabad 2017; 29:316-319. [PMID: 28718256] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Febrile fits is common problem in children. Among other risk factors, iron deficiency anaemia is considered as aggravating factor for febrile fits. Iron deficiency anaemia is preventable and treatable disease. The objective of the study was to find out iron deficiency anaemia as risk factor for febrile fits. METHODS It was a case control study. Thirty cases of febrile fits were recorded. Control group of 30 cases was taken at the same time with same variables but without febrile fits. Their temperatures and weights were recorded and laboratory haematological parameters haemoglobin, haematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), Red Blood Count (RBC) and Red Cell Distribution Width values were collected and analysed statistically with SPSS Ver 20.0. RESULTS In case group 21 had haemoglobin <11.0 gm% while in control group 13 cases had haemoglobin <11.0 gm% (Odd Ratio 3.0513 95% CI 1.0533-8.8390) Mean Haematocrit, RBC, MCV, MCH, MCHC and RDW had statistically significant difference between the two groups (p-value <0.05). CONCLUSIONS As Iron Deficiency Anaemia is a risk factor for febrile fits, treatment and prevention of iron deficiency anaemia can decrease incidence of febrile fits.
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Affiliation(s)
- Khawaja Tahir Aziz
- Department of Paediatrics, AJK Medical College/Shaikh Khalifa Bin Zayed Al-Nahyan Hospital/CMH, Muzaffarabad-Azad Jammu & Kashmir, Pakistan
| | - Naheem Ahmed
- Department of Paediatrics, AJK Medical College/Shaikh Khalifa Bin Zayed Al-Nahyan Hospital/CMH, Muzaffarabad-Azad Jammu & Kashmir, Pakistan
| | - Abdul Ghaffar Nagi
- Department of Paediatrics, AJK Medical College/Shaikh Khalifa Bin Zayed Al-Nahyan Hospital/CMH, Muzaffarabad-Azad Jammu & Kashmir, Pakistan
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RTS,S/AS01E malaria vaccine (MoSQUIRIX*) Children living in malaria-endemic regions: little efficacy, poorly documented harms. Prescrire Int 2017; 26:5-8. [PMID: 30730633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Malaria remains a major public health problem in most tropical coun- tries. Plasmodium falciparum infection can be life-threatening, especially in children. Insecticide-treated bed nets have been shown to reduce deaths due to malaria among young children. A malaria vaccine (RTS,S/AS01E) containing two adjuvants has been assessed for its ability to prevent P. falciparum malaria among young children living in endemic areas. The clinical data have been analysed by the European Medicines Agency (EMA) in conjunction with the World Health Organization (WHO). Efficacy has been evaluated in sub-Saharan African countries. Two trials including a total of more than 16 000 children aged 6 weeks to 17 months compared the malaria vac- cine with a rabies vaccine or a menin- gococcal vaccine. Most of the children were healthy, had ready access to healthcare, and were protected with bed nets. In these trials, three injections of the malaria vaccine one month apart did not reduce overall mortality or malaria mortality in low-mortality settings. In the year following vaccina- tion, the risk of malaria episodes was reduced by about 30% among children aged 6 to 12 weeks and by about 50% among those aged 5 to 17 months.The incidence of severe malaria was only reduced in the older age group. Vac- cine efficacy waned rapidly over time, even with a booster dose at 18 months. During clinical trials, reactions at the injection site and systemic reac- tions were more frequent with the malaria vaccine than with the compara- tor vaccines. Febrile seizures during the days following vaccination were 2 to 5 times more frequent with the malaria vaccine among children aged 5 to 17 months. The malaria vaccine may also carry a risk of meningitis, as well as a risk of pneumonia among HIV-infected children and premature infants.
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Zurynski YA, McRae JE, Quinn HE, Wood NJ, Macartney KK. Paediatric Active Enhanced Disease Surveillance inaugural annual report, 2014. Commun Dis Intell (2018) 2016; 40:E391-E400. [PMID: 28278415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment of selected uncommon vaccine preventable diseases and potential adverse events following immunisation (AEFI). PAEDS enhances other Australian surveillance systems by providing prospective detailed clinical and laboratory data for the same child. METHODS Specialist surveillance nurses screen hospital admissions, emergency department records, laboratory and other data, to prospectively identify hospitalised children aged under 15 years in 5 paediatric tertiary referral hospitals in New South Wales, Victoria, South Australia, Western Australia and Queensland. Standardised protocols and case definitions are used across all sites. Conditions under surveillance include vaccine preventable diseases: acute flaccid paralysis, varicella, pandemic and seasonal influenza and pertussis, and potential AEFIs: febrile seizures and intussusception. PAEDS also conducts surveillance for acute childhood encephalitis. RESULTS Since August 2007, PAEDS has recruited a total of 6,227 hospitalised cases in total, for all conditions. From January to December 2014, there were 1,220 cases recruited across all conditions. Key outcomes include: enhanced acute flaccid paralysis surveillance to reach World Health Organization targets; supporting varicella and influenza vaccination in children; confirmation of a known low risk of febrile seizures following the 1st dose of measles-mumps-rubella vaccine but no increased risk of febrile seizures after measles-mumps-rubella-varicella vaccine, and a slightly increased risk of developing intussusception 1-7 days after rotavirus vaccination in infants aged less than 3 months. Acute childhood encephalitis data facilitated rapid investigation and response to the enterovirus 71 outbreak in 2013-2014. CONCLUSIONS PAEDS provides unique policy-relevant data. This is the first of planned PAEDS annual reports to Communicable Diseases Intelligence.
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Affiliation(s)
- Yvonne A Zurynski
- Deputy Director, Australian Paediatric Surveillance Unit, Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales
| | - Jocelynne E McRae
- PAEDS Network Manager, Clinical Nurse Consultant, National Centre for Immunisation Research and Surveillance, Kids Research Institute, The Children's Hospital at Westmead, New South Wales
| | - Helen E Quinn
- Senior Research Fellow, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Kids Research Institute, The Children's Hospital at Westmead; New South Wales
- Lecturer, Child and Adolescent Health, University of Sydney, New South Wales
| | - Nicholas J Wood
- Clinical Research Fellow, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Kids Research Institute, The Children's Hospital at Westmead; New South Wales
| | - Kristine K Macartney
- Deputy Director, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Kids Research Institute, The Children's Hospital at Westmead; New South Wales
- Associate Professor, Discipline of Child and Adolescent Health, University of Sydney, New South Wales
- Staff Specialist, Department of Microbiology and Infectious Diseases, The Children's Hospital at Westmead, New South Wales
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Agrawal J, Poudel P, Shah GS, Yadav S, Chaudhary S, Kafle S. Recurrence Risk of Febrile Seizures in Children. J Nepal Health Res Counc 2016; 14:192-196. [PMID: 28327685] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Identifying children with febrile seizure who are at risk for recurrence is important so that special attention can be given to them. The objective of this study was to identify the risk factors for recurrence of febrile seizures in children. METHODS This prospective hospital based study was conducted from July 2013 to August 2014 'among children of 6 months to 6 years of age at Bishweshwar Prasad Koirala Institute of Health Sciences (BPKIHS), Nepal. Children meeting the selection criteria were enrolled in study. Clinical, investigation, treatment and outcome parameters were analyzed. RESULTS A total of 92 children with febrile seizure were enrolled in study. Males accounted for 70% and females 30%. Simple febrile seizure was present in 48% and complex febrile seizures were seen in 52%. Recurrence of seizure was seen in one third of cases. Loss of consciousness was most common post-ictal phenomenon followed by confusion and lethargy. Upper respiratory infection was the most common precipitating factor. Generalized Tonic Clonic Seizure was the most common seizure type present in 79% of cases. Significant risk factors for recurrence occurred in males (p=0.088), age less than 1 year (p=0.003). Most of the recurrence occurred within one year of first seizure. CONCLUSIONS Febrile Seizure is common in males. Almost one third of children with febrile seizure are at risk for recurrence. The significant risk factors for recurrences are male gender and age <1year.
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Affiliation(s)
- J Agrawal
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - P Poudel
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - G S Shah
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Yadav
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Chaudhary
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Kafle
- Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Li R, Stewart B, McNeil MM, Duffy J, Nelson J, Kawai AT, Baxter R, Belongia EA, Weintraub E. Post licensure surveillance of influenza vaccines in the Vaccine Safety Datalink in the 2013-2014 and 2014-2015 seasons. Pharmacoepidemiol Drug Saf 2016; 25:928-34. [PMID: 27037540 PMCID: PMC10878475 DOI: 10.1002/pds.3996] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/29/2016] [Accepted: 02/14/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE The changes in each year in influenza vaccine antigenic components as well as vaccine administration patterns may pose new risks of adverse events following immunization (AEs). To evaluate the safety of influenza vaccines annually administered to people ≥ 6 months, we conducted weekly post licensure surveillance for seven pre-specified adverse events following receipt of influenza vaccines during the 2013-2014 and 2014-2015 seasons in the Vaccine Safety Datalink (VSD). METHODS We used both a historically-controlled cohort design with the Poisson-based maximized sequential probability ratio test (maxSPRT) and a self-controlled risk interval (SCRI) design with the binomial-based maxSPRT. For each adverse event outcome, we defined the risk interval on the basis of biologic plausibility and prior literature. For the historical cohort design, numbers of expected adverse events were calculated from the prior seven seasons, adjusted for age and site. For the SCRI design, a comparison window was defined either before vaccination or after vaccination, depending on each specific outcome. RESULTS An elevated risk of febrile seizures 0-1 days following trivalent inactivated influenza vaccine (IIV3) was identified in children aged 6-23 months during the 2014-2015 season using the SCRI design. We found the relative risk (RR) of febrile seizures following concomitant administration of IIV3 and PCV13 was 5.3 with a 95% CI 1.87-14.75. Without concomitant PCV 13 administration, the estimated risk decreased and was no longer statistically significant (RR: 1.4; CI: 0.54 - 3.61). CONCLUSION No increased risks, other than for febrile seizures, were identified in influenza vaccine safety surveillance during 2013-2014 and 2014-2015 seasons in the VSD. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rongxia Li
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brock Stewart
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael M. McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Alison Tse Kawai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | | | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Postnatal steroids and febrile seizures. Arch Dis Child 2016; 101:740. [PMID: 27435741 DOI: 10.1136/archdischild-2016-311455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 11/04/2022]
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Maimburg RD, Olsen J, Sun Y. Neonatal hyperbilirubinemia and the risk of febrile seizures and childhood epilepsy. Epilepsy Res 2016; 124:67-72. [PMID: 27259071 DOI: 10.1016/j.eplepsyres.2016.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 02/05/2016] [Accepted: 05/17/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of the study was to estimate the association between newborn children treated with phototerapy for hyperbilirubinemia and the subsequent risk of febrile seizures or epilepsy in early childhood. METHODS We conducted a follow-up study of singleton children (N=70 230) born between February 1998 and May 2003 from the Danish National Birth Cohort (DNBC). Information on exposure to phototherapy for hyperbilirubinemia was obtained from a questionnaire in the DNBC. Information on epilepsy and febrile seizures were obtained from the Danish National Hospital Registry (DNHR). Cox proportional hazard regression model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). RESULTS Newborns treated with phototherapy for hyperbilirubinemia had a higher risk of developing epilepsy in early childhood (HR: 1.66, 95% CI: 1.23-2.24) but not febrile seizures (HR: 1.04, 95% CI: 0.86-1.27). The increases risk of epilepsy were only present for boys (HR: 1.98, 95% CI: 1.40-2.78) not for girls (HR: 1.14, 95% CI: 0.64-2.02) CONCLUSION: Phototherapy for hyperbilirubinemia in newborns was associated with an increased risk of epilepsy for males in early childhood. No excess risk was seen with febrile seizures.
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Affiliation(s)
- Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Denmark; Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark.
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Section of Epidemiology, School of Public Health, University of California at Los Angeles, CA, USA.
| | - Yuelian Sun
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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Hussain S, Tarar SH. Febrile seizrues: demographic, clinical and etiological profile of children admitted with febrile seizures in a tertiary care hospital. J PAK MED ASSOC 2015; 65:1008-1010. [PMID: 26338751] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The hospital-based prospective study was conducted in Combined Military Hospital, Kharian, Pakistan, from January 2012 to December 2013, to determine the demographic, clinical and aetiological profile of paediatric patients admitted with febrile seizures. Patients clinically diagnosed as a case of febrile seizure were included in study. Patient's information was collected using a predesigned proforma. Out of total enrolled 100 children, 68(68%) were male and 32(32%) female. Mean age of the sample was22.58±12.50 months. Mean time interval between onset of fever and occurrence of seizures was17.68±12.09 hours. Overall, 78(78%) patients had simple seizures. Only 30(30%) patients had positive family history and 35(35%) had recurrence of seizures during the same episode of illness. Acute respiratory infection was the commonest cause for FS in 72(72%).Besides, 64(64%) patients were malnourished, 77(77%) had anaemia and 51(51%) had raised total leukocyte count.
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Affiliation(s)
- Shabbir Hussain
- Paediatrics Department, Combined Military Hospital, Kharian, Pakistan
| | - Saba Haider Tarar
- Paediatrics Department, Combined Military Hospital, Kharian, Pakistan
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Li N, Chen YZ, Zhou KY. [Changing trends and clinical characteristics of febrile seizures in children]. Zhongguo Dang Dai Er Ke Za Zhi 2015; 17:176-179. [PMID: 25760845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics and changing trends of febrile seizures (FS) in children. METHODS The clinical data of 1 922 children with FS admitted from 2004 to 2013 were analyzed retrospectively. The clinical characteristics and changing trends of FS in the two five-year periods were analyzed. RESULTS In 1 922 children with FS, the male/female ratio was 2.27:1. The mean age at onset was 3.0±1.8 years, while the peak age at onset was 1-3 years. There were 1 556 children (80.96%) with simple FS and 366 (19.04%) with complex FS. The number of children with FS in the second five-year period (1 202 cases) increased by 66.9% compared with that in the first five-year period (720 cases). The proportion of children with complex FS was significantly higher in the second five-year period than in the first five-year period (21.13% vs 15.56%; P<0.05). In children with simple FS, there were no significant differences in the age and body temperature at onset, convulsion duration, and the incidence of complications between the two five-year periods (P>0.05). However, children with complex FS had a significantly lower age at onset, a significantly lower body temperature at onset, a significantly longer convulsion duration, and a significantly higher incidence of complications including myocardial injury and hyponatremia in the second five-year period than in the first five-year period (P<0.05). CONCLUSIONS In the last decade, the number of children with FS and incidence of complex FS increased, and the outcome became worse according to clinical characteristics, suggesting that more attention should be paid to timely diagnosis and treatment of complex FS.
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Affiliation(s)
- Ning Li
- Department of Pediatrics, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medical University, Shenzhen, Guangdong 518000, China.
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Klopfer SO, Stek JE, Petrecz M, Reisinger KS, Black SB, Goveia MG, Nicholson O, Gardner JL, Grosso AD, Brown ML, Kuter BJ, Schödel FP. Analysis of safety data in children after receiving two doses of ProQuad® (MMRV). Vaccine 2014; 32:7154-60. [PMID: 25219563 DOI: 10.1016/j.vaccine.2014.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND In randomized clinical studies, over 11,800 children, 12 months to 6 years of age, were administered ProQuad(®), a combination measles, mumps, rubella, and varicella vaccine (MMRV). This paper describes the safety following a 2-dose regimen of MMRV administered to children in the second year of life. METHODS Safety data from five clinical studies were combined for all children who were scheduled to receive two doses of MMRV ∼3-6 months apart. All vaccinated children were followed for safety following each dose of MMRV. RESULTS Of 3112 children who received a first dose of MMRV, 2780 (89.3%) received a second dose of MMRV. Overall, 70.5% and 57.7% of children reported ≥1 adverse experiences following first and second doses of MMRV, respectively. Injection-site redness was statistically significantly higher postdose 2 than postdose 1, while injection-site pain/tenderness was statistically significantly higher postdose 1 compared to postdose 2. Rashes were statistically significantly lower postdose 2 compared to postdose 1. Ten febrile seizures (8 postdose 1, 2 postdose 2) were reported following MMRV vaccination. The incidence of febrile seizures postdose 1 of MMRV was 0.26% (8/3019) compared to 0.07% (2/2695) postdose 2 of MMRV. CONCLUSIONS Administration of two doses of MMRV has an acceptable safety profile in children 12 to 23 months of age. There is a small increase in the risk of febrile seizures following the first dose of MMRV as compared to the component vaccines, but the risk for any individual child is relatively low.
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Affiliation(s)
| | - Jon E Stek
- Merck & Co., Inc, Whitehouse Station, NJ, United States
| | - Maria Petrecz
- Merck & Co., Inc, Whitehouse Station, NJ, United States
| | | | - Steven B Black
- Cincinnati Children's Hospital, Cincinnati, OH, United States
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Martinez-Cayuelas E, Herraiz-Martinez M, Villacieros-Hernandez L, Cean-Cabrera L, Martinez-Salcedo E, Alarcon-Martinez H, Domingo-Jimenez R, Perez-Fernandez V. [Complex febrile crises: should we change the way we act?]. Rev Neurol 2014; 59:449-458. [PMID: 25354507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Febrile seizures are one of the most frequent reasons why patients visit the healthcare specialist. Up until now, patients with complex febrile seizures (CFS) have been hospitalised, bearing in mind the higher percentages of epilepsy and acute complications that were classically reported. Today there are studies that back the idea of being less invasive in the management of these patients. AIMS. To describe the characteristics of patients hospitalised due to CFS and to propose a new protocol to be followed in dealing with such cases. PATIENTS AND METHODS The medical records of patients hospitalised because of CFS (January 2010-December 2013) were analysed retrospectively. Epidemiological and clinical data are presented, together with information from complementary tests and about development. RESULTS CFS account for 4.2% of all neuropaediatric cases of admittance to hospital in (67 patients). Mean age at the time of the event: 25 months. A pathological family history existed in 47% of cases, and 31% had a previous personal history of febrile seizures. The CFS lasted less than five minutes in 54% of patients; there were also recurrences, most of them with a total of two crises and during the first day (CFS due to recurrence are the most frequent). None of the complementary tests that were carried out were of any use as a diagnostic aid during the acute phase. During their follow-up, five patients presented complications. Patients with a family history of febrile seizures presented a higher risk of epilepsy or recurrence (p = 0.02), with no significant differences as regards age, number of seizures, febrile interval, epileptic status or type of CFS. CONCLUSIONS The CFS are not associated with greater acute complications, and the complementary examinations do not allow high-risk patients to be distinguished at an early stage. Hospitalising them could be avoided in the absence of other clinical signs and symptoms, and thus be limited to selected cases.
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Abstract
SUMMARY Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.
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Affiliation(s)
- Awa Ba-Diop
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
| | - Benoît Marin
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; CEBIMER: Center of Epidemiology, Biostatitics, and Research Methodology, CHU Limoges, France
| | - Michel Druet-Cabanac
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
| | - Edgard B Ngoungou
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; Unit of Neuroepidemiology and Tropical Infectious Diseases, Department of Epidemiology, Biostatistics, University of Health Sciences, Libreville, Gabon
| | - Charles R Newton
- KEMRI/Wellcome Trust Collaborative Programme, Centre for Geographical Medicine, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, and Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France; CEBIMER: Center of Epidemiology, Biostatitics, and Research Methodology, CHU Limoges, France.
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Sattar S, Saha SK, Parveen F, Banu LA, Momen A, Ahmed AU, Quddush MR, Karim MM, Begum SA, Haque MA, Hoque MR. Intermittent prophylaxis of recurrent febrile seizures with clobazam versus diazepam. Mymensingh Med J 2014; 23:676-685. [PMID: 25481585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Febrile seizures are the most common type of seizure among children that can be prevented by using prophylactic drugs like Clobazam and Diazepam. The present prospective study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh over a period of 1 year from July 2012 to June 2013 to compare the effectiveness of intermittent Clobazam versus Diazepam therapy in preventing the recurrence of febrile seizures and assessed adverse effects of each drug. A total of 65 patients (32 children administered Clobazam and rest 33 children received Diazepam) of simple and complex febrile seizures aged 6 months to 5 years of both sexes were the study population. Data were collected by interview of the patients, clinical examination and laboratory investigations using the research instrument. Data were analyzed by using Chi-square (χ2) Test, Student's 't' Test and Fisher's Exact Test. For all analytical tests, the level of significance was set at 0.05 and p<0.05 was considered significant. The proportion of patients was higher between age 12-36 months and male was predominant in the both Clobazam and Diazepam groups. Over 31% of patients in Clobazam group who experienced episode of fever within 3 months, 40.6% within 6 months and 9.4% within 9 months compared to 36.4% in Diazepam group within 3 months, 45.5% within 6 months & 12.1% within 9 months after discharge from the hospital. Three (9.4%) patients in Clobazam group and 7(21.3%) in Diazepam group who experienced febrile convulsion during the follow up period. From the data adverse effects within 3 and 6 months experienced by the patient's drowsiness, sedation and ataxia were higher in Diazepam group than those in Clobazam group. However, within 9 months lethargy and irritability were somewhat higher in Clobazam group than those in Diazepam group. The mean duration of hospitalization was significantly higher in Diazepam group compared to Clobazam group (6.0±1.0 vs. 4.6±0.08 days, P<0.001). Seven (21.2%) out of 33 children with febrile seizures in Diazepam group had a history of recurrent seizures, whereas 3(9.4%) of 32 children in the Clobazam group. The risks of recurrent febrile seizure in the Diazepam group was 2.6 times greater compared to those in the Clobazam group (P=0.186). The result indicates that Clobazam is safe, efficacious, requires less frequent dosing and has less adverse effects such as drowsiness, sedation, ataxia and irritability as compared to Diazepam. So, Clobazam may be an alternative to Diazepam given intermittently for prevention of recurrent febrile seizures.
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Affiliation(s)
- S Sattar
- Dr Shamima Sattar, Assistant Professor, Department of Pharmacology, Community Based Medical College, Bangladesh (CBMCB), Mymensingh, Bangladesh
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Xu X, Zhang Y, Sun H, Liu X, Yang X, Xiong H, Jiang Y, Bao X, Wang S, Yang Z, Wu Y, Qin J, Lin Q, Wu X. Early clinical features and diagnosis of Dravet syndrome in 138 Chinese patients with SCN1A mutations. Brain Dev 2014; 36:676-81. [PMID: 24168886 DOI: 10.1016/j.braindev.2013.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/23/2013] [Accepted: 10/09/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize the early clinical features of Dravet syndrome (DS) patients with SCN1A gene mutations before the age of one. METHODS SCN1A gene mutation screening was performed by PCR-DNA sequencing and multiple ligation-dependent probe amplication (MLPA). The early clinical features of DS patients with SCN1A mutations were reviewed with attention to the seizures induced by fever and other precipitating factors before the first year of life. RESULTS The clinical data of 138 DS patients with SCN1A gene mutations were reviewed. The median seizure onset age was 5.3 months. Ninety-nine patients (71.7%) experienced seizures with duration more than 15 min in the first year of life. Two or more seizures induced by fever within 24h or the same febrile illness were observed in 93 patients (67.4%). 111 patients (80.4%) had hemi-clonic and (or) focal seizures. Seizures had been triggered by fever of low degree (T<38 °C) in 62.3% (86/138) before the first year of life. Vaccine-related seizures were observed in 34.8% (48/138). Seizures in 22.5% (31/138) of patients were triggered by hot bath. Carbamazepine, oxcarbazepine, lamotrigine, phenobarbital and phenytoin showed either no effect or exacerbating the seizures in our group. CONCLUSION The seizure onset age in DS patients was earlier than that was in common febrile seizures. When a baby exhibits two or more features of complex febrile seizures in the first year of life, a diagnosis of DS should be considered, and SCN1A gene mutation screening should be performed as early as possible. Early diagnosis of DS will help clinicians more effectively prescribe antiepileptic drugs for stronger prognosis.
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Affiliation(s)
- Xiaojing Xu
- Department of Pediatrics, Peking University First Hospital, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, China.
| | - Huihui Sun
- Department of Pediatrics, Beijing Ji Shui Tan Hospital, China
| | - Xiaoyan Liu
- Department of Pediatrics, Peking University First Hospital, China
| | - Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, China
| | - Xinhua Bao
- Department of Pediatrics, Peking University First Hospital, China
| | - Shuang Wang
- Department of Pediatrics, Peking University First Hospital, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, China
| | - Jiong Qin
- Department of Pediatrics, Peking University First Hospital, China
| | - Qing Lin
- Department of Pediatrics, Peking University First Hospital, China
| | - Xiru Wu
- Department of Pediatrics, Peking University First Hospital, China
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Shrestha D, Dhakal AK, Shakya H, Shakya A, Shah SC, Mehata S. Clinical characteristics of children with febrile seizure. J Nepal Health Res Counc 2014; 12:162-166. [PMID: 26032052] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Febrile seizure is common in children below five years of age. This study was conducted to evaluate the clinical profile of children presenting with febrile seizure in a teaching hospital. METHODS This was a descriptive retrospective study among children presenting with febrile seizure in a teaching hospital from July 2009 to June 2013. Children between six months to six years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient's demographic and clinical data were collected from the in-patients records and analyzed. RESULTS This study included 103 children with febrile seizure. Out of which 67% were male. Simple febrile seizure and complex febrile seizure were observed in 76.7% and 23.3% of patients respectively. Majority of children (71.8%)had generalized tonic clonic seizure followed by tonic seizures. Most of children (72.8%) who developed first episode of seizure were below 24 months of age with the mean age of 20.7 (±12.1) months. Overall 33% of patients developed recurrence of febrile seizure and first episode of febrile seizure at age one year or below was associated with the seizure recurrence. Upper respiratory tract infections were the commonest cause of fever in these children. CONCLUSIONS Febrile seizure was observed predominantly in children below age of two years and simple febrile seizure was the ommonest variety. Recurrence of febrile seizure was common and significantly associated with the first episode of febrile seizure at the age of one year or below.
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Affiliation(s)
- D Shrestha
- Department of Pediatrics, KIST Medical College, Lalitpur, Nepal
| | - A K Dhakal
- Department of Pediatrics, KIST Medical College, Lalitpur, Nepal
| | - H Shakya
- Department of Pediatrics, KIST Medical College, Lalitpur, Nepal
| | - A Shakya
- Department of Pediatrics, KIST Medical College, Lalitpur, Nepal
| | - S C Shah
- Department of Pediatrics, KIST Medical College, Lalitpur, Nepal
| | - S Mehata
- Nepal Health Sector Support Programme (NHSSP), MoHP, Nepal
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Abstract
Febrile seizures (FSs) occur in children older than 1 month and without prior afebrile seizures in the absence of a central nervous system infection or acute electrolyte imbalance. Their pathogenesis is multifactorial. The most relevant familial studies evidence an occurrence rate ranging from 10% to 46% and median recurrence rate of 36% in children with positive familial history for FS. The main twin studies demonstrated a higher concordance rate in monozygotic twins with FS than in dizygotic ones. Linkage studies have proposed 11 chromosomal locations responsible to FS attributed to FEB1 to FEB11. Population-based association studies have shown at least one positive association for 14 of 41 investigated genes with FS. The proinflammatory cytokine interleukin 1β (IL-1β) was the most investigated and also gene associated with susceptibility to FS. A possible role in the overlapping of epilepsy and FS was found for 16 of 36 investigated genes. SCN1A, IL-1β, CHRNA4, and GABRG2 were the most commonly involved genes in this context. The genetic background of FS involves the regulation of different processes, including individual and familial susceptibility, modulation of immune response, and neuronal excitability and interactions with exogenous agents such as viruses.
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Abstract
Temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS) commonly arise following early-life long seizures, and especially febrile status epilepticus (FSE). However, there are major gaps in our knowledge regarding the causal relationships of FSE, TLE, HS and cognitive disturbances that hamper diagnosis, biomarker development and prevention. The critical questions include: What is the true probability of developing TLE after FSE? Are there predictive markers for those at risk? A fundamental question is whether FSE is simply a marker of individuals who are destined to develop TLE, or if FSE contributes to the risk of developing TLE. If FSE does contribute to epileptogenesis, then does this happen only in the setting of a predisposed brain? These questions are addressed within this review, using information gleaned over the past two decades from clinical studies as well as animal models.
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Affiliation(s)
- Katelin P. Patterson
- />Department of Anatomy and Neurobiology, University of California-Irvine, Irvine, CA USA
| | - Tallie Z. Baram
- />Department of Anatomy and Neurobiology, University of California-Irvine, Irvine, CA USA
- />Department of Pediatrics, University of California-Irvine, Irvine, CA USA
- />Department of Neurology, University of California-Irvine Medical Center, Irvine, CA USA
| | - Shlomo Shinnar
- />Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
- />Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
- />Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
- />Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
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