Aspectos electroclínicos de la epilepsia temporal mesial / Neuropsychological risk in temporal lobe epilepsy

Introducción: La epilepsia del lóbulo temporal mesial se considera la más frecuente de las epilepsias focales, con signos y síntomas característicos que ayudan a definir su diagnóstico. Contenidos: Dentro de su historia natural, las crisis pueden iniciar en los primeros años de vida, usualmente como episodios febriles con un periodo de remisión, para reaparecer en la adolescencia o en el adulto joven. La presentación electroencefalográfica tiene un patrón característico, con aparición de puntas y ondas agudas interictales en la región temporal anterior, por lo general unilaterales, y con actividad ictal generalmente theta en la misma localización. La causa más frecuente es la esclerosis del hipocampo. El tratamiento con medicamentos anticrisis puede controlar la epilepsia, aunque algunos casos pueden evolucionar a la farmacorresistencia, en la cual la cirugía de epilepsia está indicada, y tiene buenos resultados. Conclusiones: Esta revisión se centra en la descripción de las características electroclínicas de la epilepsia temporal mesial, para hacer un diagnóstico temprano e iniciar un tratamiento adecuado, a efectos de lograr un mejor pronóstico y una mejor calidad de vida para los pacientes con epilepsia y sus familiares.

Introduction: Mesial temporal lobe epilepsy is considered the most common of the focal epilepsies, with characteristic signs and symptoms that help define its diagnosis. Contents: In the natural history of the disease, seizures can begin in the first years of life, usually as febrile seizures with a period of remission, to reappear in adolescence or in the young adult. The electroencephalographic presentation has a characteristic pattern with the appearance of interictal sharp waves and spikes in the anterior temporal region, usually unilateral, and with generally theta ictal activity in the same location. The most common cause is hippocampal sclerosis. Treatment with antiseizure medication can control epilepsy. However, in some cases evolution of drug resistance can occur, leading to epilepsy surgery as the most appropriate treatment, based on its good results. Conclusions: This review focuses on the description of the electroclinical characteristics of temporal mesial epilepsy, in order to make an early diagnosis and adequate treatment, thus providing a better prognosis and quality of life for patients with epilepsy and their families.

Analysis of clinical features of convulsion in rotavirus enteritis and the risk factors for multiple convulsion / 中国医师进修杂志

Objective:To analyze the clinical features of convulsion in rotavirus enteritis and the risk factors of multiple convulsion.Methods:The clinical data of children with rotavirus enteritis complicated with convulsion admitted to Xi'an Children's Hospital from January 2018 to March 2021 were retrospectively analyzed. According to whether there was fever during convulsion, they were divided into febrile seizure (FS) group and afebrile seizure (AFS) group.Results:A total of 274 children with rotavirus enteritis accompanied by convulsion were enrolled. The male to female ratio was 2.26∶1 in the FS group, while the male to female ratio was 1∶1.1 in the AFS group. The median number of vomiting in the AFS group was higher than that in the FS group: 4(2, 6) times per day vs. 2(1, 5) times per day, P<0.01. One convulsion was dominant in the FS group (80.68%), and more than two convulsions in the AFS group (62.90%). In the FS group, 60.23% of convulsions occurred on the first day of the course of disease, while in the AFS group,79.57% of convulsions mainly occurred on the second and third day of the course of disease. There was no statistical difference in duration of convulsion and overall course of disease between the two groups ( P>0.05). The median of hypersensitive C-reactive protein (CRP) and procalcitonin (PCT) in FS group were higher than those in AFS group: 5.52(1.45, 15.50) mg/L vs. 0.98(0.50, 3.17) mg/L, 0.17(0.07, 0.46) μg/L vs. 0.06(0.05, 0.15) μg/L. The median of alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA) and creatine kinase isoenzyme(CK-MB) in the AFS group were higher than those in the FS group: 28.00(21.00, 34.25) U/L vs. 25.00(19.00, 31.00) U/L, 53.00(45.00, 62.00) U/L vs. 50.00(40.00, 58.00) U/L, 390.00(296.00, 474.25) μmol/L vs. 331.00(250.00, 399.75) μmol/L, 67.00(49.75, 94.25) U/L vs. 59.50(37.25, 78.75) U/L, the differences were statistically significant ( P<0.05). The median age and the median of UA levels in ≥3 convulsions group were higher than those in ≤2 convulsions group: 21(18, 26) months vs. 18(15, 21) months, 411.00(296.50, 496.50) μmol/L vs. 364.00(278.00, 440.50) μmol/L, while the median of serum Na +, the mean value of serum Cl - in the ≥3 convulsions group were lower than those in the ≤2 convulsions group: 135.50(133.75, 137.25) mmol/L vs. 136.60(134.50, 138.20) mmol/L, (103.76 ± 3.26) mmol/L vs. (105.08 ± 4.26) mmol/L, the differences were statistically significant ( P<0.05). The age ≥18 months in children with rotavirus enteritis and convulsion ( OR = 3.359, P = 0.002, 95% CI 1.544 - 7.307) and the serum Cl - < 104.8 mmol/L ( OR = 2.17, P = 0.019, 95% CI 1.138 - 4.138) had an increased risk of convulsions ≥3 times during the course of rotavirus enteritis. Conclusions:Rotavirus enteritis FS mostly occurred on the first day of the course of disease, most of them had convulsion once, hs-CRP and PCT were relatively high. In AFS, convulsions were more than 2 times, and occurred on the 2nd and 3rd day of the course of disease. ALT, AST and UA were relatively high. Children with age ≥18 months and serum Cl - < 104.8 mmol/L had an increased risk of convulsions ≥3 times during the course of the disease.

Evaluation of the risk factors for recurrence and the development of epilepsy in patients with febrile seizure / Avaliação de fatores de risco para recorrência e desenvolvimento de epilepsia em pacientes com convulsões febris

Abstract Background Although febrile seizure (FS) is generally considered benign and self-limiting, there are differences regarding the risk factors, the prognosis, and the development of epilepsy. Objective To examine the clinical and sociodemographic characteristics of patients diagnosed with FS, and to determine the risks of recurrence and the development of epilepsy. Methods Between 2015 and 2019, we performed a retrospective evaluation of 300 patients with FS followed for at least 24 months. Results The first episode of FS was simple in 72.7% of the patients and complex in 27.3%, and it recurred in 40%. Age under 12 months in the first FS, complex FS, and neurodevelopmental delay were found to statistically increase the risk of recurrence (p< 0.05). A total of 7% of the patients developed epilepsy, and this rate was found to be higher in patients with neurodevelopmental delay and long-term use of antiepileptic drugs (p< 0.001). The development of epilepsy was also observed in 77.8% of the patients with abnormal electroencephalogram (EEG). Epilepsy developed more frequently in those with abnormal EEG (p<0.001). Conclusions Neurodevelopmental delay was an important risk factor for FS recurrence and the development of epilepsy. Abnormality in the EEG is an important risk factor for the development of epilepsy. We found that the long-term prophylactic treatment did not cause decreases in the recurrence of FS nor in the development of epilepsy.

Resumo Antecedentes Embora a convulsão febril (CF) seja geralmente considerada benigna e autolimitada, existem diferenças nos fatores de risco, prognóstico e desenvolvimento de epilepsia. Objetivo O objetivo foi examinar as características clínicas e sociodemográficas de pacientes diagnosticados com CF e determinar os riscos de recorrência e desenvolvimento de epilepsia. Métodos Trezentos pacientes com CF, acompanhados por pelo menos 24 meses, foram avaliados retrospectivamente entre 2015 e 2020. Resultados A primeira CF foi simples em 72,7% dos pacientes e complexa em 27,3%. CS foi recorrente em 40% dos pacientes. Encontrou-se que a idade da primeira CF inferior a 12 meses, CF complexa e atraso no neurodesenvolvimento aumentaram estatisticamente o risco de recorrência (p< 0,05). Epilepsia se desenvolveu em 7% dos pacientes. A epilepsia foi maior em pacientes com atraso no desenvolvimento neurológico e uso prolongado de drogas antiepilépticas (p< 0,001). A epilepsia se desenvolveu em 77,8% dos pacientes com eletroencefalograma (EEG) anormal. Uma diferença estatisticamente significativa foi determinada em pacientes com EEG anormal em risco de epilepsia (p< 0,001). Conclusões O atraso no neurodesenvolvimento foi um importante fator de risco para recorrência de CF e epilepsia. A anormalidade do EEG é um importante fator de risco para o desenvolvimento de epilepsia. O tratamento de profilaxia a longo prazo não diminuiu a recorrência de CS e o desenvolvimento de epilepsia.

Two cases of febrile infection-related epilepsy syndrome with a literature review / 中国医师杂志

Objective:To explore the clinical features, diagnosis and treatment of febrile infection-related epilepsy syndrome (FIRES).Methods:The clinical data of 2 cases of FIRES admitted to Changde First People′s Hospital from 2020 to 2022 were retrospectively analyzed, and the clinical characteristics, diagnosis and treatment methods and prognosis of the disease were discussed in combination with relevant literature.Results:Two children with FIRES were all acute onset, with fever as the first symptom, and status epilepticus appeared 3 to 5 days later. The efficacy of various antiepileptic drugs was poor. After ketogenic diet treatment, one child recovered well, and another child still had frequent convulsions under ventilator assisted breathing on the 27th day of admission. His family signed to give up the treatment. At the same time, compared with the domestic and foreign literature, the clinical characteristics of the two children are basically the same as those of the reported cases.Conclusions:FIRES is common in healthy children in the past. After seizures, it rapidly progresses to status epilepticus. MRI of the head and cerebrospinal fluid can have no characteristic changes. The effect of routine antiepileptic drugs is not good. Ketogenic diet can improve the condition of children, but the overall prognosis is not good.

Epilepsia refractaria con convulsiones febriles plus en niños con mutaciones de la subunidad alfa de canales de sodio (SCN1A): un reporte de caso / Refractory epilepsy with febrile seizures in a child with sodium channel alpha subunit mutation (SCN1A): A case report

RESUMEN Se presenta caso de una niña de 10 años con cuadro de epilepsia mioclónica juvenil severa en la infancia, que a los 6 meses de edad debutó con crisis tónico-clónicas generalizadas (TCG) luego de la administración de una dosis de vacuna DPT, con posteriores crisis TCG, mioclónicas y múltiples episodios de estado epiléptico refractarios a fármacos antiepilépticos (FAE) de primera y segunda línea durante los primeros 5 años. Las crisis se asociaron a retraso global en el desarrollo luego del primer episodio. Durante la evolución se realizaron estudios que incluyen resonancia magnética cerebral que fue normal y tomografía por emisión de positrones (PET-CT) que evidenció alteraciones en el metabolismo en región temporal izquierda, además de estudios para inmunodeficiencias y trombofilias sin alteraciones. Los electroencefalogramas iniciales fueron normales, pero video electroencefalograma de 12 horas mostró actividad irritativa en la región central con diseminación bilateral. Los estudios genéticos identificaron una mutación en el marco de lectura de tipo "frameshift" del gen SCN1A mediante secuenciación de la región codificante. Luego de los primeros años de vida, la paciente presenta, atípicamente, remisión progresiva de las crisis con posterior desmonte de FAE y mejoría del neuro-desarrollo en el proceso interdisciplinario de rehabilitación.

SUMMARY We report the case of a 10-year-old female with a history of severe myoclonic epilepsy of infancy who presents with generalized tonic-clonic (GTC) seizures at 6 months of age after administration of a DPT vaccine, who then begins to present frequent and severe GTC seizures, myoclonic seizures and multiple refractory status epilepticus poorly controlled with first and second line anti-epileptic drugs (AEDs). This was accompanied by development delay. Studies performed on the patient included brain MRI which was normal, immunodeficiency and trombophilic studies which were normal and electroencephalographs: studies (EEG) that were at first mostly normal. The most significant findings were seen during a 12-hour video-EEG which reported epileptogenic activity in central region with bilateral dissemination and a PET-CT that showed metabolism alterations in the left temporal region. Due to this presentation a channelopathy was suspected and a coding region sequentiation study was performed which identified a frameshift mutation of the SCN1A gene confirming the diagnosis. Atipically, after 5 years the patient begins to present a favorable evolution with significant seizure remission even allowing the progressive weaning of AEDs and a remarkable stalemate of developmental delay after interdisciplinary rehabilitation process was started.

Effect analysis of diazepam combined with phenobarbital in the treatment of febrile convulsions in children / 中国基层医药

To investigate the clinical effect of diazepam combined with phenobarbital in the treatment of febrile convulsions in children.Methods From January 2015 to July 2017,100 children with febrile convulsions in the Women＇s and Children＇s Hospital of Ningbo were selected and divided into two groups by random number table,with 50 cases in each group.The control group was treated with diazepam ,while the observation group was treated with diazepam combined with phenobarbital.The clinical efficacy,anticonvulsive time,myocardial enzyme index,hypersensitive C-reactive protein and incidence of adverse reactions were compared between the two groups . Results (1)The total clinical effective rate of the observation group (98%) was higher than that of the control group (χ2 ＝4.891,P＜0.05),and the time of stopping convulsion [(20.92 ±4.49) min] was shorter than that of the control group(t＝5.443,P＜0.05).(2) After treatment,the creatine kinase isoenzymes [(25.93 ±12.76) U／L], phosphocreatinase [(189.47 ±7.35 ) U／L], hydroxybutyrate dehydrogenase [( 276.73 ±12.85 ) U／L ], lactate dehydrogenase[(305.94 ±13.27)U／L],hypersensitive C-reactive protein[(5.04 ±1.65)ng／L] in the observation group were lower than those in the control group (t＝4.961,5.333,5.901,6.160,5.354,all P＜0.05).(3) During the treatment period, no obvious adverse reactions occurred in both two groups.Conclusion The combination of diazepam and phenobarbital can effectively arrest febrile convulsions in children ,improve the clinical efficacy ,protect myocardial cells,it has fewer adverse reactions ,it is safe and reliable.

Effect analysis of diazepam combined with phenobarbital in the treatment of febrile convulsions in children / 中国基层医药

Objective@#To investigate the clinical effect of diazepam combined with phenobarbital in the treatment of febrile convulsions in children.@*Methods@#From January 2015 to July 2017, 100 children with febrile convulsions in the Women's and Children's Hospital of Ningbo were selected and divided into two groups by random number table, with 50 cases in each group.The control group was treated with diazepam, while the observation group was treated with diazepam combined with phenobarbital.The clinical efficacy, anticonvulsive time, myocardial enzyme index, hypersensitive C-reactive protein and incidence of adverse reactions were compared between the two groups.@*Results@#(1)The total clinical effective rate of the observation group(98%) was higher than that of the control group(χ2=4.891, P<0.05), and the time of stopping convulsion[(20.92±4.49)min] was shorter than that of the control group(t=5.443, P<0.05). (2)After treatment, the creatine kinase isoenzymes[(25.93±12.76)U/L], phosphocreatinase[(189.47±7.35)U/L], hydroxybutyrate dehydrogenase[(276.73±12.85)U/L], lactate dehydrogenase[(305.94±13.27)U/L], hypersensitive C-reactive protein[(5.04±1.65)ng/L] in the observation group were lower than those in the control group(t=4.961, 5.333, 5.901, 6.160, 5.354, all P<0.05). (3)During the treatment period, no obvious adverse reactions occurred in both two groups.@*Conclusion@#The combination of diazepam and phenobarbital can effectively arrest febrile convulsions in children, improve the clinical efficacy, protect myocardial cells, it has fewer adverse reactions, it is safe and reliable.

Síndrome epiléptico ligado al cromosoma X por mutación de la protocaderina 19 (OMIM 300088) asociado con leucoencefalopatía y tractopatía posterior reversible / X-linked epileptic syndrome by protocadherin 19 mutation associated with leukoencephalopathy and posterior reversible tractopathy

La epilepsia con retardo mental ligado al cromosoma X por mutación del gen PCDH19, es una condición que solo se presenta en las mujeres. El cuadro clínico suele verse complicado con retardo global del desarrollo y epilepsia. En la edad adulta puede manifestarse con discapacidad intelectual y hasta 20 % de las mujeres afectadas no presentan convulsiones ni retardo intelectual. Se presenta el caso de una niña con epilepsia, retardo del desarrollo y conversión autista, asociados con leucoencefalopatía y tractopatía posterior reversible por mutación del PCDH19 (c.142G>T/ p.Glu48X).

Epilepsy and mental retardation produced by mutations in gene PCDH19 (protocadherin 19) is an X-linked syndrome restricted to females. It starts with global and speech developmental delay and epilepsy; intellectual disability may continue in adults. At least in 20% of cases, there are no seizures or intellectual retardation. We report the case of a girl with epilepsy, developmental delay, and autistic conversion associated with posterior reversible leukoencephalopathy and tractopathy produced by PCDH19 mutation (c.142G>T/ p.Glu48X).

Research progress of febrile seizures / 中国医师进修杂志

Febrile seizures (FS) is the most common convulsive disorder in childhood and is a frequent problem for pediatricians.Most of the children have a good prognosis, but some children have recurrent attacks. Severe cases can even develop into epilepsy, which can cause great damage to the physical and mental health of children.Further understanding and studying issues related to febrile seizures has become a major concern for pediatricians and many families.This article reviews the definition, incidence, classification, etiology, pathogenesis, and epilepsy correlation and management measures of febrile seizures, and is expected to be applied in clinical practice to provide guidance for the prevention, diagnosis and treatment of febrile seizures.

Current Clinical Features of Febrile Seizures in a Pediatric Emergency Room / 이화의대지

OBJECTIVES: To expand current knowledge on febrile seizures (FSs), the most common childhood seizure disorder, we investigated clinical features and risk factors of FS in the pediatric emergency department of a center in western Seoul. METHODS: Children with FS that visited the pediatric emergency room of the Ewha Womans University Medical Center from January to December 2014 were included in this study. A retrospective medical record review was conducted for a total of 404 seizure events relative to 265 patients. RESULTS: A total of 150 boys and 115 girls were enrolled. Children presenting their first FSs were 70.9% (n=188). Average age of FS onset was 28.9 months. Family history was reported in 95 children (36.8%) with higher relevance of paternal inheritance (44.2%, n=42/95). More than half of the seizures (56.4%, n=228/404) occurred on the first day of fever. The most common cause of fever was upper respiratory tract infection (65.8%, n=266/404). Children attending a daycare center had higher incidence of multiple FS compared to those cared for at home. Approximately one third of seizure events (31.7%, n=128/404) were admission cases, mainly because of prolonged fever. CONCLUSION: FS is a common neurologic disorder with relatively high admission rate among pediatric emergency department visits. Daycare attendance is associated with current increased incidence of multiple FS. Further study with long-term follow up is necessary to expand knowledge on improving clinical care strategy in FS.

Hemorragia intraventricular en recién nacido. Presentación de un caso / Intraventricular Hemorrhage in the Newborn. A Case Report

La hemorragia intraventricular es una grave enfermedad que suele presentarse en las primeras horas o días después del nacimiento pretérmino en niños con peso inferior a 1 500 g. Se presenta el caso de un recién nacido a término, con peso adecuado, masculino, producto de parto no institucional, que a los 17 días fue remitido al Hospital Paquito González Cueto, con fiebre y convulsiones. Ingresó en Unidad de Cuidados Intensivos Pediátricos. Se constató aumento del perímetro cefálico, fontanela anterior tensa e hipertonía global. La ecografía transfontanelar reveló hemorragia subependimaria/intraventricular. Se realizó tomografía computarizada y resonancia magnética para confirmar diagnóstico. La sintomatología y resultados ecoencefalográficos presentaron una evolución satisfactoria como ocurre en el 65 % de casos. Se decidió la presentación del caso por manifestarse la entidad en un recién nacido a término y con peso adecuado, lo que es poco usual y por darse la circunstancia de haber nacido fuera de una institución hospitalaria, por lo que, aunque no se pudo establecer la relación entre este hecho y la enfermedad, contribuye a que los médicos generalistas desarrollen la habilidad de sospechar diagnósticos de tal gravedad en casos que no necesariamente se ajusten a lo que está clásicamente descrito como más frecuente.

Intraventricular hemorrhage is a serious disease that usually occurs in the first hours or days of life, especially in premature infants weighing less than 1500 g. We present the case of full-term newborn with normal birth weight who was non-institutionally delivered. At 17 days old, he was referred to the Paquito González Cueto Hospital because of fever and seizures. Subsequently, he was admitted to the Pediatric Intensive Care Unit. Increased head circumference, tense anterior fontanelle and global hypertonia were found. A transfontanelle ultrasound revealed a subependymal/intraventricular hemorrhage. Computed tomography and magnetic resonance imaging were used to confirm the diagnosis. Symptoms and echoencephalographic results improved as occurs in 65% of cases. We decided to present this case since the condition developed in a full-term newborn with normal weight, which is unusual, and the fact that he was born outside a hospital. Although the relationship between this fact and the disease could not be established, it helps general practitioners to develop the ability to consider such serious diseases in cases that do not necessarily meet what is classically described.

The curative effect of Xingnaojing injection in the treatment of children febrile convulsion / 中国基层医药

Objective To explore the influence of Xingnaojing injection on the duration of fever,convulsions and rate of relapse in the treatment of children with febrile convulsion.Methods Reviewed the medical records of 157 patients with febrile convulsion.Patients were assigned to Xingnaojin treatment (n =68) and conventional therapy group according to whether Xingnaojing injection was added in the conventional treatment(n =89).Collected the duration of fever since they accepted treatment in hospital,whether occurred convulsion again and untoward effect,had a follow -up of 6 months,in order to record whether they had relapse.Results In Xingnaojing group,the duration of fever was (2.43 ±1.38)d,which was shorter than (3.75 ±2.24)d of the control group(t =4.28,P <0.05).The occurrence rate of convulsion again in Xingnaojing group was 11.76%,which was lower than 25.83% of the control group(χ2 =4.821,P <0.05).Following -up for 6 months,Xingnaojing group had better rate of relapse (7.35%) than the control group(20.22%) (χ2 =5.108,P <0.05).No untoward effect was observed.Conclusion Xingnao-jing injection can shorter the duration of fever and prevent convulsion,while without obvious untoward effect,could apply to the treatment of children febrile convulsion.

Clinical characteristics and genetic analysis of a family of febrile seizure with paroxysmal kinesigenic dyskinesia / 中华神经科杂志

Objective To discuss clinical,electroencephalogram(EEG) and PRRT2 gene mutation by reporting a febrile seizure (FS) with paroxysmal kinesigenic dyskinesia (PKD) family.Methods Detailed clinical data of the family were collected.The proband (Ⅳ1) and another 4 patients (Ⅲ1,Ⅲ4,Ⅳ2,Ⅳ3)were studied through clinical examinations.Clinical symptoms of Ⅳ2 were not typical,who was diagnosed as a suspected case.Mutation analysis of PRRT2 gene was screened by polymerase chain reaction (PCR) and DNA direct sequencing in 5 patients (Ⅳ1,Ⅲ1,Ⅲ4,Ⅳ2,Ⅳ3) and 4 unaffected family members (Ⅱ2,Ⅲ2,Ⅲ5,Ⅳ4).Results PKD patients had brief involuntary movements in the limbs or trunk induced by sudden voluntary movement when patients were in the stationary state since the teenagers.Two cases (Ⅲ,Ⅲ4) were accompanied by FS.Three cases(Ⅳ1,Ⅲ1 and Ⅲ4)had abnormal EEG records.The PRRT2 gene mutation (c.649dupC mutation) was identified in a healthy member (Ⅳ4) and 4 patients (Ⅳ1,Ⅲ1,Ⅲ4,Ⅳ3).Conclusions FS with PKD family has a PRRT2 gene mutation.The diagnosis is mainly based on family history,typical clinical manifestations and genetic test.This kind of disease may have pre-symptomatic patients.

Changes of IL-1β and IL-1ra expression in the hippocampus of rats with frequent febrile seizures / 中国小儿急救医学

Objective To evaluate the changes of IL-1β and IL-lra in hippocampus of rats with frequent febrile seizures(FS).Methods 21-day-old male Sprague-Dawley(SD)rats were randomly divided into 3 groups:normal control group(NC group),hyperthermic control group(HC group)and febrile seizures group(FS group).IL-1β and IL-1ra levels in hippocampus of these rats were determined by ELISA methods,IL-1β mRNA and IL-1ra mRNA levels in hippocampus were measured by RT-PCR.Results IL-1β mRNA and protein levels in hippocampus of rats in FS group were significantly higher than those in NC group and HC group(P＜0.01,P＜0.05).IL-1ra mRNA and protein levels in hippocampus of rats in FS group were significantly higher than those in NC group and HC group(P＜0.01,P＜0.05),too.IL-1ra/IL-1β protein ratio showed no significant difference among 3 groups.Conclusion Frequent FS can cause the increase of IL-1β and IL-lra mRNA and protein levels in hippocampus,suggesting that IL-1β and IL-1ra may be involved in the pathogenesis of hippocampal neuron damage in FS rat.

Atualização no diagnóstico e tratamento das crises epilépticas febris / Update on diagnosis and treatment of febrile seizures

As crises epilépticas febris são uma entidade benigna da infância e a maioria das crianças que a apresenta terá apenas um episódio na vida. Apesar disso, as crises geram grande apreensão nos familiares e há grande discussão na literatura sobre quando estes pacientes devem ser tratados e qual a melhor opção terapêutica. Esta revisão traz uma síntese dos dados e recomendações atuais para diagnóstico e tratamento dos pacientes que apresentem crises febris.

Febrile seizures are a benign condition of childhood and most children will have only one episode in their lifetime. Nevertheless, a crisis generates major concern in the family and there is much discussion in literature about when to treat as well as which is the best therapeutic approach. This review summarizes data and current recommendations for diagnosis and treatment of patients with febrile seizures.

Clinical characterstics of roseola infantum with febrile convulsions / 国际儿科学杂志

Objective To explore the clinical characteristics of roseola infantmn with febrile convulsions.Methods All cases with roseola infantum or with febrile convulsions were retrospectively collected who were confirmed during January 2005 to February 2008. There were 31 cases of roseola infantum with febrile convulsions. Their clinical features were compared with cases of roseola infantum without febrile convulsions and eases of other febrile convulsions,respectively, and further analyzed with literature. Results There were 17.1% (3 1 / 181 ) roseola infantum with febrile convulsions among febrile convulsions and 24.4% (31/127)among febrile convulsions less than 2 years;The incidence of roseola infantum with febrile convulsions was 15.7% (31/198) among roseola infantum. The median age of roseola infantum with febrile convulsions was less than that of other febrile convulsions. There were no significant differences in sex, age, maximum body temperature, duration of fever and day of rash onset between roseola infantum with and without febrile convulsions ( P > 0.05 ), but the frequency of family history of febrile convulsions was significantly higher in roseola infantum with febrile convulsions than in those without febrile convulsions ( P < O. 05). Conclusions Familial predisposition is a risk factor in roseola infantum with febrile convulsions. In most cases the prognosis of roseola infantum with febrile convulsions was good,but it can be associated with severe diseases of central nervous system. Roseola infantum should be considered when encountering children under the age of 1 year with a first febrile convulsion.

Expression levels of ICAM-1 and LFA-1 mRNA on PBMC 0f children with febrile seizures / 中国医师杂志

Objective To explore the neuroimmunomedulation mechanism of ICAM-1 and LFA-1 in children with febrile seizures (FS).Methods 40 children with FS were dividedinto simple FS(SFs)groupin20 cases and complex FS(CFS)groupin20 cases,and 30 health children matched with regard to age and sex were enrolled into control group.The real-time fluorescence quantitative PCR wag used to detect the expression of PBMC ICAM-1 mRNA.At the same time,the PBMC LFA-1 mRNA expression wfs studied with Send-QuantitativeRT-PCR analysis.Results The levels of PBMC ICAM-1 mRNA in SFS group were significantly higher than those in control group and CF$group(P<0.05).The levels ofPBMC ICAM-1 mRNA showed downtrend between CFS group and control group.but there was no statistical difference between the two groups(P>0.05).The levels of PBMC LFA-1 mRNA grey-scales in SFS group were significantly higher than those in control group and CFS group(P<0.05).In addition,the levels of PBMC LFA-1 mRNA in CFS group showed downtrend than those in control group,but there wti8 no statistical difference between the two groups(P>0.05).Conclusions The gene expression levels of PBMC ICAM-I/LFA-I in SFS group were different from those in CFS group.Inflammable immunopathology damage induced by ICAM-1/LFA-1 may play an important role in the pathogenesis of SFS.On the contrary,ICAM-1/LFA-1 may have seme neuroprotective effects on the pathogenesis of CFS.

Changes of melatonin and cellular immunological function in children with febrile seizures and its clinical significance / 中国医师杂志

Objective To investigate the changes of melatonin and cellular immunological function in children with febrile seizures and its clinical significance. Methods 50 children, including 23 cases with complex febrile seizure (CFS) and 27 cases with simple febrile seizure (SFS) , and 25 cases with upper respiratory infections children selected as control group were enrolled in this study. Serum melato- nin was measured by enzyme-linked immunosorbent assay (ELISA) and cellular immunological function was measured by flow eytomcter. Results The levels of serum melatonin in the 3 groups of CFS, SFS, control were(14. 91±2. 61) ng/L, (20. 72±2. 54) ng/L, (23.93± 2. Ol) ng/L, respectively. The melatonin levels in CFS children were significantly decreased than that in control group and SFS children (P <0. O1). CD3 + ,CD4 +, the ratio of CD4 + /CD8 + and CD8 + in CFS group were significantly decreased than that in control group and SFS group (P <0.01). The ratio of CD4 +/CD8 + in SFS group was significantly decreased than that in control group (P <0.05), but CD3 + ,CD4 + and CD8 + had no statistics significance among these groups(P >0. 05). The serum rnelatonin level were positive related withdecreaseddegreeofCD3+,CD4+ andtberatioofCD4+ /CDS+ (r≥0. 472, P <0.05). Conclusion The disorder cfcellular immunological function was possible related with the loss of serum melatonin, and the loss of serum melatonin maybe one of the reasons for febrile seizures relapse and brain injured.

Mosaic SCN1A mutation in a family with partial epilepsy with febrile seizures plus / 中华神经科杂志

Objective To study the SCN1A gene in a family with partial epilepsy with febrile seizures plus ( PEFS+ ) and its characteristics of inheritance. Methods The clinical features of the 2 patients and their father were summarized. All 26 exons of SCN1A gene were screened with denaturing high performance liquid chromatography (DHPLC), and direct sequence analysis was pedormed on those with abnormal elution peak. Pyrosequencing was subsequently performed in those without abnormality in direct sequence analysis. Results The proband and his sister had the phenotype of PEFS+ . The same heterozygous mutations (AS768G) on exon 26 which caused the related amino acid change (Q1923R) were found among them. Their father had frequent febrile seizures (FS) in childhood, and seizures stopped spontaneously. No abnormality was found in direct sequence but mosaic mutation in the same site was discovered with pyrosequencing (mutation quantity was 25% ). Conclusions The mutatin of SCN1A could cause partial epilepsy. PEFS+ could be inherited, the relatives carrying the affected gene may have mild clinical symptoms, possibly resulting from the low concentration of the mutated gene due to mosaic mutation.

Effects of febrile seizures in children with abnormal EEG tracing and intelligence summary(Clinical analysis of 112 cases) / 中国基层医药

Objective To study the Effects of febrile seizures in children with abnormal EEG and intelligence,the size of age at onset,duration of the seizure,positive family history,some variation of the epilepsy and mental retardation.Methods Do so within 24 hours of admission EEG 1,two weeks after a review of the EEG.This information painting some patients who do test PPVT test.Results Information in the 28 cases of abnormal EEG activities in the context of epileptiform discharges were eight cases.Select a 2.5-year-old to 5-year-old all abnormal EEG tests were done painting,PPVT test: eight cases of mental retardation,edge-six cases,four cases of mental retardation.Conclusion Effects of febrile seizures first attack aged less than 1 year old or more than six years old,a perinatai brain injury history,with EEG slow wave,a sharp variation can be affected for the slow payment of epilepsy and mental retardation.