Establishment and analysis of nomogram prediction model for early critical changes in children with febrile convulsion / 中国实用护理杂志

Objective:To establish a nomograph prediction model of early critical changes in children with febrile convulsion, and to provide guidance for the prevention and nursing of children with febrile convulsion.Methods:Convenient sampling method was adopted to select 384 children with febrile convulsion in Anhui Children ′s Hospital from January 2018 to April 2021 as the research objects. Based on pews, the children with febrile convulsion were divided into 334 cases of non risk group and 50 cases of risk group. Binary Logistic regression analysis were used to determine the independent risk factors affecting the early critical changes of children with febrile convulsion. A nomogram was drawn based on the independent risk factors. The discrimination and consistency of the model were verified by model ROC curve and Hosmer Lemeshow goodness of fit.The external validation of model prediction efficiency were verified by validation data. Results:Binary Logistic regression analysis showed that age, respiratory rhythm disorder, unconsciousness, breath rate, heart rate, neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), duration of first convulsion and mean body temperature after first convulsion were influence factors for early critical changes in children with febrile convulsion ( P<0.05). The C-index of the model was 0.974 (95% CI 0.954-0.993), and the C-index of the external validation of the model was 0.922 (95% CI 0.880-0.966). The results of H-L fitting test showed that the difference was not statistically significant( χ2=0.29, P>0.05). Conclusions:The early critical changes of children with febrile convulsion may be affected by respiratory rhythm disorder, confusion of consciousness, breath rate, heart rate, NLR, RDW, duration of the first convulsion, mean temperature after the first convulsion and other factors. Pediatric emergency department should collect corresponding intervention measures for children with febrile convulsion according to the establishment of prediction model to prevent their early deterioration.

Association Of Febrile Seizure With Hyponatremia- A Prospective Study

Background & Objective-Febrile seizure is the most common seizure disorder in the pediatric age group and often recurs within the rst twenty four hours. It has been observed that children have lower serum sodium levels was a risk factor for recurrence of febrile seizure. The study was conducted to ascertain the role of serum sodium level in the rst episode of febrile seizure and as a predictor of seizure recurrence within the same febrile illness. Material and methods-It was a prospective observational study conducted at Tertiary medical teaching hospital, in Department of Pediatrics. 55 Children of age 6 months to 60 months presenting with rst episode of seizure with fever in our Hospital were selected for the study. Serum sodium levels were evaluated in all the children. Results-Sr. Sodium level reveals that in 72.73% of the children Sr. Sodium Level was ≤ 135 whereas in 27.27% it was >135 and mean level was 133.49±6.02.Conclusion-Measurement of the serum sodium in a child with febrile seizures helps in predicting seizure recurrence within the same febrile illness.

Hypercalciuria and febrile convulsion in children under 5 years old / 소아과

PURPOSE: The association between hypercalciuria and febrile convulsion is controversial. The present study aimed to investigate the statistical association between hypercalciuria and childhood febrile convulsions. METHODS: Overall, 160 children aged 6 months to 5 years, including 80 children with febrile convulsion and 80 febrile children without convulsion (comparison group), were recruited. All laboratory tests, including 24-hour urine calcium, were undertaken in an academic clinical laboratory. RESULTS: Forty-five children of the febrile convulsion group (60%) and 30 of the comparison group (40%) had hypercalciuria. There was a significant difference between the 2 groups (P=0.02). CONCLUSION: Our results indicated that there is a statistical association between convulsion and hypercalciuria in children. Since we found this association with a cross-sectional assessment, further studies, especially prospective and controlled designs, are needed.

Association of Low Serum Ionized Magnesium Level with Fever-Triggered Seizures in Epileptic Children / 대한소아신경학회지

PURPOSE: Several studies have shown that magnesium plays an important role in modulating N-methyl-D-aspartate (NMDA)-related seizures by blocking NMDA ion channel receptors. Clinicians usually measure total serum magnesium levels instead of biologically active ionized magnesium levels. We compared the serum ionized magnesium (iMg2+) level between epileptic children with and without a history of fever-triggered seizure (FTS). METHODS: All epileptic children who visited the outpatient clinic or pediatric emergency department at Korea University Guro Hospital between January 2015 and July 2017 were included. Only epileptic children aged 1–8 years who were newly diagnosed within 2 years were included. RESULTS: There were 12 children with FTS and 16 without FTS. Median serum iMg2+ level was 0.93 (0.85–1.14, quartile) mEq/L. Serum iMg2+ level was significantly lower in epileptic children with FTS (0.86 mEq/L) compared to those without FTS (1.10 mEq/L) (P=0.005). No difference was noted in clinical variables between the two groups. Lower serum iMg2+ level significantly increased the risk of having FTS in epileptic children based on multivariable logistic regression analysis (odds ratio [OR]=0.028). CONCLUSION: Serum iMg2+ level was significantly lower in epileptic children with FTS than in those without FTS. Measurement of biologically active serum iMg2+ level could be considered in epileptic children with recurrent FTS. A large-scale prospective study is warranted.

Clinical Observation of Levetiracetam Combined with Sodium Valproate or Diazepam in the Prevention of Children with Recurrent Febrile Seizures / 中国药房

OBJECTIVE:To explore the preventive effect and safety of levetiracetam combined with sodium valproate of diaze-pam on recurrent febrile seizures(FS). METHODS:A total of 90 children with recurrent FS were randomly divided into observa-tion group and control group with 45 cases in each group. Control group was treated with sodium valproate or diazepam orally. On the basis of control group,observation group additionally received levetiracetam orally,with initial dose of 15 mg/kg,bid,for 7 d,and then decreasing gradually;decreasing to 10 mg/kg on 8th-12th day,bid;decreasing to 5 mg/kg on 13th-15th day,bid;drug withdrawal on 16th day. The children of 2 groups were followed up for 1 years,and received routine test every 2 months. The times of fever,the rate of recurrent convulsion,the conversion of epilepsia and the incidence of ADR were recorded in 2 groups during follow-up period. The serum levels of NSE and S-100β protein were determined in 2 groups before treatment and 6 months after treatment. The intelligence and behavior ability of 2 groups were scored by Chinese Modified Wechsler Intelligence Scale for Children and Children’s Adaptive Behavior Rating Scale. RESULTS:3 children of observation group and 2 of control group were failure in follow-up. During the follow-up period,fever times and the rate of recurrent convulsion in observation group were signifi-cantly lower than in control group,with statistical significance(P0.05). After treatment,serum levels of NSE and S-100β in 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical signif-icance(P<0.05). To the end of follow-up,verbal IQ,performance IQ and total IQ score of observation group were significantly higher than those of control group,and the cognition factor,social factor and behavior ability scores of observation group were sig-nificantly higher than those of control group,with statistical significance (P<0.05). CONCLUSIONS:Levetiracetam combined with sodium valproate or diazepam can prevent the occurrence of recurrent FS,relieve cerebral injury and improve the intelligence and behavior ability of the children,so as to improve the life quality of Children.

Moxibustion for pediatric diseases in / 中国针灸

was considered as the existing earliest monograph of TCM etiology and pathogenesis, and 6 volumes of total 50 volumes in this book involved pediatric diseases, which summarized the medical achievements of pediatrics beforeDynasty. Without detailed prescription, moxibustion was highly valued in this book and was applied for various types of pediatric emergency. With moxibustion for pediatric diseases inas starting point, three aspects, including caution about moxibustion, moxibustion at back-and moxibustion for febrile convulsion were discussed in this article.

Caregivers' Knowledge, Concerns and Management of Pediatric Febrile Convulsions

PURPOSE: The purpose of this study was to investigate caregivers' knowledge, concerns, and management of children with febrile convulsions (FC). METHODS: A descriptive correlation study was conducted with 133 caregivers whose children had been diagnosed with a FC. A self-administered questionnaire was used for data collection. Descriptive statistics, t-test, one-way analysis of variance and Pearson's correlation were used for data analysis. RESULTS: The mean percent of correct answers related to knowledge was 48.5%. Many caregivers believed that FC causes brain damage and did not know that risk of subsequent epilepsy in FC is rare. Levels of concern about FC were high. Caregivers were highly concerned about further FC attacks in the night and tended to worry that Febrile children were apt to get a fever. Many caregivers used management practices which are not recommended for FC in children. There was a statistically significant negative correlation between caregivers' knowledge and concerns about FC. There was also a positive correlation between caregivers' knowledge and management of FC. CONCLUSION: Findings suggest that improvements are needed in caregivers' knowledge and management of FC. Caregivers' concerns related to misconception need to be addressed. Development and evaluation of educational interventions on changing caregivers' management of FC are recommended.

Correlation between Acetaminophen Consumption and CSF Glucose Level in Febrile Convulsion.

Hyperglycemia and hyperglycorrhagia common occur in children with febrile seizures. Rapid release of cortisol and adrenaline after seizures as a stress reaction induce elevated glucose concentration in Cerebral Spinal Fluid (CSF). The purpose of this study was to assess the correlation between acetaminophen consumption and CSF glucose level in children with febrile convulsion.This cross- sectional study was performed over 3-18 months old children who were admitted at pediatric section of teaching hospital during 7 years. Comparisons between the mean CSF glucose concentrations in the children who taken and no taken acetaminophen during 6 hours before convulsion was performed using Student's t-test and Mann- Whitney test.The glucose level in the CSF of children who no taken acetaminophen (82±8 mg/dl) was significantly higher than children taken acetaminophen (53±4 mg/dl). (P=0.0001).The use of acetaminophen before convulsion decrease CSF glucose concentration in febrile convulsive children

Epileptic events in the XIX century as reported by the Brazilian Royal Family / Eventos epilépticos no século XIX segundo relatos da Família Real Brasileira

Members of the Brazilian Royal Family carry a rich medical history of epileptic seizures and alike. OBJECTIVE: To present the medical knowledge about epilepsy by the time of the Brazilian Empire, as reported by the royal family. METHOD: Narrative review of historical facts about D. Pedro I's family health. RESULTS: The Royal Family, since D. João VI's generation is full of members with epilepsy or acute symptomatic seizures of different etiologies. CONCLUSION: The reported cases suggest that Dom Pedro I's family presented epilepsy with tonic-clonic generalized seizures, besides psychogenic, organic non epileptic events and acute symptomatic seizures. As a whole, this familial epilepsy could fit the diagnosis of generalized epilepsy with febrile convulsion plus.

Há uma história médica rica de crises epilépticas e similares nos membros da família real brasileira. OBJETIVO: Apresentar o conhecimento médico sobre epilepsia à época do Império no Brasil, conforme informado pelos acometidos da família real. MÉTODO: Revisão narrativa de fatos históricos sobre a saúde da família de D. Pedro I. RESULTADOS: A genealogia da família real, desde a geração de D. João VI é repleta de pessoas acometidas por epilepsia ou crises sintomáticas agudas de diversas etiologias. CONCLUSÃO: O relato de casos sugere que Dom Pedro I e sua família apresentavam epilepsia de incidência familiar predominantemente com crises tônico-clonicas generalizadas, além de eventos sintomáticos agudos, psicogênicos e orgânicos não epilépticos. Como um todo, a epilepsia dessa família poderia ser enquadrada no diagnóstico de epilepsia generalizada com convulsão febril plus.

Role of CSF Analysis for the First Episode of Febrile Seizure among Children between Six Months to Five Years of Age.

Introduction: A febrile convulsion is defined as a seizure that occurs in association with fever in children from six months to five years of age, with no evidence of a central nervous system infection or other identifiable causes of seizure and no history of an afebrile seizure. Simple febrile seizures are brief (<15 minutes), generalized, and occur in association with fever and only once during a 24-hour period without postictal pathology. Febrile Seizures have longer duration (>15 min), or have focal features or if they recur within 24 hours are defined as complex. In May 1996, the American Academy of Paediatrics (AAP) issued practice parameters regarding the neurodiagnostic evaluation of children with a first simple febrile seizure, who present within 12 hours after the seizure. It may be due to meningitis. This study was done to find out role of cerebro spinal fluid (CSF) analysis to rule out the meningitis in different age group of children presenting with first episode of fever with seizure. Design: A prospective study was carried out from June 2008 to July 2009 at the Western Regional hospital, Department of Paediatrics, Pokhara, Nepal. A total of 110 hospitalized children between the age group five months to 5 years were included in the study. Results: 16 (14.54%) children were diagnosed to have meningitis. In the age group of 6 – 12 months, 6 (21.4%) had meningitis while in 12-18 months, 6 out of 31 (19.3%) had meningitis and in more than 18 months age group only 4 out of 51 (7.84%) were detected with meningitis. Conclusion: In cases of apparent febrile seizure, meningitis should always be considered as a differential diagnosis. Lumbar puncture is must to rule out meningitis in all children between the ages of six months to eighteen months presenting with first episode of fever with seizure to rule out meningitis, even in the absence of meningeal signs.

Cholecystokinin expression in hippocampus and cerebral cortex of weanling rats following heat stress and febrile convulsions / 国际儿科学杂志

Objective To analyze the expression of cholecystokinin(CCK) in rat' s hippocampus and cerebral cortex following heat stress and febrile convulsions (FC). Methods Warm water was used to induce FC model. Immunohistochemistry method tested CCK protein. Results Very few or no CCK neurons were seen in the control rats. There was weaker expression of CCK in cerebral cortex of HS group,mainly located in PIR,ENT and RS subfield.No CCK positive ceiis were seen in hippocampus of HS rats. In contrast, abundant expression of CCK protein was found in hippocampus and cerebral cortex of FC group. They were well-distributed, without characteristic subnucleus-specific distribution. Conclusion Abundant induction of CCK in hippocampus and cerebral cortex of FC group suggested that CCK may play a role in the central control of FC.

Relationship between iron deficiency anemia and febrile convulsion in infants / 소아과

PURPOSE: The association between iron deficiency anemia and febrile convulsion in infants has been examined in several studies with conflicting results. Therefore, the authors aimed to evaluate the precise relationship involved. METHODS: In this case-control study, the authors assessed 100 children with a diagnosis of febrile convulsion, aged between 9 months and 2 years, during January 2007 to July 2009. The control group consisted of 100 febrile children without convulsion; controls were closely matched to the cases by age, gender, and underlying disease. RESULTS: The mean ages of the febrile convulsion and control group were 16.3+/-7.4 and 15.8+/-6.1 months, respectively, and the two groups had no differences in clinical features. Iron deficiency anemia (Hb <10.5 gm/dL) was more frequent in the febrile convulsion group than in the control group, although there was no statistical significance. Unexpectably, the RDW (red blood cell distribution width) was significantly lower and the MCNC (mean corpuscular hemoglobin concentration) was significantly higher among seizure cases than among the controls (P<0.05). There is no statistical difference between simple and complex febrile groups in the clinical and laboratory profiles. On multiple logistic regression analysis, iron deficiency anemia was more frequent, but the RDW was lower, among the cases with febrile convulsion, compared with the controls. Conclusions: Our study suggests that the iron deficiency anemia is associated with febrile convulsion, and screening for iron deficiency anemia should be considered in children with febrile convulsions.

Prolactin protein and Zinc transporter 1 mRNA expressions in weanling rats following heat stress and febrile convulsions / 中华急诊医学杂志

Objective To analyze the expression of prolactin protein and ZnT1 mRNA in rat brain in the wake of heat stress and febrile convulsion(FC).Method Thirty-six weanling Spragne-Dawley rats were randomly divided into control group(n=8) and other 28 rats were used to induce heat stroke by warm water but three of them failed to produc expected heat stress.Consequently,there were 35 rats eligible to be models of heat stroke,and of them,10 rats showed heat stress(HS group,n=10) and 15 rats had 5-grade febrile convulsion (FC group,n = 15).The inmmunohistocbemistry and in situ hybridization method were used in this study.The IR) neurons were found in the rats of control group.The deep immune staining was found in the PIR,Era and RS regions of cerebral cortex and light immune staining was found in the PRH,PAR and FR regions of cerebral cortex in HS group.In addition,the PRL-IR positive neurons were found around the midline strip of thalamus without characteristic subnucleus-specific distribution.However,abundant induction of PRL-IR positive neurons with diffuse distribution were found in cerebral cortex,hippoeampus,amygdala,thalamus and hypotha]amns of rats in FC and FC rats showed more PRD-IR positive neurons in cerebral cortex than those in rats of control group (P<ZnT3 mRNA positive cells were seen in I-IS and control group.In contrast,abundant induction of ZnT3 mRNA There is an elevated zinc metabolism in hippocampus of FC group.

Unprovoked seizures in children with complex febrile convulsion; short-term outcome / 소아과

PURPOSE: Febrile convulsions (FC) were considered to be a benign seizure syndrome that is distinct from epilepsy. But it is thought that children with complex features i.e., partial or prolonged seizures or multiple episodes of FC would bear a higher risk of developing unprovoked seizures. The aim of this study is to look into the relative significance of each criteria that define complex febrile convulsions (CFC) as a predictor of subsequent epilepsy. METHODS: All children were retrospectively identified for a febrile seizure through pediatric departments of the Konyang University Hospital. Information was collected from medical records and interviews with parents. Patients with abnormal neurological examinations at presentation were excluded. RESULTS: This study was performed from March 2000 to December 2003. Sixty-three out of 314 children (20.0%) with febrile convulsion fulfilled the criteria for CFC and forty-four children of them have been followed for 12 months or more. Ten of these (23.2%) had unprovoked seizures for 14-62 months (median 34.2+/-11.6 months). The patients with partial FC showed a trend toward a higher risk (57.1%) of developing epilepsy than the patients with multiple or prolonged febrile convulsions (26.7%, 24.1% respectively). CONCLUSION: We found that the partial feature of febrile convulsion is associated with subsequent epilepsy.

The clinical study of febrile convulsion / 中国实用内科杂志

Objective To study the differences of electrolytes,C-reactive protein in different type,gender and recur- rent of febrile convulsion.Methods 174 cases of children febrile convulsion were collected.We detected the electro- lytes,C-reactive protein respectively and analyzed their relationship.Results In children febrile convulsion,the lev- els of the electrolytes,C-reactive protein had nothing to do with the type,gender and recurrent of the febrile convul- sion.Conclusion We should treat routinely the children who suffered from febrile convulsion without considering the type,gender and recurrent.

The Recurrence Rates of Febrile Seizures Related to the Degree of Fever

PURPOSE: Recently, many studies on febrile convulsions again suggest that the degree of pyrexia may be related to the recurrence of febrile convulsions. In a previous study, we advocated that a low body temperature during the initial febrile convulsions is associated with an increase of recurrent febrile convulsions. Therefore, we have expanded the study by including 246 febrile convulsions during 6 years and investigated risk factors and especially the relationship between pyrexia and the recurrence rates. METHODS: Children with febrile convulsions were divided into three groups according to the degree of fever. Group I showed body temperatures higher than 39.5 degrees, group II from 38.5 to 39.4 degrees, and group III lower than 38.4 degrees. Then, we analyzed the recurrence rates of febrile convulsions. RESULTS: There occurred recurrent febrile convulsions in 19(41.3%) children with family history of febrile convulsion and 5(35.7%) children whose first-degree relatives diagnosed epilepsy. In group I, 5(13.5%) infants aged 6-18 months and 5(19.2%) aged 19-30 months had recurrent febrile convulsions. In group II, 22(36.1%) infants aged 6-18 months and 8(24.2%) aged 19-30 months had recurrent febrile convulsions. In group III, 21(42.0%) infants aged 6-18 months and 8(38.1%) aged 19-30 months had recurrent febrile convulsions. CONCLUSION: Children with a lower degree of pyrexia and also younger age at the onset of the first febrile convulsion were more susceptible to recurrent febrile convulsios than otherwise.

The Influence of Low Serum Sodium Levels on the Risk of Repeated Febrile Convulsions during the Same Febrile Illness

PURPOSE: Hyponatremia may be common in febrile convulsions and lower the threshold for febrile convulsions. We evaluated the association between hyponatremia and febrile convulsions and also examined the effect of hyponatremia on the recurrence of convulsions during the same febrile illness. METHODS: Serum sodium levels were measured from 98 children with febrile convulsions, among whom there were 21 recurrent and 77 non-recurrent patients during the same febrile illness. Also, as a control group, we selected 32 febrile and 48 non-febrile children, who did not have febrile convulsions. Results were analyzed by Student's t-test and logistic regression. RESULTS: The average serum sodium level in febrile convulsions was 135.5+/-3.7 mEq/ L, which was significantly lower than 138.7+/-3.2 mEq/L of febrile children and 138.0+/-3.0 mEq/L of non-febrile children in the control group(P<0.05). The average serum sodium level in recurrent febrile convulsions during the same febrile illness was 133.1+/-4.1 mEq/ L, which was significantly lower than 136.1+/-3.3 mEq/L in non-recurrent febrile convulsions(P<0.05). CONCLUSION: The serum sodium levels of the patients with febrile convulsions were significantly lower than those of the children in the control group. Also, the lower the sodium levels were, the higher recurrent febrile convulsions during the same febrile illness occurred.

The Levels of Zinc and Neuron-specific Enolase in Febrile Convulsion / 소아과

PURPOSE: To determine the role of zinc in febrile convulsion and to evaluate whether febrile convulsion causes neuronal damage, serum and cerebrospinal fluid(CSF), zinc and CSF neuron-specific enolase(NSE) levels were measured in patients with febrile convulsion, epilepsy and aseptic meningitis. METHODS: Three groups were formed as follows: group I:53 children with febrile convulsion; group II:34 children with epilepsy; and group III, 40 children with aseptic meningitis. Serum and CSF zinc and CSF NSE levels were measured in each groups. RESULTS: The serum zinc levels of groups I, II and III had a mean of 74.71+/-18.26 microgram/dL, 104.35+/-31.43 microgram/dL and 87.03+/-24.47 microgram/dL, respectively, and the values of group I were significantly lower than those of the other two groups. The CSF zinc levels of groups I, II and III were found to have a mean 27.72+/-17.93 microgram/dL, 44.73+/-26.72 microgram/dL and 54.44+/-28.43 microgram/dL, respectively. In group I, the CSF zinc levels were significantly lower than those of other two groups. The CSF NSE levels of groups I, II and III had a mean of 11.61+/-2.96 ng/mL, 16.51+/-5.46 ng/mL and 14.60+/-3.02 ng/mL respectively and the values of group I were significantly lower than those of others. CONCLUSION: We confirmed that low zinc levels in serum and CSF are participants in the pathogenesis of febrile convulsion, but we could not find out the evidence of neurologic damage in patients with febrile convulsion using NSE levels in CSF.

Changes of Serum Kalium,Natrium,Chlorine,Calcium and Glucose in Children with Febrile Convulsion and Their Clinical Significance / 实用儿科临床杂志

Objective To study the changes and clinical significance of serum kalium,natrium,chlorine,calcium and glucose in children with febrile convulsion(FC).Methods Serum kalium,natrium,chlorine,calcium and glucose concentrations were measured in 41 children with FC(FC group),30 children with fever and without convulsion(fever group) and 30 normal children(normal group) by automatic biochemical detector.Results Serum kalium and calcium concentrations had no significant difference between FC group and fever group,but they were significantly lower than those of normal group(F=5.965,3.048 P0.05).Conclusions There are hyponatremia,hyperglycemia and lowered blood kalium and calcium in patients with FC.Hence,while treating the patient with FC,the disturbance of blood electrolytes and glucose need be corrected to avoid the recurrence of FC and the progressive injury of important organs such as brain.

Changes and clinical significance of plasma arginine vasopressin in children with febrile convulsion / 第三军医大学学报

Objective To explore the mechanism of arginine vasopressin(AVP) in the onset of febrile convulsion.Methods Radioimmunoassay(RIA) was used to determine plasma AVP levels in 24 children with complicated febrile convulsion,32 children with simple febrile convulsion,20 children with upper respiratory infection,and 18 normal children.Their plasma sodium ion and plasma osmotic pressure were measured at the same time.Results AVP level in complicated febrile convulsion group and simple febrile convulsion group was significantly higher than upper respiratory infection group and control group(P