Crisis febril como manifestación inicial de COVID-19 / Febrile crisis as initial manifestation of COVID-19

Introducción: La COVID-19 es una enfermedad que ha mostrado una baja morbilidad y mortalidad en pediatría. Las crisis febriles constituyen una de las causas más frecuentes de admisión en los servicios de urgencia y de interconsultas con el neuropediatra. Objetivo: Interpretar la presencia de crisis febril simple en pacientes admitidos en servicios de urgencia pediátricos como manifestación inicial de COVID-19. Presentación del caso: Paciente femenina de un año de edad, con antecedentes de salud anterior que acude al cuerpo de guardia con fiebre de 38 ℃; y crisis motora, de inicio generalizada, tónico-clónica, que cedió con medidas antitérmicas. Por protocolo se realiza punción lumbar la cual resulta negativa. Se ingresa, 24 horas después comienza con manifestaciones catarrales, se hace otoscopia y se diagnostica una otitis media aguda, por lo que se inicia tratamiento antibiótico. Se realiza la prueba de reacción en cadena de la polimerasa para la COVID-19 con resultado positivo, por lo que se remite para el Hospital Pediátrico San Miguel del Padrón. Conclusiones: Se debe sospechar la presencia de COVID-19 ante paciente que acude a servicio de urgencias por una crisis febril, como único problema de salud. LA COVID-19 es una enfermedad que ha demostrado que se puede presentar de diversas formas(AU)

Introduction: COVID-19 is a disease that has shown low morbidity and mortality in pediatrics. Febrile crises are one of the most common causes of admission to emergency services and consultations with the neuropediatrician. Objective: Interpret the presence of simple febrile crisis in patients admitted to pediatric emergency services as an initial manifestation of COVID-19. Case presentation: One-year-old female patient, with a previous health history, who is attended in the emergency service with a fever of 38 ℃; and motor crisis, of widespread onset, with tonic-clonic seizures, which yielded with antypiretic measures. By protocol, lumbar puncture is performed which is negative. She was admitted, and 24 hours later there is an onset of catarrhal manifestations; an otoscopy is performed and acute otitis media is diagnosed, so antibiotic treatment is initiated. The polymerase chain reaction test for COVID-19 (PCR) is performed with a positive result, so, the patient is referred to the San Miguel del Padrón Pediatric Hospital. Conclusions: COVID-19 should be suspected in patients who attend to the emergency services due to a febrile crisis as the only health problem. COVID-19 is a disease that has been shown to occur in a variety of ways(AU)

Crisis o convulsiones febriles: certezas y preguntas / Febrile seizures: questions and answers

Las crisis febriles están asociadas a fiebre en niños entre 6 y 60 meses de edad, sin infección del sistema nervioso central u otras causas de crisis sintomáticas agudas y sin historia de crisis afebriles previas. Ocurren en aproximadamente el 2-5% de los niños. Se debe considerar la posibilidad de una infección del sistema nervioso, a pesar de que la frecuencia es extremadamente baja cuando el examen físico posterior a la crisis no es orientador. Mientras que el manejo clínico de los niños con crisis febriles simples está bien definido, considerándolas como eventos benignos auto-limitados, la conducta en los niños con crisis febriles complejas es controvertida. Se asocian con un aumento relativamente pequeño del riesgo de epilepsia, el cual no puede ser prevenido mediante ninguna forma de tratamiento. El rol del electroencefalograma también es controvertido. Analizamos los datos de varios estudios y concluimos que las descargas epileptiformes tienen valores predictivos positivos bajos e implican pequeñas variaciones entre la probabilidad pre y post-prueba para el desarrollo de epilepsia posterior. Se ha propuesto realizar resonancias magnéticas encefálicas para detectar cambios a nivel hipocampal previos, agudos o posteriores a crisis focales o estatus febriles que pudieran relacionarse con el riesgo de esclerosis mesial temporal y de epilepsia temporal. La relación etiológica entre estas entidades continúa siendo un tema controvertido. En cualquier caso, los estudios alterados no van a cambiar el manejo clínico de las crisis febriles y pueden contribuir al sobre-diagnóstico.

A febrile seizure occurs in association with fever in a child aged 6 to 60 months, without central nervous system infection or other known cause of acute seizures in a child without a prior history of afebrile seizures. Febrile seizures occur in about 2-5% of children. Central nervous system infections should be considered in patients with febrile seizures, even though the frequency of this possibility is low, especially when patients do not return to baseline. Simple febrile seizures are considered benign events and there are clear guidelines about evaluation and management, but the evaluation of complex febrile seizures is controversial. They are associated with a small increased risk of epilepsy which cannot be prevented. The role of electroencephalography is controversial. We analyzed the data of many studies and concluded that epileptiform discharges have poor positive predictive value. Neuroimaging is recommended to look for acute or pre-existing hippocampal abnormalities following febrile status or focal febrile seizures that could be associated to the risk of developing mesial temporal sclerosis and temporal lobe epilepsy. The relationship between these disorders and febrile seizures remains a controversial issue. An abnormal electroencephalography or magnetic resonance imaging studies will not change the clinical management and could contribute to overdiagnosis.

Valoración del niño con una primera crisis no provocada / Evaluation of a child with a first unprovoked seizure

Los episodios paroxísticos son uno de los trastornos neurológicos más frecuentes en niños. Es importante diferenciar entre los trastornos paroxísticos no epilépticos, las crisis sintomáticas agudas, las crisis febriles y las crisis no provocadas. La historia clínica permite, en la gran mayoría de los casos, poder llegar al diagnóstico. Las crisis no provocadas únicas son frecuentes en el niño. La tasa de recurrencia tras una primera crisis no provocada varía entre un 23-96% en los dos años siguientes a la primera crisis. El objetivo de este trabajo es describir cómo evaluar al paciente con una primera crisis no provocada y revisar el valor predictivo de los distintos factores de riesgo de recurrencia. Entre dichos factores de riesgo, se evalúan datos como la presencia de antecedentes familiares de epilepsia, historia previa de crisis febriles, edad de debut, tipo de crisis, presencia de crisis prolongadas o crisis agrupadas, crisis de presentación en sueño, anomalías neurológicas, evidencia de una etiología definida, y presencia de anomalías epileptiformes en el electroencefalograma. Los factores de riesgo de recurrencia más importantes son la etiología de las crisis y la presencia de anomalías epileptiformes en el electroencefalograma.

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.

Crisis convulsivas febriles: revisión integral / Febrile Seizures: Comprehensive Review

Las convulsiones febriles (CF) son el trastor-no convulsivo más frecuente en la niñez y motivo común de consulta en los departa-mentos de emergencia. Son eventos críticos que coinciden con procesos febriles, en niños de 6 a 60 meses, sin infección del SNC, trastornos metabólicos, ni anomalías neurológicas previas. Estos trastornos son de carácter benigno y autolimitado, sin secuelas neurológicas a largo plazo. La prevalencia de CF es de aproximadamente 2 - 5 %, se ha descrito una mayor incidencia en varones en un 60%, con una relación 2:1. Los niños con antecedentes familiares en primer grado con CF, tienen un riesgo de 4-5 veces más alto que la población general de presentar CF, a pesar de esto algunos casos son esporádicos, lo que sugiere que elemen-tos genéticos y ambientales influyen en su aparición. El diagnóstico es fundamental-mente clínico, los exámenes complementa-rios deben reservarse para casos específi-cos y descartar otras patologías. El trata-miento únicamente está indicado en el manejo de las crisis agudas persistentes...(AU)

¿Crisis febriles complejas o síndrome de Dravet?: Descripción de 3 casos clínicos / Complex febrile Seizures or Dravet syndrome?: Description of 3 case reports

Introduction: Dravet syndrome (DS) is one of the most intractable forms of epilepsy that begins in infancy. This syndrome is characterized by beginning with complex febrile seizures (FS) in a healthy infant and progresses to refractory epilepsy with psychomotor regression. The detection of a SCN1A mutation encoding the sodium channel can confirm the diagnosis. Objective: To report 3 confirmed cases of genetically DS. Case reports: We describe 3 girls diagnosed with complex FS that started when they were between 2 and 7 months old. FS were frequent, hemi generalized and myoclonic associated with recurrent febrile status epilepticus (SE). Despite FS and SE recurrence, the psychomotor development, electrophysiological studies and magnetic resonance imaging (MRI) of the brain were normal. After a year, they developed afebrile seizures progressing to refractory epilepsy with developmental regression. A molecular study detected SCN1A mutation confirming DS. The specific antiepileptic treatment and prevention of febrile episodes allowed partial control of epilepsy with some recovery of psychomotor skills. Conclusions: The high frequency complex FS associated with recurrent SE in a previously healthy infant should alert about the possibility of DS. Molecular diagnostics helps us to establish a drugs and non-drug therapies treatment, as well as long-term prognosis and genetic counseling.

Introducción: El Síndrome de Dravet (SD) es una de las formas más intratables de epilepsia que debuta en lactantes con convulsiones febriles (CF) complejas recurrentes que evolucionan posteriormente a epilepsia refractaria con regresión psicomotora. La detección de una mutación del canal de Sodio (SCN1A) permite certificar el diagnóstico. Objetivo: Reportar 3 casos de SD confirmados genéticamente. Casos clínicos: Se describen 3 niñas con diagnóstico de CF complejas iniciadas entre los 2 y 7 meses de edad. Las CF eran frecuentes, hemigeneralizadas, mioclónicas asociadas a status epilepticus (SE) febriles recurrentes. A pesar de la recurrencia de CF y SE, tanto el desarrollo psicomotor como los estudios electrofisiológicos y la resonancia magnética (RM) cerebral, fueron normales. Posterior al año iniciaron crisis afebriles que evolucionaron a epilepsia refractaria con regresión del desarrollo. El estudio molecular detectó la mutación SCN1A confirmando SD. El tratamiento antiepiléptico específico y la prevención de cuadros febriles permitieron un control parcial de la epilepsia con recuperación de algunas habilidades psicomotoras. Conclusiones: La alta frecuencia de CF complejas asociadas a SE recurrentes en un lactante previamente sano, debe alertar sobre la posibilidad de un SD. El diagnóstico molecular nos permite instaurar un tratamiento antiepiléptico y terapias no farmacológicas además de un pronóstico a largo plazo y consejería genética.

Convulsión febril / Febrile seizure

Febrile seizures are the most common seizure disorder in the pediatric population and represent a frequent cause of consultation in emergency departments, confirming its importance. We present an updated and practical review regarding this pathology, along with an operative definition that supports the application of a flowchart that integrates concepts and procedures that can be easily applied at any location nationwide. This review is designed to provide an analytic framework regarding pediatric febrile seizures, as well as present a guideline based on our experience in the emergency department by summarizing the main benzodiazepines in actual use that have been proved to be both safe and effective in treating this disorder, such as lorazepam and midazolam...

Convulsión febril simple / Simple febrile convulsion

La crisis febril simple está relacionada con una gran variedad de patologías que cursan con fiebre. Su manejo amerita un enfoque claro para prevenir complicaciones, evitar el riesgo de recurrencias, optimizar los recursos y lograr una adecuada orientación de los padres. Se revisa la literatura sobre convulsión febril simple, debido a que pese a la exacta definición de ésta, sus criterios diagnósticos y tratamiento en el servicio de urgencias aun dan lugar a controversias. Es necesario unificar conceptos y actualizarlos, para disminuir el diagnóstico equivocado que conlleva a errores terapéuticos...

A simple febrile crisis is related with a great variety of febrile illnesses. A clear approach to management is essential in order to prevent complications and recurrence risk, optimizing resources and achieving adequate counseling to parents. The literature on simple febrile convulsion was reviewed. Despite it has an exact definition, there are still controversies regarding its diagnostic criteria and management at the emergency ward. Unifying and updating concepts is needed to reduce wrong diagnosis leading to therapeutic errors...

Infectious causes associated with febrile seizure in children

To establish the infectious cause associated with the increase in temperature in patient with febrile convulsion admitted to the Prince Hashim Hospital and its association with the season, Retrospective study, including all children hospitalized with the diagnosis of febrile convulsion during period of two years from February 2007 to February 2009. We included 88 patients. Infectious diarrhea was the most important cause of fever [43%] followed by acute pharyngitis [36%] and bronchopneumonia [5%]. Less common causes such as cellulitis, urinary tract infection and post-vaccination reactions were associated in a small number of cases. In our study, winter time is more commonly associated with infectious disease outbreaks of gastrointestinal and respiratory infections [42%], followed by summer season [24%]. Gastrointestinal and upper respiratory tract infections were the most common causes of elevated temperature and subsequent febrile seizure. The epidemics of respiratory and diarrheal infections in winter season result in increasing the incidence of this disease

Crises convulsivas febris na sala de emergência. Análise de 66 casos pediátricos / Febrile convulsions in the emergency room - an analysis of 66 pediatric cases

Introdução: Crise convulsiva febril é o tipo mais frequente de crise convulsiva na infância, ocorrendo em 2% a 5% das crianças saudáveis sob aspecto neurológico. O objetivo de nosso estudo foi analisar dados epidemiológicos e neurológicos nestes pacientes atendidos no setor de emergência pediátrica. Métodos: Foram incluídos pacientes com crise convulsiva febril atendidos no setor de emergência do Hospital Pequeno Príncipe entre fevereiro e outubro de 2007 e excluídos os pacientes com menos de 30 dias de vida, com crises epiléticas afebris prévias e com diagnóstico de infecção do sistema nervoso central. Resultados: Foram avaliadas 66 crianças, sendo 54,6% do sexo masculino e 45,4% do sexo feminino, com idade entre 3 e 85 meses (média de 32,5 meses). Quanto à história familiar, 83,4% não tinham parentes de primeiro grau com crise convulsiva e 12,1% tinham parentes de primeiro grau com crise febril. De acordo com a classificação, 75,8% apresentaram crises com duração inferior a 15 minutos, 16,7% tiveram crises focais e 83,3% crises generalizadas. Uma única crise no dia do atendimento no setor de emergência ocorreu em 75,8% dos casos. Quanto à etiologia da febre, 22 (33,4%) crianças apresentaram rinofaringite, sete (10,6%) otite, sete (10,6%) tonsilite, cinco (7,6%) diarreia aguda, quatro (6,1%) sinusite, três (4,5%) laringite, uma (1,5%) infecção do trato urinário e uma (1,5%) apresentou pneumonia. A maioria das crianças (75,8%) foi medicada exclusivamente com antitérmicos e medidas físicas para controle de temperatura, enquanto as demais receberam drogas anticonvulsivantes. Conclusão: Crises convulsivas febris são as ocorrências mais comuns de avaliação neuropediátrica no setor de emergência. É frequente que essas crises durem menos de 15 minutos e possuam apresentação generalizada.

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.

Neurological disorders in children and adolescents.

OBJECTIVE: To ascertain the prevalence of active epilepsy, febrile seizures (FS), cerebral palsy (CP) and tic disorders (TD) in aged 19 years or less. METHODS: This was a cross-sectional observational study conducted as a two-stage door-to-door survey of a stratified randomly selected population in 2003-04. Trained field workers screened the population followed by case examination by the field neurologist. RESULTS: A total of 16979 (male 8898, female 8081) subjects aged <or= 19 years were surveyed. The prevalence rates per 100,000 population of active epilepsy, FS, CP and TD with 95% confidence intervals are 700.87 (580.60-838.68), 1113.14 (960.07-1283.59), 282.70 (CI 208.43-374.82) and 35.34 (12.96-76.92) respectively. Active epilepsy prevalence shows a rising trend and that of other disorders a declining trend with age. Of the epileptics who had brain CT scans, 23.4% showed single or multiple lesions suggestive of neurocysticercosis. Regarding treatment, 23.5% of the epileptics never received any antiepileptic drugs. Among those with history of FS, 9.5% developed epilepsy later on. The prevalence of FS among slum dwellers is lower than in the non-slum population. Among CP cases, 39.6% gave history of birth anoxia, 16.7% kernicterus and 31.3% epilepsy. Prevalence of CP is significantly associated with lower education status. CONCLUSION: The prevalence of CP and TD is lower than reported from western countries. CP prevalence is also comparatively lower than in many community studies from India. Compared to western nations, higher proportion of FS cases develops epilepsy. A third of the CP cases have seizures which is higher than in many Indian studies. Birth anoxia is a common cause of CP and educational underachievement is frequent.

Children with first episode of fever with seizure: is lumbar puncture necessary?

Fever with seizure, a common presentation with which a child may present to the emergency is mainly due to febrile seizure, but it may also be due to meningitis. This study was done to find out the incidence of meningitis and to find out whether lumbar puncture is necessary in different age groups of children presenting with first episode of fever with seizure. A prospective study was conducted in the emergency department of Kanti Children's Hospital. Children who presented with first episode of fever and seizure in the age group of 6 months to 5 years were included. Meningitis was diagnosed on the basis of either cytological and biochemical criteria or if a bacterial pathogen was isolated. Of the 175 children included, 17% were diagnosed to have meningitis. Cerebrospinal fluid was positive for a bacterial pathogen in 4.5% of the cases. In the age group of 6 months to 12 months, 30% of the children had meningitis as compared to 20 % and 5% in other age groups of 12- 18 months and above 18 months respectively. All children with culture proven bacterial meningitis were in the age group of 6-12 months and had no evidence of meningeal irritation. Signs of meningeal irritation had high specificity in diagnosing meningitis. Organisms grown were Haemophilus influenza in three cases, Streptococcus pneumoniae in two cases and Staphylococcus aureus in three cases. In conclusion, incidence of meningitis was found to be high in children presenting with first episode of fever and seizure. Lumbar puncture to rule out meningitis should especially be considered in children in the younger age group even without evidence of meningeal irritation.

Febrile seizures: a review for family physicians.

Febrile seizures are the most common cause of convulsions in children. Most are simple in nature, although those with focal onset, prolonged duration ((3)15 min) or those that recur within 24 h or within the same febrile illness are considered complex. Diagnosis of this condition is essentially clinical and based on its description provided by parents. Its pathophysiology remains unclear, but genetics plays a major role in conferring susceptibility. Although most febrile seizures are benign and associated with minor viral illnesses, it is critical that the child be evaluated immediately to reduce parental anxiety and to identify the cause of the fever. It is essential to exclude underlying pyogenic meningitis, either clinically or, if any doubt remains, by lumbar puncture. The risk of pyogenic meningitis is as low (< 1.3%) as the risk in a febrile child without seizures. After an initial febrile seizure (simple or complex), 3-12% of children develop epilepsy by adolescence. However, the risk of developing epilepsy after an initial simple febrile seizure is low (1.5-2.4%). Since the vast majority of children have a normal long-term outcome, antiepileptic medication is not recommended to prevent recurrence of febrile seizures. Oral diazepam or clobazam, given only when fever is present, is an effective means of reducing the risk of recurrence. The family physician can play an important role in counseling the parents that most febrile seizures are brief, do not require any specific treatment or extensive work-up, the probability of frequent or possibly threatening recurrences is low and the long-term prognosis is excellent.

Management of simple febrile seizures; A study conducted in Imam Hospital, Oromieh

Different medical and rehabilitation interventions have been used for treatment of cerebral palsy [CP]. In addition to conventional methods, complementary medicine such as homeopathy has been used in treatment of neurodevelopmental disorders. This study has been done to determine what effect homeopathic treatment would have on motor development [MD] of children with spastic CP, when added to rehabilitation normally used for such children. This 2004 study was a double blind clinical trial, conducted on twenty-four subjects recruited from a developmental disorders clinic in Tehran. Using the minimization technique, subjects were divided to the case and control groups. Routine rehabilitation techniques were carried out for 4 months on both groups. In addition the cases were given homeopathy drugs, while the controls received placebos. Levels of gross and fine motor development were assessed with the Denver Developmental Screening Test II [DDST II]. Data was collected by assessment forms, direct observations and examinations. Dependant variables in the two groups were compared at the beginning and at the end of the study. The average ages of the case and control groups were 28 and 28.4 months respectively. Gross and fine motor development and motor developmental quotient in the case group, compared to the controls showed no statistically significant differences. Based on the results of this study adding homeopathy to rehabilitation had no significant effect on motor development of CP children. Considering the documented effects of homeopathy on the physical status of children with CP it would be better not to reject the possibility of effects of homeopathy on motor development of children with CP. As homeopathy is young in Iran, it is recommended to conduct further more extensive research on the effects of homeopathy on neurodevelopmental diseases

lumbar puncture always necessary in the febrile child with convulsion?

Febrile convulsion is the most common benign convulsive disorder in children. Meningitis is one of the most important causes of fever and convulsions, diagnosed by lumbar puncture [LP], a painful and invasive procedure much debated regarding its necessity. This study evaluates the frequency of abnormal LP findings in a group of patients, to determine whether or not unnecessary LP can be prevented without missing patients with serious problems such as meningitis. The study was a descriptive, cross sectional study, conducted on 200 children suffering from fever and convulsions. Medical files of patients were taken from the hospital records and relevant data were collected to complete the appropriate forms. Of 200 patients included in the study, 116 [58%] children were male, and 84 [42%] were female. 47 cases [23.5%] underwent LP, of whom just one [0.5%] had abnormal LP and meningitis. Regarding Considering the low prevalence of meningitis in children with convulsion and fever, we conclude that by means of precise clinical examination and monitoring, it is possible to prevent unnecessary LP in these patients