Crisis febriles simples y complejas, epilepsia generalizada con crisis febriles plus, FIRES y nuevos síndromes / [Simple febrile seizure, complex seizure, generalized epilepsy with febrile seizure plus, FIRES and new syndromes].

Febrile seizures are the most common seizures in childhood. They have been observed in 2-5

of children before the age of 5, but in some populations this figure may increase to 15

. It is a common cause of pediatric hospital admissions and cause of anxiety for parents. Febrile seizures could be the first manifestation of epilepsy. About 13

of epileptic patients have a history of febrile seizure, and 30

have had recurrent febrile seizures. Their phenotypic characteristics allow, in the majority of cases, a classification of the seizure, an elaboration of a prognosis and to assume a specific therapeutic attitude. It is possible to describe a spectrum according to their severity, from the benign simple seizure to the more complex, febrile seizure plus, Dravet’syndrome, and FIRES. During the past decade, molecular genetic studies have contributed to the identification of genetic factors involved in febrile seizure and related disorders, making the necessity of a careful follow up of these patients in order to detect risk factors earlier. We have reviewed the medical literature to update current knowledge of febrile seizures, their prognosis and their relation to new epileptic syndromes.

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.

Serum zinc level in children with febrile convulsion and its comparison with that of control group

Febrile convulsion is the most common disorder in childhood with good prognosis. There are different hypotheses about neurotransmitters and trace element [such as zinc] changes in cerebrospinal fluid and serum, which can have a role in pathogenesis of febrile convulsion. The aim of the present prospective analytical case-control study was to determine whether there was any changes in serum zinc level in children with febrile convulsion during seizure. Ninety-two children aged 6 months to 5 years were divided into three groups: group A, 34 children with febrile convulsion, group B, 40 children having fever without convulsion, and group C, and 18 children with non-febrile convulsion. Serum zinc levels for the three groups were estimated by atomic absorption spectrophotometry [AAS]. Data were analyzed to compare zinc level among the three groups using appropriate statistical tools employing SPSS 13. Serum zinc levels of groups A, B, and C had a mean value of 76.82 +/- 24.36mg/1, 90.12 +/- 14.63 mg/1 and 94.53 +/- 17.39 mg/l, respectively. Serum zinc level of group A was lower than those of the other two groups [P < 0.006]. It was also lower in group B than in group C [P < 0.006]. These findings revealed that serum zinc level decreases during infection; this decrease was more significant in patients with febrile convulsion

Recurrencia de crisis febriles en una población chilena / Febrile seizures recurrence in Chilean children

Objective: Evaluate the clinical presentation and risk factors for recurrence of first febrile seizure (FS) in patients at Pediatric Emergency Department or Neurology Units at Clinical Hospital Universidad Catolica (UC) and Hospital Herminda Martin from Chillan (HM). Method: Descriptive-observational study of children with age average of 2.9 years-old, with first febrile seizure between January 1, 2003 and December 31, 2005. Results: Total 158 patients; 76 percent presented a simple FS and 24 percent a complex FS as first episode, only 1 case with febrile epileptic status. In 22 percent and 18 percent respectively, there was a FS history and epilepsy in first degree relatives. 34 percent of patients presented a second episode; 36 percent of these cases present a third FS and 9 percent more than 3 episodes. The average time of recurrence was 6.9 months. The most important risk factors for recurrence were: epilepsy history in first degree relatives and type of febrile seizure, with hazard ratio of 2.5 (p = 0.001) and 1,8 (p = 0.03) respectively. When fitting both variables, only family history of epilepsy was significant. Conclusions: Most of FS episodes are simple and 34 percent present recurrence. Family history of epilepsy and type of febrile seizure are associated recurrence risk factors. The follow-up of these patients does not predict their future risk of epilepsy.

Objetivo: Evaluar la presentación clínica, recurrencia y factores de riesgo de recurrencia en un grupo de pacientes con primoconvulsión febril que consultaron en Urgencia pediátrica y/o consulta neurológica en los hospitales Clínico Universidad Católica (UC) y Herminda Martín de Chillan (HM). Método: Estudio observacional descriptivo de niños con primoconvulsión febril entre el Iº de Enero del 2003 y el 31° de Diciembre 2005 con seguimiento promedio de 2,92 años. Resultados: De 158 pacientes, el 76 por ciento debutó con una CF simple y el 24 por ciento con una CF compleja (1 status febril). En el 22 y 18 por ciento había antecedentes de CF y epilepsia en familiares de primer grado respectivamente. Recurrieron 34 por ciento de los pacientes y de ellos el 36 por ciento presento una tercera CF y el 9 por ciento más de tres episodios. El promedio de tiempo de recurrencia fue 6,9 meses. Los factores de riesgo más importantes de recurrencia fueron el antecedente de epilepsia en familiares de primer grado y tipo de crisis con un hazard ratio de 2,5 (p = 0,001) y 1,8 (p = 0,03) respectivamente. Al ajustar ambas variables sólo antecedentes familiares de epilepsia fue significativa. Conclusiones: La mayoría de las CF es simple y recurre un 34 por ciento. Los antecedentes familiares de epilepsia y tipo de crisis son factores de riesgo asociados a recurrencia). El seguimiento no permite evaluar el riesgo de epilepsia a futuro en estos pacientes.

Convulsiones febriles en pediatría / febrile seisures in pediatrics

La convulsión febril es el trastorno neurológico más común y de ingreso a las salas de emergencia en las casas de salud de los 6 meses a los 6 años; por ello nuestro objetivo es actualizar el conocimiento en la etiología, la fisiopatología, la clasificación y protocolizar la atención en este tipo de pacientes. El sexo masculino es el más susceptible, ninguna prueba de laboratorio puede confirmar o descartar que el episodio que se produjo es una convulsión o que la causa que lo desencadenó haya sido la fiebre. El electroencéfalograma tiene poco valor en la evaluación por ello se considera innecesario realizarlo luego de la primera convulsión. En sospecha de convulsión febril no es necesario realizar la tomografía y la resonancia magnética...

Helmintos y protozoos intestinales; estudio medico social de 52 casos / Intestinal helmints and protozoos, medico-social study - 52 cases

En el presente estudio se resaltan las peculiaridades clinicas de 52 casos de patologia debida a helmintos y protozoos intestinales, junto a los caracteres epidemiologicos de los mismos en comparacion adicional a un grupo "testigo" portador de patologia diferente.

Pontas parietais evocadas ao eletrencefalograma e convulsöes febris / Evoked parietal spikes in the electroencephalogram and febrile convulsions

Foi feita a pesquisa de pontas evocadas ao eletrencefalograma pela percussäo dos pés e mäos em 2307 crianças de 2 a 15 anos de idade. Foram encontradas pontas evocadas em 69 (2,99%). Convulsöes febris ocorreram em 226 casos e dentre esses 13 apresentaram pontas evocadas. Foi verificada associaçäo de convulsöes febris e pontas evocadas particularmente naquelas crianças em que havia atividade epileptiforme, principalmente de localizaçäo parietal. Säo feitos comentários sobre a importância desses achados em relaçäo à compreensäo da natureza da atividade epileptiforme em crianças com convulsöes febris, assim como em relaçäo às possíveis implicaçöes prognósticas

Normas para la atención de las crisis convulsivas / Standards for the attention of the convulsive crisis

Como una necesidad en tratar de unificar criterios entre los pediatras del país, que atienden niños en los Servicios de Emergencias de nuestros hospitales se elaboraron estas normas que luego de revisiones cuidadosas, son las que en la actualidad son la guía de los Médicos Internos y Residentes del Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Contiene el enfoque clínico, diagnóstico y tratamiento ante un paciente que convulsiona por primera vez o conocido convulsionador que recae, febril o afebril.