A preliminary study on the association between prognostic nutritional index and neutrophil-to-lymphocyte ratio with nutritional status and inflammation in febrile children's susceptibility to seizures

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between nutritional status, inflammation, and susceptibility to seizures in febrile children. METHODS: This observational single-center study was carried out from January 2020 to December 2023 with 324 children aged 6 months and 6 years; 106 were diagnosed with febrile seizure, 108 were febrile children, and 110 were healthy controls. The prognostic nutritional index and neutrophil-to-lymphocyte ratio were calculated, and the cutoff threshold was established through receiver operating characteristics. The study utilized correlation and univariate-multivariate logistic regression analysis. The comparison between simple and complex febrile seizure was conducted to analyze differences. RESULTS: The optimal cutoff values were identified as 61.25 for prognostic nutritional index and 1.04 for neutrophil-to-lymphocyte ratio. Our findings showed a significant negative association between febrile seizure and platelet count, high C-reactive protein, and high ferritin levels. Additionally, the febrile seizure group showed a significant positive correlation with high neutrophil-to-lymphocyte ratio values (≥1.04) and body temperature (≥38). Our findings revealed that high neutrophil-to-lymphocyte ratio, high C-reactive protein, and age less than 18 months were independently associated with seizure susceptibility in febrile children. CONCLUSION: High neutrophil-to-lymphocyte ratio values and low prognostic nutritional index scores may serve as novel surrogate independent factors for seizure susceptibility in febrile children. Febrile children who are less than 18 months old are more prone to experience seizures than older febrile children. Moreover, there was a correlation between febrile seizures and elevated C-reactive protein levels and neutrophil-to-lymphocyte ratio values.

Association of serum vitamin D levels and simple febrile seizures in children

Background: Febrile seizure is one of the commonest childhood neurologic diseases. There is an increasing concern that vitamin D deficiency may play an etiological role. This study was conducted to find out the association between vitamin D levels and febrile seizure. Objective were to determine the association of vitamin D levels in children with simple febrile seizure.Methods: This case control study was conducted in institute of child and mother health, Dhaka from July 2019 to June 2020. Children aged six to sixty months with simple febrile seizure were ‘cases’ and those having fever without seizure were controls. Detailed history regarding breastfeeding, intake of calcium and vitamin D rich diet, sunlight exposure, family history of seizure was taken and physical examinations were done. Data collection was done through a pretested structured questionnaire. Serum vitamin D level was measured.Results: There were 44 cases of simple febrile seizure and 50 controls. Mean age of the study participants was 16.5±8.9 and 14.4±7.1 months in case group and control group respectively, with a majority in the age group 6-12 months. 34.1% of cases and 22% of controls had deficient vitamin D while 50% of cases and 34% of controls had insufficient vitamin D, respectively. Reduced vitamin D level was more common in case group. Mean vitamin D level was also significantly lower in case group.Conclusions: Decreased vitamin D level was found to be significantly associated with simple febrile seizure.

Clinical features of children with febrile seizures caused by Omicron variant infection / 中国当代儿科杂志

OBJECTIVES@#To study the clinical features of children with febrile seizures after Omicron variant infection.@*METHODS@#A retrospective analysis was performed on the clinical data of children with febrile seizures after Omicron variant infection who were admitted to the Department of Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, from December 1 to 31, 2022 (during the epidemic of Omicron variant; Omicron group), and the children with febrile seizures (without Omicron variant infection) who were admitted from December 1 to 31, in 2021 were included as the non-Omicron group. Clinical features were compared between the two groups.@*RESULTS@#There were 381 children in the Omicron group (250 boys and 131 girls), with a mean age of (3.2±2.4) years. There were 112 children in the non-Omicron group (72 boys and 40 girls), with a mean age of (3.5±1.8) years. The number of children in the Omicron group was 3.4 times that in the non-Omicron group. The proportion of children in two age groups, aged 1 to <2 years and 6-10.83 years, in the Omicron group was higher than that in the non-Omicron group, while the proportion of children in two age groups, aged 4 to <5 years and 5 to <6 years, was lower in the Omicron group than that in the non-Omicron group (P<0.05).The Omicron group had a significantly higher proportion of children with cluster seizures and status convulsion than the non-Omicron group (P<0.05). Among the children with recurrence of febrile seizures, the proportion of children aged 6-10.83 years in the Omicron group was higher than that in the non-Omicron group, while the proportion of children aged 3 years, 4 years, and 5 years in the Omicron group was lower than that in the non-Omicron group (P<0.05).@*CONCLUSIONS@#Children with febrile seizures after Omicron variant infection tend to have a wider age range, with an increase in the proportion of children with cluster seizures and status convulsion during the course of fever.

Investigations of clinical characteristics and inflammatory markers of febrile seizures induced by coronavirus infection

@#The study of children who experienced with febrile seizures(FS) as a result of COVID-19 infection to gain insight into the clinical characteristics and prognosis of neurological damage, with the aim of improving prevention, diagnosis, and the treatment of neurological complications. This study investigated the clinical features of 53 children with FS who were admitted to Sanya Women and Children’s Hospital from December 1, 2022, to January 31, 2023. The results indicated that the duration of convulsion in the case and control group was 7.90±8.91 and 2.67±1.23 (minutes) respectively. The analysis reveals that convulsions occurred within 24 hours in 39 cases (95.12%) of the case group, and in 8 cases (66.7%) of the control group. The difference was statistically significant (P<0.05). Additionally, the case group presented lower counts of WBC and NEU compared to the control group (p<0.05). The findings indicate that convulsions manifest at earlier stages of COVID-19 in children and the last longer than in the control group. It is therefore crucial for healthcare workers to remain attentive to patients with COVID-19 who report fever within 24 hours, and act promptly to implement preventive measures, particularly in cases of prolonged fever. It is essential to integrate the clinical manifestation, particularly convulsions, and the continuous numerical changes of inflammatory factors to assess COVID-19 linked with febrile seizures. In addition, larger-scale multi-center and systematic research are necessary to aid clinicians in monitoring neuropathological signals and biological targets, enabling more equitable diagnosis and treatment plans.

Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures

Justification: Febrile seizures are quite common in children but there are controversies in many aspects of their diagnosis and management. Methods: An expert group consisting of pediatric neurologists and pediatricians was constituted. The modified Delphi method was used to develop consensus on the issues of definitions and investigations. The writing group members reviewed the literature and identified the contentious issues under these subheadings. The questions were framed, pruned, and discussed among the writing group members. The final questions were circulated to all experts during the first round of Delphi consensus. The results of the first round were considered to have arrived at a consensus if more than 75% experts agreed. Contentious issues that reached a 50- 75% agreement was discussed further in online meetings and subsequently voting was done over an online platform to arrive at a consensus. Three rounds of Delphi were conducted to arrive at final statements. Results: The expert group arrived at a consensus on 52 statements. These statements pertain to definitions of febrile seizures, role of blood investigations, urine investigations, neuroimaging, electroencephalography (EEG), cerebrospinal fluid analysis and screening for micronutrient deficiency. In addition, role of rescue medications, intermittent anti-seizure medication and continuous prophylaxis, antipyretic medication and micronutrient supplementation have been covered. Conclusion: This consensus statement addresses various contentious issues pertaining to the diagnosis and management of febrile seizures. Adoption of these statements in office practice will improve and standardize the care of children with this disorder.

Study Of Febrile Seizure In Pediatric Patients

Background:Febrile seizures are among the leading cause of pediatric emergency hospital admission and affect 2% to 5% of pediatric population1,2 and are by far the most common type of seizure in childhood.Various risk factors are said to play a role in aetiology of FS are gender, developmental delay, maternal history of smoking, family history, bacterial and viral infections, certain vaccinations and iron deficiency, low serum sodium at the time of presentation. Preventive measure to remove such risk factor could lead to lower the incidence of febrile seizure.Objective: To study occurrence of predictive risk factors like gender, age, low birth weight in children with febrile seizure. To study fever and seizure pattern in above children. To observe positive family history pertaining to febrile seizure. Material And Methods:An observational prospective study was conducted in the tertiary care hospital over a 2 year period. Children aged 6 months to 60 months diagnosed as febrile seizure and admitted at pediatric ward were included in the study. A total of 69 patients were enrolled in the study. All information was collected from parents and indoor case sheets after taking verbal consent. Data was entered in Microsoft excel and analysis was carried out using SPSS version 21. Result:Gender wise amale predominance was seen. Youngerage group isa risk factor. Majority of children (92.8%) presented with simple FS with seizure duration less than 5 minutes. Majority (82.6 %) had fever for < 24 hour prior to FS. Positive family history of FS is observed in 20.2% children. Conclusion:Identification of predictive risk factor will help clinician to educate and counsel parents regarding seizure recurrence, prophylactic use of antipyretic and measures during seizure activity.

Review on Febrile Seizures in Children

Background: Febrile seizures are a common, yet benign neurological disorder and characterized by convulsions associated with fever in childhood due to the effect of fever ontheimmature brain. All treating clinicians must understand the nature and evaluation of this benign condition.Objective:To provide up-to-date knowledge on febrile seizures and their evaluation.Methods:A search was conducted with key terms “febrile seizures” or “febrile convulsion” invarious databases and writings. The literature included clinical trials, descriptive and observational studies, meta-analyses, and randomized control trials. Results:Febrile seizures occur between the ages of6 months to 5years in all ethnic groups. The exact mechanism has been still unknown although several etiologies have been proposed including genetic and environmental factors. Febrile seizures can be either simple or complex. Febrile seizures generally occur within the first day of feverbut rarely happen after 24 hours. Most of the time, febrile convulsions are short-lasting and self-limiting. The diagnosis is mainly based on the clinical description,and investigations have a limited role. Children less than one yearof age with suspicion of bacterialinfection need lumbar puncture to exclude meningitis. Management mostly depends on control of fever and the treatment of underlying conditions which precipitate fever. Some children can have prolonged convulsions which need anticonvulsants to abort an acute attack. Otherwise,long term prophylactic anticonvulsants have an insignificant role in the prevention of recurrencesof febrile seizures. Physical methods also play an insignificant role. As the condition commonly carries a favorable prognosis, unnecessary interventions should be avoided. Since febrile seizures recur in a significant proportion of children, they may bring needless fears and anxieties in parents. However, proper health education for parents by health care personnel might alleviate the anxiety and improve the quality of life of children with febrile seizures.Conclusion:Febrile convulsions are benign and self-limiting. Continuous use of anticonvulsants to prevent the recurrence of febrile seizures is notendorsed. Intermittent prophylaxis at the time of fever is also not routinely recommended. Both physical methods and antipyretics have limited value in the prevention of febrile seizures

Role of serum sodium levels in recurrence and recurrent episodes of febrile seizure

Background: Simple febrile seizures are the common childhood seizures, usually affecting 1 in 20 children between the age group of 6 months to 60 months. Earlier studies have shown an association between low serum sodium as a cause for febrile seizures and its recurrences. The present study was to determine the role of serum sodium in predicting febrile seizure recurrence within 24 hrs and recurrent episodes.Methods: Children aged between 6 months to 60 months with first episode of febrile seizures, admitted to the Paediatric ward of MOSC medical college Kolenchery, were recruited in the study. Inclusion criteria were demographic data, family history, clinical examinations, and laboratory investigations (serum sodium and hemoglobin).Results: Of the total study population of 100 children 33 had recurrences in 24 hours and 16 had recurrent episodes. About 57 children had a family history of febrile seizures, out which 28 children had recurrence of febrile seizure within 24 hours. 26 children had family history of epilepsy, of which only 8 had recurrences in 24 hours and 5 had recurrent episodes. Serum sodium levels of 69 children was above 130 mmol/l and 31 children had sodium level below 130mmol/l. Of 31 children, with low serum sodium levels (<130mmol/l), 29 had recurrence within 24 hours, which was not statistically significant. The sodium levels of 16 children who had recurrent episodes of seizure, was also between 130.1-135mmol/. No significant differences were seen between the serum sodium levels in simple febrile seizures and recurrent episodes.Conclusions: Study showed low serum sodium is not statistically significant to predict a recurrence within 24 hours, but a relative hyponatremia can predispose, a febrile child to occurrence of simple febrile seizure.

Clinical, epidemiological and laboratory characteristics of children with febrile seizures

Background: Febrile seizure is the most common type of seizure disorder that occurs in children aged 6-60 months. Recurrences are common. This study was conducted to evaluate the epidemiology, clinical profile and laboratory parameters of children presenting with febrile seizure in a teaching hospital.Methods: This was a descriptive retrospective study among children presenting with febrile seizure admitted to KIMS, Bengaluru from March (2018-2019). Children between six months to five years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient’s demographic and clinical data were collected from the in-patient records and analysed.Results: Among 60 children with febrile seizures were enrolled in our study with highest prevalence in males (58%) and amongst 13-24 months age group (37%). Majority (20%) presented in the monsoon season (June) and in the morning hours (43%). Simple febrile seizures and complex febrile seizures were observed in 60% and 40% respectively. Majority (73%) who developed first episode of seizure were below 24 months ago with mean age of 18.71±11.50 months. 42% had recurrence and was significantly associated with first episode of febrile seizures at age ≤1 year and family history of seizures. Upper respiratory tract infections were the commonest cause of fever. Anaemia and leucocytosis were seen in 72% and 70% cases respectively.Conclusions: Febrile seizure was observed predominantly in children below two years, simple febrile seizure being the commonest. Recurrence was common and significantly associated with the first episode of febrile seizure at the age one year or below and family history. Majority had anaemia which showed that iron deficiency anaemia could be a risk factor. Leucocytosis was present in most which could be either due to underlying infection or due to the stress of seizure itself.

Clinical profile of children with febrile seizure in a peripheral teaching hospital

Background: Febrile seizure is a common problem in children below 5years of age. This study was conducted to evaluate the clinical profile of children presenting with febrile seizures and to identify the risk factors for recurrence of febrile seizures in these children in a teaching hospital.Methods: A matched case-control study was conducted over a year period from November 2017 to November 2018 in the Department of Pediatrics. One hundred patients with febrile seizures admitted, aged 6-60 months were matched with another one hundred children having fever but without seizure with the same age range, attending the same hospital during the same period. Patients with prior episodes of afebrile seizures, abnormal neurodevelopment, on anticonvulsants and not meeting the age criteria were excluded.Results: The mean age and standard deviation for cases were 25.8'15.19 months and for control was 29.9'18.5 months. Out of which 64% had a febrile seizure for the first time and 36% had recurrent febrile seizures and 64% were males. Simple febrile seizure and complex febrile seizure were observed in 76.7% and 23.3% of patients respectively. The majority of children (71.8%) had a generalized tonic-clonic seizure followed by tonic seizures. Upper respiratory tract infections were the commonest cause of fever in these children. Low temperature at the onset of Febrile Seizure (p=0.001), short duration of fever before the onset of Febrile Seizure (0.026) and atypical Febrile Seizure (p=0.022) were the risk factors for a recurrent febrile seizure.Conclusions: Febrile Seizure is a common pediatric problem seen in males, observed predominantly in children below the age of two years and simple febrile seizure was the commonest variety. Almost one-third of children with Febrile Seizure are at risk for recurrence at a later date. The risk factors for these recurrences are modest rise in body temperature at the onset of febrile seizure, the onset of seizure within 12 hours of fever and atypical presentation.

Efficacy of intermittent prophylaxis vis a vis no prophylactic interventions in febrile seizure recurrence: randomised controlled trail

Background: To compare efficacy of intermittent prophylaxis during subsequent febrile episodes with antipyretics alone or antipyretics with anticonvulsant (clobazam) vis a vis no prophylactic interventions except need-based antipyretic measures in preventing recurrence of febrile seizures.Methods: This prospective randomized controlled interventional study was carried out in neurologically normal children. Study conducted over 14 months (March 2014 - May 2015), tertiary care hospital Mumbai. Inclusion criteria was, children aged from 6 month to 5 years with history of simple febrile seizure, lasting for less than 15 minutes, with Frequency less than one episode in 24 hours. Children with history of afebrile or complex febrile seizure, CNS comorbidity, family history of epilepsy, abnormal electroencephalogram, Unwillingness or non-feasibility of follow up were excluded from study. The patients were randomly grouped in A (No Prophylaxis n= 60), B (Antipyretic prophylaxis n=57) and C (Antipyretics + clobazam prophylaxis n=55). All cases were followed up telephonically every 15 days from date of first seizure as well as personal follow up at 1,3,6 months either in the hospital or at home. End point of study was taken as six months of follow-up from enrolment or lost-to-follow up. Efficacy of intervention was compared using chi-square test, Pearson chi-square test with/without Yates continuity correction and/or Fisher exact test, with p value of <0.05 as test of significance.Results: Sixty cases in group A developed febrile episodes and 6 of them developed recurrence of febrile seizures, with a recurrence rate of 10% among total cases and 9.67% among all febrile episodes. Recurrence rate was significantly higher (10%) in cases who did not receive any prophylactic intervention (Group A) as compared to pooled recurrence rate in group B and C together 1.78% (p=0.022).Conclusion: Regular antipyretic prophylaxis, alone or along with clobazam does not reduce the risk of recurrence in simple febrile seizures as compared to those who receive antipyretic intervention.

Intermittent clobazam prophylaxis in simple febrile convulsions: a randomised controlled trial

Background: Febrile seizure (FS) is the most common type of childhood seizure disorder with a prevalence of 2-5% in children less than 5 years. Although the prognosis of febrile seizure is usually good, however, the possibility of recurrence keeps many parents and families in a state of anxiety and concerned, for years after the first seizure. Thus, intermittent prophylactic treatment might be advised in children with high risk of recurrence.Methods: The study was a prospective randomized, double blind, placebo-controlled trial conducted at Department of Pediatrics, Umaid Hospital, Dr S N Medical College, Jodhpur on neurologically normal children aged from 6 months to 5 years with a history of simple febrile seizures and normal electroencephalogram without any evidence of acute central nervous system infection. Subjects were randomly prescribed oral clobazam according to weight of child and placebo when they developed a febrile disease during the first 48 h of the onset of fever.' Temperature reduction measures with paracetamol and tepid sponging were also advised. Patients were followed up for the frequency and time of febrile seizure recurrence, febrile episodes and side effects of drugs for 12 months.Results: Ten (3.8%) of 257 episodes in clobazam group and 38 (14.07%) episodes in placebo group had seizure recurrence (p value <0.001). The two groups were not significantly different in terms of side effects. (p >0.05).Conclusions: Intermittent oral clobazam therapy is a very effective measure in preventing recurrence of febrile seizures.

Association of vitamin D levels with simple febrile seizures in under five children: a case control study

Background: There is increasing concern that vitamin D deficiency may play etiological role in Febrile seizures. Few studies have reported vitamin D deficiency in children with recurrent febrile seizures and hypocalcemia seizures. 'The objective of this study is to explore vitamin D status in children aged 6 months to 5 years with first episode of febrile seizure and to find the association between vitamin D levels and febrile seizure.Methods: A hospital-based case control study was conducted in sub district hospital, Katra over a period of three years. Cases were children of age group 6 months to 5 years presenting with first episode of simple febrile seizure to the casualty or OPD. For each case, a control was selected with similar age group and same sex who came for short duration fever (<2 days) but without seizures. A 5ml of blood sample for measurement of 25 hydroxy vitamin D was taken from the peripheral vein of each participant by trained laboratory technician. In order to categorise various degrees of vitamin D deficiency, Indian Academy of paediatrics criteria was used. Results were presented in the form of percentages and Odds ratio was calculated as measure of association.Results: A total of 75 cases and 75 controls were included in the study. Cases and controls were comparable as per baseline characteristics. Strong and significant (p<0.01) association of febrile seizures with vit D levels was observed.Conclusions: There was a high prevalence of vitamin D insufficiency among cases of simple febrile seizure.

Association Analysis of Interleukin-1β, Interleukin-6, and HMGB1 Variants with Postictal Serum Cytokine Levels in Children with Febrile Seizure and Generalized Epilepsy with Febrile Seizure Plus

BACKGROUND AND PURPOSE: Febrile seizure (FS) is a unique type of seizure that only occurs during childhood. Genelized epilepsy with febrile seizure plus (GEFS+) is a familial epilepsy syndrome associated with FS and afebrile seizure (AFS). Both seizure types are related to fever, but whether genetic susceptibility to inflammation is implicated in them is still unclear. To analyze the associations between postictal serum cytokine levels and genetic variants in the cytokine genes interleukin (IL)-1β, IL-6, and high mobility group box-1 (HMGB1) in FS and GEFS+. METHODS: Genotyping was performed in 208 subjects (57 patients with FS, 43 patients with GEFS+, and 108 controls) with the SNaPshot assay for IL-1β-31 (rs1143627), IL-1β-511 (rs16944), IL-6-572 (rs1800796), and HMGB1 3814 (rs2249825). Serum IL-1β, IL-6, and HMGB1 levels were analyzed within 2 hours after seizure attacks using the ELISA in only 68 patients (38 FS, 10 GEFS+, and 20 controls). The allele distribution, genotype distribution, and correlations with serum cytokine levels were analyzed. RESULTS: Near-complete linkage disequilibrium exists between IL-1β-31 and IL-1β-511 variants. CT genotypes of these variants were associated with significantly higher postictal serum IL-1β levels than were CC+TT genotypes in FS (both p<0.05). CT genotypes of IL-1β-31 and IL-1β-511 variants were more strongly associated with FS than were CC+TT genotypes (odds ratio=1.691 and 1.731, respectively). For GEFS+, serum IL-1β levels after AFS for CT genotypes of IL-1β-31 and IL-1β-511 were also higher than for CC+TT genotypes. No significant associations were found for IL-6 and HMGB1. CONCLUSIONS: Genetic variants located in IL-1β-31 and IL-1β-511 promotor regions are correlated with higher postictal IL-1β levels in FS. These results suggest that IL-1 gene cluster variants in IL-1β-31 and IL-1β-511 are a host genetic factor for provoking FS in Korean children.

Management of febrile seizure and differentiating it from epilepsy: A short review

Febrile seizure is the most common seizures seen in infancy and pre-school era. They are mostly benign in nature. There are two categories of febrile seizures, simple and complex. Both the International League against Epilepsy and the American academy of paediatrics have published definitions on the classification of febrile seizures. Simple febrile seizures are mostly benign, but a prolonged (complex) febrile seizure can have long term consequences. Most children who have a febrile seizure have normal health and development after the event, but recent evidence suggests a small subset of children presenting with seizures and fever may have recurrent seizure or develop epilepsy. Diagnosis is solely clinical. But other causes of fever and seizure must be ruled out. Electroencephalogram, lumbar puncture and neuroimaging, all are to be used for specific indications but not routinely. Treatment consists of acute management and prophylaxis for further attack. This review will give an overview of the definition of febrile seizures, epidemiology, evaluation, treatment, outcomes and recent research.

Influence of SCN1A intronic mutations in mRNA splicing and relation of mRNA splicing changes with phenotype in febrile seizures related epilepsy / 中华神经医学杂志

Objective To study the influence of SCNIA intronic mutations in mRNA splicing in febrile seizures related epilepsy,and investigate the association between splicing changes and genotype-phenotype-inheritance pattern.Methods Molecular cloning of 5 SCN1A intronic mutations was performed in patients with partial epilepsy with antecedent febrile seizures plus (PEFS+) and Dravet syndrome (DS) through constructing mutant and wild-type plasmids of pTragetE2-3-4-5 and E24-25-26 by using Minigene splicing assay,and the in vitro expressions in HENK293 cells were detected.The mRNA splicing changes were analyzed qualitatively and quantitatively by reverse transcription (RT)-PCR and real time quantitative (q)-PCR.Results (1) Using RT-PCR,DS mutants presented a whole exon skipping without significant remain of normal mRNA transcripts,while PEFS+ mutants showed partial exon skipping or intronic insertion with coexistence of normal and aberrant mRNA transcripts.(2) Statistical differences were found between relative quantity (RQ) of aberrant and normal mRNA in PEFS+ mutant (c.473+5G＞A:4.92％±1.05％ and 6.10％±0.21％;c.473+5G＞C:7.97％±1.12％ and 3.94％ ±1.25％) and that in DS mutant (c.602+1G＞A:60.51％±1.81％ and 0.060％±0.022％,P＜0.05);similarly,there were statistical differences between relative RQ of normal and aberrant mRNA in PEFS+ mutant c.4853-25T＞A (71.22％±11.92％ and 7.38％±1.61％) and that in DS mutant c.4853-1G＞C (0.08％±0.01％ and 22.11％±2.83％,P＜0.05).Conclusion The position and difference of splicing patterns of SCNIA intronic mutations are potential molecular pathogenesis for phenotypic difference of febrile seizures related epilepsy.

The Prognostic Factors Affecting the Occurrence of Subsequent Unprovoked Seizure in Patients Who Present with Febrile Seizure after 6 Years of Age / 대한소아신경학회지

PURPOSE: Few reports have described the prognostic factors affecting the occurrence of subsequent unprovoked seizure in patients who present with febrile seizure (FS) after 6 years of age. We investigated the prognostic factors affecting the development of unprovoked seizures after FS among patients from Jeju Island. METHODS: We included patients who developed FS after 6 years of age, who presented to our outpatient clinic between January, 2011 and June, 2017. Clinical data were obtained through chart reviews and phone call interviews. We used logistic regression analysis to analyze the risk factors associated with the occurrence of subsequent unprovoked seizure. RESULTS: Of the 895 patients who presented to our hospital due to their febrile seizure, 83 developed FS after 6 years of age. Among them, 3 patients were prescribed antiepileptic drugs before the onset of the unprovoked seizure, and 4 patients developed an unprovoked seizure before 6 years of age. Thus, overall, 76 patients were included in the study. 51 patients developed first FS before 6 years of age. In the remaining patients, the first FS developed after 6 years of age. The mean observational period since the last outpatient follow-up visit was 3.2 years (median 3.04 years, range: 1.42-4.71 years). Among them, 21% developed an unprovoked seizure. Logistic regression analysis showed that electroencephalographic (EEG) abnormalities served as an independent risk factor for a subsequent unprovoked seizure. CONCLUSION: EEG is the proper diagnostic tool to predict the risk of a subsequent unprovoked seizure in patients with FS after 6 years of age.

Iron Deficiency Anemia: The Possible Risk Factor of Complex Febrile Seizure and Recurrence of Febrile Seizure / 대한소아신경학회지

PURPOSE: A relationship between Febrile seizure (FS) and iron deficiency anemia (IDA) has been found in several studies. However, few studies have focused on the role of IDA in complex febrile seizures (CFS) and simple febrile seizures (SFS) and there is no report on whether IDA is a risk factor for recurrence. The aim of this study was to investigate the role of IDA in SFS and CFS and to examine the effect of IDA on recurrence. METHODS: Patients (n=166) who had been diagnosed with FS were enrolled in our study. Subjects were divided into the following groups for analysis: the SFS and CFS groups, recurrence and non-recurrence groups. The onset age was compared in each group of patients and laboratory test results based on IDA were compared. RESULTS: Between the SFS and the CFS groups, there was no significant difference in laboratory test results based on IDA. There was a significant difference in onset age between the two groups and the onset age tended to be lower in the CFS group (24.00 vs. 16.49 months) (P=0.004). Comparing recurrence and non-recurrence groups, the mean corpuscular volume was significantly different (P=0.043) with the recurrence group having a lower mean corpuscular volume level (78.92 vs. 77.48). The onset age in the recurrence group was lower (26.02 vs. 19.68 months). CONCLUSION: This study suggests that onset age could be a risk factor for CFS, and IDA may not contribute to elevating the risk of CFS. However, IDA may play an important role in the recurrence of FS.

Prognosis in Late-Onset Febrile Seizure / 대한소아신경학회지

PURPOSE: There is a paucity of evidence about prognosis after a first febrile seizure in older children. We investigated the prognosis and potential risk factors associated with subsequent unprovoked seizures in children who had experienced a first febrile seizure over 6 years of age, which we termed as late-onset febrile seizure. METHODS: We included all patients six years or older who presented to the emergency department with a febrile seizure between 2009 and 2015. Clinical data was collected by chart review and parents were contacted for information on seizure progress. We used the Cox proportional-hazards model and Kaplan-Meier analysis for evaluating the risk factors for subsequent unprovoked seizures. RESULTS: Of 247 patients, we excluded 168 children who had a history of epilepsy, unprovoked, or febrile seizure and who were followed-up for period less than six months. Overall, 79 patients were classified as having had a first late-onset febrile seizure. During follow-up of 34.9±25.7(mean±SD) months, unprovoked seizure recurred in 7 of 79 patients (9%). The cumulative probability of seizure recurrence was 4% at 6 months, 6% at 1 year and 9% at 2 years. Clinical variables predictive of subsequent unprovoked seizures were not proved. CONCLUSION: This is the first multicenter study focusing on prognosis after a late-onset febrile seizure in children six years or older. The percentage of subsequent unprovoked seizure in patients with late-onset febrile seizure was 9% at 2 years of follow-up. Prospective follow-up study with longer duration is warranted.

Progress of adverse effect of routine vaccination in children with epilepsy / 中华实用儿科临床杂志

Routine vaccination is a most important way to prevent and control various kinds of infection disease,however,concerns about epileptic diseases after vaccination worries patients and health care providers.Many studies have shown that the risk of febrile seizure(FS)increases after measles-mumps-rubella(MMR)and iphtheria-tetanus-pertussis(DTP)vaccine,but this increase is associated with the fever after vaccine.The prognosis of vaccine related FS is similar to non-vaccine FS.Moreover,no evidence has shown that vaccine is related with non-febrile seizure and epileptic encephalopathy.