Febrile seizures and celiac disease

Abstract

We read with great interest the article by Ruggieri et al1Ruggieri M. Incorpora G. Polizzi A. Parano E. Spina M. Pavone P. Low prevalence of neurologic and psychiatric manifestations in children with gluten sensitivity.J Pediatr. 2008; 152: 244-249Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar on the association between celiac disease (CD) and neurologic manifestations. Their results show that of the 835 children with gluten sensitivity (GS), 3 patients have had febrile seizures (FS). This figure (0.36%) shows a 10- to 20-fold decrease compared with the usual prevalence figure of FS: 3% to 8%.2Sadleir L.G. Ingrid E. Scheffer I.E. Febrile seizures Clinical Review.BMJ. 2007; 334: 307-311Crossref PubMed Scopus (135) Google Scholar Even more, as far as we know, this is the lowest rate of FS ever reported. In fact, in patients with thalassemia, a rate 4.4 times less than that of the general population has been reported,3Auvichayapat P. Auvichayapat N. Jedsrisuparp A. Thinkhamrop B. Sriroj S. Piyakulmala T. et al.Incidence of febrile seizures in thalassemic patients.J Med Assoc Thai. 2004; 87: 970-973PubMed Google Scholar and it was hypothesized that iron overload may be a major factor that prevents FS. By the way, iron overload is not a usual feature of patients with CD. The literature has also documented an association between FS and iron deficiency anemia,4Pisacane A. Sansone R. Impagliazzo N. Coppola A. Rolando P. D'Apuzzo A. et al.Iron deficiency anaemia and febrile convulsions: case-control study in children under 2 years.BMJ. 1996; 313: 343Crossref PubMed Scopus (70) Google Scholar and it was suggested that the group of patients with FS plus anemia should be screened for CD.5Macdonald C.E. Playford R.J. Iron deficiency anaemia and febrile convulsions . . . and celiac disease.BMJ. 1996; 313: 1205Crossref PubMed Scopus (4) Google Scholar There is also a report of 3 cases of FS among 75 patients with CD,6Kieslich M. Errazuriz G. Posselt H.G. Moeller-Hartmann W. Zanella F. Boehles H. Brain white-matter lesions in celiac disease: a prospective study of 75 diet-treated patients.Pediatrics. 2001; 108: e21Crossref PubMed Scopus (107) Google Scholar which gives a figure of 4% of prevalence. Surprisingly, Ruggieri et al1Ruggieri M. Incorpora G. Polizzi A. Parano E. Spina M. Pavone P. Low prevalence of neurologic and psychiatric manifestations in children with gluten sensitivity.J Pediatr. 2008; 152: 244-249Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar stated that “the overall prevalence of febrile and afebrile seizures, were similar to those seen in the general population.” We have performed a retrospective medical record review to estimate the proportion of CD within patients with FS. Any patient with FS who tested for EMA or tTG was recruited. Subject characteristics: the 56 subjects ranged in age from 1.2 to 18.2 years; 22 subjects were male and 34 were female; weeks of gestation, mean 38.70; rate of gluten sensitivity among children with FS: 8.92%. Of the 56 patients, 5 tested positive for EMA or tTG and were proven with biopsy according to the ESPGHAN criteria. Our own observation is not in agreement with that of Ruggieri et al.1Ruggieri M. Incorpora G. Polizzi A. Parano E. Spina M. Pavone P. Low prevalence of neurologic and psychiatric manifestations in children with gluten sensitivity.J Pediatr. 2008; 152: 244-249Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar ReplyThe Journal of PediatricsVol. 153Issue 2PreviewVerd and Nadal Amat raise criticism on the prevalence figures of febrile seizures (FS) (0.36%) that we recorded in the group of 835 children with gluten sensitivity (GS) screened for the occurrence of neurologic or psychiatric manifestations.1 They consider these figures too low (10 to 20-fold lower) as compared with the usual prevalence of FS, either in the general population (stated as 3% to 8%) and in other groups of disorders (eg, patients with thalassemia) and too low as compared with the previously reported2 figures for FS in celiac disease (CD). Full-Text PDF