Febrile Convulsions In Children Research Articles

A clinical study of CK-BB and endothelin on brain damage induced by febrile convulsion in children

目的 探讨热性惊厥(FC)患儿血清脑型肌酸激酶同工酶(CK-BB)和血浆内皮素(ET)水平的变化及其与脑损伤程度的关系.方法 将2005年11月至2007年12月在我院小儿内科病房救治的60例FC患儿作为FC组,其中单纯型热性惊厥(SFC)组和复杂型热性惊厥(CFC)组各30例,健康儿童30例作为正常对照组,分别进行血清CK-BB和ET的测定,CK-BB采用比色法测定,ET采用放射免疫法测定.结果 SFC组CK-BB的浓度为(11.85±3.16)U/L、ET的浓度为(66.73±14.62)ng/L;正常对照组CK-BB的浓度为(8.34±3.49)U/L,ET的浓度为(55.75±8.14)ng/L;两组比较差异有显著性(P<0.01);CFC组CK-BB的浓度为(18.94±5.59)U/L、ET的浓度为(92.65±21.57)ng/L,与SFC组和正常对照组比较差异均有非常显著性(P<0.01);惊厥发作持续时间≥15 min的患儿CK-BB的浓度为(14.99±3.51)U/L、ET的浓度为(91.42±21.13)ng/L,惊厥发作持续时间<15 min的患儿CK-BB的浓度为(9.84±3.47)U/L,ET的浓度为(61.11±10.33)ng/L,两者比较差异有非常显著性(P<0.01).结论 血清中CK-BB和ET水平与脑损伤的程度密切相关,CK-BB和ET水平越高,脑损伤程度越严重.FC后CK-BB和ET的及时检测对判断脑损伤程度及预后有重要意义。

Temporal lobe epilepsy -- not a consequence of childhood febrile convulsions in Denmark.

Temporal lobe epilepsy in particular has been considered a consequence of childhood febrile convulsions. Previous studies have dealt with populations of epileptic children. This retrospective, follow-up study concerns 362 children with a primary diagnosis of febrile convulsions. 4% developed epilepsy. When followed into early adulthood one half of those remitted. The incidence of temporal lobe epilepsy among the none-remitters did not differ from that of a random population of epileptics.

Febrile Seizures: Interleukin 1β and Interleukin-1 Receptor Antagonist Polymorphisms

In order to investigate the association between IL-1beta -511 C-->T and IL-1 receptor antagonist intron 2 variable tandem repeat polymorphisms, and febrile seizures in children, 90 children (mean age, 19.7 +/- 11.2 months) diagnosed with febrile seizure and 106 healthy controls (mean age, 14.2 +/- 3.6 months) with no seizure or neurologic events were included in the study. The polymorphisms were analyzed using restriction fragment length polymorphism and agarose gel electrophoresis methods. In the patient group, the frequencies of IL-1beta genotypes CC, CT, and TT were 24.4%, 52.2%, and 23.3%, respectively, compared with 38.7%, 50.95%, and 10.4%, respectively, in the control group. The TT genotype was significantly more common in the patient group than in the control group (P = 0.044), and the T allele frequency was significantly higher in the patient group (0.50 vs 0.36, P = 0.040). Among the three genotypes (RN1/1, RN1/2, and RN2/2) of the IL receptor antagonist gene variable tandem repeat polymorphisms, the frequency of both the RN2/2 genotype and the RN2 allele were significantly higher in the patient group (P = 0.007). Also RN2 allele frequency was found higher in patient group than controls (0.29 vs 0.15, P = 0.020). IL-1beta -511 and IL-1 receptor antagonist intron 2 variable tandem repeat polymorphisms may be involved in susceptibility to febrile convulsions in children.

Risk factor of influenza virus infection to febrile convulsions and recurrent febrile convulsions in children

Purpose : Febrile convulsions are a common pediatric neurological disease, and it is important to prevent such a disease by controlling the risk factors that may recur. A recent report states that influenza virus infections have a high probability of a relationship with febrile convulsions; therefore, it is necessary to identify the clinical properties of febrile convulsions in relation to domestic influenza virus infections. Methods : Between November 2005 and February 2008, children hospitalized because of febrile convulsions and subsequently confirmed to have influenza infections were enrolled as subjects (patient group, n=11). The control subjects were those admitted with influenza virus infections but no febrile convulsions (control group 1, n=46) and those who developed febrile convulsions without influenza virus infection (control group 2, n=53). Results : The patient group showed a higher maximum body temperature (39.30.5), more histories of past febrile convulsions (72.7%), and a shorter total duration of fever (2.91.2 days) than control group 1. When multivariate analysis was performed, the probability of febrile convulsions was found to be as high as 225.9 times in patients who had influenza virus infections with a past history of febrile convulsions (OR=225.9, 95% CI: 1.7-4780.0, P0.7 days) before convulsion than control group 2; these convulsions were mostly a recurrence of febrile convulsions. When multivariate analysis was performed, the cases with a past history of febrile convulsions showed 5.5 times (OR=5.5, 95% CI: 1.2-25.1, P=0.03) the probability of convulsions when infected with the influenza virus, and this probability decreased by 0.3 times over one-day increments of the febrile period until febrile convulsions (95% CI: 0.1-0.9, P=0.02). Maximum body temperature, total duration of fever, family history of febrile convulsions, and complex febrile convulsions did not show a statistical significance. Conclusion : In cases of pediatric influenza virus infection, the past history of febrile convulsions could be identified within the risk factor of recurrent febrile convulsions. Therefore, influenza vaccination of children having a past history of febrile convulsions will be helpful to avoid the recurrence of these convulsions.

Correlation Between Acetaminophen Consumption and CSF Glucose in Febrile Convulsion

Background: Hyperglycemia and hyperglycorrhagia are common associations of febrile seizures. Rapid release of cortisol and adrenaline after seizures as a stress reaction induces elevated glucose concentration. During fever release of Interleukin 1 beta, an endogenous pyrogenic cytokine, inhibits insulin release and stimulates the secretion of cortisol. The purpose of our study was to asses the correlation of acetaminophen consumption and CSF glucose concentration in febrile convulsion. Method: In this cross-sectional analytic study,CSF samples were analyzed from 63 children, 3—18 months age with febrile convulsion. Comaprisons between the mean CSF glucose concentrations in the children who taken and no taken acetaminophen during 6 hour before convulsion were performed using Student’s t-test and Mann-whitney test Results: CSF glucose levels were significantly higher (P = 0.0001) in children who were not taken acetaminophen (82± 8mg/dL) as compared with children taken acetaminophen (53± 4mg/dL.) Conclusion: The use of acetaminophen decreases CSF glucose concentration in febrile convulsive children.

Progression in temporal lobe epilepsy

To determine the relationship between hippocampal, amygdalar, and entorhinal cortex atrophy and duration of epilepsy, presence of secondary generalized seizures, and prolonged childhood febrile convulsions in patients with pharmacologically intractable temporal lobe epilepsy (TLE). Volumetric MRI of the hippocampus, amygdala, and entorhinal cortex were performed in 86 consecutive patients with TLE and 44 age- and sex-matched healthy control subjects. Linear regression analysis was used to explore the relation between the volumetric measurements and the clinical parameters. In simple regressions, duration of epilepsy but not age at seizure onset was related to hippocampal (r2 = 0.19, p < 0.001), entorhinal cortex (r2 = 0.11, p = 0.002), and amygdalar (r2 = 0.15, p < 0.001) atrophy ipsilateral to the seizure focus. Prediction of the regression function to time of onset of recurrent seizures (time = 0) resulted in a y intercept of < 0 for the hippocampus and the entorhinal cortex but was not different from 0 for the amygdala. Patients with a positive history of febrile convulsions had smaller hippocampal volumes ipsilateral to the seizure (p < 0.001). No relationship was found between febrile convulsions and entorhinal cortex and amygdalar volumes or between secondary generalization of seizures and any mesial temporal volume. Progressive volume loss in the mesial temporal lobe in relation to duration of epilepsy is not limited to the hippocampus but affects the entorhinal cortex and the amygdala.

Perivascular clustering in temporal lobe epilepsy: oligodendroglial cells of unknown function

Marked perivascular clustering (PC), i.e., groups and rows of small round cells along white matter vessels, is seen in temporal lobe epilepsy (TLE) specimens obtained by surgery. This study focuses on the constituting cell types and discusses clinical significance and pathogenesis of PC, which are so far unknown. Based on a series of 59 nonlesional TLE surgical specimens, we characterized PC by immunohistochemistry and correlated the amount of PC with clinical parameters. PC cells were variably positive for galactocerebroside, myelin basic protein and S-100 protein, while glial fibrillary acidic protein, vimentin, nestin and neuronal antigens were not expressed. There was no correlation between the amount of PC and any clinical feature, including age at surgery, age at epilepsy onset, duration of epilepsy, preoperative seizure frequency, childhood febrile convulsions, family history of epilepsy, and postsurgical outcome. Our findings suggest oligodendroglial differentiation of PC, while its primary (dysplastic) versus secondary (reactive) pathogenesis remains unresolved.

The association between febrile convulsion in children and chronic hyperventilation in parents

Background Febrile convulsion and chronic hyperventilation syndrome (spasmophilia) are suspected to share the same root of pathophysiology, a genetic trait abnormality related to ion channel that could cause neuronal hyperexcitability.Objective To determine the prevalence ratio of parents with chronic hyperventilation syndrome between two groups of children with and without febrile convulsion.Methods A cross-sectional design study was used, with a tertiary hospital setting (Kariadi Hospital). Participants were selected consecutively based on eligibility criteria. Febrile convulsion was diagnosed based on a modified Livingstone criteria. Chronic hyperventilation syndrome in parents was determined using the clinical diagnostic test of spasmophilia (88.4% sensitivity and 6 1.6% specificity). Statistical calculations were conducted with two by two table analysis and within the 95% confidence interval.Results Sixty-two children (mean age 18 months) who met the eligibility criteria were included. The parents' mean ages were 33 years (father) and 29 years (mother). The prevalence ratio of father, mother and both parents with chronic hyperventilation between the febrile convulsion group and the non-febrile convulsion group were 2.56 (95% CI 0.53 to 12.31), 6.19 (95% CI 1.70 to 22.6) and 18.7 (95% CI3.07 to 113.9), respectively.Conclusion Febrile convulsion can be anticipated in children of parents who suffer from chronic hyperventilation syndrome.

Voxel based morphometry of grey matter abnormalities in patients with medically intractable temporal lobe epilepsy: effects of side of seizure onset and epilepsy duration

Objectives: To investigate the use of whole brain voxel based morphometry (VBM) and stereological analysis to study brain morphology in patients with medically intractable temporal lobe epilepsy; and to determine...

A splice-site mutation in GABRG2 associated with childhood absence epilepsy and febrile convulsions.

Missense mutations in the GABRG2 gene, which encodes the gamma 2 subunit of central nervous gamma-aminobutyric acid (GABA)(A) receptors, have recently been described in 2 families with idiopathic epilepsy. In one of these families, the affected individuals predominantly exhibited childhood absence epilepsy and febrile convulsions. To assess the role of GABRG2 in the genetic predisposition to idiopathic absence epilepsies. The GABRG2 gene was screened by single-strand conformation analysis for mutations. Furthermore, a population-based association study assessing a common exon 5 polymorphism (C588T) was carried out. The sample was composed of 135 patients with idiopathic absence epilepsy and 154 unrelated and ethnically matched controls. A point mutation (IVS6 + 2T-->G) leading to a splice-donor site mutation in intron 6 was found. The mutation, which is predicted to lead to a nonfunctional protein, cosegregates with the disease status in a family with childhood absence epilepsy and febrile convulsions. The association study did not find any significant differences in the allele and genotype frequencies of the common exon 5 polymorphism (C588T) between patients with idiopathic absence epilepsy and controls (P>.35). Our study identified a splice-donor-site mutation that was probably causing a nonfunctional GABRG2 subunit. This mutation occurred in heterozygosity in the affected members of a single nuclear family, exhibiting a phenotypic spectrum of childhood absence epilepsy and febrile convulsions. The GABRG2 gene seems to confer a rare rather than a frequent major susceptibility effect to common idiopathic absence epilepsy syndromes.

Childhood febrile convulsions—which factors determine the subsequent epilepsy syndrome? A retrospective study

To analyze the spectrum of epilepsy syndromes which follow childhood febrile convulsions (FC) and to examine whether retrospective analysis of clinical features of the FC enables discrimination of patients who develop temporal lobe epilepsy (TLE) from those who develop generalized epilepsy (GE). One hundred and thirteen patients with epilepsy and antecedent FC were retrospectively analyzed. We inquired in detail about the clinical characteristics of FC (age, duration, number, focal symptoms) as well as family history, birth history, neurological status, and psychomotor development before onset of FC. Forty five (39.8%) patients had TLE, 41 (36.6%) GE, and 27 (23.9%) had extratemporal epilepsy (ETE). Patients with TLE had a significantly longer duration of FC ( P≤0.001), more often focal features ( P≤0.001), and febrile status epilepticus ( P≤0.001) than patients with GE. Age at FC, Number of FC, family history, birth history and neurological status at FC did not differ between groups. A stepwise discriminant model allowed correct assignment after cross validation in 84.2% to TLE and in 100% to GE. A broad spectrum of epilepsy syndromes follow FC. We found a strong association of prolonged and focal FC with later development of TLE. Short generalized FC were associated with GE.

Polymorphisms for interleukin 1 beta exon 5 and interleukin 1 receptor antagonist in Taiwanese children with febrile convulsions.

To investigate whether interleukin 1 beta (IL-1 beta) exon 5 and IL-1 receptor antagonist (IL-1Ra) gene polymorphisms can be used as markers of susceptibility to febrile convulsions in children. Children were divided into 2 groups: those with febrile convulsions (group 1; n = 51) and normal control subjects (group 2; n = 83). Polymorphisms for IL-1 beta exon 5 and IL-1Ra gene polymorphisms were detected by polymerase chain reaction. Genotypes and allelic frequencies for IL-1 beta exon 5 and IL-1Ra gene polymorphisms in both groups were compared. Genotype and allele frequencies for IL-1 beta exon 5 in both groups were not significantly different. Proportions of E1 homozygotes and E1/E2 heterozygotes for IL-1 beta exon 5 were 50 (98.1%) and 1 (1.9%), respectively, in group 1 and 82 (98.8%) and 1 (1.2%), respectively, in group 2. Frequencies of alleles E1 and E2 for IL-1 beta exon 5 were 101 (99.0%) and 1 (1.0%), respectively, in group 1 and 165 (99.4%) and 1 (0.6%), respectively, in group 2. Genotype proportions and allele frequencies for IL-1Ra between groups were significantly different. Proportions of genotypes I/I and I/II for IL-1Ra were 49 (96.1%) and 2 (3.9%) in group 1 and 69 (83.1%) and 14 (16.9%) in group 2. Frequencies of alleles I and II for IL-1Ra were 100 (98.0%) and 2 (2.0%) in group 1 and 152 (91.6%) and 14 (8.4%) in group 2. The IL-1Ra allele I is associated with a higher susceptibility to febrile convulsion, which may become a useful marker for predicting the development of febrile convulsions. The IL-1 beta exon 5 gene polymorphisms are not a useful marker for predicting the susceptibility to febrile convulsions.

The influence of long-term treatment with histamine H1 receptor antagonists and theophylline on the incidence of febrile convulsion in children with atopic dermatitis and/or asthma

The influence of long-term treatment with histamine H1 receptor antagonists and theophylline on the incidence of febrile convulsion in children with atopic dermatitis and/or asthma

The expanding spectrum of herpesvirus infections of the nervous system.

Herpesviruses cause various acute, subacute, and chronic disorders of the central (CNS) and peripheral (PNS) nervous systems in adults and children. Both immunocompetent and immunocompromised individuals may be affected. Zoster (shingles), a result of reactivation of varicella zoster virus (VZV), is the most frequent neurologic complication. Other neurological complications include encephalitis produced by type I herpes simplex virus (HSV-1), and less frequently HSV-2, as well as by VZV and cytomegalovirus (CMV). Acute meningitis is seen with VZV and HSV-2, and benign recurrent meningitis with HSV-2. Combinations of meningitis/ encephalitis and myelitis/radiculitis are associated with Epstein Barr Virus (EBV); myelitis with VZV, CMV, EBV, and HSV-2; and ventriculitis/encephalitis with VZV and CMV. Brainstem encephalitis due to HSV and VZV, and polymyeloradiculitis due to CMV are well documented. HHV-6 produces childhood exanthem subitum (roseola) and febrile convulsions. Immunocompetent and immunocompromised hosts manifest different incidences and patterns of herpesvirus infections. For example, stroke due to VZV-mediated large vessel disease (herpes zoster ophthalmicus) occurs predominantly in immunocompetent hosts, while small vessel disease (leukoencephalitis) and ventriculitis develop almost exclusively in immunocompromised patients. EBV-associated primary CNS lymphomas also are restricted to immunosuppressed individuals. Recent large CSF PCR studies have shown that VZV, EBV, and CMV more frequently produce meningitis, encephalitis, or encephalopathy in immunocompetent hosts than was formerly realized. We review herpesvirus infections of the nervous system and illustrate the expanding spectrum of disease by including examples of a 75-year-old male on steroid treatment for chronic lung disease with fatal HSV-2 meningitis and an 81-year-old male with myasthenia gravis, long-term azathioprine use, and an EBV-associated primary CNS lymphoma.

La Atención Primaria de Salud y las hospitalizaciones por Ambulatory Care Sensitive Conditions en Cataluña

Ambulatory Care Sensitive Conditions (ACSC) are a set of selected codes of hospital discharge diagnosis intended to measure avoidable hospitalizations. Primary Health Care Services may avoid the hospitalizations due to ACSC by applying any of the following interventions, that are characteristics of this level of care: a) primary prevention; b) secondary prevention, and c) tertiary prevention and rehabilitation. Observational, cross-sectional pilot study on 248,174 hospital discharges, from a population of 2,248,704 inhabitants in 161 Basic Health Care Units (BHCU), recorded in the minimum basic set of hospital discharge data in Catalonia during 1996. The complete list of diagnostic codes of ACSC, identified in the literature search, has been used. Crude and age-standardised hospitalisation rates have been estimated. Standardised hospitalisation ratio (SHR) has been computed to compare hospitalisation rates between BHCU. To analyse the effect of variables associated with high ACSC admission rates, multivariate analysis has been carried out by means of Poisson's regression. Hospitalisation due to ACSC account for 13% of all hospitalizations and 16% of hospital stay days. Acute and chronic diseases of the lower respiratory tract are the first cause of hospitalisation at any age group (< 5, 15-64 and > or = 65 years). The most common diagnostic groups, for all ages are respiratory disorders (acute and chronic diseases of the lower respiratory tract and pneumonia) and urinary tract conditions (pyelonephritis/urinary tract infection). The so-called self-limited health problems (ear, nose and throat mild infections/infections of the upper respiratory tract, febrile convulsions in children and gastroenteritis) account for more than 10% of all hospitalizations by ACSC, 45% of which occur in children. The overall crude hospitalisation rate by ACSC is 146.9/10,000 inhabitants (range: 12.4/10,000-239.9/10,000). SHR ranges from 0.01 to 1.85. "Hospital admissions due to ACSC" is a valid indicator to assess global performance of Primary Health Care and it identifies a part of hospital activity that is amenable to be cared for at Primary Health Care level and therefore potentially avoidable.

The use of antipyretic medications in the prevention of febrile convulsions in children.

Febrile convulsions are a relatively common outcome in paediatric febrile illness, although it is not known why some children suffer these. Antipyretic medications may form the basis for some treatment regimens, although they are not recommended in published guidelines. There is little evidence that the prophylactic use of antipyretics has any effect in reducing the incidence of febrile convulsions. Consequently, educational interventions aimed at reducing parental fear and helping them to care for their children during febrile illnesses may be more efficacious.

Effects of information on parental knowledge of febrile convulsions

The purpose of this study was to study the effects of giving information to parents with febrile convulsive children. All parents of children with febrile convulsions who are seen at Worcester Royal Infirmary are given information. Fifty parents of children who had had a first febrile convulsion during May 1996 to December 1996 were interviewed by telephone from July to September 1997. The same questions were asked of 50 parents of children who came to a community health clinic and who had not had febrile convulsions. The design used open questions and covered medical history, general child health knowledge and knowledge of febrile convulsion. The answers were compared using a chi-squared test (significance levelP< 0.05). Possible confounding factors were tested by a correlation test. No difference was found between the two groups in family structure, housing, and general child health knowledge. Information about febrile convulsions was retained by informed parents. Both groups thought the given information was useful and should be written in the child health record book. Information about febrile convulsions was remembered by parents.

Risk factors for a first febrile convulsion in children: a population study in southern Taiwan.

To identify risk factors for a first febrile convulsion among 3-year-old children by a matched case-control population study. All 11,714 neonatal survivors born in Tainan City between October 1989 and September 1991 were enrolled. At age 3, 10,460 children were available for telephone survey for febrile convulsions, and were confirmed by home visit interviews. Those without history of seizure were randomly matched to each febrile convulsion case by age, gender, and residence district. Two hundred fifty six children had febrile convulsions, and 218 of them and their matched controls were available for analysis. The febrile convulsion cases had significantly more febrile episodes (four or more) per year (33.0 vs. 22.5%; p = 0.021), and cases had a higher percentage of developmental delay (3.7 vs. 0.4%; p = 0.046) and a higher percentage of febrile convulsions in their siblings (12 vs. 0.4%; p = 0.011) than controls. The other sociodemographic, environmental, and biologic variables showed no differences between cases and controls. Step-wise logistic regression showed a highly significant independent association between febrile convulsions and history of febrile convulsions in the siblings, and a moderate one between febrile convulsions and the number of febrile episodes per year. The presence of febrile convulsions in the siblings and the number of fever episodes per year were the independent and significant predictors of febrile convulsion for an individual case in our population-based sample.

Incidence of febrile convulsions in children with congenital hypothyroidism

Brain excitability has been inconsistently reported to be increased both in hypo‐ and hyperthyroidism, but there have been few studies on the effects of thyroid hormones on brain excitability in children. With this in mind, we investigated the incidence of febrile convulsions (FCs) among patients with congenital hypothyroidism, who have been taking L‐ thyroxine since the age of 1 month. The incidence of FCs among congenital hypothyroid patients was 1.6% (1/63) which was significantly low (p &lt; 0:05) compared with that of normal control children who visited our hospitals as outpatients (28/341, 8.2%) and that of others (322/3301, 9.8%) investigated 33 years ago in the same area. The incidence of FC among siblings of the 63 patients (7/74, 9.5%) was not statistically different from the controls. At least 8 of the 126 parents (6.4%) had experienced FC, however, only one child was affected in the 8 families. In conclusion, it seems likely that patients with congenital hypothyroidism on regular L‐T4 replacement are less prone to experience FC. More studies on the incidence of convulsive disorders in children with thyroid diseases are needed to clarify the effects of thyroid hormones on brain excitability.

Nocturnal temporal lobe epilepsy.

To analyze clinical, electrophysiologic, and neuroradiologic characteristics and prognostic factors in a group of patients with temporal lobe epilepsy (TLE) and complex partial seizures (CPS) occurring exclusively or predominantly after they fall asleep or before they awaken. CPS arising during sleep are classically identified with frontal lobe epilepsy. TLE associated with seizures occurring only or predominantly during sleep (nocturnal TLE) is less common. From a series of patients with refractory TLE studied between 1980 and 1996, the authors identified 26 patients (15 men) with nonlesional nocturnal TLE (mean age, 40 years). Clinical and laboratory characteristics of these individuals were studied and compared with a group of 72 age-matched, randomly selected patients with nonlesional TLE and predominantly diurnal seizures (diurnal TLE). Mean age at seizure onset was similar for both groups (16.3 versus 18.7 years). In the nocturnal TLE group, 2 of 26 patients had a positive family history of epilepsy, 18 reported an aura, 4 presented with CPS in clusters, 11 had unilateral and 15 bilateral temporal EEG abnormalities, and 14 of 21 studied had unilateral mesial temporal atrophy. None of these factors differed significantly in the two groups except for higher frequency of the following in the diurnal TLE group compared with the nocturnal TLE group: positive family history for epilepsy (33% versus 8%, p=0.01), estimated frequency of seizures (median, 14 versus 2 per month; p < 0.01), and presence of antecedent febrile convulsions (33% versus 11%, p=0.04). In the nocturnal TLE group, eight patients underwent surgical therapy and became seizure free (follow-up, > 12 months). Only two were seizure free on medication. Infrequent and nonclustered seizures, rare family history of epilepsy, and low prevalence of childhood febrile convulsions characterize nocturnal TLE. Within the TLEs, the nocturnal TLE form seems to have a better surgical prognosis.