Recurrent Febrile Convulsions Research Articles

Characteristics of pediatric patients with febrile convulsions admitted to a tertiary care hospital in Riyadh, Saudi Arabia

Abstract: BACKGROUND: Febrile convulsions (FCs) are the most common type of seizures in children. They usually occur between the ages of 6 months and 5 years and affect 2%–5% of children worldwide. The aim of this study was to describe the epidemiological and clinical characteristics of children who have been diagnosed with FCs and admitted to a tertiary care hospital in Riyadh. MATERIALS AND METHODS: The study included pediatric patients aged between 3 months and 5 years who presented to the emergency department of King Abdullah Specialist Children’s Hospital in Riyadh, Saudi Arabia and were admitted to hospital with FC diagnosis during 2015 to 2021. The hospital’s electronic medical records system was reviewed to obtain patients’ information on age, gender, clinical characteristics, laboratory investigations, length of hospital stay, and outcome. Data was analyzed using Stata 12; Chi-square test was used to determine association between categorical variables, while t-test or Mann–Whitney U test compared continuous data between two groups. RESULTS: A total of 247 children with FC diagnoses were included in the analysis; 0.4% of pediatric patients were admitted to the hospital with the diagnosis of FC. Most of the patients (77%) convulsions were triggered by upper respiratory tract infections and median duration of the convulsion episode was 4 min; 55% of the patients had a simple FC, and 40% had recurrence of FCs. Developmental delays were more common in children with recurrent FCs (15%) compared to children who had only one episode of convulsion (2.7%) [P < 0.001]. CONCLUSION: During the study period, 0.4% of pediatric patients were admitted to hospital with FC diagnoses. Larger multicenter studies are needed to evaluate FCs based on their clinical and operational characteristics to improve the quality of care, decrease the length of patient hospital stay, and lower the recurrence rate.

Is vitamin D deficiency a risk factor in the occurrence and recurrence of febrile convulsions in children?

Background: Febrile seizure (FS) is the commonest childhood seizure. Our aim was to evaluate low Serum 25(OH) vitamin D level (vitamin D) as a risk factor for FS and whether vitamin D supplementation reduces its recurrence. Methods: A prospective cohort of children aged 6-60 months with FS (cases) and children with fever ≤3 days without seizures (controls) were recruited over a 2-year period. Vitamin D level was measured; those with low levels (<20 ng/ml) were treated with vitamin D for 3 months. Telephonic follow up was done upto 3 months regarding compliance, thereafter, upto 24 months for seizure recurrence. Results: 259 children (125 cases,134 controls) were recruited. Overall, 90 children (34.7%) had low vitamin D level. There was no difference between cases and controls with low vitamin D levels (p=0.37). 22 (17.6%) children had seizure recurrence. Of this serum vitamin D level was low in 2 (9.1%) while 20 (90.9%) had sufficient levels (p=0.021). The odds ratio for FS recurrence was 5.8 times higher among cases with normal vitamin D level (>20 ng/ml). Conclusions: There was no difference in mean vitamin D levels between cases and controls. However, there was significantly lower seizure recurrence in children who had low vitamin D level at presentation and had received vitamin D therapy. We postulate that treatment with vitamin D may reduce risk of FS recurrence even in those with serum vitamin D level in the “sufficient” range as per the recommended guidelines. Larger RCTs are needed to confirm these findings.

The Association between Hyponatremia and Recurrent Febrile Convulsion

Background: Febrile seizures are a common pediatric problem, yet there is a great deal of disagreement about the appropriate diagnostic evaluation of a child with this disorder. Different predisposing factors have suggested enhancing the susceptibility to febrile seizure and its recurrence. Objective: To determine the effect of hyponatremia in recurrent febrile convulsions. Materials and Methods: A case-control study was carried out at Al-Zahraa teaching hospital in Al-Najaf city during the period between 1 January and the end of October 2021. One hundred fifty children in the age range between six months and six years old were studied. We classified the patients into three groups: Group (A) included 50 children who presented with fever without seizure; group (B) included 50 children who presented with simple febrile convulsion; and group (C) included 50 children who presented with recurrent febrile convulsions. Group A was considered as the control group. The serum level of sodium Na+ was estimated in these three groups by Na kits. Results: There was no significant difference between males and females, in all age groups. Also, it was shown that a family history of febrile convulsion represented 20%, 50%, and 50% in groups A, B, and C, respectively; a family history of recurrent febrile convulsion represented 4%, 4%, and 10%, in groups A, B, and C, respectively; and a family history of epilepsy represented 0%, 4%, and 0% in groups A, B, and C, respectively. A value of P in family history of febrile convulsion was 0.002, in family history of recurrent febrile convulsion was 0.345, and in family history of epilepsy was 0.132. Therefore, there was no significant difference in all parameters except a family history of febrile convulsion that was significant in all three groups. Also, the study will show no significant difference in age, white blood cell count, and random blood surge whereas there is a significant difference in temperature. A significant difference in serum sodium level was the lowest in group C. Regarding calcium level, there was a significant difference between groups A and B. Conclusion: There is a significant association between recurrent febrile convulsion and lower level of serum sodium, in which serum sodium concentration is lower in those patients with recurrent febrile convulsion.

Risk Factors of Recurrent Febrile Convulsions in Children in AL-batool Teaching Hospital

Background: Febrile seizures are the most common convulsive disorder in infants and children. Its occurbetween the age of 6 and 60 mo.There are two type of febrile convulsion simple and complex; A simplefebrile seizure is a primary generalized, usually tonic-clonic, attack associated with fever, lasting for amaximum of 15 min, and not recurrent within a 24-hour period. A complex febrile seizure is more prolonged(>15 min), focal, and/or recurs within 24 hr .Aim of the study: To identify the risk factors for recurrence of febrile convulsions in children.Materials and Methods: This was a case-controlled study done at Al Batool teaching hospital .Studyconducted over a period of five months , from August 2018 to December 2018 . All children with febrileseizure belonging to age group of 6 months to 6 years were included in the study.Results : Compared to children with first attack of febrile convulsion, children with recurrent seizures wereyounger at onset (12_24mo.) (26% vs. 54%), mainly male (72% vs. 62%) and had more often family history(second degree relative), low degree of temperature (78% vs. 36%),simple febrile convulsion (52% vs.68%),duration of fever less than12 hours (78% vs. 70%), and frequent febrile illnesses (74% vs. 20%). firstdegree family history of febrile convulsion and family history of epilepsy were not significant risk factors.Conclusions: The risk factors associated with increased incidence of recurrence FC are: male sex, agebetween12_24 months at the onset of the first FC, family history of FC in a second degree relative, durationof fever <12 hours ,simple type of convulsion &frequent attack of febrile illness(>4per year).

Comparative study on the efficacy and safety of low-dose sodium valproate vs. diazepam in the prevention and treatment of pediatric febrile convulsion

Background Febrile convulsion has a serious impact on the health and development of children. Diazepam treatment for febrile convulsion has many adverse reactions, which have a negative impact on the therapeutic effect. Therefore, the present study examined the efficacy and safety of low-dose sodium valproate on the treatment of pediatric patients with febrile convulsion. Methods From August 2016 to August 2019, a total of 110 children who suffered recurrent febrile convulsions were selected for the present study. These children were randomly divided into the observation group and the control group, with 55 children in each group. The control group was given low-dose diazepam therapy, while the observation group received low-dose sodium valproate. The therapeutic effects were compared between the two groups. Results The observation group had a significantly lower effective rate (94.55%) than the control group (74.55%, P<0.05) and significantly shorter antispasmodic time and fever clearance time (11.60±2.08 min and 11.39±1.81 h, respectively) than the control group (16.07±2.89 min and 17.09±3.12 h) (P<0.05). Six months after treatment, the observation group had higher scores on cognitive development indices than the control group, including gross motor skills, language, adaptability, fine motor skills, and social interaction (P<0.05). In addition, the observation group had a significantly lower incidence of adverse reactions and recurrence rate (5.45% and 3.64%, respectively) than the control group (20.00% and 18.18%) (P<0.05). Conclusions In the prevention and treatment of pediatric febrile convulsions, low-dose sodium valproate can rapidly relieve the clinical symptoms of children. In addition, this medication exhibits a high safety profile and significantly improves the cognitive ability of the patients. Low-dose sodium valproate has a definite therapeutic effect. Therefore, treatment with low-dose sodium valproate is worth promoting.

Comparative study on the efficacy and safety of low-dose sodium valproate vs. diazepam in the prevention and treatment of pediatric febrile convulsion.

BackgroundFebrile convulsion has a serious impact on the health and development of children. Diazepam treatment for febrile convulsion has many adverse reactions, which have a negative impact on the therapeutic effect. Therefore, the present study examined the efficacy and safety of low-dose sodium valproate on the treatment of pediatric patients with febrile convulsion.MethodsFrom August 2016 to August 2019, a total of 110 children who suffered recurrent febrile convulsions were selected for the present study. These children were randomly divided into the observation group and the control group, with 55 children in each group. The control group was given low-dose diazepam therapy, while the observation group received low-dose sodium valproate. The therapeutic effects were compared between the two groups.ResultsThe observation group had a significantly lower effective rate (94.55%) than the control group (74.55%, P<0.05) and significantly shorter antispasmodic time and fever clearance time (11.60±2.08 min and 11.39±1.81 h, respectively) than the control group (16.07±2.89 min and 17.09±3.12 h) (P<0.05). Six months after treatment, the observation group had higher scores on cognitive development indices than the control group, including gross motor skills, language, adaptability, fine motor skills, and social interaction (P<0.05). In addition, the observation group had a significantly lower incidence of adverse reactions and recurrence rate (5.45% and 3.64%, respectively) than the control group (20.00% and 18.18%) (P<0.05).ConclusionsIn the prevention and treatment of pediatric febrile convulsions, low-dose sodium valproate can rapidly relieve the clinical symptoms of children. In addition, this medication exhibits a high safety profile and significantly improves the cognitive ability of the patients. Low-dose sodium valproate has a definite therapeutic effect. Therefore, treatment with low-dose sodium valproate is worth promoting.

Recognition and management of febrile convulsions in children.

Febrile convulsions (FCs) are characterised by convulsions associated with fever in children aged between 6 months and 6 years. FCs are relatively common and affect 3-4% of children in western countries. This is the most common seizure disorder seen in children. The cause of febrile illness in FC is usually benign and most frequently due to acute viral infection. Convulsions secondary to an intracranial infection (e.g. meningitis, encephalitis) or from acute electrolyte imbalance should not be labelled as FCs. The diagnosis is based mainly on clinical history, and further investigations are generally unnecessary; management is largely symptomatic. Prolonged FC may need anticonvulsant medication to stop the seizure. Referral to paediatric neurologists may be considered in cases of complex or recurrent FC or in children where there is a pre-existing neurological disorder. One third of children with a first FC will develop a further FC during subsequent febrile illness; the likelihood increases in presence of other risk factors. This article outlines the presentation, management, investigations and prognosis for FC, and highlights how nurses in different clinical settings can provide education, support and counselling to help families return to normality after the event. An illustrative case study is also included to highlight the challenges faced by health professionals while managing children with this condition.

Recurrence of Febrile Convulsions

During two years, 92 patients who experienced first febrile convulsion were followed-up in the Pediatric Neurology Clinic, Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta for at least one year. Of the 92 patients 58 (63%) were males and 34 (37%) females. Most of the patients were less than 4 years, and only 6 patients (6,5%) aged more than 4 years. Eight (8, 7%) of the 92 patients suffered from recurrence of febrile convulsions, and in 5 of them the recurrence occurred within the first 6 months of follow-up. The recurrences of febrile convulsions occurred mostly in patients less than one year of age, those with tonic seizures, those with neurological disorders, and those who had history of epilepsy in their family. In this study the occurrence of recurrent febrile convulsions in patients with normal EEG was higher than that in patients with abnormal EEG.

Effect of implementing an educational module on improving mothers knowledge, home management and attitude about febrile convulsion

Background/Objective: Febrile convulsions (FCs) are the most common convulsive disorder of childhood, and represent a benign condition in children. FC occurrence can affect negatively on the familial quality of life and the parents may experience anxiety and fear with every time child develops fever. Therefore, parents and care givers should be educated about febrile convulsion and its home management. The aim of this study was to evaluate the effect of implementing an educational module on mother's knowledge, home management and attitude about febrile convulsion.Methods: A quasi experimental research design using one group pre &amp; post-test was used. The study sample included 107 mothers of children with febrile convulsion according to statistical consultant and statistical formula. The inclusion criteria were: all mothers of children with first or recurrent FC and the children age was from 6 months to five years. The study was conducted at the Emergency department, outpatient clinic and medical word affiliated to Mansoura University Children's Hospital, Egypt. Results: It was found that, fifty two percent (52.3%) of studied children were boys with the mean age were Mean ± SD 2.76 ± 1.30 for children and 30.29 ± 6.41 for mothers. Percentage of studied mother with good knowledge at base line was low (11.2%) while, this percentage was improved to 65.4% with a mean knowledge score 3.98 ± 2.18 before module and 9.70 ± 1.56 after module implementation. In addition, sixty four percent (64.4%) of studied mothers had inappropriate practice and home management compared to less than half (44.9%) after module implementation; the difference was statistically significant (p = .005). Only 25.3% of mothers had positive attitude about febrile convulsion before module implementation and this percentage was improved to 57.9% after module implementation with the mean score of attitude 18.42 ± 5.84 before module and 24.71 ± 6.76 post module implementation and the difference was statistically significant (p = .025).Conclusions: The study concluded that, the use of educational intervention programs and mothers support group were influenced positively in improving mothers’ knowledge, home management &amp; attitude about FC and its management; but still some mothers having inappropriate home management and negative attitude. Therefore, it is recommended further education in the pediatric clinic or via mass media.

ASUHAN KEPERAWATAN PADA BALITA RESIKO KEJANG DEMAM BERULANG DENGAN PENINGKATAN SUHU TUBUH DI RSU Dr. WAHIDIN SUDIRO HUSODO MOJOKERTO

Febrile convulsion in children are fairly common disease in under five children. The increase of body temperature is very concerned to patient with febrile convulsion, because the increase of high body temperature will triggers recurrence of convulsion. The purpose of this research design was to perform nursing care on febrile convulsion with nursing problem of the risk of febrile convulsion recurrence. The research design was a case study with one respondent who diagnosed with febrile convulsion and had the risk of febrile convulsion recurrence. Data collection methods were interviews, observation, and documentation using format nursing care for children. Assessment used four main sources, namely the client, the nurse, the client's family, and the medical record. Then enforced nursing diagnosis, intervention, implementation, and evaluation. From the assessment obtained data mother said her child was having fever, lips slightly red, fussy, had convulsion ± 3 times during at the puskesmas. Body temperature was 37,7 o C, pulse rate was 113x/ minute, respiration rate was24x/ minute. From the result of assessment the nursing diagnose was recurrence of febrile convulsions and ineffectiveness of thermoregulation. The result of data from complaint and condition of client there was nursing problem of the risk offebrile convulsion recurrence and ineffectiveness of thermoregulation. Intervention conducted was assesed history of seizures , giving health education about febrile Convulsion, warm compress, monitoring vital signs regularly, and take action of interdependent. The result of evaluation nursing care in 3 days nursing problem of febrile convulsion recurrence and ineffectiveness thermoregulation resolved. Key words: Nursing care, Recurrence febrile convulsion, Hypertermia

Recognition and management of febrile convulsion in children

Febrile convulsion is characterised by convulsion associated with fever in an infant or child aged between six months and six years. The febrile illness causing the convulsion should not be secondary to an intracranial infection (meningitis or encephalitis) or acute electrolyte imbalance. Most cases of febrile convulsion are short lived and self-terminating. However, a few cases of prolonged febrile convulsion may need anticonvulsant medication to stop the seizure. Management is mainly symptomatic, although anticonvulsants may have a role in a small number of children with complex or recurrent febrile convulsion. Referral to paediatric neurologists may be necessary in cases of complex or recurrent febrile convulsion, or in those where a pre-existing neurological disorder exists. One third of children will develop a further febrile convulsion during subsequent febrile illness. Nurses have a vital role in managing children with febrile convulsion, educating parents about the condition and dispelling myths. This article outlines the presentation, management, investigations and prognosis for febrile convulsion, indicating how nurses working in different clinical areas can help to manage this common childhood condition.

A case of congenital insensitivity to pain with anhidrosis.

A case of congenital insensitivity to pain with anhidrosis.

Renal function in children with febrile convulsions.

Febrile convulsions (FC) are the most frequent seizure disorder in children. Some studies have detected serum electrolyte disturbances in patients with FC. This study determines serum electrolytes, renal function tests, and frequency of urinary tract infection in hospitalized children with FC. In this descriptive, cross sectional study, we evaluated 291 children with FC admitted to the Neurology ward of Ali-Asghar Children's Hospital from 2008- 2013. Data was recorded on age, sex, type (simple, complex), and recurrence of seizures, family history of FC and epilepsy, serum electrolytes, renal function tests, and urinary tract infections. A total of 291 patients with diagnosis of FC were admitted to our center. Of these 291 patients, 181 (62.2%) were male. The mean age was 24.4 ± 14.6 months. There were simple, complex, and recurrent FCs in 215 (73.9%), 76 (26.1%) and 61 (21%) of patients, respectively. Urinary tract infections (UTI) were found in 13 (4.5%) patients, more present in females (p-value = 0.03) and under 12 months of age (p-value = 0.003). Hyponatremia, hypocalcemia, and hypokalemia was detected in 32 (11%), 16 (5.5%), and 4 (1.4%) of cases, respectively. Twentyfour (8.2%) patients had a glomerular filtration rate less than 60 ml/min/1.73m2. There were no abnormalities in serum magnesium, BUN, and creatinine levels. During FCs, mild changes may occur in renal function but a serum electrolyte evaluation is not necessary unless patients are dehydrated. In children with FC, urinary tract infections should be ruled out.

Risk factors for epilepsy in Nigerians - a cross-sectional case-control study

The identification of risk factors that predispose to development of epilepsy is crucial to its primary prevention. This study evaluated the risks conferred by some predisposing factors. This cross-sectional analytical study assessed the relative contributions of various risk factors to development of epilepsy in 244 adult Nigerians with epilepsy compared with equal number of age- and sex-matched controls. Odds ratio and Fisher exact test were used to express significant association. Birth asphyxia (OR 6.87), recurrent childhood febrile convulsions (OR 5.74), central nervous system (CNS) infections (OR 3.38), head trauma (OR 1.82), rural dwelling without health care access (OR 2.44), and history of epilepsy in first-degree relatives (OR 3.44) were identified as significant risk factors for epilepsy. Prompt diagnosis and appropriate treatment for febrile diseases and CNS infections, use of head helmets and car seat belts would contribute to reduced incidence.

Etiologies of epilepsy and health-seeking itinerary of patients with epilepsy in a resource poor setting: Analysis of 342 Nigerian Africans

PurposeThe understanding of causation of epilepsy, especially in resource poor African countries where prevalence rates are very high, would aid strategies for primary prevention. This study sought to determine the causes of epilepsy in Nigerian Africans and health-itinerary of patients with epilepsy. MethodThis was an observational, cross-sectional descriptive study of consecutive newly diagnosed adult patients with epilepsy using a mixed-methods approach of face-to-face in-depth interview of patients’ parents and relations, health care personnel who had given medical attention at any time and telephone interview. A structured interview schedule was used to obtain demographic information, details of seizure variables, health seeking itinerary and history of previous hospitalizations. Data was analyzed descriptively with SPSS version 17. ResultsThree hundred and forty-two patients with epilepsy with a mean age of 31.4±11.98 years participated in the study. Most of the patients (68.1%; 233/342) were unemployed and students. There were 270 (78.9%) patients with generalized epilepsy. No identifiable etiology was found in 37.7%, but of the remaining 62.3%, the commonest causes included post traumatic (19.6%), recurrent childhood febrile convulsions (13.2%), post-stroke (6.7%), brain tumors (5.9%), neonatal jaundice (5.3%), birth-related asphyxia (5%) and history of previous CNS infections (4.7%). Family history of epilepsy was obtained in 9.9%, all of whom had primarily generalized seizures. 61.4% of them sought initial attention from the traditional healers or in prayer houses. ConclusionThis study showed the pattern of causes of epilepsy in Nigerian Africans. The health seeking behavior and itinerary of the PWE revealed a preference for traditional healers. There is need for health policies and epilepsy awareness campaigns to prevent causes of seizures and improve the knowledge of the public respectively.

Diurnal Variation in Febrile Convulsions

This study sought to determine diurnal variations in febrile convulsions, and to investigate whether such variations influenced the severity of febrile convulsions. The study involved 326 children, between ages 6 months and 6 years, with simple febrile convulsions. Data were collected systematically by interviewing witnesses within the week after febrile convulsions occurred. The frequency of febrile convulsions was approximately 5 times greater in the evening than in early morning. An adaptation curve revealed that the maximum occurrence of febrile convulsions was at 4:00 pm (4:00-4:59 pm), and the minimum, at 4:00 am (4:00-4:59 am), similar to the pattern of human body temperature. Temperature and seizure duration did not differ significantly between high-frequency and low-frequency zones (2:00-7:00 pm and 2:00-7:00 am, respectively) (high-frequency zone vs low-frequency zone, 39.20 degrees C (S.D., 0.68 degrees C) vs 39.22 degrees C (S.D., 0.64 degrees C) and 3.82 minutes (S.D., 5.27 minutes) vs 3.14 minutes (S.D., 3.19 minutes)). These results suggest that the circadian rhythm does not change seizure propensity, but its hourly occurrence is attributable to an elevation in the temperature set point in the 24-hour period. The prevention of recurrent febrile convulsions by rectal administration of anticonvulsants in high-frequency zones would be clinically helpful.

Identification of risk factors for recurrent febrile convulsion

Background Febrile convulsion (FC) occurs in about 2 to 4percent of all children, approximately one third of whom willthen develop recurrent febrile convulsion (RFC). Risk factorsfor RFC are family history of convulsions, an age of less than 18months, a relatively lower temperature and shorter duration offever preceeding the first FC.Objective The aim of the study was to determine the risk factorsfor RFC.Methods One hundred children aged 6 months to 5 years withFC or RFC were included in this case-controlled study, which wascarried out from July 2006 to June 2007. Data on the children'sfirst FC were collected from medical records and the family historywas taken directly from the parents.Results Fifty children with RFC and 50 children withoutrecurrence were included in this study. An age of less than 18months (P&lt; 0.0001, COR= 71.37), a family history of FC(P&lt; 0.0001, COR= 6.00), and a fever duration ofless than 12hours preceding the first FC (P&lt; 0.0001, COR = 4.96) wereassociated with a risk of recurrence. A relatively lower degree oftemperature at first febrile convulsion did not increase the riskfor RFC (P = 1.21). Multivariate logistic regression showed thatyounger age and shorter duration of fever preceding the first FCwere associated with RFC.Conclusion Younger age and shorter duration of fever precedingthe first FC are associated with an increased risk ofRFC.

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.

Effect of zinc protoporphyrin on carbon monoxide/heme oxygenase-1 system in rats subjected to recurrent febrile convulsion

Background Studies on febrile convulsion (FC)-caused brain injury are disputed in many aspects. How FC cause nervous system injury in the developmental period and what are the characteristics of these pathological injury are unknown. The current studies have demonstrated that heme oxygenase-1 (HO-1) exerts effects on brain injury mainly by catalyzing hemoglobin to produce degradation products, and HO-1 not only has neuroprotective effects, but also has neurotoxic effects during the FC-caused brain injury. Study on the effect of zinc protoporphyrin (ZnPP) on brain injury is still in the stage of animal experiment. Objective To observe the effects of ZnPP on carbon monoxide (CO)/HO-1 system of rats subjected to FC, and to analyze the action pathway of ZnPP in brain protective effect. Design A randomized controlled animal experiment. Setting Department of Pediatrics, First Hospital Affiliated to Jiamusi University. Materials Sixty-five Wistar rats, of either gender, were involved in this study. They were randomized into normal control group( n = 14, 37 °C water bath) and febrile treatment group ( n = 51, 44.5 °C hot water bath). Febrile treatment group was sub-divided into febrile non-convulsion group (FNC group, n = 16) and FC group ( n = 35). FC group was further sub-divided into simple convulsion group ( n = 20) and ZnPP treatment group ( n = 15). HO-1 mRNA in situ hybridization kit was provided by Boster Bioengineering Co., Ltd. ZnPP(dark brown powder) was the product of Jingmei Bioengineering Company. Methods This study was carried out in the postgraduate laboratory of Jiamusi University between January 2004 and January 2007. Rats in the febrile treatment group were placed in the 44.5 °C hot water bath box. If rats did not convulse in the water within 5 minutes, they were taken out, namely FNC group ( n = 16), and those, which were convulsed within 5 minutes, were taken out immediately when they presented such a phenomenon, namely FC group ( n = 35). Convulsion induction was conducted once every other day, totally 10 times. Rats were euthanized for analysis at 24 hours after the last induction. Rats in the control group were placed in the 37 °C water. Rats in the ZnPP treatment group were intraperitoneally injected with ZnPP at 45 μmol/kg before FC attack. Rats in the simple convulsion group were only induced to be convulsed but not administrated. Main outcome measures CO level in the brain tissue homogenate and plasma of rats in each group was detected with a spectrophotometer. HO-1 mRNA expression in the hippocampal CA1 region, CA3 region and dentate gyrus of rats was observed by in situ hybridization technique. Results Sixty-five Wistar rats were involved in the study. Two rats died respectively due to drowning and convulsion in the FC group. One rat died due to convulsion drowning in the ZnPP treatment group. ▪ Plasma CO concentration of control group and ZnPP treatment group was significantly lower than that of the FC group ( P < 0.01), and was significantly higher in the ZnPP treatment group than in the FNC group ( P < 0.05). ▪ CO level in the brain tissue homogenate was significantly lower in the control group and ZnPP treatment group than in the FC group ( P < 0.01), and was very significantly higher in the ZnPP treatment group than in the control group ( P < 0.01). ▪ HO-1 mRNA expressions in the neuron of hippocampal CA1 region, CA3 region and dentate gyrus of the control group were the lowerest, and those in the FC group were the highest. HO-1 mRNA expression in the neuron of dentate gyrus in the FC group was significantly higher than that in the ZnPP treatment group ( P < 0.01), and those in the FNC group and control group was significantly lower than that in the ZnPP treatment group ( P < 0.01). Conclusion FC can cause brain injury. Over-expression of HO-1 mRNA and the increase of CO are involved in the patho-physiological process of FC. ZnPP can inhibit HO-1mRNA activity and decrease CO level, which is one of pathways for protecting brain.

Antipyretic prehospital therapy for febrile convulsions: Does the treatment fit? A literature review

Objective The objective of this literature search was to find evidence to support (or refute) the prehospital emergency use of antipyretic therapies, such as tepid sponging and paracetamol, to prevent the recurrence of febrile convulsions. Methods An on-line literature search was made of Medline. The key text words utilised were febrile convulsion(s); febrile seizure(s); infantile convulsion(s); paracetamol; acetaminophen; rectal administration; treatment; prevention; pathophysiology, (a)etiology; recurrence; tepid; sponging; bathing; antipyretic; temperature reduction; fever. References from retrieved papers were also sought and reviewed where available. Each paper was critically appraised for relevance and content. Results Forty-eight papers were identified. Twenty-nine were irrelevant. Conclusions The available evidence suggests that neither antipyretic medication (including paracetamol) nor tepid sponging prevent the recurrence of febrile convulsions following a simple initial fit, and both are associated with risk to the patient. We recommend that neither intervention be used in the prehospital phase of treatment.