Zinc in CSF of patients with febrile convulsion

Objective : This prospective study was carried out from July-December 1999 to see the status of zinc in CSF of children with febrile convulsion and to compare this to that of control.Methods : Forty-two cases of febrile convulsion and 30 controls (fever without convulsion) were enrolled into the study. CSF zinc was estimated by atomic absorption spectrophotometry (AAS) in Atomic Energy Center, Dhaka and compared between the two groups.Results : The mean zinc level in CSF in the study sample was 40.19mgm/L and that in control was 74.98mgm/L This difference was statistically significant (p<0.001).Conclusion : The study concludes that a significantly lower of zinc exists in CSF of children with febrile. However no relationship was found between CSF zinc status with age, sex, degree & duration of fever and time of lumbar puncture after convulsion.     

Serum and cerebrospinal fluid zinc levels in children with febrile convulsions

The mechanisms underlying febrile convulsions (FC), which have multiple etiological factors, are not yet clear. The aim of the present study was to determine whether there were any changes in serum and cerebrospinal fluid (CSF) zinc (Zn) levels in children with febrile convulsion during seizures. A total of 102 children were included in the study, with four groups formed as follows: group A, 40 children with FC (aged 9 months to 5 years); group B, 20 children having fever without convulsion (aged 6 months to 5 years); group C, 20 children with afebrile convulsion (aged 6 months to 6 years) and group D, 22 healthy children (aged 5 months to 6 years). Serum and CSF zinc levels for groups A, B and C and serum Zn levels only for group D were measured. The serum Zn levels of 17 children in group A were again measured during healthy periods. Serum Zn levels of groups A, B, C and D had a mean of 0.70 ± 0.10 mg/dL, 1.07 ± 0.08 mg/dL, 1.26 ± 0.32 mg/dL and 1.17 ± 0.21 mg/dL, respectively, and the values of group A were lower than those of the other three groups (P < 0.001). In group B, serum Zn levels were also lower than those of groups C and D (P < 0.05). The CSF Zn levels of groups A, B and C were found to have a mean of 0.07 ± 0.02 mg/L, 0.12 ± 0.02 mg/L and 0.14 ± 0.04 mg/L, respectively. In group A, the CSF Zn levels were lower than those of groups B and C (P < 0.001), and in group B they were lower than those of group C (P < 0.05). For the 17 patients in group A, serum Zn levels during healthy periods (0.87 ±0.10 mg/dL) were found to be higher than the values shortly after seizures, but lower than those of groups B, C and D (P < 0.001). We could not observe any relationship between zinc levels of the serum and CSF and the degree and duration of the fever. These findings suggest that serum and CSF Zn levels decreased during infectious diseases, and that this decrease was more significant in patients with FC.     

The role of fever on cerebrospinal fluid glucose concentration of children with and without convulsions

In febrile convulsions glucose concentrations are known to increase both in the blood and cerebrospinal fluid (CSF). The reason behind this increase is, however, incompletely understood. We have studied the effects of convulsion and fever on the CSF and blood glucose concentrations in four different groups of children: febrile and non-febrile children, with and without convulsions. The concentration of glucose in the CSF was significantly higher in febrile children with (4.4 ± 0.1 mmol/1, mean ± SEM n = 35, p < 0.01, ANOVA, Duncan's test) and without convulsions (3.9 ± 0.2mmol/1, n = 22, p < 0.05) than in non-febrile, non-convulsive children (3.3 ±0.1 mmol/1, n = 21). In non-febrile convulsive children, the CSF glucose concentration was 3.7 ± 0.2mmol/l (n = 10). Both fever and seizures increased the CSF glucose levels (p < 0.0001 and p = 0.028, respectively, analysis of covariance). There was a linear correlation between the body temperature and concentration of glucose in the CSF (r = 0.454, p < 0.0001, n = 88, Pearson's correlation analysis). The changes in blood glucose concentrations between the groups parallelled those found in the CSF. Our results show that hyperglycaemia and an increase in the CSF glucose concentration in febrile convulsions is not explained just by a stress reaction, evoked by the seizure, as has been hypothesized earlier, but by the influence of increased body temperature as well.     

CSF Glucose Concentrations in Infants with Febrile Convulsions and the Possible Effect of Acetaminophen

The present study was done to explore the relationship between the cerebrospinal fluid (CSF) glucose concentration, body temperature, seizure duration, and acetaminophen administration. Retrospective record review of 117 consecutive febrile convulsive infants aging 3 to 18 months admitted to Bahrami Children Hospital were studied. There was a positive correlation between CSF glucose level and body temperature in those who had not taken acetaminophen before admission (r = 0.515, n = 83). CSF glucose levels were significantly higher (P = 0.014) in febrile children (75.33 mg/dL, n =70) as compared with afebrile children (66.16 mg/dL, n = 13). In those administered acetaminophen there was a negative correlation between the CSF glucose level and body temperature (r = - 0.389, P = 0.023, n = 34). CSF glucose concentration was not significantly different (P = 0.076) in those who had taken acetaminophen than those who had not taken. Type of febrile seizure, fever, convulsion duration and multiplicity were not significantly correlated with CSF glucose concentration.     

Lower degree of fever at the initial febrile convulsion is associated with increased risk of subsequent convulsions.

We studied 132 children admitted consecutively with their first febrile convulsion to assess whether the degree of fever at the onset of the convulsion can predict the risk of subsequent convulsions. The children studied were reviewed at least 2 years after the initial febrile convulsion to determine the number of children who had recurrences of febrile convulsions and/or afebrile convulsions. Children with body temperatures below 39 degrees C at the onset of their initial febrile convulsion (Group 1) were two and half times more likely to experience multiple convulsions within the same illness than those with body temperatures above 39 degrees C (Group 2). This occurred when the body temperature rose above that which had triggered the initial febrile convulsion. Children in Group 1 were also over three times more likely to experience recurrent febrile convulsion in subsequent illnesses than those in Group 2. As for subsequent development of afebrile convulsion or epilepsy, although the risk was low, it only occurred in Group 1. It is suggested that the known association between multiple convulsions, recurrent febrile convulsions and epilepsy may be due to the single predisposing factor of a low degree of fever at the onset of febrile convulsion. Each child with febrile convulsion may have his own threshold for eliciting a convulsion with fever; the lower this threshold is, the more likely are subsequent convulsions.     

Zinc concentration in serum and cerebrospinal fluid simultaneously decrease in children with febrile seizure: findings from a prospective study in Bangladesh

Objective: Since the underlying mechanisms of febrile seizure (FS) having multi‐factorial aetiology yet remains unclear, we conducted this prospectively designed cross‐sectional study to determine if there was any simultaneous change in zinc (Zn) concentration (conc.) in serum and cerebrospinal fluid (CSF) among the FS children in comparison to their matched non‐seizure febrile (NSF) peers. Methods: Zn concentration (level) in both serum (intravenous blood) and CSF (lumber puncture: LP) of 50 children with FS and 30 NSF peers (serving as control) were measured employing graphite furnace atomic absorbance spectrophotometer. Data were analysed to compare Zn level between two groups using appropriate statistical tools employing SPSS/Windows 12.0. Results: Mean Zn conc. in both serum and CSF was less in FS children (464.60 ± 64.57 and 46.28 ± 7.46, respectively) than their matched NSF peers (749.33 ± 73.19 μg/L and 111.28 ± 19.11 μg/L, respectively) showing significant differences both in serum (p < 0.001) and CSF (p < 0.001). None of serum or CSF‐Zn differed significantly with age, degree and duration of fever between FS and NSF peers. CSF‐Zn among these children showed an upward trend in LP specimen taken beyond 12 h following FS episodes. Conclusion and recommendation: Serum and CSF‐Zn simultaneously decreased in FS children in comparison to their matched NSF peers. Further prospectively designed multicentral studies are recommended to conduct in geographically diverse regions involving larger sample to confirm or refute our findings. It remains crucial in standardizing/strengthening national seizure prevention protocol with adequate Zn supplementation.     

Role of viruses in febrile convulsions.

A disseminated viral illness was demonstrated by isolating a virus from the CSF, blood or urine in 27% of 73 children who were admitted to hospital after a first febrile convulsion. However, a viral aetiology could be implicated for 86% of the children after combining results of tissue culture, electron microscopy, mouse inoculation, complement fixation tests, and interferon assay. Parallel bacterial cultures showed a possible pathogen in 29% of children, but in only 4% was the pathogen isolated from the CSF, blood, or urine. No correlation was found between the nature of the pathogen (or evidence of its dissemination) and the severity of the convulsion, degree of fever, CSF protein, CSF white cells, or the WBC. The results suggest that a febrile convulsion could be a response to invasion of the blood stream or central nervous system by a micro-organism which is usually a virus. Invasion may be of such brief duration that successful isolation of the virus from the blood, CSF, or urine in not more commonly achieved.     

热性惊厥患儿血清细胞因子水平的变化及临床意义

目的 了解6月～2岁单纯性和复杂性热性惊厥患儿血清IFN-α,IL-8和TNF-α水平的异常变化。方法 应用ELISA法检测64例单纯性热性惊厥和52例复杂性热性惊厥患儿血清IFN-α,IL-8和TNF-α的含量,并对IL-8和TNF-α进行了相关性研究。结果 单纯性热性惊厥组血清TFN-α,IL-8和TNF-α的含量分别为467.68±112.46 ng/L,74.38±18.74 ng/L和812.36±232.38 ng/L,其含量明显高于正常对照组（P﹤0.01）,也明显高于单纯性热性惊厥组（P﹤0.01）。IL-8和TNF-α在这两组疾病中分别呈正相关（r1=0.565,r2=0.64,P ﹤0.01）。结论 ①在单纯性热性惊厥和复杂性热性惊厥中,细胞因子明显增加,在增强机体免疫系统抗感染的同时,也激发了免疫性炎症反应,对组织细胞可能产生损伤。②IL-8和TNF-α在两组疾病中形成一对辅助因子,并参与了整个病理过程。     

Cerebrospinal fluid zinc concentrations in febrile convulsions

Zinc modulates the activity of glutamic acid decarboxylase, the rate limiting enzyme in the synthesis of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter. Low cerebrospinal fluid GABA values have been reported in association with several seizure disorders, including febrile convulsions. It is also known that fever and/or infections may cause a reduction in serum zinc concentrations. In this study the hypothesis that febrile convulsions are related to low cerebrospinal fluid zinc was tested. Cerebrospinal fluid zinc concentrations were measured in 66 febrile children: 32 with febrile convulsions, 18 with fever but without convulsions, and 16 with aseptic (viral) meningitis. There was no statistically significant difference in the cerebrospinal fluid zinc between the three groups of children, and the mean concentration was 26.2 micrograms/l. No significant relationship was found between either age, gender, maximal temperature, type of infection, or time of performance of the lumbar puncture and cerebrospinal fluid zinc concentration. These results do not support the hypothesis that febrile convulsions are related to reduced cerebrospinal fluid zinc concentrations.     

Cerebrospinal fluid zinc concentrations in febrile convulsions.

Zinc modulates the activity of glutamic acid decarboxylase, the rate limiting enzyme in the synthesis of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter. Low cerebrospinal fluid GABA values have been reported in association with several seizure disorders, including febrile convulsions. It is also known that fever and/or infections may cause a reduction in serum zinc concentrations. In this study the hypothesis that febrile convulsions are related to low cerebrospinal fluid zinc was tested. Cerebrospinal fluid zinc concentrations were measured in 66 febrile children: 32 with febrile convulsions, 18 with fever but without convulsions, and 16 with aseptic (viral) meningitis. There was no statistically significant difference in the cerebrospinal fluid zinc between the three groups of children, and the mean concentration was 26.2 micrograms/l. No significant relationship was found between either age, gender, maximal temperature, type of infection, or time of performance of the lumbar puncture and cerebrospinal fluid zinc concentration. These results do not support the hypothesis that febrile convulsions are related to reduced cerebrospinal fluid zinc concentrations.     

Serum sodium levels and probability of recurrent febrile convulsions

In a prospective study of 69 children with febrile convulsions, serum sodium levels were often lower than normal (52% had levels <135 mmol/l). The mean level (134.4±0.4 mmol/l) was significantly lower as compared to a group of children without fever (140.6±0.4 mmol/l,n=23) and as compared to a group with fever but without convulsions (137.6±0.6 mmol/l,n=31). The probability of a repeat convulsion within the same febrile period appeared to be significantly related to the serum sodium level.Conclusion Measurement of the serum sodium is a valuable investigation in the child with a febrile convulsion. The lower the serum sodium level, the higher the probability of a repeat convulsion. This knowledge may be of practical value in deciding whether to admit the child or allow it to return home and in advising parents or carers of the risk of a repeat convulsion.     

Recurrence rate of febrile convulsion related to the degree of pyrexia during the first attack

Ninety-four children consecutively admitted to the hospital between January 1980 and December 1982 with their first febrile convulsion (FC) were studied to assess the influence of the degree of pyrexia on the recurrence rate of FC. Thirty-eight of sixty-three children between 6 and 18 months of age (the peak incidence of FC) with fever above 40 degrees C were almost seven times less likely to have subsequent convulsions with fever, than those whose initial febrile convulsion was associated with a lower degree of pyrexia. It is suggested that the degree of pyrexia is a factor that influences the recurrence of FC. This may explain why some children have a reduced frequency of subsequent FC compared with others who appear to be at comparable risk.     

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目的观察血浆、脑脊液中神经肽Y(NPY)的质量浓度变化,探讨NPY在惊厥性疾病中的作用及临床意义。方法选取2002-09—2003-08在陕西省人民医院儿科住院的惊厥性疾病患儿,采用放射免疫分析方法检测血浆和脑脊液中NPY的质量浓度。结果(1)惊厥组血浆中NPY质量浓度第7天较第1天增高,差异有显著性(t=5·366,P<0·01),惊厥组各组第7天与第1天自身比较差异有显著性(t=3·509,3·480,3·379,P<0·05);脑炎无惊厥组第7天较第1天增高,但差异无显著性(t=1·056,P=0·309);惊厥组与脑炎无惊厥组、对照组相比,差异有显著性(t=5·728,P<0·01;t=6·990,P<0·001),脑炎无惊厥组与对照组比较差异无显著性意义(t=0·987,P>0·05),惊厥组各组之间差异也有显著性(F=34·674,P<0·01)。(2)惊厥组脑脊液中NPY质量浓度与脑炎无惊厥组、对照组比较差异有显著性(t=7·830,5·699,P<0·001),脑炎无惊厥组与对照组比较差异无显著性(t=0·112,P=0·911),惊厥组各组之间差异也有显著性(F=68·931,P<0·01)。(3)血浆和脑脊液中NPY质量浓度与惊厥发作次数有关(P<0·05),与性别、年龄、体重无显着相关,P均大于0·05;第1、7天血浆NPY质量浓度与第1天脑脊液NPY质量浓度有显着正相关性(r=0·954,P<0·001;r=0·950,P<0·001)。结论(1)惊厥性疾病患儿血浆、脑脊液中NPY质量浓度均增高,与惊厥发作次数有关,但在惊厥发生的不同阶段质量浓度不同。(2)血浆与脑脊液中NPY质量浓度呈正相关性,血浆中的质量浓度能间接反映脑脊液质量浓度。提示动态监测NPY质量浓度可能有助于对惊厥的临床诊断、治疗及预后的判断。     

惊厥患儿血清、脑脊液神经元特异性烯醇化酶变化的意义惊厥患儿血清、脑脊液神经元特异性烯醇化酶变化的意义

目的 探讨脑脊液和血液神经元特异性烯醇化酶（NSE）水平在判断惊厥性脑损伤中作用。方法 以60例患儿作为研究对象，分为非神经系统疾病组、周围神经疾病组、短程惊厥组和长程／持续惊厥组，比较各组脑脊液和血清NSE水平差异；同时观察惊厥患儿脑电图和头颅影像学改变。结果 惊厥发作后患儿血清和脑脊液NSE水平升高，且长程／持续惊厥组NSE水平升高更为明显；NSE在血清及脑脊液水平变化具有一致性；长程／持续惊厥组脑电图异常阳性率明显高于短程惊厥组，而两组头颅影像学方面改变无显著差异。结论 NSE检测有助于及时判断惊厥性脑损伤，与脑电图反映脑功能受损意义一致，且较头颅影像学改变更敏感。惊厥后及时动态观察血清或脑脊液NSE水平变化，并结合脑电图检查对判断脑损伤程度及预后有重要价值。     

惊厥患儿血清、脑脊液神经元特异性烯醇化酶变化的意义

目的探讨脑脊液和血液神经元特异性烯醇化酶(NSE)水平在判断惊厥性脑损伤中作用。方法以60例患儿作为研究对象,分为非神经系统疾病组、周围神经疾病组、短程惊厥组和长程/持续惊厥组,比较各组脑脊液和血清NSE水平差异;同时观察惊厥患儿脑电图和头颅影像学改变。结果惊厥发作后患儿血清和脑脊液NSE水平升高,且长程/持续惊厥组NSE水平升高更为明显;NSE在血清及脑脊液水平变化具有一致性;长程/持续惊厥组脑电图异常阳性率明显高于短程惊厥组,而两组头颅影像学方面改变无显著差异。结论NSE检测有助于及时判断惊厥性脑损伤,与脑电图反映脑功能受损意义一致,且较头颅影像学改变更敏感。惊厥后及时动态观察血清或脑脊液NSE水平变化,并结合脑电图检查对判断脑损伤程度及预后有重要价值。     

Evaluation of Selenium Levels and Mean Platelet Volume in Patients with Simple Febrile Convulsion

Objective: This study aimed to evaluate serum selenium levels and mean platelet volume in children who experience simple febrile convulsion. Methods: The study comprised 42 patients diagnosed with simple febrile convulsions and a control group of 30 healthy children. Blood samples were taken following a febrile convulsion. Selenium levels in the serum of both the patients and control subjects were measured with the hydride formation method on an atomic absorption spectrometry device and mean platelet volume was evaluated. Findings: When the mean values of the febrile convulsion patients were compared with those of the control group, the mean selenium levels and thrombocyte count were found to be statistically significantly low (P=0.002, P=0.01 respectively) and the mean platelet volume values were statistically significantly high (P=0.002). Conclusion: While low serum selenium levels cause the onset of a febrile seizure in patients with simple febrile convulsion, it is thought that the increased mean platelet volume shows infection activity causing febrile convulsion.Key Words: Febrile Convulsion, Selenium, Platelet: Mean Platelet Volume, Antioxidant     

616例小儿热性惊厥首次发作的临床特点及危险因素分析

目的了解热性惊厥患儿首次发作的临床特点及危险因素,指导临床医师对有危险因素的患儿采取相应干预措施,降低热性惊厥的发生。方法选取我院2016年8月至2018年8月收治的616例首次热性惊厥患儿为研究对象,回顾性分析患儿的临床特征及首次发作危险因素,并随机抽取同期发热但无惊厥发作(既往也无惊厥病史)的601例患儿为对照组。结果616例热性惊厥患儿,男344例,女272例,汉族584例,蒙古族32例。1岁以下126例(20.5%),~3岁405例(65.8%),3岁以上85例(13.7%)。发作病因中以急性上呼吸道感染[53.6%(330/616)]、疱疹性咽峡炎[25.9%(160/616)]及幼儿急疹[10.5%(65/616)]居前3位。惊厥发作时体温在38.0℃及以上者570例(92.5%),16例(2.6%)患儿惊厥发作后出现发热。534例(86.7%)患儿在发热24 h内出现惊厥发作。608例(98.7%)患儿表现为全面强直阵挛性发作。惊厥持续时间<5 min 548例(89.0%)、~14 min 48例(7.8%)、~29 min 16例(2.6%)及≥30 min 4例(0.4%)。572例(92.9%)患儿在单次热程中仅1次惊厥发作。临床类型中单纯性热性惊厥占88.3%(544/616),复杂性热性惊厥占11.0%(68/616),惊厥持续状态占0.7%(4/616)。危险因素分析显示首次惊厥时年龄、低钠、低铁、低锌、剖宫产、异常出生史、抽搐前1周疫苗接种史及热性惊厥家族史在热性惊厥组和对照组中差异有统计学意义(P<0.05)。Logistic回归分析发现首次发热惊厥年龄、低铁、剖宫产、低钠及热性惊厥家族史是热性惊厥首次发作的独立危险因素(P<0.05)。结论热性惊厥首次发作多见于3岁以内婴幼儿,以单纯性热性惊厥为主,惊厥发作时体温高,易发生于发热后24 h内,病毒感染是最常见病因。引起热性惊厥首次发作的危险因素依次为首次发作年龄、低铁、剖宫产、低钠及热性惊厥家族史,针对危险因素采取相应的干预措施可降低热性惊厥的发生。     

癫痫和热性惊厥患儿脑脊液生长抑素的变化

目的探讨癞痫(EP)和热性惊厥(FC)患儿脑脊液(CSF)生长抑素(SS)含量及其与EP和FC发病机制关系。方法采用放射免疫法(RIA)测定EP和FC患儿CSF中SS含量。结果EP组CSF中SS水平(139.59±45.95)ng/L明显高于FC组(89.71±37.51)ng/L和对照组(77.31±37.10)ng/L(P均<0 05);FC组CSF中sS水平(89 71±37 51)ng/L与对照组比较无显著性差异(P>0.05);严重组EP和FC患儿CSF中SS水平与普通组比较均无显著性差异(P均>0.05)。结论SS参与EP发作,可能有致EP发作作用,而与FC的惊厥发作无关。     

Thalassemia major may decrease the frequency of febrile convulsions in children

Aim: We aimed to determine the relative frequency of febrile convulsion in children with major thalassemia to theorize that higher serum iron levels could reduce the incidence of febrile convulsion. Background: Febrile convulsion is the most common type of seizure in childhood that its causes are not fully understood. However, some risk factors have been cited such as the serum iron level. Materials and methods: Three hundred and fifty-nine children aged more than 5 years with major thalassemia who were receiving blood were enrolled as the case group. The control group consisted of 357 children without thalassemia aged 4–7 years (151 boys, 206 girls) who were referred to healthcare centers for routine health monitoring. Included data were the history of febrile convulsion, age of onset and type and the frequency of convulsions. Results: Children in control group significantly experienced more febrile convulsions than thalassemic children [4/359 (1.1%) in the thalassemic children and 14/357 (3.9%) in the control group had experienced febrile convulsions (P = 0.017)]. Conclusion: The frequency of febrile convulsion in children with major thalassemia is less than that of normal children. Children with thalassemia major may have higher serum levels of iron and such high serum iron levels might have a protective role in the children who have a vulnerability for febrile convulsions.     

THE EFFECTIVENESS OF PHENOBARBITAL IN THE PREVENTION OF RECURRENT FEBRILE CONVULSIONS IN CHILDREN WITH AND WITHOUT A HISTORY OF PRE-, PERI- AND POSTNATAL ABNORMALITIES

Abstract. Three hundred children who had an initial febrile convulsion were divided into two groups. In one group were children with a single brief generalized initial febrile seizure and no history of pre-, peri- or postnatal abnormalities which might suggest the possibility of brain damage and in the other group those with such abnormalities and/or a "severe" initial febrile convulsion. Daily phenobarbital produced a significant decrease in febrile seizure recurrences in both groups, as compared to children who received phenobarbital at the onset of fever and no phenobarbital prophylaxis. "Intermittent" phenobarbital given at the onset of fever did not produce a significant difference in recurrence rate as compared with no phenobarbital.