Childhood febrile seizures: overview and implications

This article provides an overview of the latest knowledge and understanding of childhood febrile seizures. This review also discusses childhood febrile seizure occurrence, health services utilization and treatment costs. Parental reactions associated with its occurrence and how healthcare providers can assist parents with dealing effectively with this potentially frightening and anxiety-producing event are also discussed.     

September 2001: 51-year-old man with seizures since childhood.

The September 2001 COM. A 51 year old man with refractory seizures presented with a recent seizure while at work but no other neurologic deficit. Imaging studies demonstrated a solid and cystic lesion of the right temporal lobe. Microscopic and immunohistochemical studies demonstrated an atypical ganglioglioma due to the presence of neurofibrillary tangles within the neoplastic ganglion cell component. This is the fifth case reported in the literature. Neoplastic ganglion cells and neurofibrillary tangles are discussed both separately and as integral components of this rare tumor.     

Epileptogenesis after prolonged febrile seizures: mechanisms, biomarkers and therapeutic opportunities

Epidemiological and recent prospective analyses of long febrile seizures (FS) and febrile status epilepticus (FSE) support the idea that in some children, such seizures can provoke temporal lobe epilepsy (TLE). Because of the high prevalence of these seizures, if epilepsy was to arise as their direct consequence, this would constitute a significant clinical problem. Here we discuss these issues, and describe the use of animal models of prolonged FS and of FSE to address the following questions: Are long FS epileptogenic? What governs this epileptogenesis? What are the mechanisms? Are there any predictive biomarkers of the epileptogenic process, and can these be utilized, together with information about the mechanisms of epileptogenesis, for eventual prevention of the TLE that results from long FS and FSE.     

Hereditary febrile seizures: Phenotype and evidence for a chromosome 19p locus

The occurrence of febrile seizures (FSs) in large autosomal dominant FS kindreds makes possible accurate delineation of the pure clinical phenotype of hereditary FS among secondary FS cases, and the identification of gene loci causing susceptibility to FS. Recently FS gene loci on chromosomes 8 and 19 were identified. We studied the phenotype of FS in four large families in which FS is an autosomal dominant trait. Among 30 affected secondary FS cases, mean age of onset was 16.3 months (range 4 to 36 months), sex ratio was equal, and 43% were complex (13 of 30). Among these 30 secondary FS cases, the mean number of FSs was 2.1, half had only a single FS, and none had afebrile seizures. Penetrance was 0.67, approximately the same as in our previous larger group of 40 multicase FS families (0.64). The occurrence of DPT encephalopathy in a sib of a patient with FS raises the possibility that these two etiologies are related. Linkage studies showed that one of the four families (Family 1) was linked to chromosome 19p markers, none of the families was linked to chromosome 8q markers, and the largest FS family (Kindred 6) was unlinked to either 19p or 8q markers, supporting the hypothesis of genetic heterogeneity for FS. Am. J. Med. Genet. 79:354–361, 1998. © 1998 Wiley-Liss, Inc.     

Ultrastructure and histogenesis of the renal tumors of childhood: an overview

This review discusses the ultrastructural and immunohistochemical features of the common childhood renal tumors, with an emphasis on their diagnostic usefulness. Speculations regarding their histogenesis also are presented, with the hope that these may serve to diminish some of the confusion surrounding the classification of these morphologically diverse lesions.     

The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management

BackgroundFever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies.AimTo summarize recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria.SourcesA narrative literature review by searching the MEDLINE database, and recent conference abstracts.ContentStudies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalized patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum β-lactamase-producing Enterobacteriaceae and fluoroquinolone-resistant Salmonella enterica. Among those with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important.ImplicationsUnderstanding the local epidemiology of fever aetiology, and the use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalized patients infected with organisms that are not susceptible to empiric antibacterial regimens.     

Cochlear function and audiogenic seizures: developmental covariance in the LP/J mouse

Innate susceptibility to audiogenic seizures develops and declines at varying rates and ages, depending upon genotype and environmental conditions. Auditory dysfunctions have been experimentally produced which induce susceptibility in otherwise nonsusceptible mouse strains. In order to more closely correlate cochlear functions and audiogenic seizures in genetically susceptible mice, both measures were obtained from LP/J mice, at ages ranging from 8 to 120 days. Susceptibility to sound-produced convulsions was first noted at 12 days, was maximal from 18 to 32 days, declined rapidly by 40 days, and disappeared by 120 days of age. Cochlear nerve-evoked potential thresholds were very high at 12 days, were lowest between 18 and 32 days and increased thereafter. The correlation between susceptibility and cochlear thresholds was greatest for high frequencies (r = -.93), intermediate for midfrequency (r = -.77), and poorest for low frequencies (r = -.56). It was concluded that either genetic or environmental factors which produce an intermediate level of high frequency cochlear damage in the young mouse will produce susceptibility to audiogenic seizures.     

The GABBR1 locus and the G1465A variant is not associated with temporal lobe epilepsy preceded by febrile seizures

Background  

Polymorphism G1465A in the GABBR1 gene has been suggested as a risk factor for non-lesional temporal lobe epilepsy (TLE); however, this genetic association study has not been independently replicated. We attempted to replicate this study in our cohort of patients with TLE. Furthermore, we also analyzed the coding sequence of this gene and searched for disease-causing mutations.     

The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.     

羚羊角与钩藤联合用药抑制热性惊厥大鼠脑损伤作用机制研究

目的:探讨羚羊角与钩藤联合用药对热性惊厥所致发育期大鼠脑损伤的保护作用及其作用机制。方法:采用热水浴建立热性惊厥大鼠模型,实验分为5 组,空白对照组、模型组、羚羊角组、钩藤组、羚羊角与钩藤联合用药组(简称联用组),每组10 只,共50 只。通过HE 染色法观察组织病理情况;ELISA 法检测各组大鼠脑组织TNF-α、IL-1β、Glu 及Asp 含量;免疫组化法检测大鼠海马区TNF-α、IL-1β表达情况。结果:联用组、羚羊角组、钩藤组脑组织Asp、Glu、TNF-α及IL-1β及海马区TNF-α、IL-1β含量显著低于模型组(P<0.01,P<0.05)。联用组脑组织Asp、TNF-α及IL-1β含量较钩藤组显著降低(P<0.05)。联用组海马区TNF-α较羚羊角组、钩藤组显著降低(P<0.05),IL-1β较钩藤组表达显著降低(P<0.05)。结论:羚羊角与钩藤联合用药抑制热性惊厥所致大鼠脑损伤,效果优于羚羊角及钩藤单用,其作用机制可能与其抑制促炎症因子TNF-α、IL-1β及兴奋性氨基酸Asp、Glu 表达有关。     

Attachment in middle childhood: predictors,correlates, and implications for adaptation

Middle childhood is a relative lacuna in behavioral attachment research. We examined antecedents, correlates, and implications of parent–child attachment at age 10 in a longitudinal study of community families from a Midwestern US state (N = 102, mothers, fathers, and children). Dimensions of security, avoidance, ambivalence, and disorganization of children’s attachment to each parent were observed in lengthy naturalistic interactions and assessed using Iowa Attachment Behavioral Coding (IABC). IABC scores were meaningfully associated with history of parental responsiveness (7–80 months) and with earlier and concurrent attachment security, assessed with other established instruments (parent- and observer-rated Attachment Q-Set at 25 months, children’s reports at age 8 and 10). Structural equation modeling analyses revealed that the overall history of responsive care was meaningfully associated with Security, Avoidance, and Disorganization at age 10, in both mother–child and father–child relationships, and that most recent care uniquely predicted Security. IABC scores were also meaningfully related to a broad range of measures of child adaptation at ages 10–12. Cumulative history of children’s security from infancy to middle childhood, integrating measures across relationships and methodologies, also predicted child adaptation at ages 10–12.     

Stability and instability of childhood traits: implications for personality development of animals

Concepts of animal personality and human temperament are nearly identical, both emphasizing overt behaviors rather than conscious processes, and assuming a primary role of biology in shaping individual differences. A point of divergence is emphasis on development among temperament scholars. Whereas most definitions of personality and temperament emphasize differential continuity-the maintenance of individual differences in behavioral tendencies over time-several behaviors demonstrate absolute discontinuity-age-related changes in mean levels. Attention to species-wide changes in behaviors may generate insight regarding the forces that govern individual differences. Differential continuity may also be heterotypic, with an inferred genotypic attribute being manifest in different behaviors at different ages. Structural continuity-persistence of correlational patterns among variables at different ages-represents a tool for identifying coherence in the common underpinnings of these diverse behaviors. This article describes research exemplifying these forms of continuity in humans, and suggests potential implications for animal personality investigations.