Convulsions in childhood shigellosis. Clinical and laboratory features in 153 children

We studied 153 children who experienced convulsions associated with shigellosis. The male-female ratio was 1.2:1.0. Thirty-six children had a previous history of febrile convulsions, and 31 children had a family history of convulsive disorder. Most of the children were 0.5 to 3 years of age, although 49 (32%) were older than 3 years of age and 20 (13.1%) were older than 5 years of age. All children were febrile; in 75% of the children, the temperature was over 39 degrees C. The majority of the children had generalized, self-limited convulsions, which lasted less than ten minutes. In 30 children the seizures were categorized as complex; ten of them had recurrent episodes, although none had any residual neurologic deficit. The total leukocyte count was usually within normal limits, but the differential count characteristically showed a marked increase in the number of band forms. Hypocalcemia (blood calcium level, less than 9.01 mg/dL [less than 2.25 mmol/L]) was observed in four patients; hyponatremia (blood sodium level, 130 mEq/L [130 mmol/L]), in 11 patients; and hypernatremia (blood sodium level, 157 mEq/L [157 mmol/L]), in one patient. Electroencephalographic (EEG) studies were performed in ten children, and lumbar punctures were performed in 34 children; both procedures usually yielded normal results. Shigella sonnei was isolated from 69% of the children; Shigella flexneri from 25%; Shigella boydii from 5%; and Shigella dysenteriae from 1%. Due to the benign and self-limited nature of most of the convulsions, neither diagnostic procedures, nor drug therapy, are usually necessary. These measures should, however, be considered in complicated cases characterized by focal or prolonged seizures.     

Febrile convulsions and later development of epilepsy

A group of 172 epileptic children who had had prior febrile convulsions was compared with a group of 674 who had not. Children with epilepsy and prior febrile convulsions were similar in some respects (sex ratio, positive family history for seizures) to children with pure febrile convulsions and in most respects (type of epilepsy, mental status, initial EEG, and two- and four-year remission rates in the long-term outcome) to epileptic children without prior febrile convulsions. Our data do not support the current view that febrile convulsions, per se, are the main cause of mesial temporal sclerosis, le, temporal lobe epilepsy. Thus, our clinical findings support previously expressed doubts on the role of febrile seizures in temporal lobe epilepsy that were based on pathohistologic findings.     

Intramuscular midazolam vs intravenous diazepam for acute seizures

Objective : To determine effectiveness of intramuscular midazolam to control acute seizures in children as compared to intravenous diazepam.Methods: 115 children in the age group of 1 month to 12 years who presented with acute convulsions were enrolled in the study. Patients who already had an intravenous access present were treated intravenous diazepam. Patients without an IV access at the time of convulsions were randomised into 2 groups and treated with either intramuscular midazolam or intravenous diazepam for control of seizures. Time interval from administration of drug to cessation of seizures was compared. Effectiveness of IM midazolam in various age groups, types of convulsions and etiology of convulsions was analyzed. Side effects of both drugs were evaluated.Results: the mean interval to cessation of convulsions with IM midazolam was 97.22 seconds whereas in diazepam group without prior IV access it was 250.35 seconds and in diazepam group with prior IV access it was 119.4 seconds. IM midazolam acted faster in all age groups and in patients with febrile convulsions, which was statistically significant. IM midazolam was equally effective in various types of convulsions be it GTC or focal convulsions. 7 patients (10.8%) had thrombophlebitis associated with IV diazepam administration whereas none of the patients in the midazolam group had any side effects, which was statistically significant.Conclusion: IM midazolam is an effective agent for controlling acute convulsions in children especially in children with febrile convulsions. It has relatively no side effects as compared to Intravenous diazepam and can be used as a first line agent for treatment of acute convulsions in patients with difficult intravenous access.     

Epilepsy and mental retardation following febrile seizures in childhood

In an unselected group of children who were seen following an initial febrile convulsion, the frequency of subsequent afebrile seizures was 3.5% and of mental retardation 1%. The most common afebrile seizure type was generalized major (86%). About 3/4 of the children who developed afebrile seizures did so by three years and all by five years following the initial febrile seizure. The children with afebrile seizures differed from those without afebrile seizures in the frequency of neonatal abnormality, family history of mental retardation, focal initial febrile convulsions, and delay in psychomotor milestones before the initial febrile seizure. Only about 1/3 of the children who developed afebrile seizures ever had a recurrent febrile convulsion and none had complex recurrent febrile seizures. Half the children with mental retardation had histories of delay in psychomotor milestones prior to the initial febrile seizure, and no child with mental retardation had any seizure longer than five minutes. The administration of daily phenobarbital did not reduce the frequency of epilepsy, in spite of a significant reduction in the incidence of recurrent febrile seizures. There remains no evidence that the prevention of recurrent febrile convulsions significantly decreases the frequency of afebrile seizures or mental retardation.     

Epilepsy and Mental Retardation Following Febrile Seizures In Childhood

ABSTRACT. In an unselected group of children who were seen following an initial febrile convulsion, the frequency of subsequent afebrile seizures was 3.5% and of mental retardation 1%. The most common afebrile seizure type was generalized major (86%). About 3/4 of the children who developed afebrile seizures did so by three years and all by five years following the initial febrile seizure. The children with afebrile seizures differed from those without afebrile seizures in the frequency of neonatal abnormality, family history of mental retardation, focal initial febrile convulsions, and delay in psychomotor milestones before the initial febrile seizure. Only about 1/3 of the children who developed afebrile seizures ever had a recurrent febrile convulsion and none had complex recurrent febrile seizures. Half the children with mental retardation had histories of delay in psychomotor milestones prior to the initial febrile seizure, and no child with mental retardation had any seizure longer than five minutes. The administration of daily phenobarbital did not reduce the frequency of epilepsy, in spite of a significant reduction in the incidence of recurrent febrile seizures. There remains no evidence that the prevention of recurrent febrile convulsions significantly decreases the frequency of afebrile seizures or mental retardation.     

Convulsions in shigellosis. Evaluation of possible risk factors

We studied 158 children with culture-proven shigellosis, 37 (23.4%) of whom had convulsions. Historical, clinical, and laboratory data were compared between patients with and without convulsions to define risk factors for the development of seizures. Age was the most important predisposing factor. The highest incidence of shigellosis associated with convulsions was found in children between 6 months and 4 years of age. Peak body temperature and a family history of convulsions also independently affected the development of seizures. Sex and Shigella strain showed differences between the groups but failed to reach statistical significance.     

Osmolality and electrolytes in cerebrospinal fluid and serum of febrile children with and without seizures

Abstract During acute febrile diseases mild disturbances of water and electrolyte balance occur frequently. It has been suggested that changes in electrolyte balance, in particular hyponatraemia, might predispose a child to convulsions during febrile illness; however, the changes of electrolytes in the CSF are not known.We have studied the effects of fever and convulsions on water and electrolyte balance in CSF and serum by measuring osmolality and electrolyte concentrations in children. The febrile population consisted of 60 children, 36 of whom had seizures during fever. Twenty-one children without convulsions and nine children with epileptic symptoms were nonfebrile controls. We noticed that CSF is subject to changes in osmolality and electrolyte concentration during fever, while convulsions do not exhibit such changes. CSF osmolality and sodium concentrations were lower in febrile children than in nonfebrile controls. The osmolality in febrile children with convulsions was 3.8% (P<0.01) and without seizures 3.5% (P<0.01) lower than in nonfebrile nonconvulsive children. The changes in CSF sodium concentration, and to a lesser extent potasium and chloride concentrations, paralleled those of CSF osmolality. A positive correlation was observed between the CSF and serum osmolatities (r=0.73,P<0.0001), and sodium concentrations (r=0.63,P<0.0001). A negative correlation between the body temperature and both CSF osmolality (r=–0.66,P<0.0001) and sodium concentration (r=–0.59,P<0.0001) exhibits also the important regulative role of increased body tmeperature.Conclusion Fever is an important factor for disturbances in fluid and electrolyte balance. The alterations in CSF osmolality and sodium concentration do not, however, give an unambiguous explanation for the susceptibility to simple febrile seizures.     

Shigellosis: incidence of convulsions and resistance to antibiotics

One hundred and ninety-three children with bacillary dysentery were admitted to the "Assaf Harofeh Hospital" during the years 1975-1980. Generalized convulsions were observed in 37 (19.2%) children. The incidence of seizures was significantly higher in children whose age ranged between 1 and 6 years when compared to those below or above this age range. Convulsions were not observed when fever was below 38 degrees C, however, higher fever was not associated with a parallel increase in their incidence. Temperature above 38 degrees C was less common in infants compared to older children. These findings suggest that convulsions in shigellosis do not differ from simple febrile convulsions in respect to age, sex, presence and degree of fever. The incidence of resistance to either ampicillin or trimethoprim-sulfamethoxazole was similar in all the various shigella strains isolated in our population.     

Continuous phenobarbital treatment after a 'simple febril convulsion'

In only a small proportion of young children with brief, generalized, febrile convulsions do afebrile seizures develop, but this fraction is several times the prevalence of epilepsy in an unselected population. The risk of another febrile convulsion is approximately 30%. Febrile status epilepticus during a subsequent infection is a potential source of serious morbidity and mortality. Intermittent phenobarbital administration during subsequent, febrile illnesses confers little protection against recurrent, febrile convulsions. Continuous phenobarbital administration during the preschool years is indicated for most children who have had a simple febrile convulsion.     

Phenobarbital compared with carbamazepine in prevention of recurrent febrile convulsions. A double-blind study

In a double-blind trial, children who had recurrent and/or complex febrile convulsions were treated with either phenobarbital sodium or carbamazepine. Forty children were suitable for analysis; 19 were receiving carbamazepine, and 21 were receiving phenobarbital. Of the carbamazepine-treated patients, nine (47%) had recurrent convulsions despite therapeutic levels of the drug, while only two (10%) of the phenobarbital-treated patients suffered further seizures. These results confirm previous findings suggesting that carbamazepine is not as effective in the prophylactic treatment of febrile convulsions as phenobarbital.     

Febrile status epilepticus

As part of a study of status epilepticus in children (Maytal J, Shinnar S, Moshe SL, Alvarez LA. Pediatrics. 1989; 83:323-331); 44 children with febrile convulsions lasting more than 30 minutes were followed for a mean of 28 months (range 4 to 72). Thirty children were followed prospectively. Children with prior afebrile seizures or evidence of acute central nervous system infection were excluded. Nine (20%) children had prior neurological deficits. The duration of the febrile seizure was 0.5 to 1 hour in 41 cases (85%), 1 to 2 hours in 5 (10%), and greater than 2 hours in 2 children (5%). No child died or developed new neurological deficits following the seizures. The risk of recurrent seizures was increased, but only in the group with prior neurological abnormality. Six (66%) of these children had subsequent febrile seizures compared with 12 (34%) of the normal children (P = .08). Three (33%) had recurrent febrile status epilepticus compared with only 1 (3%) normal child (P = .023). The 2 children in the prospective arm of the study with recurrent febrile status epilepticus were both neurologically abnormal (P = .035). All 3 of the children who subsequently had afebrile seizures (2 prospective) were neurologically abnormal (P = .006 overall, P = .035 for prospective only). It is concluded that the occurrence of febrile status epilepticus in a neurologically impaired child is a risk factor for subsequent febrile as well as afebrile seizures. The occurrence of febrile status epilepticus in an otherwise normal child does not significantly increase the risk for subsequent febrile (brief or prolonged) or afebrile seizures in the first few years following the episode.     

Factors predicting the risk of relapse after antiepileptic drug discontinuation in children with partial seizures

The purpose of this study is to identify possible factors which could influence the seizure recurrence after anti-epileptic drug (AED) withdrawal in children with partial epilepsy. AED was discontinued in 82 children who had been free of partial epileptic seizures for 2.0–11.0 years (mean 4.7 years). Twenty-four patients (29.3%) had a relapse from a few days to 6.1 years (mean 1.2 years) after AED discontinuation. Significantly more common in children who relapsed were: younger age at beginning of AED withdrawal, occurrence of complicated febrile convulsions (5/24 vs 1/58,P<0.01), abnormal neurological examination (8/24 vs 8/58,P<0.05), delayed psychomotor development (7/24 vs 7/58,P<0.05), focal slowing (6/24 vs 3/58,P<0.01) and focal epileptiform discharges (7/24 vs 6/58,P<0.05) in the last EEG before AED discontinuation. Between the two groups no statistical significant differences no statistical significant differences concerning the age at onset of seizures, the duration at AED therapy after the last seizure, the familial occurrence of epilepsy and background EEG abnormalities in the last EEG before AED discontinuation were found. On the basis of EEG, occurrence of febrile convulsions, and neurological and developmental examination it may be possible to predict which children have the best chance to remain free of recurrence after AED discontinuation.Presented in part at the European Congress of Epileptology, Oporto, Portugal, September 6–10, 1994     

Antipyretic effectiveness of acetaminophen in febrile seizures: Ongoing prophylaxis versus sporadic usage

A controlled clinical study compared the antipyretic effectiveness of acetaminophen administered at regular 4 h intervals (group 1,n=53) versus sproadic usage contingent upon a body temperature above 37.9°C (group 2,n=51) in 104 children presenting with simple febrile convulsions. The incidence of febrile episodes or temperature values were similar in spite of significantly larger amounts of acetaminophen administered to patients in group 1. Four and 4 children in groups 1 and 2, respectively, had a second episode of febrile seizures, in all of them within the first 24 h of admission. We conclude that the prophylactic administration of acetaminophen in children with febrile seizures is not effective in the prevention of fever, the reduction of its degree, or in preventing the early recurrence of febrile seizures.     

The relationship between drug treatment and the clinical characteristics of febrile seizures

Background  Drugs such as theophylline, antihistamines, and antiallergics with anti-histaminic actions have been shown to induce febrile seizures. The relationship between febrile seizures and medications has not been actively investigated. The present study aimed to investigate the relationship between the clinical characteristics of febrile seizures and the use of medications. Methods  Two hundred and sixty-five children treated at our emergency room due to febrile seizures were studied to investigate the relationship between the clinical characteristics of febrile seizures, such as the type and duration of convulsions, and the drug treatment. Results  The duration of convulsions was longer among children who took theophylline and antihistamines than among children who did not take these medications. Of the antihistamines, mequitazine did not prolong the duration of convulsion. Conclusions  Theophylline should not be used in febrile children, particularly infants. Cautions should be taken in using histamine H1 antagonists in young infants because such drugs could potentially disturb the anticonvulsive central histaminergic system. However, mequitazine appears to be a suitable antihistamine for use in children with febrile seizures, since it does not prolong convulsions.     

Viral infections and recurrences of febrile convulsions

To determine whether complicated febrile seizures occur more often in children with a proven viral infection, we performed viral examinations on 144 children with febrile convulsions, of whom 112 had simple and 32 had complicated seizures. A diagnosis of virus infection was verified in 46% of the former patients and 53% of the latter. Three adenoviruses, one parainfluenza virus type 2 and one type 3, one respiratory syncytial virus, one echovirus type 11, one herpes simplex virus type 2, and one influenza B virus were isolated from the cerebrospinal fluid. A simple febrile convulsion occurred in seven children with a positive cerebrospinal fluid viral isolation, and two had a complex febrile seizure. In a follow-up of 2 to 4 years (mean 3.3 years), 21 of the 107 children with simple seizures (19.6%) and 3 of the 32 children with complicated seizures (9.4%) had recurrent febrile seizures. The children with positive evidence for a viral infection, even with a virus isolated from the cerebrospinal fluid, had no more recurrences than those without any proven viral infection. We conclude that children with a proven viral infection have no worse prognosis than those without.     

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.     

975例儿科急诊惊厥病因分析

目的：探讨儿童惊厥的病因学分布规律及影响因素,提高儿科急诊对惊厥的评估、识别、干预及分流的水平,制定预防、管理及健康宣教的对策和措施。方法回顾性分析2013年10月至2014年10月广州市妇女儿童医疗中心（儿童院区）儿科急诊975例惊厥患儿的临床资料。结果975例惊厥患儿中病因排在前3位的分别是热性惊厥[588例（60.3％）]、癫痫[163例（16.7％）]、轻度胃肠炎并良性婴幼儿惊厥[111例（11.4％）]。按年龄段划分,其中＜1岁惊厥病因以热性惊厥[75例（34.1％）]和癫痫[75例（34.1％）]为主,其次为颅内感染[22例（10.0％）],1～6岁儿童期惊厥病因以热性惊厥为主[487例（70.3％）],其次为轻度胃肠炎并良性婴幼儿惊厥[97例（14.0％）],＞6岁儿童期惊厥病因仍以热性惊厥[26例（41.9％）]和癫痫[20例（32.3％）]为主。结论在儿童惊厥中,热性惊厥是所有年龄段的首位病因,对比以往的研究,癫痫和轻度胃肠炎并良性婴幼儿惊厥的比重增加,颅内感染的比重下降。快速准确地评估病情及识别病因对管理惊厥患儿起关键作用。     

Parental Reactions to a Child's First Febrile Convulsion:A Follow-up Investigation

ABSTRACT. The severe psychological reactions of most parents to the first febrile convulsions of their child contrast with the doctors' consideration of febrile convulsions as a simple and benign phenomenon. Fifty-two parents whose child had been admitted with febrile convulsions were interviewed about their immediate and long-term reactions. Most of the parents knew little about febrile convulsions before the fit. Parents with previous knowledge of febrile convulsions took more appropriate measures during the fit than parents without such knowledge. Sixty per cent of the parents slept restlessly for some time after the fit, 13% watched their child at night, and 29% had dyspeptic symptoms. Parents of young children should as a routine be offered general information by the family doctor about fever and febrile convulsions. Parents who have watched their child during a fit need specific information in order to avoid long-term reactions.     

Parental reactions to a child's first febrile convulsion. A follow-up investigation

The severe psychological reactions of most parents to the first febrile convulsions of their child contrast with the doctors' consideration of febrile convulsions as a simple and benign phenomenon. Fifty-two parents whose child had been admitted with febrile convulsions were interviewed about their immediate and long-term reactions. Most of the parents knew little about febrile convulsions before the fit. Parents with previous knowledge of febrile convulsions took more appropriate measures during the fit than parents without such knowledge. Sixty per cent of the parents slept restlessly for some time after the fit, 13% watched their child at night, and 29% had dyspeptic symptoms. Parents of young children should as a routine be offered general information by the family doctor about fever and febrile convulsions. Parents who have watched their child during a fit need specific information in order to avoid long-term reactions.     

Low sodium levels in serum are associated with subsequent febrile seizures

Fever plays an important role in causing disturbances in fluid and electrolyte balance. Hyponatraemia has been thought to enhance the susceptibility to seizures associated with febrile illnesses in childhood. We have studied serum electrolyte levels in children with simple and complicated febrile convulsions. Sodium levels were lower in those children with complicated convulsions in comparison with those having simple convulsions (136.07 ± 3.06 mmoll⁻¹, mean ± SD, n = 42, and 137.62 ±2.63mmoir¹, n = 71, respectively; p < 0.01, Student's Mest). The sodium concentrations were lowest in children with repeated seizures (134.20 ± 2.30 mmoll⁻¹, n= 15) compared with children having simple ( p < 0.01, ANOVA, Duncan's test) or other complicated types of febrile convulsions: focal seizures (137.08 ± 3.82 mmoir¹, n = 12, p < 0.01), seizures lasting longer than 15 minutes (138.00 ± 2.45 mmoll⁻¹, n = 5, p < 0.05) and children over 5 years (136.70 ±2.06 mmoll⁻¹, n = 10, p < 0.05). Serum potassium levels showed no statistically significant differences between the patient groups. Our results show that hyponatraemia may increase the risk for multiple convulsions during the same febrile illness.