Risk factors for the occurrence of recurrent convulsions following an initial febrile convulsion]

The results of a follow up study of 155 Dutch children who visited the emergency room of an urban paediatric hospital after experiencing their first febrile seizure are presented. Median follow up time was 38 months (range 27-60). Of these 155 initially untreated children 58 (37%) suffered at least one, 47 (30%) at least two and 27 (17%) at least three recurrent seizures. The recurrence hazard after any seizure was highest in the first six months, and dropped markedly after 6 months without seizures. The effect of the various postulated risk factors on the occurrence of any recurrent seizure and three or more recurrences was assessed. A first degree family history of febrile or nonfebrile seizures appears to be a predictor of multiple recurrences; an age of at least 30 months and a temperature of 40.0 degrees C or higher at the initial seizure are associated with a decreased risk. Several factors act together on the risk of recurrent seizures, sometimes in opposite directions. By considering the action of all relevant factors (age at onset, family history and features of the initial febrile seizure) subgroups of children with one year seizure recurrence rates as low as 15% and as high as 48% were identified.     

Prevalence of febrile seizures in Dutch schoolchildren

During a scheduled visit to the school physician, the number of children with a history of febrile seizures was determined in 3570 children attending primary schools in the suburban area of the city of Rotterdam. At the age of 6 years, 140 had experienced at least one febrile seizure (3.9%, 95% confidence interval 3.3% to 4.5%). Of these, 19 (14%) had experienced a recurrent seizure during the same febrile illness. Recurrent seizures in subsequent fever episodes occurred in 26%. The median age at onset was 18 months. One-third of the children had visited the hospital directly after the seizure, and 6% had used anticonvulsant drugs for at least 6 months. Of all the children, 5.4% had a positive first-degree family history of febrile seizures. Children with a positive family history were at a 4.5-fold increased risk of experiencing febrile seizures. Since in this study a generally accepted definition of febrile seizures was used, the estimated prevalence in Dutch school-children may well be compared with prevalence rates found in the United States and Great Britain.     

Prevalence of febrile seizures in Dutch schoolchildren

Summary. During a scheduled visit to the school physician, the number of children with a history of febrile seizures was determined in 3570 children attending primary schools in the suburban area of the city of Rotterdam. At the age of 6 years, 140 had experienced at least one febrile seizure (3.9%, 95% confidence interval 3.3% to4.5%). Of these, 19 (14%) had experienced a recurrent seizure during the same febrile illness. Recurrent seizures in subsequent fever episodes occurred in 26%. The median age at onset was 18 months. One-third of the children had visited the hospital directly after the seizure, and 6% had used anticonvulsant drugs for at least 6 months. Of all the children, 5.4% had a positive first-degree family history of febrile seizures. Children with a positive family history were at a 4.5-fold increased risk of experiencing febrile seizures. Since in this study a generally accepted definition of febrile seizures was used, the estimated prevalence in Dutch schoolchildren may well be compared with prevalence rates found in the United States and Great Britain.     

The long-term risk of epilepsy after febrile seizures in susceptible subgroups

A family history of seizures, preexisting brain damage, or birth complications may modify the long-term risk of epilepsy after febrile seizures. The authors evaluated the association between febrile seizures and epilepsy in a population-based cohort of 1.54 million persons born in Denmark (1978-2002), including 49,857 persons with febrile seizures and 16,481 persons with epilepsy. Overall, for children with febrile seizures compared with those without such seizures, the rate ratio for epilepsy was 5.43 (95% confidence interval: 5.19, 5.69). The risk remained high during the entire follow-up but was particularly high shortly after the first febrile seizure, especially in children who experienced early (<1 year of age) or late (>3 years of age) onset of febrile seizures. At 23 years of follow-up, the overall cumulative incidence of epilepsy after febrile seizures was 6.9% (95% confidence interval: 6.5, 7.3). In conclusion, persons with a history of febrile seizures had a higher rate of epilepsy that lasted into adult life, but less than 7 percent of children with febrile seizures developed epilepsy during 23 years of follow-up. The risk was higher for those who had a family history of epilepsy, cerebral palsy, or low Apgar scores at 5 minutes.     

热性惊厥患儿血清IL-6、IL-10水平与呼吸道病毒感染的关系

目的探讨热性惊厥(FS)患儿血清白细胞介素-6(IL-6)、IL-10表达水平并与呼吸道病毒感染的关系。方法选取2017年3月~2019年3月来嘉兴市妇幼保健院就诊的136例热性惊厥患儿为研究对象,同期选取88例健康儿童作为对照组;采用酶联免疫吸附法检测血清IL-6、IL-10表达水平,采用免疫荧光法对受试者鼻咽部脱落细胞进行病毒抗原检测,分析不同类型病毒感染热性惊厥患儿血清中IL-6、IL-10水平及患儿临床特征,探讨对非典型热性惊厥(复杂性热性惊厥,CFS)患儿临床特征的危险因素。结果CFS组患儿血清IL-6水平显著高于单纯性热性惊厥(SFS)组和对照组,SFS组患儿血清IL-6水平显著高于对照组,差异有统计学意义(P<0.05);CFS组患儿血清中IL-10表达水平显著低于SFS组和对照组,SFS组患儿血清中IL-10水平显著低于对照组,差异有统计学意义(P<0.05)。流感病毒A(FluA)组热性惊厥患儿血清中IL-6水平显著高于副流感病毒(PIV)组、腺病毒(ADV)组、呼吸道合胞病毒(RSV)组,FluA组热性惊厥患儿血清中IL-10水平显著低于PIV组、ADV组、RSV组,差异有统计学意义(P<0.05);FluA、PIV、ADV、RSV 4个组之间年龄、热峰、热程、同一热程多次惊厥发作、发作后长程意识水平下降(PPIC)比较差异具有统计学意义(P<0.05)。CFS患儿临床特征的危险因素显示年龄与部分性发作有关(P<0.05),同一热程中多次惊厥发作与年龄、FluA病毒有关(P<0.05),PPIC与热程、同一热程中多次惊厥发作、ADV感染有关(P<0.05)。结论FS患儿血清IL-6表达水平上调,IL-10水平下调,不同病毒类型感染的热性惊厥患儿临床表现不同,年龄、同一热程中多次惊厥发作、FluA、PPIC等可能是FS发作的重要因素,其中FluA可能是FS发病的高危因素。     

儿童热性惊厥复发危险因素临床分析

目的 探讨儿童热性惊厥（FS）复发的危险因素。方法 选取2008年1月至2015年8月初次诊断为FS的患儿为研究对象,回顾性收集临床资料,采用单因素分析导致FS复发的影响因素,采用非条件多因素Logistic回归分析确定导致FS复发的独立危险因素。 结果 1 261例初诊为FS的病例纳入研究,按是否复发将患儿分为复发组（n = 453）及非复发组（n = 808）,2组患儿性别构成比、原发疾病、惊厥2周后脑电图变化等比较,差异无统计学意义（P＞0.05）,单因素分析结果显示复杂性FS、年龄小、惊厥时的体温低、次数多、持续时间长、发作前发热时间短、有家族FS史、缺铁性贫血、低钠血症、生活环境差异、围生期损害等11项指标与FS复发存在相关性,差异有统计学意义（P ＜0.05）。非条件多因素Logistic回归分析结果显示发病年龄小、发作时体温低、复杂性FS、发作前发热时间≤1 h、有家族FS史、合并症(缺铁性贫血/低钠血症)是导致FS复发的独立危险因素。结论 儿童FS易复发,首发时应评估危险因素,给予适当的干预措施并密切随访。     

Febrile seizures and epilepsy: the contributions of epidemiology

In the past, febrile seizures were considered to be a sign of epilepsy, a disorder characterised by recurrent unprovoked seizures. Currently, febrile seizures are considered to be a benign seizure syndrome that is distinct from epilepsy. This distinction has been possible largely because of the epidemiological evidence which is presented here in the form of a two-part argument. If febrile seizures are epilepsy one might expect that: (1) following a first febrile seizure, the risk of a second febrile seizure should be similar to the risk of an unprovoked seizure (in fact, the risk of a recurrent febrile seizure is approximately 34%, whereas the risk of an unprovoked seizure after having had a febrile seizure is approximately 2% to 3%); (2) the factors that predict recurrent febrile seizures should also predict subsequent unprovoked seizures. From the available literature, young age at the time of the first febrile seizure and a family history of febrile seizures predict recurrent febrile seizures, but do not predict subsequent unprovoked seizures. By contrast, a family history of epilepsy, complex febrile seizures and neurological abnormality are associated with an increased risk of subsequent epilepsy but are not consistently associated with the risk of a recurrent febrile seizure.     

血钠水平预测小儿单纯热性惊厥再发的实用价值

目的 探讨单纯性热性惊厥及惊厥再发与血钠浓度的关系;支持或否决血钠生化分析在热性惊厥及惊厥再发的临床价值。方法 从2004年2月到2005年8月观察、分析了160例年龄在6月龄～5岁急诊惊厥患儿的血钠水平,其中单次抽搐的单纯性热性惊厥130例,多次抽搐（再发）的单纯性热性惊厥30例,所有患儿均在静脉输液前抽出外周静脉血送血钠生化分析。结果 再发单纯性热性惊厥组比单发单纯性热性惊厥组血钠平均值低,两组间血钠值的比较,统计显示：t=3．6167,P＜0．01,差异有统计学意义。结论 支持国内外大多数学者的观点,即低血钠可能是同一次热性疾病中、24h内惊厥再发的诱因之一,临床上血钠浓度检测应作为热性惊厥病人的常规检查项目。     

Similar relative risks of seizures following measles containing vaccination in children born preterm compared to full-term without previous seizures or seizure-related disorders

Background

Febrile seizures are associated with the first dose of measles-containing vaccines and the risk increases with chronologic age during the second year of life. We used the Vaccine Safety Datalink (VSD) to determine if the relative increase in risk of seizures following receipt of measles-containing vaccine differs by gestational age at birth.

Risk of febrile seizures in childhood in relation to prenatal maternal cigarette smoking and alcohol intake

The case-control study of febrile seizures in childhood described here, comprising 472 case-control pairs in western Washington, was designed to investigate the importance of prenatal exposures as risk factors for febrile seizures and to determine the degree to which two clinical subtypes of febrile seizures (simple and complex) have different risk factors. Maternal cigarette smoking and alcohol intake during pregnancy were associated with the risk of a febrile seizure in the child. Prenatal maternal cigarette smoking was associated with a twofold increase in the risk of a simple febrile seizure (95% confidence interval 1.2-3.4), and a strong dose-response relation was found. This association could not be explained by maternal demographic variables, maternal alcohol intake, child's birth weight, or childhood medical history variables. Prenatal maternal alcohol intake was associated with a twofold increase in the risk of a complex febrile seizure (95% confidence interval 1.3-3.8), and a strong dose-response relation was present. This association could not be explained by maternal age, race, education, or cigarette smoking. These results suggest that curtailment of smoking and alcohol consumption during pregnancy, a measure already widely prescribed during pregnancy, may also be an effective means of preventing childhood febrile seizures.     

The risk of febrile seizures following influenza and 13-valent pneumococcal conjugate vaccines

BackgroundEvidence on the risk of febrile seizures after inactivated influenza vaccine (IIV) and 13-valent pneumococcal conjugate vaccine (PCV13) is mixed. In the FDA-sponsored Sentinel Initiative, we examined risk of febrile seizures after IIV and PCV13 in children 6–23 months of age during the 2013–14 and 2014–15 influenza seasons.MethodsUsing claims data and a self-controlled risk interval design, we compared the febrile seizure rate in a risk interval (0–1 days) versus control interval (14–20 days). In exploratory analyses, we assessed whether the effect of IIV was modified by concomitant PCV13 administration.ResultsAdjusted for age, calendar time and concomitant administration of the other vaccine, the incidence rate ratio (IRR) for risk of febrile seizures following IIV was 1.12 (95% CI 0.80, 1.56) and following PCV13 was 1.80 (95% CI 1.29, 2.52). The attributable risk for febrile seizures following PCV13 ranged from 0.33 to 5.16 per 100,000 doses by week of age.The age and calendar-time adjusted IRR comparing exposed to unexposed time was numerically larger for concomitant IIV and PCV13 (IRR 2.80, 95% CI 1.63, 4.83), as compared to PCV13 without concomitant IIV (IRR 1.54, 95% CI 1.04, 2.28), and the IRR for IIV without concomitant PCV13 suggested no independent effects of IIV (IRR 0.94, 95% CI 0.63, 1.42). Taken together, this suggests a possible interaction between IIV and PCV13, though our study was not sufficiently powered to provide a precise estimate of the interaction.ConclusionsWe found an elevated risk of febrile seizures after PCV13 vaccine but not after IIV. The risk of febrile seizures after PCV13 is low compared to the overall risk in this population of children, and the risk should be interpreted in the context of the importance of preventing pneumococcal infections.     

Revaccination outcomes of children with vaccine proximate seizures

BackgroundSeizures, whether febrile or afebrile, occurring within 14 days following vaccination can be considered as vaccine proximate seizures (VPSs). While the attributable risk and clinical severity of first febrile VPS is well known, the risk and clinical outcomes of VPS recurrence is less well defined.MethodsWe conducted a retrospective review of revaccination management and outcomes in children who experienced a VPS as their first seizure seen in Australian Specialist Immunisation Clinics between 2013 and 2017. Vaccination outcomes were compared between children who had a VPS as their only seizure (VPS only) and children who had further non-vaccine proximate seizures following their initial VPS (VPS+) prior to review at the clinic.ResultsWe identified 119 children with a VPS as their first seizure, of which 61 (51%) went on to have other seizures (VPS+). Children with VPS+ were more likely to present at a younger age (6.2 vs 12.5 months, P = 0.03), with afebrile seizures (42.6% vs 15.5%, P = 0.002) compared to VPS only children. VPS recurrence on revaccination was uncommon in both groups, but more common in VPS+ children (12.5% vs 2.4%, P = 0.07). Having an epilepsy diagnosis, specifically Dravet syndrome, was associated with VPS recurrence (P < 0.001). Of the four children with Dravet syndrome who had VPS recurrence, all had status epilepticus following revaccination.ConclusionIn children who presented with a single VPS as their only seizure, VPS recurrence on revaccination was uncommon. Children who had multiple non-vaccine proximate seizures following their initial VPS (VPS+) were more likely to present with afebrile VPS, at a younger age and have a VPS recurrence with vaccination. In these children, particularly those aged < 12 months, assessment and investigation for diagnosis of Dravet syndrome should be considered and additional precautions for revaccination undertaken as they are at highest risk of VPS recurrence.     

Risk of febrile seizure after measles–mumps–rubella–varicella vaccine: A systematic review and meta-analysis

BackgroundConsidering the febrile seizure rate, there is no longer a clear preference for use of measles–mumps–rubella–varicella (MMRV) vaccine over separate measles–mumps–rubella (MMR) and varicella (V) vaccine. This work was undertaken to assess the risk of febrile seizure after MMRV vaccine in children.MethodsWe searched PubMed, Embase, BIOSIS Previews, Scopus, Web of Science, Cochrane Library and other databases through 12 December 2014. Meta-analysis was conducted using R version 3.1.2 and Stata version 12.0.ResultsA total of thirty-nine studies were included. Thirty-one published or unpublished clinical trials involving about 40,000 subjects did not show significant differences in incidence of febrile seizure or vaccine related febrile seizure between MMRV and MMR with or without varicella vaccine after any doses, in the risk windows of 0–28, 0–42 or 0–56 days and 7–10 days. In addition, these studies showed that the receipt of concomitant use of MMRV and other pediatric vaccines was not a significant predictor of febrile seizure. Eight post-marketing observations involving more than 3,200,000 subjects were included. No evidence suggested elevated risk of febrile seizure associated with MMRV vaccine among children aged 4–6 years old during 7–10 days or 0–42 days after vaccination. However, an approximately 2-fold increase in risk of seizure or febrile seizure during 7–10 days or 5–12 days after MMRV vaccination was found among children aged 10–24 months, although the highest incidence of seizure was still lower than 2.95‰.ConclusionsFirst MMRV vaccine dose in children aged 10–24 months was associated with an elevated risk of seizure or febrile seizure. Further post-marketing restudies based on more rigorous study design are needed to confirm the findings.     

Effects of measles-containing vaccination in children with severe underlying neurologic disease

BackgroundMeasles outbreaks pose significant risk for those unvaccinated.Patients and methodsMeasles-containing vaccine was offered to unvaccinated children with severe neurologic diseases during a measles outbreak. Vaccination adverse events were reported by parents 30 days following vaccination. Long term effects were evaluated 12 months post vaccination.ResultsTwenty-seven children were vaccinated (36 doses given). Half of parents (51.8%) reported no adverse events following immunization. Adverse events included afebrile seizures (6/36), fever alone (5/36) and febrile seizures (5/36). Two children required hospitalization. Quadrivalent measles-containing vaccine combined with varicella was associated with febrile seizures (p = 0.04). No child needed adjustment of the anti-epileptic treatment or exhibited developmental regression.ConclusionIn a series of children with prior severe neurologic disease, the safety-tolerability profile of vaccines containing a measles vaccine component suggests that vaccination is justified. Main side effect was seizure aggravation in children with known epileptic disease.     

婴幼儿及学龄前儿童热性惊厥与缺铁性贫血关联的Meta分析

目的通过对已发表的文章进行荟萃分析以明确婴幼儿及学龄前儿童发生热性惊厥与缺铁性贫血的关系。 方法利用PubMed、Web of science、MEDLINE、万方数据知识服务平台、中国知网数据库(CNKI)、维普等数据库数据库(VIP)和Cochrane图书馆数据库等中英文电子数据库，收集1990年1月至2017年9月前已发表的关于3个月至6岁婴幼儿及学龄前儿童发生热性惊厥与缺铁性贫血相关性的文章。按纳入与排除标准由2名研究者阅读全文后进行文献筛选和资料提取，采用纽卡斯尔-渥太华量表(the Newcastle-Ottawa Scale，NOS)进行文献质量评估。Stata SE 12.0软件对缺铁性贫血是否为热性惊厥患儿风险因素进行Meta分析，计算比值比(OR)，并依据缺铁性贫血诊断标准的不同进行亚组分析。 结果本研究共检出相关文献89篇，排除重复和不相关的搜索记录11篇、只有摘要的文章18篇，以及对全文进行排查：综述2篇、缺少数据9篇以及数据雷同2篇剔除，最终纳入符合纳入与排除标准的26篇文献进行Meta分析。分析结果表明：热性惊厥与缺铁性贫血具有相关性[OR＝2.24，95%CI(1.758，2.854)，P<0.05]。 结论缺铁性贫血是婴幼儿及学龄前儿童发生热性惊厥的风险因素之一。     

Agreement between medical record and parent report for evaluation of childhood febrile seizures

Background

The monitoring of vaccine safety is critical to maintaining the public acceptance of vaccines required to ensure their continued success. Methods used to assess adverse events following immunization (AEFI) must accurately reflect their occurrence. Assessment of AEFI is often done via medical record review (MR) or via patient report (PR). However, these sources of data have not previously been compared for the analysis of AEFI. The objective of this study was to evaluate the concordance between MR and PR for young children identified as having had a febrile seizure (FS), an important AEFI, in an integrated health care system. The variables chosen for analysis were those recommended by the Brighton Collaboration Seizure Working Group for the evaluation of generalized seizure as an AEFI [1].

Methods

Parent report from phone interviews and mailed questionnaires was compared to abstracted medical records of 110 children with FS between ages 3 and 60 months. Concordance between PR and MR for characteristics and predisposing factors of FS was assessed by percent total agreement and kappa statistic.

Results

Percent total agreement between PR and MR was between 43.6 and 100% for variables studied, with 62.5% of items having >70% agreement. However, kappa was poor to fair for all measures (−0.04 to 0.33). While some variables, such as history of seizures in a sibling or parent and several seizure characteristics, were reported more often by PR, other items, such as maximum fever and several concurrent conditions, were reported more often by MR.

Conclusion

These findings demonstrate the limitations of using MR or PR alone to assess febrile seizures in children. This analysis supports the practice of collecting data from both MR and PR to most accurately portray the spectrum of predisposing factors and seizure characteristics when evaluating FS in children whenever feasible.     

Febrile seizures: current concepts concerning prognosis and clinical management

Febrile seizures are a common problem in young children. Most febrile seizures are benign in nature, although a small percentage of children may develop recurring febrile seizures or afebrile seizures. The approach to the management of this disorder varies widely from specialty to specialty despite the recent publication of studies that provide for rational treatment of febrile seizures. Most children do not need any treatment after a first simple febrile seizure. In certain children who are at risk for recurrent febrile seizures, rectal anticonvulsants should be considered for acute, short-term management. Long-term anticonvulsants should be reserved for patients who are unable to use rectal anticonvulsants or who have significant risk factors for the development of afebrile seizures.     

孤独症、精神发育迟滞的围生期危险因素及家族史的病例对照研究

【目的】 研究孤独症和精神发育迟滞的围生期危险因素及相关家族史之间的差异。 【方法】 分析在复旦大学附属儿科医院诊治的100例孤独症儿童、60例精神发育迟滞儿童以及80例发育正常儿童的围生期及家族史资料,应用方差分析、秩和检验以及χ²检验分析三组儿童围生期危险因素及家族史之间的差异。 【结果】 孤独症及精神发育迟滞儿童有家族史的比例显著高于正常儿童(35.0% vs 6.3%,P＜0.001;31.7% vs 6.3%,P=0.005),而孤独症组和精神发育迟滞组的家族史差异无统计学意义(P=0.362)。三组儿童有孕期疾病史的比例存在差异(28.00% vs 45.00% vs 26.25%,χ²=6.635,P=0.036),但两两比较后发现各组之间差异均不显著。孤独症组母亲的孕龄显著高于正常儿童组(P＜0.001),与精神发育迟滞组差异不显著,而精神发育迟滞组与正常儿童组之间的差异也不显著。三组儿童围生期缺氧或窒息史的比例不存在显著差异(8.00% vs 10.00% vs 2.50%,χ²=3.589,P=0.166)。在胎产次、孕周、生产方式、产重上,三组儿童之间差异也无统计学意义。 【结论】 1)孤独症与精神发育迟滞患儿家族史的阳性率不相上下,但均显著高于正常儿童;2)晚孕可能是孤独症的一个危险因素。     

The incidence of childhood and adolescent seizures in the UK from 1999 to 2011: A retrospective cohort study using the Clinical Practice Research Datalink

BackgroundIn postmarketing vaccine surveillance, adverse events observed in a vaccinated population are compared to the number expected based on a background incidence rate. The background rate should be accurate and obtained from a population comparable to the one vaccinated. Such rates are often not available.MethodsThe incidence rate of generalised convulsive, febrile and afebrile seizures was estimated in individuals born after 01-January-1998 and aged between 2 months and 15 years of age using the UK Clinical Practice Research Datalink (1999–2011).ResultsThe study population consisted of 1532,992 individuals (4917,369 person years (PY) of follow up). A total of 28,917 generalised convulsive seizure events were identified during follow-up, the overall incidence rate was 5.88 per 1000PY. Age specific rates increased sharply from 4/1000PY at 2 months of age, peaked at 19/1000PY at 16 months and decreased until approximately 6 years of age at which point they became relatively stable at 2/1000PY. 67% of GCSs were categorised as febrile: 56% using Read codes, 11% using free text. Febrile seizures accounted for the age trend in GCS, with rates peaking at 16.1/1000PY at 16 months of age while afebrile seizure rates remained relatively stable across all ages (24 seizures per 1000PY). Analysis by first occurrence of febrile seizure showed a similar pattern, comparable to published studies on the incidence of seizures in childhood.DiscussionThe rates reported in this study could be used in the postmarketing surveillance of infant vaccines. However, given the variation across strata, and the potential underascertainment of seizure events presenting to A&E, care must be taken when interpreting and using these rates.     

Prevalence of wheezing and associated risk factors among infants in Recife, Pernambuco State, Brazil

The aim of this study was to verify the prevalence of wheezing in infants (< 1 year of age) in Recife, Pernambuco State, Brazil, and to identify associated risk factors. Sample and methods: the study was performed according to the protocol of the International Study of Wheezing in Infants (EISL) in children ranging from 12 to 15 months of age. The sample was analyzed for presence or absence of wheezing. A total of 1,071 parents of children ranging from 12 to 15 months of age were interviewed. Prevalence of wheezing in the first year of life was 43%, with no difference between the sexes. Wheezing in the first year of life was associated with pneumonia, family history of asthma, more than nine episodes of upper airway infection, and the first cold before six months of age (p < 0.001). Prevalence of wheezing in the first year of life was high in Recife. Early onset (and high number) of colds, family history of asthma, and pneumonia were associated with wheezing in these children.