The effects of antihistamines on the semiology of febrile seizures

Objective

The aim of this study was to clarify the effects of antihistamines on the semiology of febrile seizures.

热性惊厥血浆内皮素及心肌酶含量变化及临床意义

目的研究热性惊厥血浆内皮素(ET)及心肌酶同工酶(CK-MB)的动态变化及临床意义。方法选用热性惊厥患儿30例,分别于惊厥24 h内和惊厥后7 d取静脉血各2 mL和正常对照组22例取静脉血各2 mL检测ET和CK-MB。结果热性惊厥组与正常组比较,24 h内血浆内皮素(ET)及心肌酶同工酶(CK-MB)明显升高,结果有显著差异。热性惊厥组24 h内增高的血浆内皮素(ET)及心肌酶同工酶(CK-MB)于7 d后降至正常。结论内皮素参与了热性惊厥的发病过程,而心肌酶在热性惊厥时升高,故测定ET和CK-MB可判定热性惊厥患儿有无一过性的脑功能及心功能损伤。     

基于脏腑和气血辨证理论探讨新型冠状病毒肺炎的肺外表现＊

新型冠状病毒肺炎现已被认为是具有广泛表现的多器官疾病，除肺以外，可累及多系统。张忠德教授根据临床抗疫经验，结合温病理论和中医脏腑、气血辨证理论，提出疫疠之气从口鼻入肺，借助肺朝百脉随气血抵达深层脏腑，继而相应脏腑气血功能失常的病机观念。在消化道，可表现为邪留三焦，里结阳明等证候；在心脏血管系统，可表现为心肾阳衰，热入营血等证候。在治疗中，张教授主张治肺为本，平调五脏，早期扶正，全程扶正。强调在疾病传变阶段，面对多系统表现时，抓住主（重）症和变化的症状。此外，张教授在《伤寒论》大柴胡汤和四逆汤基础上加减化裁，自拟柴胡解毒方和扶正救肺方，治疗重症新冠肺炎收到良好疗效，为中医药治疗本病提供了经验和思路。     

清代岭南伤寒名家郭元峰《伤寒论》学术思想概略

郭元峰,广东南海人,清代岭南名医,医术精湛,学术颇丰,崇经典,深研仲景伤寒之说,提出许多创见。郭氏对伤寒及治疗次第的认识言简意赅,切中要害,对六经本证述之简当,紧扣临床,辨证从实际需要出发,辨证手段丰富,师古而不泥古,活用经方,参以时方,是岭南经方派的重要代表之一。     

Impact of rotavirus vaccination on childhood hospitalizations for seizures: Heterologous or unforeseen direct vaccine effects?

There is a growing interest in the possible relationship between rotavirus (RV) vaccine and hospitalizations due to childhood seizures. We explored variation in hospitalization rates after 9 years of vaccination against pre-vaccination period for children <5 years of age from Galicia (Northwest Spain) before and after the introduction of the RV vaccines. Hospitalization rates for childhood seizures in Galician children were compared before and after RV vaccine introduction (in 2007) using different statistical approaches, including time series analyses. Our study cohort totaled 7,712 children <5 years of age admitted to hospital between 2002 and 2015 for “all kind of childhood seizures”. Hospitalization rates decreases steadily with reductions ranging from 22.3% (95% CI: 15.0–29.1) in 2008, to 50.9% (95% CI: 45.5–55.7) in 2014, and significant results were also observed for <1, 1, and 2-year-old children in comparison with pre-vaccination period hospitalization rate. Regression models indicate a negative association between RV vaccination and hospitalizations for all kind of seizures. In addition, time series analyses are consistent with this finding and predict that vaccination coverage will affect hospitalization rates for “all kind of seizures” after 9 months. The results strongly support that RV vaccination has significantly reduced hospitalization rates due to childhood seizures.     

Convulsiones febriles simples y complejas, ¿son tan diferentes? Manejo y complicaciones en urgencias

ObjectiveWe aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure.Material and methodsWe performed a retrospective cohort study including patients aged 0-16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis.ResultsWe identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61).ConclusionsThe systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.     

A novel inherited SCN1A mutation associated with GEFS+ in benign and encephalopathic epilepsy

Generalized epilepsy with febrile seizures plus (GEFS+) is an autosomal dominant condition often caused by mutations in SCN1A that usually first manifests as childhood simple febrile seizures but may progress to a variety of afebrile generalized seizure types. Here, we describe the case of an 8-year-old boy with a novel SCN1A mutation who developed febrile seizures at 10 months of age which eventually advanced to frequent afebrile tonic-clonic seizures. His condition was unresponsive to several antiepileptic drugs and the ketogenic diet, and he experienced gradual cognitive decline. The patient’s father carries the same novel mutation, but he only experienced childhood simple febrile seizures. SCN1A mutations display incomplete penetrance and variable expressivity, and the resulting severity may depend on the location and type of mutation, whether the mutation was spontaneous or inherited, and the effect of modifying alleles. The identification of novel pathogenic SCN1A mutations may eventually advance therapeutic development and prognostic capabilities.     

Protective effects of maternal administration of curcumin and hesperidin in the rat offspring following repeated febrile seizure: Role of inflammation and TLR4

Neuroinflammation has a key role in seizure generation and perpetuation in the neonatal period, and toll-like receptor 4 (TLR4) pathway has a prominent role in neuroinflammatory diseases. Administration of antioxidants and targeting TLR4 in the embryonic period may protect rat offspring against the next incidence of febrile seizure and its harmful effects. Curcumin and hesperidin are natural compounds with anti-inflammatory and antioxidant properties and have an inhibitory action on TLR4 receptors. We evaluated the effect of maternal administration of curcumin and hesperidin on infantile febrile seizure and subsequent memory dysfunction in adulthood.Hyperthermia febrile seizure was induced on postnatal days 9–11 on male rat pups with 24 h intervals, in a Plexiglas box that was heated to ~45 °C by a heat lamp. We used enzyme-linked immunosorbent assay, Western blotting, malondialdehyde (MDA), and glutathione (GSH) assessment for evaluation of inflammatory cytokine levels, TLR4 protein expression, and oxidative responses in the hippocampal tissues. For assessing working memory and long-term potentiation, the double Y-maze test and Schaffer collateral-CA1 in vivo electrophysiological recording were performed, respectivelyOur results showed that curcumin and hesperidin decreased TNF-α, IL-10, and TLR4 protein expression and reversed memory dysfunction. However, they did not provoke a significant effect on GSH content or amplitude and slope of recorded fEPSPs in the hippocampus. In addition, curcumin, but not hesperidin, decreased interleukin-1β (IL-1β) and MDA levels.These findings imply that curcumin and hesperidin induced significant protective effects on febrile seizures, possibly via their anti-inflammatory and antioxidant properties and downregulation of TLR4.