Febrile seizures

Febrile seizures are the most common convulsive disorder in children. The definition, epidemiology, genetics, clinical features, evaluation and management are reviewed. The importance of evaluating the very young child with febrile seizure for an underlying CNS infection is reviewed. The current standard of treatment is discussed. The importance of recognizing and alleviating parental anxiety is discussed.     

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目的探讨热性惊厥(FC)继发癫癎(EP)的危险因素,以便早期干预.方法对1988年1月至2000年6月在内蒙古医学院第四附属医院儿科住院的253例FC患儿,进行5年至17年5个月随访观察.以第1次FC发作住院为随访起点,再次住院或家庭访问为随访方式,观察FC患儿继发EP的年发生率.并对FC患儿的发作持续时间、发作总次数、发作体温、首次发作24h内的发作次数、初发年龄、惊厥家族史、发作形式、首次发作48h内的脑电图、性别、原发病等可能继发EP的危险因素详细观察记录.所得资料应用生存分析寿命表和生存分析+COX回归作多元回归分析.结果随访253例FC继发EP 19例.5,10,17年继发EP年发生率分别是0.53%,1.69%,8.70%.FC发作持续时间和发作总次数,经分析分别P<0.05和P<0.01,B分别为负值和正值,分别RR<1和RR>1,其95%可信区间内均不包含1;发作形式和惊厥家族史,均P<0.01,B均为正值,均RR>1,其95%可信区间内均不包含1.结论 FC的发作持续时间长、发作总次数增多、局灶性发作及有惊厥家族史是继发EP的危险因素.     

论许叔微祛邪治病学术思想

据许叔微所著《伤寒论著三种》和《普济本事方》中所载病案及方药，从邪留成实，以析病机；攻逐实邪，法不拘一；奇方重剂，随宜而用３方面，详细论述了许氏祛邪治病的学术思想。     

Adverse events associated with MMR vaccines in Japan

The largest nationwide active surveillance of four Measles-Mumps-Rubella (MMR) vaccines was conducted in Japan. A total of 1255 pediatricians actively participated in the study, which comprised 8.6% of all members of the Japanese Pediatric Society. The total number of registered recipients of MMR vaccines was 38 203. They were arbitrarily given one of the MMR vaccines produced by three makers (Takeda, Osaka city, Kitasato Minato-ku, Tokyo and Biken Suita city, Japan) or the standard MMR vaccine made of designated strains (Kitasato's measles-AIK-C, Biken's mumps-Urabe Am9 and Takeda's rubella-To336) produced by Takeda, Kitasato and Biken and were observed for 35 days. The rates of virologically confirmed aseptic meningitis per 10 000 recipients were 16.6, 11.6, 3.2 and 0 for the standard MMR, Takeda MMR, Kitasato MMR and Biken MMR vaccines, respectively. The incidence of convulsions between 15 and 35 days was the highest with the standard MMR vaccine and the incidence of fever associated with vomiting occurring between 15 and 35 days (symptoms relevant to aseptic meningitis) were also the highest with the standard MMR vaccine. The incidence of parotid swelling was the lowest with Takeda MMR vaccine. This surveillance revealed that incidences of aseptic meningitis after administration of the standard MMR vaccine and of Biken MMR vaccine were different. This posed questions about the manufacturing consistency of the Urabe Am9 mumps virus vaccines. On the other hand, the National Institute of Health found that the biological characteristics of the Urabe Am9 mumps virus contained in the standard MMR vaccine and in the Biken MMR vaccine were different. The Biken Company reported that the mumps vaccine in the standard MMR vaccine was a mixture of two Urabe Am9 mumps vaccine bulks; one identical to that contained in the Biken MMR vaccine and the other produced by a different manufacturing process.     

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.     

Sodium valproate versus phenobarbital in the prophylactic treatment of febrile convulsions in childhood

Phenobarbital has been shown to offer effective prophylaxis against childhood febrile convulsions. However, a high percentage of children do not tolerate phenobarbital, mainly due to behavioral changes. Valproate, due to its low toxicity, appears to be an attractive alternative to phenobarbital treatment. Ninety children admitted with their first febrile convulsion were offered prophylactic treatment with either phenobarbital 3–5 mg/kg/day or valproate 20–30 mg /kg/day. Twenty-five children whose parents refused prophylactic treatment make up an untreated control group. Serum levels of the appropriate drug were measured at each follow-up visit. The three groups appear to be comparable. Twenty-one per cent of the phenobarbital treated children required discontinuation of the drug due to side effects. All the children tolerated valproate therapy.Twelve out of 25 untreated children suffered recurrences. Eight out of 33 children treated with phenobarbital suffered recurrences. Four out of 32 children on valproate therapy had recurrences. The difference between valproate treatment and no therapy at all is highly significant (P<0.0001). Phenobarbital did not reduce the risk of recurrence. We now recommend prophylactic treatment with valproate to children with febrile seizures.     

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.     

Decreased levels of brain cyclo-oxygenase products as a possible cause of increased seizure susceptibility in convulsion-prone gerbils

Basal levels of 5 cerebral prostanoids (PGD₂, PGF_2α, PGE₂, 6-keto-PGF_1α and throm☐ane/TX/B₂) were measured radioimmunologically in normal and convulsion-prone gerbils. Significantly less PGD₂, PGE₂ and 6-keto-PGF_1α was found in the brain of seizure-sensitive animals. After treatment with indomethacin, which reduced the amount of brain cyclo-oxygenase products, also normal gerbils exhibited convulsions following environmental stress. The results are in accordance with the hypothesis that endogenous prostanoids play a role in the regulation of seizure susceptibility.     

Spider toxin (JSTX-3) inhibits the convulsions induced by glutamate agonists

Summary The effect of a spider toxin (JSTX-3)—a specific blocker of glutamate receptors—on the behavior of mice was studied using an intracerebroventricular (i.c.v.) injection technique. At higher doses (more than 12 nmol/brain), JSTX-3 increased motor activities and induced characteristic symptoms. JSTX-3 at a dose of 4.7 nmol/brain which per se did not produce any abnormal behavior, specifically antagonized quisqualate-induced convulsions but not NMDA- or kainate-induced confulsions. These results indicate that JSTX-3 is a selective antagonist of the quisqualate receptors in the mammalian central nervous system.     

热性惊厥对大鼠行为运动及空间学习记忆的影响

目的　探讨热性惊厥对大鼠行为运动及空间学习记忆能力的影响。方法　 6 0只雄性SD大鼠随机均分为热性惊厥组 (FS) ,发热对照组 (FG)及正常对照组 (NG)。动态观察各组大鼠在斜板试验、悬吊试验、旷场活动试验中行为运动的变化以及在Morris水迷宫中空间学习记忆能力的改变。结果　在斜板试验中 ,大鼠转体时间为FS组 (9 1± 2 6 )s ,FG组 (5 3± 2 1)s,NG组 (5 3± 2 0 )s,FS组和其他两组比较差异存在显著性 (P <0 0 1) ;悬吊试验中 ,大鼠的悬吊时间分别为FS组 (33 4±18 1)s,FG组 (5 0 1± 2 0 3)s,NG组 (5 9 0± 2 0 7)s,FS组和其他两组比较差异有显著性 (P <0 0 1) ;旷场活动试验中 ,大鼠得分分别为FS组 (5 1± 2 0 )分 ,FG组 (10 4± 3 0 )分 ,NG组 (13 2± 2 3)分 ,FS组和其他两组比较差异有显著性 (P <0 0 1) ;在Morris水迷宫实验中 ,同其他两组相比 ,FS组逃逸潜伏期延长 ,搜寻策略变差 ,平台所在区域内的游泳时间百分比降低 ,穿过平台的次数减少。结论　多次热性惊厥发作可使大鼠的行为运动能力和空间学习记忆能力受损