Characteristics and Risk Factors of Central Nervous System Infection in Children With Febrile Seizures.

OBJECTIVE: The aim of the present study is to evaluate the necessity of performing lumbar puncture in patients experiencing febrile seizures, considering the epidemiology specific to Brazil. METHODS: A retrospective cross-sectional study was performed from January 2017 to December 2021. RESULTS: A total of 469 children with seizure and fever were analyzed. The identified event was the first in 65.9% (n = 309). A total of 54.2% (n = 254) of patients had a simple febrile seizure. Infectious focus, excluding previous central nervous system (CNS) infection, was identified in 35.6% (n = 167) patients. Meningitis was identified in 7.7% (n = 36) patients, all of them were viral. Patients with CNS infection had a higher frequency of symptoms such as nausea and vomiting, drowsiness, headache, and higher level of leukocytosis. A longer duration of fever was found to be more strongly associated with CNS infection. CONCLUSIONS: When considering the use of lumbar puncture in febrile seizure, it is important to conduct a comprehensive evaluation that considers multiple factors, including clinical signs, symptoms, and the overall clinical context. Meningeal signs may be less prominent, and other symptoms such as lethargy, irritability, and vomiting may serve as more reliable indicators. Although clinical examination suggestive of meningitis remains an important factor, the recurrence of febrile seizures and a longer length of fever can provide additional insights and aid in decision-making regarding lumbar puncture.

The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis.

Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67-1.04; I2 = 78%; Cochran's Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65-0.99; I2 = 70%; Cochran's Q = 0.02).    Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts. What is Known: • Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight. • However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures. What is New: • When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures. • When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.

Convulsão febril: estudo de base populacional / Febrile seizures: a population-based study

Resumo Objetivos Estabelecer a prevalência das crises febris e descrever o perfil clínico e epidemiológico dessa população. Métodos Estudo transversal de base populacional feito em Barra do Bugres (MT), de agosto de 2012 a agosto de 2013. Os dados foram coletados em duas etapas. Na primeira etapa usamos um questionário validado previamente em outro estudo brasileiro, para identificação de casos suspeitos de crises epilépticas. Na segunda etapa fizemos a avaliação neuroclínica para confirmação diagnóstica. Resultados A prevalência de crise febril foi de 6,4/1.000 habitantes (IC95% 3,8; 10,1). Não houve diferença entre os sexos. As crises febris simples foram encontradas em 88,8% dos casos. A história familiar de crise febril e epilepsia em parentes de primeiro grau esteve presente em 33,3% e 11,1% dos pacientes, respectivamente. Conclusões A prevalência da crise febril na Região Centro-Oeste foi menor do que a encontrada em outras regiões brasileiras, provavelmente relacionado à inclusão apenas das crises febris com manifestações motoras e as diferenças de fatores socioeconômicos entre as regiões pesquisadas.

Abstract Objectives To determine the prevalence of benign febrile seizures of childhood and describe the clinical and epidemiological profile of this population. Methods This was a population-based, cross-sectional study, carried out in the city of Barra do Bugres, MT, Brazil, from August 2012 to August 2013. Data were collected in two phases. In the first phase, a questionnaire that was previously validated in another Brazilian study was used to identify suspected cases of seizures. In the second phase, a neurological evaluation was performed to confirm diagnosis. Results The prevalence was 6.4/1000 inhabitants (95% CI: 3.8-10.1). There was no difference between genders. Simple febrile seizures were found in 88.8% of cases. A family history of febrile seizures in first-degree relatives and history of epilepsy was present in 33.3% and 11.1% of patients, respectively. Conclusions The prevalence of febrile seizures in Midwestern Brazil was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and differences in socioeconomic factors among the evaluated areas.

Febrile seizures: a population-based study.

OBJECTIVES: To determine the prevalence of benign febrile seizures of childhood and describe the clinical and epidemiological profile of this population. METHODS: This was a population-based, cross-sectional study, carried out in the city of Barra do Bugres, MT, Brazil, from August 2012 to August 2013. Data were collected in two phases. In the first phase, a questionnaire that was previously validated in another Brazilian study was used to identify suspected cases of seizures. In the second phase, a neurological evaluation was performed to confirm diagnosis. RESULTS: The prevalence was 6.4/1000 inhabitants (95% CI: 3.8-10.1). There was no difference between genders. Simple febrile seizures were found in 88.8% of cases. A family history of febrile seizures in first-degree relatives and history of epilepsy was present in 33.3% and 11.1% of patients, respectively. CONCLUSIONS: The prevalence of febrile seizures in Midwestern Brazil was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and differences in socioeconomic factors among the evaluated areas.

Convulsión febril / Febrile seizure

Febrile seizures are the most common seizure disorder in the pediatric population and represent a frequent cause of consultation in emergency departments, confirming its importance. We present an updated and practical review regarding this pathology, along with an operative definition that supports the application of a flowchart that integrates concepts and procedures that can be easily applied at any location nationwide. This review is designed to provide an analytic framework regarding pediatric febrile seizures, as well as present a guideline based on our experience in the emergency department by summarizing the main benzodiazepines in actual use that have been proved to be both safe and effective in treating this disorder, such as lorazepam and midazolam...

Niveles séricos bajos de zinc como factor asociado a episodio de convulsión febril simple en niños de 6 meses a 5 años atendidos en el Instituto de Salud del Niño, Lima Perú / Low serum levels of zinc as a factor associated with episode of simple febrile seizure in children of 6 months to 5 years attended at the Institute of child health, Lima Peru

Niveles séricos bajos de Zinc como factor asociado a episodio de convulsión febril simple en niños de 6 meses a 5 años atendidos en el Instituto de Salud del Niño, Lima-Perú. La convulsión febril es la forma más común de convulsiones en niños. Su patogénesis exacta no está completamente dilucidada, pero es multifactorial. El zinc modula la actividad de múltiples enzimas y de esta manera niveles bajos podrían activar ciertos receptores e inducir una descarga epiléptica en niños febriles. Sin embargo su relación con el desarrollo de convulsiones es aún poco estudiada. A pesar del su aparente buen pronóstico, las convulsiones febriles simples continúan siendo causa importante de ansiedad e incertidumbre. Objetivos: Determinar si existe asociación entre los niveles séricos bajos de zinc y la presencia de un episodio de convulsión febril simple entre los niños de 6 meses a 5 años que ingresan por emergencia del Instituto de Salud del Niño. Metodología: Estudio observacional, analítico, caso control. La unidad de análisis fueron pacientes entre 6 meses y 5 años que se atendieron en el INSN durante Julio 2013 a Junio 2014 con diagnóstico de convulsión febril simple. El muestreo fue no probabilístico de voluntarios, obteniendo un total de 57 casos y 103 controles. Se analizó antecedente de prematuridad, duración de lactancia materna, historia familiar de convulsión febril y de epilepsia, cuidado en guarderías y dosaje sérico bajo de zinc. Se usó el Chi cuadrado y se obtuvo OR respectivos. Los antecedentes útiles fueron evaluados usando regresión logística múltiple. Se consideró un nivel de confianza del 95 por ciento con un valor de p<0.05. Resultados: Se encontró diferencia estadísticamente significativa en la duración Lactancia Materna exclusiva y niveles séricos bajos de zinc. Utilizando la regresión logística múltiple se encontró que la Lactancia Materna Exclusiva otorga 0.34 veces menos riesgo de convulsionar con fiebre y que tener niveles séricos bajos de...

Low serum zinc levels as an associate factor to episode of simple febrile seizure in children 6 months to 5 years old treated at the Institute of Child Health, Lima Peru. Febrile seizure is the most common form of seizures in children. Its exact pathogenesis is not fully elucidated, but is multifactorial. Zinc modulates the activity of multiple enzymes and thus low levels may activate certain receptors and induce an epileptic discharge in febrile children. But their relationship with the development of seizures is still poorly studied. Despite his apparent good prognosis, simple febrile seizures remain a major cause of anxiety and uncertainty. Objectives: To determine the association between low serum zinc levels and the presence of an episode of simple febrile seizure among children 6 months to 5 years old admitted for emergency Institute of Child Health. Methods: An observational, analytical, case control study. The unit of analysis was patient between 6 months and 5 years who was treated at the INSN during July 2013 to June 2014 with a diagnosis of simple febrile seizure. The non-probability sampling was voluntary, obtaining a total of 57 cases and 103 controls. I analyzed antecedent prematurity, duration of breastfeeding, family history of febrile seizures and epilepsy, daycare and low serum zinc dosage. Chi square was used and obtained respective OR. Useful background were evaluated using multiple logistic regression. A confidence level of 95 per cent was considered with a P value <0.05. Results: Statistically significant difference was found in exclusive breastfeeding duration and low serum zinc. Using multiple logistic regression analysis found that exclusive breastfeeding gives 0.34 times less risk of convulsions with fever and have low serum zinc gave you 3 times more risk of convulsions with fever...

Hyperthermic seizures enhance responsiveness to pentylenetetrazole and induce cognitive dysfunction: protective effect of 3-alkynyl selenophene.

AIMS: In this study we investigated the effect of pre-treatment with 3-alkynyl selenophene (3-ASP) against the increase in responsiveness to pentylenetetrazole [PTZ seizure threshold] and cognitive dysfunction induced by experimental febrile seizures (FS). The effects of 3-ASP were compared to those of diazepam (DZP). MAIN METHODS: Young rats, at postnatal day 21, developed seizures after exposure to a stream of heated air to approximately 41°C. A non-spatial long-term memory and PTZ seizure threshold were determined 30 days after FS. The behavioural seizures were stereotyped followed by facial automatisms, often followed by body flexion. Young rats were pre-treated with 3-ASP (50 and 100mg/kg; per oral route), DZP (1 and 5mg/kg; intraperitoneally) or vehicle. KEY FINDINGS: 3-ASP and DZP pre-treatments were not effective in protecting against seizures induced by FS. 3-ASP pre-treatment protected against the increase in responsiveness to PTZ and cognitive dysfunction induced by FS. DZP pre-treatment was effective in protecting against the increase in responsiveness to PTZ, but not, against the impaired memory induced by FS. SIGNIFICANCE: 3-ASP pre-treatment protected against impairment of memory performance in the step-down passive avoidance task and the increase in the susceptibility to seizures caused by FS early in life of rats.

Childhood acute bacterial meningitis: risk factors for acute neurological complications and neurological sequelae.

OBJECTIVE: To assess acute neurological complications and neurological sequelae of childhood acute bacterial meningitis in order to determine possible warning signs. METHODS: This retrospective study evaluated children with acute bacterial meningitis (between 1 month and 14 years of age) admitted between 2003 and 2006. RESULTS: Of the 44 patients studied, 17 (38.6%) had acute neurological complications. Seizure was the most frequent (31.8%) complication. Patients with acute neurological complications showed a higher frequency of lower neutrophil count (p = 0.03), seizure at admission (p < 0.01), and S. pneumoniae as the etiologic agent (p = 0.01). Risk factors for the development of acute neurological complications were S. pneumoniae (odds ratio [OR] = 6.4, confidence interval [CI] 1.7-24.7) and neutrophil count < 60% (p < 0.01). Of the 35 patients who were followed up, 14 had neurological sequelae (40%). Behavioral change (22.9%) was the most frequent sequela. Seizures at admission (OR = 5.6, CI 1.2-25.9), cerebrospinal fluid protein concentration > 200 mg/dL (p < 0.01), and cerebrospinal fluid glucose concentration/glycemia ratio (p < 0.01) were identified as risk variables for sequelae. CONCLUSION: Neutrophil count < 60%, seizure at admission, and S. pneumoniae as the etiologic agent were identified as warning signs for acute neurological complications, while protein levels, cerebrospinal fluid glucose concentration/glycemia ratio, and seizure at admission were seen as risk factors for neurological sequelae.

Meningite bacteriana aguda na infância: fatores de risco para complicações agudas e sequelas / Childhood acute bacterial meningitis: risk factors for acute neurological complications and neurological sequelae

OBJETIVO: Estudo retrospectivo que visa avaliar as complicações neurológicas agudas e sequelas neurológicas das meningites bacterianas agudas na infância, a fim de determinar possíveis sinais de alerta. MÉTODOS: Foram avaliadas crianças (entre 1 mês e 14 anos) internadas entre 2003 e 2006, com meningite bacteriana aguda. RESULTADOS: Dos 44 pacientes incluídos, 17 (38,6%) apresentaram complicações neurológicas agudas, sendo crise convulsiva a mais frequente (31,8%). Os pacientes com complicações neurológicas agudas apresentaram com mais frequência: menor contagem de neutrófilos (p = 0,03), crise convulsiva na admissão (p < 0,01) e S. pneumoniae como agente etiológico (p = 0,01). Os fatores de risco para o desenvolvimento de complicações neurológicas agudas foram: S. pneumoniae [razão de chances (odds ratio, OR) = 6,4; intervalo de confiança (IC) 1,7-24,7] e contagem de neutrófilos < 60% (p < 0,01). De 35 pacientes seguidos ambulatorialmente, 14 apresentaram sequelas neurológicas (40%), sendo alteração comportamental a mais frequente. A ocorrência de crise convulsiva na internação (OR = 5,6; IC 1.2-25,9), proteinorraquia > 200 mg/dL (p < 0,01) e menor relação glicorraquia/glicemia (p < 0,01) foram identificadas como variáveis de risco para sequelas. CONCLUSÃO: Contagem de neutrófilos < 60%, crise convulsiva na admissão e S. pneumoniae como agente etiológico foram identificados como sinais de alerta para a ocorrência de complicação neurológica aguda, enquanto que proteinorraquia, menor relação glicorraquia/glicemia e crise convulsiva na internação foram observados como fatores de risco para a ocorrência de sequelas neurológicas.

OBJECTIVE: To assess acute neurological complications and neurological sequelae of childhood acute bacterial meningitis in order to determine possible warning signs. METHODS: This retrospective study evaluated children with acute bacterial meningitis (between 1 month and 14 years of age) admitted between 2003 and 2006. RESULTS: Of the 44 patients studied, 17 (38.6%) had acute neurological complications. Seizure was the most frequent (31.8%) complication. Patients with acute neurological complications showed a higher frequency of lower neutrophil count (p = 0.03), seizure at admission (p < 0.01), and S. pneumoniae as the etiologic agent (p = 0.01). Risk factors for the development of acute neurological complications were S. pneumoniae (odds ratio [OR] = 6.4, confidence interval [CI] 1.7-24.7) and neutrophil count < 60% (p < 0.01). Of the 35 patients who were followed up, 14 had neurological sequelae (40%). Behavioral change (22.9%) was the most frequent sequela. Seizures at admission (OR = 5.6, CI 1.2-25.9), cerebrospinal fluid protein concentration > 200 mg/dL (p < 0.01), and cerebrospinal fluid glucose concentration/glycemia ratio (p < 0.01) were identified as risk variables for sequelae. CONCLUSION: Neutrophil count < 60%, seizure at admission, and S. pneumoniae as the etiologic agent were identified as warning signs for acute neurological complications, while protein levels, cerebrospinal fluid glucose concentration/glycemia ratio, and seizure at admission were seen as risk factors for neurological sequelae.

Vaccinations and febrile seizures.

The occurrence of seizures related to fever results from complex interactions among genetic and environmental factors. The issue of the relationship between vaccination and febrile seizures is complex. It is difficult to identify whether the febrile seizures result from a nonspecific fever caused by vaccination or if these are secondary to an encephalitis or encephalopathy caused by the vaccine. There is evidence showing that vaccination does trigger the onset of febrile seizures in one third of patients with Dravet syndrome. In general, febrile seizures that occur after vaccination do not seem to be different from febrile seizures from other causes, thus advances in knowledge about febrile seizures in general should be relevant to vaccine-associated febrile seizures.

Seizures in the Jamaica cohort study of sickle cell disease.

Although there is some evidence that epilepsy is more common in Sickle Cell Disease (SCD), we sought to establish the incidence rates, risk factors for and specific types of seizures in a SCD cohort followed from birth, and how seizure occurrence affects morbidity and mortality. We examined all records of persons in the Jamaica cohort Study of Sickle Cell Disease (JSSCD) clinically identified as having experienced a seizure during their lifetime. At first presentation, seizures were classified as Febrile Convulsion, Acute Symptomatic Seizure or Single Unprovoked Seizure. The seizure classification was revised to include Epilepsy if seizures recurred. Thirty-eight persons in the JSSCD (N = 543) were identified with seizures. The 5-year cumulative incidence of febrile convulsions was 2·2%. The incidence rate of epilepsy (all genotypes) was 100/100 000 person-years, 139/100 000 for the SS genotype. Despite limited availability of diagnostic investigations, clinical seizures were associated with increased all-cause mortality. Male gender (Odds Ratio [OR]: 4·0[95% confidence interval [CI]; 1·03-20·0]) and dactylitis in childhood (OR: 17·4 [95% CI; 4·82-62·85]) were associated with increased risk of developing epilepsy. Epilepsy in persons with SCD is 2-3 times more common than in non-sickle populations and is associated with increased all-cause mortality in all sickle cell genotypes.

Convulsión febril en niños de 0 a 14 años de edad: Hospitales de San José e Infantil Universitario de San José, Bogotá D. C / Febrile convulsions in children aged 0 to 14 yearsconsulting to Hospital de San José and Hospital infantil Universitario de San José, Bogotá DC

Las convulsiones febriles en niños son un problema común a nivel mundial, debido a las múltiples patologías que pueden cursar con fiebre y desencadenar una convulsión. Un cuadro gripal con temperatura superior a 38°C puede ser suficiente para provocarlas. Consideramos indispensable conocer más acerca de esta patología y por ello nos propusimos profundizar e informar. Objetivo: describir las características clínicas y sociodemográficas de los pacientes con convulsión febril. Metodología: estudio descriptivo. Se incluyeron pacientes que consultaron a los Hospitales de San José e Infantil Universitario de San José en el período agosto 2007 a agosto 2009, que hubiesen presentado una primera convulsión febril. Se excluyeron aquellos con diagnóstico de epilepsia, en tratamiento con anticonvulsivantes, que no presentaran fiebre o no se describiera la convulsión en la historia clínica. Resultados: de un total de 468 casos (213 HSJ + 255 HIUSJ) 147 eran de 0 a 14 años de edad, encontrando que el 80,3% (118/147) presentó convulsiones tonicoclónicas. De ellos 53,4% fueron niñas, 48,3% cursaron con convulsiones simples, 80,5% no tuvieron período posictal, 43,2% no presentaron ninguna comorbilidad y cuando las hubo fueron las infecciones del sistema respiratorio las más frecuentes (23,7%). Conclusiones: se identificaron las características clínicas y sociodemográficas de los pacientes con convulsión febril, mediante la revisión de las historias clínicas, tabulación de los datos obtenidos y comparación de resultados.

A febrile convulsion is a common medical problem affecting children worldwide for it is associated to a great number of febrile conditions in which a convulsion may be precipitated. A common cold with temperature that rises over 38°C may be enough to provoke a seizure. We consider it essential to gain further knowledge on this topic, thus, we intended to explore and report. Objective: to describe the clinical and socio-demographic features of patients presenting a febrile convulsion. Methodology: descriptive study. Children who consulted to Hospital San José (HSJ) and Hospital Infantil Universitario de San José (HIUSJ) between August 2007 and August 2009, including those who had presented their first febrile convulsion. Excluding those with diagnosed epilepsy receiving anticonvulsant therapy, those who presented afebrile convulsions and those in which seizure was not described in clinical record. Results: of 468 cases (213 HSJ + 255 HIUSJ) 147 were aged 0 to 14 years, 80.3% (118/147) presented tonic-clonic seizures. 53.4% were girls, 48.3% were simple convulsions, 80.5% had no postictal period, 43.2% had no comorbidities and when present were usually related to respiratory infections (23.7%). Conclusions: clinical and socio-demographic features were identified by a clinical record, data tabulation and result comparison review.

Mesial temporal sclerosis in children.

UNLABELLED: Mesial temporal sclerosis is the most frequent cause of drug-resistant temporal lobe epilepsy but has a satisfactory response to surgery, and is considered infrequent in children. OBJECTIVE: To evaluate the clinical, electrographic and radiological spectrum of the disease in children. METHOD: Retrospective study by review of charts of 44 children with a diagnosis of mesial temporal sclerosis on magnetic resonance imaging, attended at the "Hospital das Clínicas" of the University of São Paulo Faculty of Medicine. RESULTS: Febrile seizure was identified in the history of 54% of the patients. Injuries at the left side predominated in patients with schooling difficulties (p=0.049), in those with first seizures between six months and five years (p=0.021) and in those with complex febrile seizure (p=0.032). Thirteen patients were submitted to surgery and of these, eight remained without seizures. CONCLUSION: Febrile seizure may be related in a more direct way to the presence of left-side mesial temporal sclerosis.

Mesial temporal sclerosis in children

Mesial temporal sclerosis is the most frequent cause of drug-resistant temporal lobe epilepsy but has a satisfactory response to surgery, and is considered infrequent in children. OBJECTIVE: To evaluate the clinical, electrographic and radiological spectrum of the disease in children. METHOD: Retrospective study by review of charts of 44 children with a diagnosis of mesial temporal sclerosis on magnetic resonance imaging, attended at the "Hospital das Clínicas" of the University of São Paulo Faculty of Medicine. RESULTS: Febrile seizure was identified in the history of 54 percent of the patients. Injuries at the left side predominated in patients with schooling difficulties (p=0.049), in those with the first seizures between six months and five years (p=0.021) and in those with complex febrile seizure (p=0.032). Thirteen patients were submitted to surgery and of these, eight remained without seizures. CONCLUSION: Febrile seizure may be related in a more direct way to the presence of left-side mesial temporal sclerosis.

Em adultos, esclerose mesial temporal é a causa mais freqüente de epilepsia do lobo temporal intratável por medicamentos e que responde satisfatoriamente a cirurgia, sendo considerada pouco freqüente em criança. OBJETIVO: Avaliar o espectro clínico, eletrográfico e radiológico desta patologia em crianças. MÉTODO: Estudo retrospectivo, por revisão de prontuário de 44 crianças com diagnóstico de esclerose mesial temporal na ressonância magnética, atendidos no Hospital das Clínicas da Faculdade de Medicina de São Paulo. RESULTADO: Foi identificado que 54 por cento dos pacientes apresentaram antecedente de crise febril. Lesão no lado esquerdo predominou nos pacientes com dificuldade escolar (p=0.049), naqueles com primeiras crises entre seis meses e cinco anos (p=0,021) e naqueles com crise febril complicada (p=0,032). Treze pacientes foram operados, dos quais oito ficaram livres de crises. CONCLUSÃO: Crise febril pode estar relacionada de uma forma mais direta à presença de esclerose mesial temporal no lado esquerdo.