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1.
Rev. neurol. (Ed. impr.) ; 71(10): 365-372, 16 nov., 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198071

RESUMO

INTRODUCCIÓN: El estado epiléptico representa la emergencia neurológica más frecuente en pediatría. Las convulsiones febriles prolongadas representan la etiología más frecuente. Nuestro objetivo es actualizar su epidemiología y analizar sus consecuencias evolutivas. PACIENTES Y MÉTODOS: Estudio observacional analítico de cohortes retrospectivas de niños atendidos en urgencias con estado epiléptico entre enero de 2014 y diciembre de 2018. Se recogieron las variables demográficas, los antecedentes personales, las características clínicas, las pruebas complementarias y la etiología de los estados epilépticos seguidos en nuestro hospital. Se analizaron las consecuencias evolutivas en cuanto a neurodesarrollo y epilepsia ulterior. RESULTADOS: De un total de 525.000 urgencias atendidas durante el estudio, los casos de estado epiléptico fueron 79 en 68 pacientes (16 casos/100.000 niños/año). La etiología sintomática fue la más frecuente (35,4%). El 20,6% de los pacientes presentaba antecedente de prematuridad; el 30,8%, un déficit del neurodesarrollo previo, más frecuente en caso de etiología sintomática, y el 44% estaba diagnosticado de epilepsia. La duración mediana de las crisis fue de 50 minutos. En siete pacientes se identificó un desencadenante cerebral agudo. El déficit del neurodesarrollo ulterior achacable al estado epiléptico fue del 9,1%, y se relacionó con la etiología sintomática o antecedentes de prematuridad. El desarrollo de epilepsia ocurrió en el 10,7%. CONCLUSIONES: La alteración del neurodesarrollo achacable al estado epiléptico afecta a uno de cada 11 casos. La prematuridad fue un factor de riesgo por sí misma. La epilepsia posterior a un estado epiléptico se desarrolló en uno de cada 10 casos


INTRODUCTION: Epileptic status represents the most frequent neurological emergency in pediatrics. Prolonged febrile seizures represent the most common etiology. Our objective is to update its epidemiology and analyze its evolutionary consequences. PATIENTS AND METHODS: Observational analytical study of retrospective cohorts of children seen in the emergency department with epileptic status between January-2014 and December-2018. Demographic variables, personal history, clinical characteristics, complementary tests and the etiology of the epileptic status followed in our hospital were collected. The evolutionary consequences in terms of neurodevelopment and subsequent epilepsy were analyzed. RESULTS: Of a total of 525,000 emergencies attended during the study, epileptic status cases were 79 in 68 patients (16 cases/100,000 children/year). The symptomatic etiology was the most frequent (35.4%). 20.6% of the patients had a history of prematurity, 30.8% had a deficit of previous neurodevelopment, this being more frequent in case of symptomatic etiology, and 44% were diagnosed with epilepsy. The median duration of seizures was 50 minutes. An acute brain trigger was identified in seven patients. The subsequent neurodevelopmental deficit attributable to epileptic status was 9.1% of patients related to symptomatic etiology and/or a history of prematurity. The development of epilepsy occurred in 10.7%. CONCLUSIONS: The neurodevelopmental disorder attributable to epileptic status affects one in 11 cases. Prematurity was a risk factor per se. Post-epileptic status epilepsy developed in one in 10 cases


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Estado Epiléptico/epidemiologia , Estado Epiléptico/fisiopatologia , Convulsões Febris/epidemiologia , Convulsões Febris/fisiopatologia , Estado Epiléptico/etiologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Transtornos do Neurodesenvolvimento/epidemiologia , Estudos Retrospectivos , Prognóstico , Fatores de Risco , Espanha/epidemiologia
2.
Neurology ; 95(3): e226-e238, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32611632

RESUMO

OBJECTIVE: To compare the developmental and behavioral outcomes of children experiencing an initial vaccine-proximate (VP) febrile seizure (FS) to those having a non-VP-FS (NVP-FS) and controls who have not had a seizure. METHODS: In this prospective multicenter cohort study, children with their first FS before 30 months of age between May 2013 and April 2016 were recruited from 4 Australian pediatric hospitals and classified as having VP-FS or NVP-FS. Similar-aged children with no seizure history were recruited as controls. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) was administered to participants with FS 12 to 24 months after their initial FS and to controls 12 to 42 months of age at the time of assessment. The primary outcome was the Bayley-III cognitive score. Children's preacademic skills were assessed with the Woodcock-Johnson Tests of Achievement, Third Edition, and their behavior and executive functioning were obtained from parent questionnaires. RESULTS: There was no significant difference in cognitive function between children with VP-FS (n = 62), those with NVP-FS (n = 70), and controls (n = 90) (F 2,219 = 2.645, p = 0.07). There were no differences between the groups for all other measures and no increased risk of borderline/significant impairment or behavior in the clinical range in children with VP-FS compared to those with NVP-FS or controls. CONCLUSION: VP-FS was not associated with an increased risk of developmental or behavioral problems in young children compared to children with NVP-FS or controls. Parents and providers should be reassured by the absence of adverse effects of VP-FS on the development of children.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/fisiologia , Convulsões Febris/induzido quimicamente , Convulsões Febris/epidemiologia , Vacinas/efeitos adversos , Adulto , Austrália/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Convulsões Febris/diagnóstico
3.
Brain Dev ; 42(4): 342-347, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32019687

RESUMO

OBJECTIVE: The effect of complex febrile seizures (FS), specifically focal FS, on long-term neurodevelopmental outcome is not well known. The aim of this study was to assess the association between complex FS and neurodevelopmental outcome. METHODS: A single-center, retrospective, cohort study was performed. The study included 282 children aged 6-60 months who experienced FS. Of these, 61 (22%) experienced recurrent FS, 33 (12%) prolonged FS, and 17 (6%) focal FS. The effect of these complex FS on subsequent need for special neurodevelopmental support was investigated. The neurodevelopmental status after FS was evaluated by a questionnaire. RESULTS: During a median follow-up period of 3 years post FS, 12 children (4.3%) required special neurodevelopmental support. Univariate analysis demonstrated a significant association between focal FS and the need for subsequent special neurodevelopmental support, as well as a correlation between prolonged FS and pre-existing neurodevelopmental abnormality. Multiple logistic regression analysis demonstrated that focal FS (odds ratio [OR]: 12.27; 95% confidence interval [CI]: 2.11-71.22) and pre-existing neurodevelopmental abnormality (OR: 262; 95% CI: 17-3944) were significantly associated with the need for subsequent special support. CONCLUSION: An association was found between focal FS and subsequent neurodevelopmental impairment; therefore, close follow-up with particular attention to neurodevelopmental status is required for children who experience focal FS.


Assuntos
Transtornos do Neurodesenvolvimento/epidemiologia , Convulsões Febris/epidemiologia , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões Febris/complicações
4.
Seizure ; 75: 70-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31884051

RESUMO

PURPOSE: To investigate the association between reduced prophylactic diazepam usage and short-term recurrence of febrile seizures (FSs) after the FS practice guideline was updated in Japan. METHOD: In this single-center, retrospective study, children (6-60 months of age) with FS who were transported to our center by ambulance from January 2011 through December 2018 were included. Rectal administration of diazepam (0.3-0.5 mg/kg) after the first seizure and seizure recurrence within 24 h were compared between 2011-2015 (pre-guideline revision) and 2016-2018 (post-guideline revision). RESULTS: Among the total of 509 children, 297 were transported to our hospital in 2011-2015 and 212 in 2016-2018. Rectal diazepam administration was decreased in 2016-2018 (17 %) compared to 2011-2015 (53 %, P < 0.0001), while seizure recurrence was increased in 2016-2018 (20 %) compared to 2011-2015 (12 %, P = 0.0087). Similarly, hospital revisits (23 %) and hospital admissions (26 %) were increased in 2016-2018 compared to 2011-2015 (15 %, P = 0.031 and 18 %, P = 0.026, respectively). Multiple logistic regression analyses showed that prophylactic diazepam administration was the only factor related to preventing seizure recurrence. FS recurrence after the initial seizure was significantly less frequent with diazepam use (6 %) than without diazepam use (21 %, P < 0.0001; relative risk reduction, 70 %; number needed to treat, 6.8 children). CONCLUSION: The FS practice guideline revision was associated with reduced prophylactic diazepam usage and increased FS recurrence within 24 h in Japan. Prophylactic diazepam use should be determined based on clinical safety, local health infrastructure, and parental anxiety.


Assuntos
Anticonvulsivantes/administração & dosagem , Diazepam/administração & dosagem , Profilaxia Pré-Exposição/métodos , Convulsões Febris/diagnóstico , Convulsões Febris/tratamento farmacológico , Pré-Escolar , Vias de Administração de Medicamentos , Feminino , Humanos , Lactente , Japão/epidemiologia , Masculino , Profilaxia Pré-Exposição/tendências , Recidiva , Estudos Retrospectivos , Convulsões Febris/epidemiologia , Fatores de Tempo
5.
Neurol Sci ; 41(3): 687-689, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31713190

RESUMO

The aim of this study is to evaluate the incidence of vesicoureteral reflux (VUR) in patients with febrile convulsion (FC). For this, patients that were diagnosed with FC in 2018 were retrospectively reviewed. Those with epilepsy, motor/mental retardation, or spina bifida were excluded. Mid-stream urine samples were collected in children who were toilet trained while sterile bags were used in the smaller. Urinary tract infection (UTI) was defined as ˃ 5 leucocytes/HPF in urinalysis and a subsequent positive urine culture (≥ 10.000 CFU/ml). Children with UTI were further investigated via voiding cystourethrogram (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy for VUR. Urinalysis was present in 79 among a total of 181 patients (43.6%). Forty-five of the patients were male (57%). Mean age was 2.6 ± 1.4 years. UTI was diagnosed in 6 (7.6%) patients (5 females, 1 male). Three of the girls had recurrent febrile UTI and subsequently, VUR was diagnosed in two of them. VUR is found in 2.5% of the FC cases with urine sampling. Urinalysis should not be ignored in patients with FC as it may lead to diagnosis of VUR.


Assuntos
Convulsões Febris/diagnóstico , Convulsões Febris/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/epidemiologia , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Urinálise
6.
Pediatr Emerg Care ; 36(4): 173-177, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28486267

RESUMO

INTRODUCTION: Febrile convulsion (FC) is the most common neurological disorder in childhood. The aim of this study was to determine the risk factors for recurrence and the development of epilepsy from the demographic data of these patients. METHODS: A retrospective study was made of 680 patients with FC who presented to our hospital. Patients with only FC were defined as group 1 and those who developed epilepsy after FC as group 2. Comparisons were made between the 2 groups of the demographic parameters, parental consanguinity, familial history of FCs or epilepsy, criteria for starting prophylactic treatment, response to treatment, risk factors for recurrence, and results of electroencephalogram. RESULTS: The study included a total of 680 patients comprising 399 males (59%) and 281 females (41%). A diagnosis of FC was made in 652 cases (95.8%, group 1), and epilepsy was diagnosed in 28 (4.2%, group 2). A positive familial history of FCs was determined statistically significantly higher in group 1. On the other hand, a history of pathological birth and parental consanguinity was found higher in group 2. Prophylactic treatment was administered to 89.3% of group 2 and 40.3% of group 1. CONCLUSIONS: Febrile convulsions create fear and panic in the family and are a significant health problem in Turkey. The conclusion that has been reached is that the unnecessary administration of prophylactic treatment could be prevented with education of the families on the subject of fever and correct identification of patients at risk of developing epilepsy.


Assuntos
Epilepsia/epidemiologia , Convulsões Febris/epidemiologia , Anticonvulsivantes/uso terapêutico , Pré-Escolar , Eletroencefalografia , Epilepsia/diagnóstico , Feminino , Febre/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Fenobarbital/uso terapêutico , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Convulsões Febris/diagnóstico , Convulsões Febris/terapia , Turquia/epidemiologia
7.
Pediatr Emerg Care ; 36(4): e199-e203, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28953097

RESUMO

OBJECTIVES: Fever of 39°C or higher and a white blood cell (WBC) count of 15,000/µL or greater are known predictors of occult bacteremia (OB). However, because of a decreasing prevalence of OB, WBC counts have become poor predictors of OB in populations of routinely immunized children. Thus, we aim to evaluate the clinical characteristics of OB in Japanese children and identify potential risk factors for OB. METHODS: We conducted an observational study of children aged 3 to 36 months old with positive blood cultures for Streptococcus pneumoniae or Haemophilus influenzae at an emergency department in a tertiary care children's hospital between April 2002 and December 2015. Patients with significant underlying diseases, a proven source of infection, or toxic appearance, were excluded. RESULTS: Positive blood cultures were recorded in 231 patients; of these, 110 were included in the study (S. pneumoniae, n = 102; H. influenzae, n = 8). Median age was 16 (3-34) months. Patients had a high median body temperature of 39.2 (interquartile range, 38.6-39.9) °C and median WBC of 21,120 (interquartile range, 16,408-24,242)/µL. A high rate of febrile seizures (58 patients, 53%) was observed, with complex febrile seizures accounting for 43% of the episodes. Frequency of febrile seizures was positively associated with age (P = 0.001). CONCLUSIONS: Our study revealed a high rate of children presenting with febrile seizures, especially complex seizures, among children with OB in Japan. A further study is necessary to evaluate the role of febrile seizures as a predictor for OB.


Assuntos
Bacteriemia/epidemiologia , Infecções por Haemophilus/epidemiologia , Infecções Pneumocócicas/epidemiologia , Convulsões Febris/epidemiologia , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Japão/epidemiologia , Contagem de Leucócitos , Masculino , Prevalência , Fatores de Risco , Convulsões Febris/microbiologia , Streptococcus pneumoniae/isolamento & purificação
9.
Tunis Med ; 97(4): 525-532, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31729702

RESUMO

BACKGROUND: FS are the most benign occasional seizures in childhood. Little is known about the long term follow up.  Aim: To describe a long term follow-up of FS in Tunisian families. METHODS: Field study was conducted for 30 patients with FS. We analyzed clinical phenotype of FS and associated afebrile seizures with genetic study. RESULTS: We collected 107 individuals with febrile and / or afebrile seizures. Afebrile seizures were found in 28.3% of patients. The "FS" phenotype was found in 18 families (60%), "GEFS +" in 7 (23.33%), and idiopathic generalized epilepsy in 5 (16.66%). Sequencing analyses of SCN1A, SCN1B and GABRG2 genes revealed a novel SCN1B gene mutation in one family with FS and a known SCN1A mutation in GEFS+ family. CONCLUSION: If FS are apparently isolated and infrequent, they occur most often in a family setting. The genetic studies remain difficult mainly because of the lack of phenotype-genotype correlation.


Assuntos
Linhagem , Convulsões Febris/epidemiologia , Convulsões Febris/genética , Adolescente , Adulto , Idoso , Substituição de Aminoácidos , Criança , Pré-Escolar , Consanguinidade , Epilepsia Generalizada/epidemiologia , Epilepsia Generalizada/genética , Feminino , Seguimentos , Haplótipos , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Canal de Sódio Disparado por Voltagem NAV1.1/genética , Fenótipo , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Receptores de GABA-A/genética , Tunísia/epidemiologia , Subunidade beta-1 do Canal de Sódio Disparado por Voltagem/genética , Adulto Jovem
10.
Seizure ; 73: 9-13, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31675516

RESUMO

PURPOSE: The seasonal distribution patterns of febrile seizures and of respiratory and enteric viral pathogens are similar. In this study, we analyzed trends in febrile seizures and viral infection in Korean children, using big data from the Korean Health Insurance Review and Assessment Service (HIRA). METHODS: We analyzed children younger than 6 years who visited the hospital and were diagnosed with febrile seizures from 2009 to 2016, using medical records in the HIRA database. A total of 666,136 medical records of children with a main or subdiagnosis of febrile seizure from 2008 to 2016 were included. Of these records, patients younger than 1 month and records before 2009 were excluded. Finally, 558,130 records were extracted. RESULTS: The medical records included 315,774 male children and 242,356 (43.4%) female children, with a mean age of 2.31 ± 1.31 years. The annual incidence of febrile seizure was 25.4 per 1000 person-years (27.9 for boys and 22.7 for girls). The ratio of male to female children was 1.30: 1, and records of 1-year-old children comprised the highest proportion (n = 210,400, 33.70%). The total monthly number of patients was highest in May (n = 64,969, 11.6%), and peaks were formed from April to July. The fewest patients were seen in October (n = 34,424, 6.17%). The most common viral pathogens were influenza in April and enterovirus during May-July. CONCLUSION: The seasonal distribution of febrile seizures was high from late spring to summer, and influenza virus and enterovirus were most frequently associated.


Assuntos
Infecções por Enterovirus/complicações , Influenza Humana/complicações , Estações do Ano , Convulsões Febris/epidemiologia , Convulsões Febris/virologia , Pré-Escolar , Infecções por Enterovirus/epidemiologia , Feminino , Humanos , Incidência , Lactente , Influenza Humana/epidemiologia , Masculino , Sistema de Registros , República da Coreia
11.
Euro Surveill ; 24(42)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31640840

RESUMO

BackgroundStrategies to control varicella vary across Europe. Evidence from established programmes has prompted the United Kingdom to re-evaluate the need for universal vaccination. The burden of complicated varicella is a key parameter in the cost-effectiveness analysis.AimOur objective was to estimate the burden of complicated varicella in England.MethodsThis electronic health record surveillance study used data from all NHS hospitals in England to identify varicella admissions between 2004 and 2017. The incidence of pre-defined complications of varicella was estimated using ICD-10 codes. Inpatient costs were calculated based on the payment rules for providers of NHS services.ResultsThere were 61,024 admissions with varicella between 2004 and 2017 and 38.1% had a recognised varicella complication. Incidence of hospitalisation increased by 25% and the proportion with complicated varicella by 24% from 2004/05 to 2016/17. The most common complications were bacterial skin infections (11.25%), pneumonia (4.82%), febrile convulsions (3.39%) and encephalitis (2.44%). Complication rates were higher in older age groups and the type of complications more severe. Length of stay for complicated varicella was 3.1 times longer than for uncomplicated varicella and inpatient costs were 72% greater.ConclusionComplicated varicella has a substantial health and economic burden. These data together with data on impact on quality of life are important in informing the cost-effectiveness analysis of universal varicella vaccination.


Assuntos
Varicela/diagnóstico , Custos de Cuidados de Saúde/estatística & dados numéricos , Herpesvirus Humano 3/isolamento & purificação , Hospitalização/estatística & dados numéricos , Pneumonia/complicações , Convulsões Febris/complicações , Dermatopatias Bacterianas/complicações , Adolescente , Idoso , Varicela/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Registros Eletrônicos de Saúde , Inglaterra/epidemiologia , Feminino , Herpesvirus Humano 3/imunologia , Hospitalização/economia , Humanos , Incidência , Lactente , Tempo de Internação , Masculino , Pneumonia/epidemiologia , Vigilância da População , Qualidade de Vida , Atenção Secundária à Saúde , Convulsões Febris/epidemiologia , Dermatopatias Bacterianas/epidemiologia
12.
Artigo em Alemão | MEDLINE | ID: mdl-31529181

RESUMO

Trends of frequent chronic diseases and health problems, e.g. allergic diseases, have already been published based on the KiGGS Wave 2 study as part of the health monitoring of children and adolescents in Germany. The present work complements these findings with results on less frequent noncommunicable diseases and the trend of communicable, vaccine-preventable diseases.Information from parents about diagnoses and diseases of their 0­ to 17-year-old children from the representative cross-sectional survey KiGGS Wave 2 (2014-2017) are compared with those from the KiGGS baseline survey (2003-2006) and KiGGS Wave 1 (2009-2012).The current KiGGS results show almost unchanged prevalences for the noncommunicable diseases epilepsy, migraine, and heart disease. However, the data from KiGGS Wave 2 are supportive of an increased prevalence of diabetes mellitus, which nevertheless continues to be relatively rare and predominantly type 1 diabetes in children and adolescents.The decline in measles, chicken pox, and whooping cough diseases related to changes in vaccination recommendations shows that preventive measures can effectively benefit children and adolescents.However, the data on vaccine-preventable diseases indicate regionally varying immunity gaps in certain age groups, so the prevention potential of the vaccination recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute does not seem to have been sufficiently exploited.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Doença Crônica/epidemiologia , Viroses/epidemiologia , Adolescente , Varicela/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Epilepsia/epidemiologia , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Cardiopatias/epidemiologia , Humanos , Lactente , Recém-Nascido , Sarampo/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Convulsões Febris/epidemiologia , Coqueluche/epidemiologia
13.
Sci Total Environ ; 692: 589-594, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31539966

RESUMO

BACKGROUND: Several studies have reported an association between seizure and the lunar cycle; however, results are conflicting. Thus, we investigated whether emergency department (ED) visits due to febrile seizure (FS) or FS plus were affected by lunar cycle. METHODS: We reviewed the medical records of patients who were admitted to the ED with a main diagnosis of FS or FS plus from January 1, 2005 to August 31, 2018 (13 years 8 months), a period of 4991 days with 169 lunar cycles. During that period, we collected weather data such as mean temperature, average atmospheric pressure (AP), and humidity according to lunar phase (new moon, first quarter, full moon, and third or last quarter). RESULTS: A total of 1979 patients were identified. We found male predominant with a mean age of 2.62 ±â€¯2.09 years. Acute pharyngotonsillitis was the most common cause of fever, generalized tonic-clonic seizure was the most common type of seizure, and the mean peak body temperature was 38.77 ±â€¯0.81 °C. The lunar cycle did not affect the onset or frequency of FS after adjustment; however, several factors, including season, O3 and NO2 concentrations, and holidays, were associated with FS. CONCLUSION: We did not find an association between lunar cycle and FS or FS plus. However, several factors, including season, O3, NO2, and holidays were associated with FS or FS plus.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Lua , Convulsões Febris/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões Febris/etiologia , Fatores de Tempo
14.
Clin Epigenetics ; 11(1): 118, 2019 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426844

RESUMO

BACKGROUND: Temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) is a common pharmaco-resistant epilepsy referred for adult epilepsy surgery. Though associated with prolonged febrile seizures (FS) in childhood, the neurobiological basis for this relationship is not fully understood and currently no preventive or curative therapies are available. DNA methylation, an epigenetic mechanism catalyzed by DNA methyltransferases (DNMTs), potentially plays a pivotal role in epileptogenesis associated with FS. In an attempt to start exploring this notion, the present cross-sectional pilot study investigated whether global DNA methylation levels (5-mC and 5-hmC markers) and DNMT isoforms (DNMT1, DNMT3a1, and DNMT3a2) expression would be different in hippocampal and neocortical tissues between controls and TLE patients with or without a history of FS. RESULTS: We found that global DNA methylation levels and DNMT3a2 isoform expression were lower in the hippocampus for all TLE groups when compared to control patients, with a more significant decrease amongst the TLE groups with a history of FS. Interestingly, we showed that DNMT3a1 expression was severely diminished in the hippocampus of TLE patients with a history of FS in comparison with control and other TLE groups. In the neocortex, we found a higher expression of DNMT1 and DNMT3a1 as well as increased levels of global DNA methylation for all TLE patients compared to controls. CONCLUSION: Together, the findings of this descriptive cross-sectional pilot study demonstrated brain region-specific changes in DNMT1 and DNMT3a isoform expression as well as global DNA methylation levels in human TLE with or without a history of FS. They highlighted a specific implication of DNMT3a isoforms in TLE after FS. Therefore, longitudinal studies that aim at targeting DNMT3a isoforms to evaluate the potential causal relationship between FS and TLE or treatment of FS-induced epileptogenesis seem warranted.


Assuntos
DNA (Citosina-5-)-Metiltransferase 1/genética , DNA (Citosina-5-)-Metiltransferases/genética , Epilepsia do Lobo Temporal/genética , Hipocampo/química , Neocórtex/química , Convulsões Febris/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Metilação de DNA , Epigênese Genética , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Especificidade de Órgãos , Projetos Piloto , Convulsões Febris/genética
15.
Vaccine ; 37(25): 3362-3368, 2019 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-31064673

RESUMO

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.


Assuntos
Hospitalização/estatística & dados numéricos , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Convulsões Febris/epidemiologia , Cobertura Vacinal/estatística & dados numéricos , Pré-Escolar , Feminino , Gastroenterite/prevenção & controle , Humanos , Lactente , Masculino , Estudos Retrospectivos , Rotavirus/imunologia , Infecções por Rotavirus/epidemiologia , Convulsões Febris/prevenção & controle , Espanha/epidemiologia
16.
Epilepsy Behav ; 95: 154-160, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31059921

RESUMO

BACKGROUND: Studies suggest that the relationship between seizures and stress starts early in life. However, evidence of long-term altered stress reactivity following early-life seizures is lacking. Our objectives were to assess alterations in stress hormone reactivity in children with past febrile seizures (FS) and investigate how these alterations relate to clinical characteristics. METHOD: This case-control study compared a convenience sample of children with simple FS (n = 24), complex FS (n = 18), and matched healthy controls (n = 42). Stress was induced by electrode placement for an electroencephalography (EEG) exam. Salivary cortisol to stress, using three samples collected before and after the stressor, was compared between groups and sex. The relationship between stress reactivity and clinical characteristics (i.e., FS duration, age at first FS, time since the last FS) was investigated. RESULTS: Cortisol reactivity to stress was significantly different depending on study groups, F(1, 78) = 6.415, p = 0.003, η2p = 0.141, but not sex nor was there a significant interaction between group and sex (p ≥ 0.581). Participants with simple FS showed higher cortisol reactivity to stress (M = 14.936, Standard deviation (SD) = 26.852) compared with those with complex FS (M = -4.663, SD = 18.649, p = 0.015) and controls (M = -3.817, SD = 18.907, p = 0.003). There was no significant difference between participants with complex FS and controls (p > 0.999). Stress reactivity was not linked to clinical characteristics. CONCLUSIONS: Children with past simple FS showed greater changes in salivary cortisol following stress, suggesting enhanced stress sensitivity. As similar results were not found in a population with complex FS, our study shows that stress alterations are not caused by seizure severity. Future studies are needed to investigate whether stress sensitivity may be premorbid to simple FS and may contribute to simple FS incidence.


Assuntos
Hidrocortisona/metabolismo , Convulsões Febris/epidemiologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/metabolismo , Estudos de Casos e Controles , Pré-Escolar , Comorbidade , Eletroencefalografia/efeitos adversos , Feminino , Humanos , Lactente , Masculino
17.
Epilepsia ; 60(5): 818-829, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30977115

RESUMO

OBJECTIVE: The true prevalence of epileptic seizures and epilepsy in 22q11.2 deletion syndrome (22q11.2DS) is unknown, because previous studies have relied on historical medical record review. Associations of epilepsy with other neurodevelopmental manifestations (eg, specific psychiatric diagnoses) remain unexplored. METHODS: The primary caregivers of 108 deletion carriers (mean age 13.6 years) and 60 control siblings (mean age 13.1 years) completed a validated epilepsy screening questionnaire. A subsample (n = 44) underwent a second assessment with interview, prolonged electroencephalography (EEG), and medical record and epileptologist review. Intelligence quotient (IQ), psychopathology, and other neurodevelopmental problems were examined using neurocognitive assessment and questionnaire/interview. RESULTS: Eleven percent (12/108) of deletion carriers had an epilepsy diagnosis (controls 0%, P = 0.004). Fifty-seven of the remaining 96 deletion carriers (59.4%) had seizures or seizurelike symptoms (controls 13.3%, 8/60, P < 0.001). A febrile seizure was reported for 24.1% (26/107) of cases (controls 0%, P < 0.001). One deletion carrier with a clinical history of epilepsy was diagnosed with an additional type of unprovoked seizure during the second assessment. One deletion carrier was newly diagnosed with epilepsy, and two more with possible nonmotor absence seizures. A positive screen on the epilepsy questionnaire was more likely in deletion carriers with lower performance IQ (odds ratio [OR] 0.96, P = 0.018), attention-deficit/hyperactivity disorder (ADHD) (OR 3.28, P = 0.021), autism symptoms (OR 3.86, P = 0.004), and indicative motor coordination disorder (OR 4.56, P = 0.021). SIGNIFICANCE: Even when accounting for deletion carriers diagnosed with epilepsy, reports of seizures and seizurelike symptoms are common. These may be "true" epileptic seizures in some cases, which are not recognized during routine clinical care. Febrile seizures were far more common in deletion carriers compared to known population risk. A propensity for seizures in 22q11.2DS was associated with cognitive impairment, psychopathology, and motor coordination problems. Future research is required to determine whether this reflects common neurobiologic risk pathways or is a consequence of recurrent seizures.


Assuntos
Síndrome de DiGeorge/complicações , Epilepsia/genética , Transtornos do Neurodesenvolvimento/genética , Convulsões/genética , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Criança , Síndrome de DiGeorge/epidemiologia , Epilepsia/epidemiologia , Epilepsia/fisiopatologia , Feminino , Humanos , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/genética , Masculino , Transtornos das Habilidades Motoras/epidemiologia , Transtornos das Habilidades Motoras/genética , Transtornos do Neurodesenvolvimento/epidemiologia , Prevalência , Convulsões/epidemiologia , Convulsões/fisiopatologia , Convulsões Febris/epidemiologia , Convulsões Febris/genética , Convulsões Febris/fisiopatologia , Sensibilidade e Especificidade , Inquéritos e Questionários , Reino Unido/epidemiologia , Escalas de Wechsler , Adulto Jovem
18.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31004046

RESUMO

BACKGROUND: Febrile seizures (FSs) are a common pediatric condition caused by a sudden rise in temperature, affecting 3% to 5% of children aged ≤6 years. Although vaccination can cause FSs, little is known on whether FSs occurring in the time soon after vaccination (vaccine-proximate febrile seizures [VP-FSs] differ clinically from non-vaccine-proximate febrile seizures [NVP-FSs]). We compared the clinical profile and outcomes of VP-FS to NVP-FS. METHODS: Prospective cohort study of children aged ≤6 years presenting with their first FS at 1 of 5 Australian pediatric hospitals between May 2013 and June 2014. Clinical features, management, and outcomes were compared between VP-FS and NVP-FS. RESULTS: Of 1022 first FS cases (median age 19.8 months; interquartile range 13.6-27.6), 67 (6%) were VP-FSs. When comparing VP-FS to NVP-FS, there was no increased risk of prolonged (>1 day) hospitalization (odds ratio [OR] 1.61; 95% confidence interval [95% CI] 0.84-3.10), ICU admission (OR 0.72; 95% CI 0.10-5.48), seizure duration >15 minutes (OR 1.47; 95% CI 0.73-2.98), repeat FS within 24 hours (OR 0.80; 95% CI 0.34-1.89), or requirement for antiepileptic treatment on discharge (OR 1.81; 95% CI 0.41-8.02). VP-FS patients with a laboratory-confirmed infection (12%) were more likely to have a prolonged admission compared with those without. CONCLUSIONS: VP-FS accounted for a small proportion of all FS hospital presentations. There was no difference in outcomes of VP-FS compared with NVP-FS. This is reassuring data for clinicians and parents of children who experience FS after vaccination and can help guide decisions on revaccination.


Assuntos
Convulsões Febris/diagnóstico , Convulsões Febris/epidemiologia , Índice de Gravidade de Doença , Vacinação/efeitos adversos , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Resultado do Tratamento , Vacinação/tendências
19.
JAMA Netw Open ; 2(4): e192739, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-31026025

RESUMO

Importance: Sudden unexplained death in childhood (SUDC) is the fifth leading category of death among toddlers but remains underrecognized and inadequately studied. Objective: To assess the potential role of febrile seizures (FS) and other risk factors associated with SUDC and describe the epidemiology, mechanisms, and prevention of SUDC. Design, Setting, and Participants: This case series study reviewed 622 consecutive sudden child death cases aged 1 to 17 years from 2001 to 2017 from 18 countries. Data were collected from family members of children who died suddenly; these families voluntarily registered with the SUDC Foundation. Data analysis was conducted from November 2017 to February 2019. Main Outcome Measures: Certified manner of death characterized as accident, natural, or undetermined. Results: A total of 391 families with decedents aged 1 to 6 years completed a comprehensive interview on medical and social histories, and circumstances of death with forensic evaluations revealing a cause of death (sudden explained death in childhood [SEDC]) or no cause of death (SUDC). Of these children, 231 (59.1%) were male, the mean (SD) age at death was 24.9 (12.8) months, and 104 (26.6%) had a history of FS. Compared with the general population FS prevalence (2%-5%), FS prevalence among SUDC (28.8%; 95% CI, 23.3%-34.2%) and SEDC (22.1%; 95% CI, 14.8%-29.3%) were elevated. The odds of death during sleep was 4.6-fold higher in SUDC than in SEDC cases (odds ratio, 4.61; 95% CI, 1.92-11.09; adjusted P = .008). The siblings of SUDC cases were followed up for 3144 life-years, and none died prematurely from SUDC. Conclusions and Relevance: This analysis of the largest SUDC cohort confirmed an increased FS rate and found significantly increased rates of FS among SEDC. This study suggests that seizures may contribute to some SUDC and SEDC deaths. The risk of sudden death in a sibling was low. To develop and assess preventive strategies, population-based studies are needed to define the epidemiology and spectrum of risk factors and identify biomarkers of patients with FS at high risk of sudden death.


Assuntos
Morte Súbita/epidemiologia , Morte Súbita/etiologia , Convulsões Febris/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Convulsões Febris/complicações
20.
Arch Dis Child ; 104(8): 750-754, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30926585

RESUMO

OBJECTIVES: There was a reduction in febrile seizure admissions in Scotland after 2008. Our hypothesis was that a similar trend would be seen in other countries. METHODS: We obtained the number of febrile and non-febrile seizure admissions in England and Scotland 2000-2013 and the incidence of all seizure admissions 2000-2013 in European countries. We compared the incidence of admission for febrile seizure (Scotland and England) and all seizures (all countries) between 2000-2008 and 2009-2013. RESULTS: The incidence of febrile seizure admissions per 1000 children in 2009-2013 was lower than 2000-2008 in Scotland (0.79 vs 1.08, p=0.001) and England (0.92 vs 1.20, p<0.001). The incidence of all seizure admissions (but not non-febrile seizures) was lower in 2009-2013 compared with 2000-2008 in Scotland (1.84 vs 2.20, p=0.010) and England (2.71 vs 2.91, p=0.001). Across 12 European countries (including the UK), there was no difference in all seizure admissions after 2008. We explored the possibility that the fall was related to the introduction of routine pneumococcal vaccination in 2006 but there were insufficient data. CONCLUSION: A fall in admissions for febrile (but not afebrile) seizures after 2008 in Scotland and England explains a fall in all emergency admissions for seizure. A fall in all seizure admissions has not occurred in other European countries, and more research is required to understand the different outcomes in the UK and non-UK countries.


Assuntos
Serviços de Saúde da Criança , Admissão do Paciente , Convulsões Febris/epidemiologia , Adolescente , Criança , Pré-Escolar , Inglaterra/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Escócia/epidemiologia , Convulsões Febris/etiologia , Convulsões Febris/prevenção & controle , Medicina Estatal
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