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Dabla PK, Gupta S, Singh S, Viswas A, Yadav M, Sonkar SC, Koner BC. Sodium channel mutation SCN1A T875M, D188V and associated dysfunction with drug resistant epilepsy. World J Psychiatry 2025; 15:100738. [PMID: 39974498 PMCID: PMC11758033 DOI: 10.5498/wjp.v15.i2.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 11/30/2024] [Accepted: 12/20/2024] [Indexed: 01/14/2025] Open
Abstract
BACKGROUND The NaV1.1 sodium channel alpha subunit, encoded by SCN1A, is crucial for initiating and propagating action potentials in neurons. SCN1A gene has long been an established target in the etiology and therapy of epilepsy. However, very few studies have investigated the relevance of genetic variations in epilepsy and anti-epileptic drug resistance. AIM To investigate associations between polymorphisms, rs121917953 T/A and rs121918623 C/T, and drug resistance in epilepsy patients in the north Indian population. METHODS A total of 100 age- and sex-matched epilepsy patients (50 drug responsive and 50 drug resistant subjects) were recruited and SCN1A rs121918623 C/T* and rs121917953 T/A* polymorphisms were analyzed by the allele specific-PCR technique. χ 2 and Fisher's exact test were used to estimate differences between the distribution of SCN1A rs121918623 and rs121917953 gene polymorphisms among various groups. The association between distinct rs121917953 genotypes and drug resistance was analyzed using logistic regression analysis. RESULTS For the SCN1A rs121917953 T/A* (D188V) polymorphism, a significantly higher proportion of individuals with AT genotype were observed in the drug-resistant group as compared to the drug-responsive group. Additionally, a higher risk association was exhibited by AT genotype for drug resistance with an odds ratio of 3.51 and P value = 0.017. For the SCN1A rs121918623 C/T* (T875M) polymorphism, no significant difference in genotype distribution was observed between the drug-resistant and drug-sensitive groups. CONCLUSION Our findings indicate that the SCN1A polymorphism D188V is associated with a higher risk of drug resistance for the AT variant as compared to the homozygous TT wild-type. Further research is needed at the functional level and in larger cohorts to determine the potential of these genes as a therapeutic target in epilepsy subjects.
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Affiliation(s)
- Pradeep Kumar Dabla
- Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, Delhi, India
| | - Swapan Gupta
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi 110002, Delhi, India
| | - Swati Singh
- Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi 110002, Delhi, India
| | - Aroop Viswas
- Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, Delhi, India
| | - Manisha Yadav
- Multi-disciplinary Research Unit, Maulana Azad Medical College, New Delhi 110002, Delhi, India
| | - Subash Chandra Sonkar
- Multi-disciplinary Research Unit, Maulana Azad Medical College, New Delhi 110002, Delhi, India
| | - Bidhan Chandra Koner
- Multi-disciplinary Research Unit, Maulana Azad Medical College, New Delhi 110002, Delhi, India
- Department of Biochemistry, Maulana Azad Medical College, New Delhi 110002, Delhi, India
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Monsoor T, Kanai S, Daida A, Kuroda N, Sinha P, Oana S, Zhang Y, Liu L, Singh G, Duan C, Sim MS, Fallah A, Speier W, Asano E, Roychowdhury V, Nariai H. Mini-Seizures: Novel Interictal iEEG Biomarker Capturing Synchronization Network Dynamics at the Epileptogenic Zone. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.01.31.25321482. [PMID: 39974054 PMCID: PMC11838652 DOI: 10.1101/2025.01.31.25321482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
Epilepsy affects 1% of the population, with up to one-third of patients being medication-resistant. Surgery is the only curative treatment, yet over one-third of surgical patients fail to achieve seizure freedom due to the lack of a reliable epileptogenic zone (EZ) biomarker. We introduced and validated mini-seizures, frequent hypersynchronization events at EZ hubs that mirror seizure network dynamics, as a novel interictal EEG biomarker. Using a dynamical networks-based model, we analyzed short interictal intracranial EEG from 159 patients across two institutions. Our model, integrating hypersynchronous network properties and clinical data, successfully identified EZ hubs and accurately predicted one-year postoperative seizure outcomes. Our model (mean F1 score: 87%) outperformed the high-frequency oscillations-based model (mean F1 score: 79%) and seizure onset zone resection-status-based model (current clinical standard) (mean F1 score: 78%), supporting its potential as a robust interictal biomarker for EZ localization. Our findings suggest mini-seizures and seizures exist on a continuum of epileptic events, sharing common network properties. Unlike seizure-based analyses that require 1-2 weeks of monitoring to capture spontaneous seizures, mini-seizures provide a rapid alternative using only brief interictal recordings.
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Affiliation(s)
- Tonmoy Monsoor
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sotaro Kanai
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Atsuro Daida
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Naoto Kuroda
- Department of Pediatrics and Neurology, Children’s Hospital of Michigan, Wayne State University School of Medicine, MI, USA
| | - Prateik Sinha
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shingo Oana
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yipeng Zhang
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lawrence Liu
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gaurav Singh
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chenda Duan
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Myung Shin Sim
- Department of Medicine, Statistics Core, University of California, Los Angeles, CA, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William Speier
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Eishi Asano
- Department of Pediatrics and Neurology, Children’s Hospital of Michigan, Wayne State University School of Medicine, MI, USA
| | - Vwani Roychowdhury
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hiroki Nariai
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- The UCLA Children’s Discovery and Innovation Institute, Los Angeles, CA, USA
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Chen S, Zhang N, Zhang R, Zhang L, Luo D, Li J, Liu Y, Wang Y, Duan X, Tian X, Wang T. The causal relationship between systemic lupus erythematosus and juvenile myoclonic epilepsy: A Mendelian randomization study and mediation analysis. IBRAIN 2025; 11:98-105. [PMID: 40103704 PMCID: PMC11911104 DOI: 10.1002/ibra.12191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/11/2024] [Accepted: 12/18/2024] [Indexed: 03/20/2025]
Abstract
This study aimed to investigate the causal relationship between systemic lupus erythematosus (SLE) and juvenile myoclonic epilepsy (JME). Univariable and reverse Mendelian randomization (MR) analyses were performed to investigate the potential causal associations between SLE, systemic autoimmune disorders (SADs), and JME. Two-step mediation MR analysis was further performed to explore indirect factors that may influence the relationship between SLE and JME. Summary data on SADs were extracted from the Integrative Epidemiology Unit Open genome-wide association study database, and summary statistics for JME were acquired from the International League Against Epilepsy Consortium. The inverse-variance weighted (IVW) method was used for primary analysis, supplemented by MR-Egger and weighted median. In the univariable MR analysis, IVW results indicated a causal relationship between SLE and an increased risk of JME (odds ratio = 1.0030, 95% confidence interval, 1.0004-1.0057; p = 0.023). The subsequent mediation MR analysis showed that inflammatory cytokines may not be the mediating factors between SLE and JME, while the inverse MR analysis found no significant relationship. Our study indicated that genetic susceptibility to SLE was causally linked to JME. However, subsequent mediation analysis failed to identify the potential mediators that could influence this relationship. Moreover, evidence suggested that other SADs were not causally associated with JME. This study may provide guidance for screening risk factors for seizures and exploring potential treatments in SLE and JME, and even all SADs and JME.
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Affiliation(s)
- Sirui Chen
- The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Ningning Zhang
- The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Ruirui Zhang
- The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Lan Zhang
- The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Dadong Luo
- The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Junqiang Li
- Department of Neurology, Epilepsy Center, The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Yaqing Liu
- Department of Neurology, Epilepsy Center, The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
| | - Yunan Wang
- The First Clinical Medical College Chongqing Medical University Chongqing China
| | - Xinyue Duan
- The First Clinical Medical College Chongqing Medical University Chongqing China
| | - Xin Tian
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology Chongqing China
- Key Laboratory of Major Brain Disease and Aging Research (Ministry of Education) Chongqing Medical University Chongqing China
| | - Tiancheng Wang
- Department of Neurology, Epilepsy Center, The Second Hospital & Clinical Medical School Lanzhou University Lanzhou China
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Griflyuk AV, Postnikova TY, Zaitsev AV. Animal Models of Febrile Seizures: Limitations and Recent Advances in the Field. Cells 2024; 13:1895. [PMID: 39594643 PMCID: PMC11592604 DOI: 10.3390/cells13221895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 11/05/2024] [Accepted: 11/14/2024] [Indexed: 11/28/2024] Open
Abstract
Febrile seizures (FSs) are defined as seizures occurring in children aged 6 months to 5 years with a background of elevated body temperature. It is one of the most common neurological disorders of childhood, emphasizing the importance of understanding the causes of FSs and their impact on the developing nervous system. However, there are significant limitations to the technologies currently available for studying the etiology and pathophysiology of seizures in humans. It is currently not possible to adequately capture the subtle molecular and structural rearrangements of the nervous system that can occur after seizures in humans. The use of animal models can be invaluable for these purposes. The most commonly used models in modern research are hyperthermic models in rats and mice aged 10-12 days. While these models can reproduce many of the characteristics of FSs, they have certain limitations. This review outlines the key considerations when working with models of FSs, provides an overview of current approaches to producing seizures in different model subjects, and presents a summary of key findings regarding morphological and functional changes in the brain and behavioral alterations that have been identified in studies using animal models of FSs.
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Affiliation(s)
| | | | - Aleksey V. Zaitsev
- Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, 44, Toreza Prospekt, Saint Petersburg 194223, Russia; (A.V.G.); (T.Y.P.)
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Wang Q, Sun W, Zhao J, Tong L, Li B. Development and validation of a nomogram for the estimation of the prognosis of patients presenting with a febrile seizure. BMC Pediatr 2024; 24:655. [PMID: 39395948 PMCID: PMC11470667 DOI: 10.1186/s12887-024-05132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 10/04/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Febrile seizures constitute a prevalent emergency in early childhood. Previous studies indicated that certain febrile seizures in children may progress to epilepsy, exerting a substantial impact on children's health and developmental trajectory. The objective of this study was to formulate a predictive nomogram to assess the likelihood of transitioning from febrile seizures to epilepsy in pediatric patients, thereby facilitating informed decisions regarding medical interventions for febrile seizures. METHODS A total of 306 patients were enrolled and categorized into training (70%) and test (30%) cohorts. Clinical characteristics were subjected to comparison utilizing chi-squared and t tests. Multivariate logistic regression was employed to identify significant factors for predicting the risk of transitioning from febrile seizures to epilepsy, leading to the development of a nomogram. The nomogram's performance was assessed through receiver operating characteristic curves, calibration, and decision curve analysis. RESULTS Predictive factors associated with the transition to epilepsy encompassed lower Na, elevated RDW, IL-6, and increased background slow rhythm and epileptiform discharges in EEG. The nomogram, incorporating five factors, exhibited commendable predictive value (AUC train = 0.812, AUC test = 0.791) for assessing the risk of transitioning from febrile seizures to epilepsy. Calibration analyses confirmed reliability, and decision curve analysis underscored its clinical utility. CONCLUSIONS Lower Na, elevated RDW, IL-6, background slow rhythm, and epileptiform discharges are associated with the risk of transitioning from febrile seizures to epilepsy. The nomogram stands as a valuable tool for predicting this risk, aiding in the strategic implementation of medical interventions to enhance outcomes for patients with febrile seizures.
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Affiliation(s)
- Qingran Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, Shandong Province, 250012, China
- Department of Pediatrics, Qilu Hospital Dezhou Hospital of Shandong University, No.1166 Dongfang Hongxi Road, Dezhou City, Shandong Province, 253000, China
| | - Weiling Sun
- Department of Pediatrics, Qilu Hospital Dezhou Hospital of Shandong University, No.1166 Dongfang Hongxi Road, Dezhou City, Shandong Province, 253000, China
| | - Jinyan Zhao
- Department of Pediatrics, Qilu Hospital Dezhou Hospital of Shandong University, No.1166 Dongfang Hongxi Road, Dezhou City, Shandong Province, 253000, China
| | - Lili Tong
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, Shandong Province, 250012, China.
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Miyagi Y, Horiguchi Y, Yano Y, Urabe R, Kitagawa A, Kato H, Kin K. Evaluation of Febrile Seizures Focusing on the Diurnal Variation. Cureus 2024; 16:e71349. [PMID: 39539912 PMCID: PMC11558028 DOI: 10.7759/cureus.71349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 11/16/2024] Open
Abstract
Background and objectives Several studies have reported the diurnal variation of febrile seizures (FS) in children. However, it remains unclear whether there is a difference in diurnal variation depending on the types of FS. The present study aims to investigate whether simple FS or complex FS influences diurnal fluctuations. Methods In this single-facility retrospective study, Japanese pediatricians collected clinical data from 247 children with FS. We evaluated the diurnal occurrence of FS using medical files. The Kolmogorov-Smirnov test was used to assess differences in distribution by classifying days into four six-hour time periods: night (0:00-6:00), morning (6:00-12:00), afternoon (12:00-18:00), and evening (18:00-24:00). Results In the simple FS group, the highest rate was observed in the evening (35.16%), followed by the afternoon (29.69%), with the lowest rate in the morning (14.06%). In the complex FS group, the highest rates were observed in both the afternoon (30.95%) and evening (30.95%), with the lowest rate at night (16.67%). The distributions of simple FS and complex FS were significantly different. Conclusion FS exhibited different diurnal variations depending on the type of FS. Clinicians' recognition of these findings will aid in treatment.
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Affiliation(s)
- Yoshifumi Miyagi
- Department of Pediatrics, Haibara General Hospital, Shizuoka, JPN
| | - Yasunori Horiguchi
- Department of Pediatrics, International University of Health and Welfare, Atami Hospital, Atami, JPN
| | - Yasuyuki Yano
- Department of Pediatrics, Haibara General Hospital, Shizuoka, JPN
| | - Ryosuke Urabe
- Department of Pediatrics, Haibara General Hospital, Shizuoka, JPN
| | - Atsushi Kitagawa
- Department of Pediatrics, Haibara General Hospital, Shizuoka, JPN
| | - Hiroyuki Kato
- Department of Pediatrics, Haibara General Hospital, Shizuoka, JPN
| | - Kentoku Kin
- Department of Pediatrics, Haibara General Hospital, Shizuoka, JPN
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Lee YF, Lin YH, Lin CH, Lin MC. Influenza Infection During Pregnancy and Risk of Seizures in Offspring. JAMA Netw Open 2024; 7:e2434935. [PMID: 39312238 PMCID: PMC11420688 DOI: 10.1001/jamanetworkopen.2024.34935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Importance Seizure is a common neurological problem among infants and children up to age 6 years. Prenatal exposure to maternal influenza infection has been reported to be associated with childhood seizures. Objective To evaluate the association between maternal influenza infection and risk of childhood seizures. Designs, Setting, and Participants This cohort study identified mother-offspring pairs from January 1, 2004, to December 31, 2013, using records in Taiwan's Maternal and Child Health Database. Mothers who had influenza infection during pregnancy and their first offspring were identified and assigned to the influenza group. Mothers in the control group were those without influenza during pregnancy and were matched 1:4 with mothers in the influenza group by maternal age, offspring sex, and date of delivery. Offspring were followed up until December 31, 2020. Data were analyzed between March 2023 and July 2024. Exposure Diagnosis of influenza infection during pregnancy defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes 487.0, 487.1, and 487.8, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes J09, J10, and J11. Main Outcomes and Measures The primary outcome was the association between maternal influenza infection during pregnancy and risk of any type of seizures during childhood, including both epilepsy and febrile seizures. Adjusted hazard ratios (AHRs) and 95% CIs were estimated using Cox proportional hazards regression models. Pregnancy-related complications were collected as covariates. Results A total of 1 316 107 mother-offspring pairs were enrolled, of whom 75 835 mothers (predominant maternal age, 25-29 years; 39 324 male offspring [51.9%]) were assigned to the influenza group and 1 240 272 were matched and assigned to the control group (n = 303 340; predominant maternal age, 30-34 years; 157 296 male offspring [51.9%]). In the influenza group, there was a slightly higher prevalence of placenta previa or abruption compared with the control group (1.6% [1241] vs 1.4% [4350]; P < .001). The cumulative risk of seizures was higher among offspring whose mothers had influenza infection. After controlling for potential confounders, the AHRs were 1.09 (95% CI, 1.05-1.14) for seizures, 1.11 (95% CI, 1.06-1.17) for febrile convulsions, and 1.04 (95% CI, 0.97-1.13) for epilepsy. In the subgroup analysis, no statistically significant differences were observed between the trimesters regarding the timing of influenza infection. Conclusions and Relevance Results of this cohort study suggest that maternal influenza infection during pregnancy was associated with an increased risk of childhood seizures, especially febrile seizures, but not epilepsy. Further studies are needed to elucidate the mechanisms underlying childhood neurological development.
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Affiliation(s)
- Yi-Feng Lee
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsuan Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
- School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Kim KM, Choi BK, Ha WS, Cho S, Chu MK, Heo K, Kim WJ. Development and Validation of Artificial Intelligence Models for Prognosis Prediction of Juvenile Myoclonic Epilepsy with Clinical and Radiological Features. J Clin Med 2024; 13:5080. [PMID: 39274294 PMCID: PMC11396353 DOI: 10.3390/jcm13175080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/18/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Juvenile myoclonic epilepsy (JME) is a common adolescent epilepsy characterized by myoclonic, generalized tonic-clonic, and sometimes absence seizures. Prognosis varies, with many patients experiencing relapse despite pharmacological treatment. Recent advances in imaging and artificial intelligence suggest that combining microstructural brain changes with traditional clinical variables can enhance potential prognostic biomarkers identification. Methods: A retrospective study was conducted on patients with JME at the Severance Hospital, analyzing clinical variables and magnetic resonance imaging (MRI) data. Machine learning models were developed to predict prognosis using clinical and radiological features. Results: The study utilized six machine learning models, with the XGBoost model demonstrating the highest predictive accuracy (AUROC 0.700). Combining clinical and MRI data outperformed models using either type of data alone. The key features identified through a Shapley additive explanation analysis included the volumes of the left cerebellum white matter, right thalamus, and left globus pallidus. Conclusions: This study demonstrated that integrating clinical and radiological data enhances the predictive accuracy of JME prognosis. Combining these neuroanatomical features with clinical variables provided a robust prediction of JME prognosis, highlighting the importance of integrating multimodal data for accurate prognosis.
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Affiliation(s)
- Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Bo Kyu Choi
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Jeno M, Zimmerman MB, Shandley S, Wong-Kisiel L, Singh RK, McNamara N, Fedak Romanowski E, Grinspan ZM, Eschbach K, Alexander A, McGoldrick P, Wolf S, Nangia S, Bolton J, Olaya J, Shrey DW, Karia S, Karakas C, Tatachar P, Ostendorf AP, Gedela S, Javarayee P, Reddy S, Manuel CM, Gonzalez-Giraldo E, Sullivan J, Coryell J, Depositario-Cabacar DFT, Hauptman JS, Samanta D, Armstrong D, Perry MS, Marashly A, Ciliberto M. Pediatric Palliative Epilepsy Surgery: A Report From the Pediatric Epilepsy Research Consortium (PERC) Surgery Database. Pediatr Neurol 2024; 157:70-78. [PMID: 38897096 DOI: 10.1016/j.pediatrneurol.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/12/2024] [Accepted: 04/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Epilepsy surgery is an underutilized resource for children with drug-resistant epilepsy. Palliative and definitive surgical options can reduce seizure burden and improve quality of life. Palliative epilepsy surgery is often seen as a "last resort" compared to definitive surgical options. We compare patient characteristics between palliative and definitive epilepsy surgical patients and present palliative surgical outcomes from the Pediatric Epilepsy Research Consortium surgical database. METHODS The Pediatric Epilepsy Research Consortium Epilepsy Surgery database is a prospective registry of patients aged 0-18 years undergoing evaluation for epilepsy surgery at 20 pediatric epilepsy centers. We included all children with completed surgical therapy characterized as definitive or palliative. Demographics, epilepsy type, age of onset, age at referral, etiology of epilepsy, treatment history, time-to-referral/evaluation, number of failed anti-seizure medications (ASMs), imaging results, type of surgery, and postoperative outcome were acquired. RESULTS Six hundred forty patients undergoing epilepsy surgery were identified. Patients undergoing palliative procedures were younger at seizure onset (median: 2.1 vs 4 years, P= 0.0008), failed more ASM trials before referral for presurgical evaluation (P=<0.0001), and had longer duration of epilepsy before referral for surgery (P=<0.0001). During presurgical evaluation, patients undergoing palliative surgery had shorter median duration of video-EEG data collected (P=0.007) but number of cases where ictal data were acquired was similar between groups. The most commonly performed palliative procedure was corpus callosotmy (31%), followed by lobectomy (21%) and neuromodulation (82% responsive neurostimulation vs 18% deep brain stimulation). Palliative patients were further categorized into traditionally palliative procedures vs traditionally definitive procedures. The majority of palliative patients had 50% reduction or better in seizure burden. Seizure free outcomes were significantly higher among those with traditional definitive surgeries, 41% (95% confidence interval: 26% to 57%) compared with traditional palliative surgeries and 9% (95% confidence interval: 2% to 17%). Rate of seizure freedom was 46% at 24 months or greater of follow-up in the traditional definitive group. CONCLUSIONS Patients receiving palliative epilepsy surgery trialed more ASMs, were referred later after becoming drug resistant, and had longer gaps between drug resistance and epilepsy surgery compared with patients undergoing definitive epilepsy surgery. The extent of surgical evaluation is impacted if surgery is thought to be palliative. A majority of palliative surgery patients achieved >50% seizure reduction at follow-up, both in groups that received traditionally palliative and traditionally definitive surgical procedures. Palliative surgical patients can achieve greater seizure control and should be referred to an epilepsy surgery center promptly after failing two appropriate anti-seizure medications.
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Affiliation(s)
- Mary Jeno
- Division of Pediatric Neurology, Department of Neurology, University of San Francisco Benioff Children's Hospital Oakland, Oakland, California.
| | | | - Sabrina Shandley
- Neurosciences Research Center, Cook Children's Medical Center, Fort Worth, Texas
| | - Lily Wong-Kisiel
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Rani Kaur Singh
- Department of Pediatrics, Atrium Health-Levine Childrens Hospital, Wake Forest University School of Medicine, Charlotte, North Carolina
| | - Nancy McNamara
- Michigan Medicine Pediatric Neurology, CS Mott Children's Hospital, Ann Arbor, Michigan
| | - Erin Fedak Romanowski
- Michigan Medicine Pediatric Neurology, CS Mott Children's Hospital, Ann Arbor, Michigan; Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Health, Ann Arbor, Michigan
| | - Zachary M Grinspan
- Department of Pediatrics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Krista Eschbach
- Department of Pediatrics, Section of Neurology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Allyson Alexander
- Department of Neurosurgery, Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Patricia McGoldrick
- BCHP Neurology at Hawthorne, Boston Children's Health Physicians of New York and Connecticut, Valhalla, New York
| | - Steven Wolf
- Neurology at Hawthorne, Boston Children's Health Physicians of New York and Connecticut, Valhalla, New York
| | | | - Jeffrey Bolton
- Department of Neurology, Boston Children's, Boston, Massachusetts
| | - Joffre Olaya
- Department of Pediatrics, UC Irvine Children's Hospital of Orange County, Orange, California
| | - Daniel W Shrey
- Department of Pediatrics, UC Irvine Children's Hospital of Orange County, Orange, California
| | - Samir Karia
- Department of Neurology, Norton Neuroscience Institute and Children's Medical Center, University of Louisville, Louisville, Kentucky
| | - Cemal Karakas
- Division of Child Neurology, Department of Neurology, Norton Neuroscience Institute and Children's Medical Center, University of Louisville, Louisville, Kentucky
| | - Priyamvada Tatachar
- Division of Neurology - Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam P Ostendorf
- Associate Division Chief of Research, Inpatient Epilepsy and Epilepsy Surgery Program, Neurology Division, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Satyanarayana Gedela
- Department of Neurology, Nemours Children's Health, Nemours Children's Hospital, Orlando, Florida
| | - Pradeep Javarayee
- Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shilpa Reddy
- Division of Pediatric Neurology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad McNair Manuel
- Department Pediatric Neurology, Our Lady of the Lake Health, Baton Rouge, Louisiana
| | - Ernesto Gonzalez-Giraldo
- Department of Neurology, Division of Epilepsy, University of California-San Francisco, San Francisco, California
| | - Joseph Sullivan
- Department of Neurology, Division of Epilepsy, University of California-San Francisco, San Francisco, California; Benioff Children's Hospital Pediatric Epilepsy Center of Excellence, University of California San Francisco, San Francisco, California
| | - Jason Coryell
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon
| | | | - Jason Scott Hauptman
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Debopam Samanta
- Child Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dallas Armstrong
- Department of Pediatrics and Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Scott Perry
- Neurosciences Research Center, Cook Children's Medical Center, Fort Worth, Texas; Jane and John Justin Institute for Mind Health at Cook Children's Medical Center, Fort Worth, Texas
| | - Ahmad Marashly
- Neurology Department, Epilepsy Division, The Johns Hopkins University, Baltimore, Maryland
| | - Michael Ciliberto
- Department of Biostatistics, University of Iowa, Iowa City, Iowa; Child Neurology, Department of Pediatrics, University of Iowa, Iowa City, Iowa
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Schonfeld D, Gardner K, Willemsen MA, Ostrow O. Reducing unnecessary investigations in paediatric seizures in the emergency department. BMJ 2024; 385:e076814. [PMID: 38918034 DOI: 10.1136/bmj-2023-076814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- Deborah Schonfeld
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto
| | - Katie Gardner
- IWK Health, Halifax, Nova Scotia
- Department of Emergency Medicine, Dalhousie University, Halifax
| | - Michèl A Willemsen
- Amalia Children's Hospital, Nijmegen, Netherlands
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen
| | - Olivia Ostrow
- The Hospital for Sick Children, Toronto
- Department of Pediatrics, University of Toronto
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Ferretti A, Riva A, Fabrizio A, Bruni O, Capovilla G, Foiadelli T, Orsini A, Raucci U, Romeo A, Striano P, Parisi P. Best practices for the management of febrile seizures in children. Ital J Pediatr 2024; 50:95. [PMID: 38735928 PMCID: PMC11089695 DOI: 10.1186/s13052-024-01666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Febrile seizures (FS) are commonly perceived by healthcare professionals as a self-limited condition with a generally 'benign' nature. Nonetheless, they frequently lead to pediatric consultations, and their management can vary depending on the clinical context. For parents and caregivers, witnessing a seizure can be a distressing experience, significantly impacting their quality of life. In this review, we offer an in-depth exploration of FS management, therapeutic interventions, and prognostic factors, with the aim of providing support for physicians and enhancing communication with families. We conducted a comprehensive literature search using the PubMed and Web of Science databases, spanning the past 50 years. The search terms utilized included "febrile seizure," "complex febrile seizure," "simple febrile seizure," in conjunction with "children" or "infant." Only studies published in English or those presenting evidence-based data were included in our assessment. Additionally, we conducted a cross-reference search to identify any additional relevant data sources. Our thorough literature search resulted in a compilation of references, with carefully selected papers thoughtfully integrated into this review.
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Affiliation(s)
- Alessandro Ferretti
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy.
| | - Antonella Riva
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alice Fabrizio
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Capovilla
- Child Neuropsychiatry Department, Epilepsy Center, Mantova, Italy
- C. Poma HospitalFondazione Poliambulanza, Brescia, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Umberto Raucci
- General and Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Romeo
- Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pasquale Striano
- IRCCS Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Neurosciences, Mental Health and Sensory Organ (NESMOS) Department, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University, via di Grottarossa 1035/1039, Rome, 00189, Italy
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12
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Muniz MCR, Lima RV, Maia VQCC, Bezerra AM, Freire IF, Lima MCC, Matos YMT, Pontes LP, Cavalcante ANM. The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis. Eur J Pediatr 2024; 183:2049-2058. [PMID: 38456990 DOI: 10.1007/s00431-024-05501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
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.
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Affiliation(s)
- Maria Carolina Rocha Muniz
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Rian Vilar Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil.
| | | | - Arthur Meneses Bezerra
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Isabela Franco Freire
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Manuela Cavalcante Coling Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Yuri Marques Teixeira Matos
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Letícia Pinheiro Pontes
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Ana Nery Melo Cavalcante
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
- PhD in Collective Health By the University of Fortaleza, Neonatologist Pediatrician at Dr. César Cals de Oliveira General Hospital, Fortaleza, Ceara, Brazil
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Song L, Xu J, Shi Y, Zhao H, Zhang M, Wang Y, Cui Y, Chai X. An integrated strategy of UPLC-Q-TOF-MS analysis, network pharmacology, and molecular docking to explore the chemical constituents and mechanism of Zixue Powder against febrile seizures. Heliyon 2024; 10:e23865. [PMID: 38192830 PMCID: PMC10772254 DOI: 10.1016/j.heliyon.2023.e23865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
Febrile seizures (FS) are the most common type of seizures for children. As a commonly used representative cold formula for resuscitation, Zixue Powder (ZP) has shown great efficacy for the treatment of FS in clinic, while its active ingredients and underlying mechanism remain largely unclear. This study aimed to preliminarily elucidate the material basis of ZP and the potential mechanism for the treatment of FS through ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS), network pharmacology, and molecular docking. UPLC-Q-TOF-MS was firstly applied to characterize the ingredients in ZP, followed by network pharmacology to explore the potential bioactive ingredients and pathways of ZP against FS. Furthermore, molecular docking technique was employed to verify the binding affinity between the screened active ingredients and targets. As a result, 75 ingredients were identified, containing flavonoids, chromogenic ketones, triterpenes and their saponins, organic acids, etc. Through the current study, we focused on 13 potential active ingredients and 14 key potential anti-FS targets of ZP, such as IL6, STAT3, TNF, and MMP9. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis showed that inflammatory response, EGFR tyrosine kinase inhibitor resistance, AGE-RAGE signaling pathway in diabetic complications, and neuroactive ligand-receptor interaction were the main anti-FS signaling pathways. Licochalcones A and B, 26-deoxycimicifugoside, and hederagenin were screened as the main potential active ingredients by molecular docking. In conclusion, this study provides an effective in-depth investigation of the chemical composition, potential bioactive components, and possible anti-FS mechanism of ZP, which lays the foundation for pharmacodynamic studies and clinical applications of ZP.
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Affiliation(s)
- Lingling Song
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Jian Xu
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yanqiong Shi
- Department of Pharmacy, Xuhui District Central Hospital, Shanghai, 200031, China
| | - Hemiao Zhao
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Min Zhang
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
| | - Yuefei Wang
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
| | - Ying Cui
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
| | - Xin Chai
- National Key Laboratory of Chinese Medicine Modernization, State Key Laboratory of Component-based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
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Leung JSC. Febrile Seizures: An Updated Narrative Review for Pediatric Ambulatory Care Providers. Curr Pediatr Rev 2024; 20:43-58. [PMID: 36043723 DOI: 10.2174/1573396318666220829121946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While generally self-limited, febrile seizures result in significant familial distress. Ambulatory pediatric care providers must be prepared to counsel families on the causes, risk factors, management principles, and prognosis of children with febrile seizures. OBJECTIVE To provide an updated, evidence-based review of febrile seizures focused on the needs of an ambulatory pediatric care provider. METHODS A narrative review of the literature prioritizing landmark articles, metanalyses, longitudinal population longitudinal cohort studies and national level guidelines. RESULTS Febrile seizures are aberrant physiological responses to fever in children caused by complex interactions of cytokine mediated neuroinflammation, environmental triggers, and genetic predisposition. Other than investigations to determine fever etiology, routine bloodwork, lumbar punctures, neuroimaging and electroencephalograms are low yield. The general prognosis is excellent, however, clinicians should be aware of long-term outcomes including: cognitive impairment with non-simple febrile seizures; neuropsychiatric associations; recurrent febrile seizure and epilepsy risk factors; and the association between complex febrile seizures and sudden unexpected death. Children with a high risk of recurrence, complex febrile seizures, limited access to care, or extreme parental anxiety may benefit from intermittent oral diazepam prophylaxis. CONCLUSION Clinicians should consider four management priorities: 1) terminating the seizure; 2) excluding critical differential diagnoses; 3) investigating fever etiology; and 4) providing adequate counselling to families. The clinical approach and prognosis of febrile seizure can be based on subtype. Children with non-simple (i.e. complex or febrile status epilepticus) febrile seizures require closer care than the vast majority of children with simple febrile seizures, who have excellent outcomes.
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Affiliation(s)
- James Sze-Chuck Leung
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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15
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Andretta RR, de Castro LS, de Carvalho RC, Moura JACD, Fraietta R, Okada FK, Bertolla RP. Understanding the impact of varicocele on sperm capacitation. F&S SCIENCE 2023; 4:229-238. [PMID: 37169221 DOI: 10.1016/j.xfss.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To study the relationship between the seminal sample quality of men with varicocele and sperm capacitation. DESIGN Cross-sectional observational study. SETTING Academic hospital. PATIENT(S) Seventy-six men (19 control and 57 with varicocele) were analyzed. INTERVENTION(S) Semen samples were submitted to a discontinuous density gradient for sperm selection. Sperm capacitation was induced using a human tubal fluid medium supplemented with bovine serum albumin. MAIN OUTCOME MEASURE(S) After capacitation induction, the sperm were assessed by capacitation state, computer-assisted sperm motility, mitochondrial activity, membrane integrity, acrosome reaction, and intracellular oxidative stress. RESULT(S) The capacitation period increased sperm motility, showing an increase in the average path velocity and a decrease in the straightness compared with sperm before capacitation (paired analysis). After capacitation, the rate of capacitated sperm, motility, and mitochondrial activity showed differences between groups (control and varicocele). The varicocele group showed lower mitochondrial activity and capacitation than the control group. On the other hand, no significant differences were observed in the other variables evaluated. CONCLUSION(S) Varicocele men showed less viable sperm and mitochondrial activity than control men after capacitation sperm. The induction of capacitation altered motility by increasing path velocity and decreasing straightness in all of the studied groups, evidencing the occurrence of hyperactivation.
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Affiliation(s)
- Rhayza Roberta Andretta
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Letícia Signori de Castro
- Laboratory of Spermatozoa Biology, Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo, Brazil
| | - Renata Cristina de Carvalho
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Renato Fraietta
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fatima Kazue Okada
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Developmental Biology, Department of Morphology and Genetics, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Ricardo Pimenta Bertolla
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil
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Othman A, Razak SA, Nasir A, Ghazali AK, Mohd Radzi MAR. Depressive, Anxiety, and Stress Symptoms in Parents of Children Being Admitted for Febrile Seizures in a Tertiary Hospital in the East Coast of Malaysia. Eur J Investig Health Psychol Educ 2023; 13:1015-1025. [PMID: 37366781 DOI: 10.3390/ejihpe13060077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Febrile seizures in children are an alarming experience for parents. This study aimed to assess the psychological functioning of parents of children when they were being admitted for treatment of febrile seizures in the hospital, the importance of which is clear, since parents are the primary custodian of their children. This is a cross-sectional study conducted on 110 participants whose child had been admitted for a febrile seizure to Hospital Universiti Sains Malaysia from September 2020 until June 2021. The depression, anxiety, and stress levels were determined based on a validated Bahasa Melayu questionnaire of the Depression Anxiety Stress Scale (DASS-21). In addition, multiple logistic regression was used to determine the associated factors related to the participants' psychological functioning. The mean age of children with febrile seizures were 21 months old, and most children showed features of simple febrile seizures (71.8%). The prevalence of anxiety, stress, and depression were 58.2%, 29%, and 23.6%, respectively. Using multiple logistic regression, child age, family history of febrile seizures, family history of epilepsy, and length of stay in the ward were found to be significantly associated with anxiety when adjusted for other variables. Otherwise, for depression and stress, no significant associated variables were found when adjusted for other variables. Anxiety was highly reported by participants when their children were admitted for febrile seizures. Several factors impacted their anxiety, including the lower the child's age was, participants with no family history of febrile seizures before, and the longer duration of hospital stay. Therefore, further study and intervention on reducing the parent's anxiety could be emphasized in the future.
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Affiliation(s)
- Azizah Othman
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Salmi Abdul Razak
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Ariffin Nasir
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Anis Kausar Ghazali
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Unit Biostatistics and Research, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Muhammad Amiro Rasheeq Mohd Radzi
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
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Salleh H, Soon IS, Chong VH. Frequency and risk factors for febrile seizures during COVID-19 pandemic waves: an observational study. Eur J Pediatr 2023:10.1007/s00431-023-05021-0. [PMID: 37178360 PMCID: PMC10182340 DOI: 10.1007/s00431-023-05021-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
Febrile seizures (FS) are well-known manifestations of viral illnesses. The purpose of this study is to assess the prevalence and factors associated with FS among pediatric patients with COVID-19 admitted to the National Isolation Centre in Brunei Darussalam. All pediatric patients (< 12 years) during the first (n = 12), second (n = 418), and third (n = 219) waves were included in the study. In Brunei, the first, second, and third waves were caused by the original SARS-CoV-2, Delta, and Omicron variants, respectively. Data was extracted from a prospective database and the national electronic health record system. Patients with and without FS were compared to identify any significant risk factors. FS were only encountered in the third wave (n = 29, 13%) giving an overall prevalence of 4.5%; 24 (83%) occurring in the typical age group for FS (≥ 6 months to < 6 years). Five cases (17%) occurred in children 6 years and older. Comparing patients in the third wave, univariate analyses showed typical age group, previous history of FS, family history of FS, higher temperature (> 38.6 °C), and fewer symptoms on presentation (3 or less) were associated with FS. On multivariate analyses, typical age group, family history of FS, and fewer reported symptoms remained significant (all p < 0.05). Conclusions: The overall prevalence of FS in COVID-19 patients is comparable to rates reported. However, in Brunei Darussalam, FS only occurred in the third wave that has been associated with Omicron variant. Younger age group, family history of FS, and fewer symptoms on presentation are correlated with risk of FS. What is Known: • Viral infections are the most common cause of FS in children. •Young age and a personal and family history of FS are correlated with the risk of FS. What is New: • There were high rates of FS (13%) among pediatric patients admitted with COVID-19 due to the Omicron variant but not with the original and Delta variants. • FS with COVID-19 were correlated with reporting fewer symptoms on presentation.
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Affiliation(s)
- Hafizah Salleh
- Department of Paediatrics, RIPAS Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam.
| | - Ing Shian Soon
- Department of Paediatrics, RIPAS Hospital, Bandar Seri Begawan, BA1710, Brunei Darussalam
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Stafstrom CE. Warming Up to the Notion That Febrile Seizures Can Be Associated With Cognitive Impairment. Epilepsy Curr 2023; 23:199-201. [PMID: 37334416 PMCID: PMC10273815 DOI: 10.1177/15357597231163659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Cognitive Impairment Following Experimental Febrile Seizures Is Determined by Sex and Seizure Duration Kloc ML, Marchand DH, Holmes GL, Pressman RD, Barry JM. Epilepsy Behav. 2022;126:108430. doi:10.1016/j.yebeh.2021.108430 Background: Febrile seizures are the most common type of seizures in children. While in most children the outcome is favorable, children with febrile status epilepticus may exhibit modest cognitive impairment. Whether children with other forms of complex febrile seizure, such as repetitive febrile seizures within the same illness are at risk of cognitive deficits is not known. In this study, we used a well-established model of experimental febrile seizures in rat pups to compare the effects of febrile status epilepticus and recurrent febrile seizures on subsequent spatial cognition and anxiety. Methods: Male and female rat pups were subjected to hyperthermic seizures at postnatal day 10 and were divided into groups of rats with continuous seizures for ≥40 min or recurrent febrile seizures. They were then tested as adults in the active avoidance and spatial accuracy tests to assess spatial learning and memory and the elevated plus maze to measure anxiety. Results: Febrile status epilepticus rats demonstrated impaired spatial cognition in active avoidance and spatial accuracy and exhibited reduced anxiety-like behavior in the elevated plus maze. Rats with recurrent febrile seizures did not differ significantly from the controls on any measures. There were also significant sex-related differences with females with FSE performing far better than males with FSE in active avoidance but demonstrating a navigational learning impairment relative to CTL females in spatial accuracy. However, once learned, females with FSE performed the spatial accuracy task as well as CTL females. Conclusion: There is a duration-dependent effect of febrile seizures on subsequent cognitive and behavioral outcomes. Febrile status epilepticus resulted in spatial cognitive deficits and reduced anxiety-related behaviors whereas rats with recurrent febrile seizures did not differ from controls. Sex had a remarkable effect on spatial cognitive outcome where males with FSE fared worse than females with FSE. The results demonstrate that sex should be considered as a biological variable in studies evaluating the effects of seizures on the developing brain.
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Seasonal Trend of Viral Prevalence and Incidence of Febrile Convulsion: A Korea Public Health Data Analysis. CHILDREN 2023; 10:children10030529. [PMID: 36980087 PMCID: PMC10047246 DOI: 10.3390/children10030529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023]
Abstract
Febrile convulsion (FC) is the most common seizure disease in children, which occurs with a fever. We investigated the Korean Health Insurance Review and Assessment Service data of patients aged between 6 months and 5 years at the time of FC diagnosis. Diseases that can cause seizures with fever, such as neoplasms, metabolic disorders, nervous system disorders, cerebrovascular diseases, perinatal problems, and congenital abnormalities, were excluded. Weekly virus-positive detection rate (PDR) data were obtained from the Korea Disease Control and Prevention Agency for adenovirus, parainfluenza virus, respiratory syncytial virus (HRSV), influenza virus, coronavirus (HCoV), rhinovirus (HRV), bocavirus, metapneumovirus (HMPV), rotavirus, norovirus, and astrovirus. Using the Granger test, we then analyzed the monthly PDR and investigated the association between FC incidence and monthly PDR. We additionally identified monthly and seasonal FC incidence trends using the autoregressive integrated moving average. Between 2015 and 2019, 64,291 patients were diagnosed with FC. Annually, the incidence was the highest in May and the lowest in October. Most patients were diagnosed during the spring (26.7%). The PDRs for HRSV, HCoV, HRV, HMPV, and norovirus were associated with FC incidence after 1 month.
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20
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Han JY, Han SB. Pathogenetic and etiologic considerations of febrile seizures. Clin Exp Pediatr 2023; 66:46-53. [PMID: 36635899 PMCID: PMC9899550 DOI: 10.3345/cep.2021.01039] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/22/2022] [Indexed: 01/14/2023] Open
Abstract
Febrile seizure (FS), which occurs in febrile children without underlying health problems, is the most common type of seizure disorder in children. The suggested pathogenesis of FS derived from several animal and human studies is multifactorial and debatable. Neuronal hyperexcitability, which develops during inflammatory responses that accompany fever, provokes seizures. However, the exact role of each inflammatory mediator (e.g., cytokines) is undefined in terms of the connection between systemic or local inflammation and the central nervous system, and the mechanisms by which cytokines increase neuronal excitability remain unclear. In contrast, the cause of fever in most children with FS is usually mild respiratory virus infection (e.g., rhinovirus, influenza virus, adenovirus, and enterovirus) rather than severe bacterial infections. In temperate regions, the major causative respiratory viruses seem to mirror seasonally prevalent respiratory viruses in the community. Therefore, vigorous efforts to identify the causative pathogen of fever may not be necessary in children with FS. Genetic factors seem to play a role in neuronal hyperexcitability, and some types of genetic variation have been identified in several genes encoding ion channels of neurons that participate in neuronal excitation. Although most children with FS have benign outcomes, some characteristics such as complex FS, febrile status epilepticus, consecutive afebrile seizures, and the presence of neurodevelopmental disabilities may require further genetic and neurologic evaluations.
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Affiliation(s)
- Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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21
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Tanaka T, Yamaguchi H, Ishida Y, Tomioka K, Nishiyama M, Toyoshima D, Maruyama A, Takeda H, Kurosawa H, Tanaka R, Nozu K, Nagase H. Clinical and laboratory characteristics of complex febrile seizures in the acute phase: a case-series study in Japan. BMC Neurol 2023; 23:28. [PMID: 36653748 PMCID: PMC9847116 DOI: 10.1186/s12883-023-03051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with complex febrile seizures (CFS) often display abnormal laboratory results, unexpectedly prolonged seizures, and/or altered consciousness after admission. However, no standardized values have been established for the clinical and laboratory characteristics of CFS in the acute phase, making the management of CFS challenging. This study aimed to determine the clinical and laboratory characteristics of children with CFS during the acute phase. In particular, the duration of impaired consciousness and the detailed distribution of blood test values were focused. METHODS We retrospectively reviewed medical records of a consecutive pediatric cohort aged 6-60 months who were diagnosed with CFS and admitted to Kobe Children's Hospital between October 2002 and March 2017. During the study period, 486 seizure episodes with confirmed CFS were initially reviewed, with 317 seizure episodes included in the analysis. Detailed clinical and laboratory characteristics were summarized. RESULTS Among 317 seizure episodes (296 children with CFS), 302 required two or fewer anticonvulsants to be terminated. In 296 episodes showing convulsive seizures, median seizure duration was 30.5 min. The median time from onset to consciousness recovery was 175 min. Impaired consciousness lasting > 6, 8, and 12 h was observed in 13.9%, 7.6%, and 1.9% patients with CFS, respectively. Additionally, the distribution of aspartate aminotransferase, lactate dehydrogenase, creatinine, and glucose were clarified with 3, 10, 50, 90, and 97 percentile values. CONCLUSION This study detailed the clinical and laboratory findings of acute-phase CFS using the data of the largest 15-year consecutive cohort of children with CFS. These results provide important information for appropriate acute management of CFS.
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Affiliation(s)
- Tsukasa Tanaka
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroshi Yamaguchi
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Yusuke Ishida
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kazumi Tomioka
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Masahiro Nishiyama
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan ,grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Azusa Maruyama
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Hiroki Takeda
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroshi Kurosawa
- grid.415413.60000 0000 9074 6789Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- grid.415413.60000 0000 9074 6789Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kandai Nozu
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroaki Nagase
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
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22
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Salehi A, Salari S, Jullienne A, Daglian J, Chen K, Baram TZ, Obenaus A. Vascular topology and blood flow are acutely impacted by experimental febrile status epilepticus. J Cereb Blood Flow Metab 2023; 43:84-98. [PMID: 35912523 PMCID: PMC9875348 DOI: 10.1177/0271678x221117625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Febrile status epilepticus (FSE) is an important risk factor for temporal lobe epilepsy and early identification of those at high risk for epilepsy is vital. In a rat model of FSE, we identified an acute (2 hrs) novel MRI signal where reduced T2 relaxation values in the basolateral amygdala (BLA) predicted epilepsy in adulthood; this T2 signal remains incompletely understood and we hypothesized that it may be influenced by vascular topology. Experimental FSE induced in rat pups reduced blood vessel density of the cortical vasculature in a lateralized manner at 2 hrs post FSE. Middle cerebral artery (MCA) exhibited abnormal topology in FSE pups but not in controls. In the BLA, significant vessel junction reductions and decreased vessel diameter were observed, together with a strong trend for reduced vessel length. Perfusion weighted MRI (PWI) was acutely increased cerebral blood flow (CBF) in cortex, amygdala and hippocampus of FSE pups that correlated to decreased T2 relaxation values compared to controls. This is consistent with increased levels of deoxyhemoglobin associated with increased metabolic demand. In summary, FSE acutely modifies vascular topological and CBF in cortex and BLA that may underlie acute MRI signal changes that predict progression to future epilepsy.
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Affiliation(s)
- Arjang Salehi
- Department of Anatomy and Neurobiology, School of Medicine, University of California Irvine, Irvine CA, USA
| | - Sirus Salari
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine CA, USA
| | - Amandine Jullienne
- Department of Pediatrics, School of Medicine, University of California Irvine, Irvine CA, USA
| | - Jennifer Daglian
- Department of Anatomy and Neurobiology, School of Medicine, University of California Irvine, Irvine CA, USA
| | - Kevin Chen
- Department of Anatomy and Neurobiology, School of Medicine, University of California Irvine, Irvine CA, USA
| | - Tallie Z Baram
- Department of Anatomy and Neurobiology, School of Medicine, University of California Irvine, Irvine CA, USA.,Department of Pediatrics, School of Medicine, University of California Irvine, Irvine CA, USA
| | - Andre Obenaus
- Department of Anatomy and Neurobiology, School of Medicine, University of California Irvine, Irvine CA, USA.,Department of Pediatrics, School of Medicine, University of California Irvine, Irvine CA, USA
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23
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Yang N, Chen YB, Zhang YF. The rearrangement of actin cytoskeleton in mossy fiber synapses in a model of experimental febrile seizures. Front Neurol 2023; 14:1107538. [PMID: 37181554 PMCID: PMC10170767 DOI: 10.3389/fneur.2023.1107538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background Experimental complex febrile seizures induce a persistent hippocampal hyperexcitability and an enhanced seizure susceptibility in adulthood. The rearrangement of filamentous actin (F-actin) enhances the excitability of hippocampus and contributes to epileptogenesis in epileptic models. However, the remodeling of F-actin after prolonged febrile seizures is to be determined. Methods Prolonged experimental febrile seizures were induced by hyperthermia on P10 and P14 rat pups. Changes of actin cytoskeleton in hippocampal subregions were examined at P60 and the neuronal cells and pre- /postsynaptic components were labeled. Results F-actin was increased significantly in the stratum lucidum of CA3 region in both HT + 10D and HT + 14D groups and further comparison between the two groups showed no significant difference. The abundance of ZNT3, the presynaptic marker of mossy fiber (MF)-CA3 synapses, increased significantly whereas the postsynaptic marker PSD95 did not change significantly. Overlapping area of F-actin and ZNT3 showed a significant increase in both HT+ groups. The results of cell counts showed no significant increase or decrease in the number of neurons in each area of hippocampus. Conclusion F-actin was significantly up-regulated in the stratum lucidum of CA3, corresponding to the increase of the presynaptic marker of MF-CA3 synapses after prolonged febrile seizures, which may enhance the excitatory output from the dentate gyrus to CA3 and contribute to the hippocampal hyperexcitability.
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Affiliation(s)
- Nuo Yang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Yin-Bo Chen
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Yan-Feng Zhang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
- *Correspondence: Yan-Feng Zhang,
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24
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The utility of mobile telephone-recorded videos as adjuncts to the diagnosis of seizures and paroxysmal events in children with suspected epileptic seizures. S Afr Med J 2022; 113:42-48. [PMID: 36537547 DOI: 10.7196/samj.2023.v113i1.16661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Epilepsy is often diagnosed through clinical description, but inter-observer interpretations can be diverse and misleading. OBJECTIVE To assess the utility of smartphone videos in the diagnosis of paediatric epilepsy. METHODS The literature was reviewed for evidence to support the use of smartphone videos, inclusive of advantages, ethical practice and potential disadvantages. An existing adult-based quality of video (QOV) scoring tool was adapted for use in children. A pilot study used convenience sampling of videos from 25 patients, which were reviewed to assess the viability of the adapted QOV tool against the subsequent diagnosis for the patients with videos. The referral mechanism of the videos was reviewed for the source and consent processes followed. RESULTS A total of 14 studies were identified. Methodologies varied; only three focused on videos of children, and QOV was formally scored in three. Studies found that smartphone videos of good quality assisted the differentiation of epilepsy from non-epileptic events, especially with accompanying history and with more experienced clinicians. The ethics and risks of circulation of smartphone videos were briefly considered in a minority of the reports. The pilot study found that the adapted QOV tool correlated with videos of moderate and high quality and subsequent diagnostic closure. CONCLUSIONS Data relating to the role of smartphone video of events in children is lacking, especially from low- and middle-income settings. Guidelines for caregivers to acquire good-quality videos are not part of routine practice. The ethical implications of transfer of sensitive material have not been adequately addressed for this group. Prospective multicentre studies are needed to formally assess the viability of the adapted QOV tool for paediatric videos.
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25
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Güler H, Esen EE, Balcıoğlu E, Göktepe Ö, Yılmaz H, Yay AH, Nisari M, Al Ö, Uçar S, Güçlü Ekinci HK, Tokpınar A, Yılmaz S. Bone development in offspring of pregnant rats treated with carbamazepine: Evaluation by three different methods. Epilepsia 2022; 63:3066-3077. [PMID: 36168801 DOI: 10.1111/epi.17422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study was carried out to determine the effect of intrauterine carbamazepine (CBZ) exposure on fetal bone development during pregnancy. METHODS In the study, 24 female Wistar pregnant rats were used. Rats were 20 weeks old. They had an average body weight of 150-200 g. Pregnant rats were randomly selected and divided (n = 6) into a control group, low-dose CBZ (10 mg/kg/day) group, medium-dose CBZ (25 mg/kg/day) group, and high-dose CBZ (50 mg/kg/day) group. The ossification length (mm) and ossification area (mm2 ) of the long bones of the fetuses in the experimental and control groups were calculated. The densities of alkaline phosphatase (AP) and tartrate-resistant acid phosphatase (TRAP) were analyzed. The ossification regions of the femurs of the fetuses were examined under a light microscope. Microstructural images of the femurs were evaluated with scanning electron microscope photographs. The densities of minerals involved in the ossification process were analyzed. RESULTS According to the results of the study, all three doses of CBZ caused loss of ossification areas, and it was observed that this bone loss also increased statistically significantly depending on the dose increase (p < .05). Calcium concentration decreased in the CBZ groups. When the electron microscope images were examined, it was determined that the cartilage matrix of the CBZ groups was thinned. In the histological evaluation of the groups, narrowing of the primary bone collar and smaller bone spicules in the ossification region compared to the control group were noted due to the increase in dose in the CBZ groups. In immunohistochemical staining, it was observed that the TRAP and AP expression values of the femurs were the lowest in the CBZ groups. These decreases were also statistically significant when compared with the control group. SIGNIFICANCE It was revealed with both microscopic and macroscopic findings that exposure to intrauterine CBZ negatively affected ossification and bone growth.
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Affiliation(s)
- Hatice Güler
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Eda Esra Esen
- Basic Medical Sciences, Department of Anatomy, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Esra Balcıoğlu
- Basic Medical Sciences, Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Özge Göktepe
- Basic Medical Sciences, Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Yılmaz
- Basic Medical Sciences, Department of Anatomy, Ordu University, Ordu, Turkey
| | - Arzu Hanım Yay
- Basic Medical Sciences, Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehtap Nisari
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Özge Al
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sümeyye Uçar
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hilal Kübra Güçlü Ekinci
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Adem Tokpınar
- Basic Medical Sciences, Department of Anatomy, Ordu University, Ordu, Turkey
| | - Seher Yılmaz
- Basic Medical Sciences, Department of Anatomy, Yozgat Bozok University, Yozgat, Turkey
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26
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Arasa J, López-Lacort M, Díez-Domingo J, Orrico-Sánchez A. Impact of rotavirus vaccination on seizure hospitalizations in children: A systematic review. Vaccine 2022; 40:6711-6721. [PMID: 36280558 DOI: 10.1016/j.vaccine.2022.09.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Previous studies found conflicting results about the effect of rotavirus (RV) vaccination on seizure hospitalizations in children younger than 5 years old. OBJECTIVES To evaluate the evidence of the impact of RV vaccination on the prevention of seizure hospitalizations in children. METHODS A systematic review was conducted in the electronic database MEDLINE of all observational studies in children younger than 5 years old published since 2006. Two reviewers performed title/abstract, full-text review, and data extraction. RESULTS Thirteen studies met eligibility criteria. Nine studies reported a significant reduction in seizure hospitalizations upon RV vaccine introduction, three studies reported an absence of significant impact, and one study reported a significant rise in seizure hospitalization after the introduction of RV vaccines. LIMITATIONS The great variability between study designs, case definitions and potential biases prevent quantifying the impact of RV vaccination against seizure hospitalizations. CONCLUSIONS RV vaccination might prevent seizure hospitalizations in children; however, robust, and well-designed studies are needed to better determine the strength of this association.
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Affiliation(s)
- Jorge Arasa
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21, 46020 Valencia, Spain
| | - Mónica López-Lacort
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21, 46020 Valencia, Spain
| | - Javier Díez-Domingo
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21, 46020 Valencia, Spain; Universidad Católica de Valencia San Vicente Mártir, Carrer de Quevedo, 2, 46001 València, Spain
| | - Alejandro Orrico-Sánchez
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21, 46020 Valencia, Spain; Universidad Católica de Valencia San Vicente Mártir, Carrer de Quevedo, 2, 46001 València, Spain.
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27
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A Review of the Multi-Systemic Complications of a Ketogenic Diet in Children and Infants with Epilepsy. CHILDREN 2022; 9:children9091372. [PMID: 36138681 PMCID: PMC9498174 DOI: 10.3390/children9091372] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022]
Abstract
Ketogenic diets (KDs) are highly effective in the treatment of epilepsy. However, numerous complications have been reported. During the initiation phase of the diet, common side effects include vomiting, hypoglycemia, metabolic acidosis and refusal of the diet. While on the diet, the side effects involve the following systems: gastrointestinal, hepatic, cardiovascular, renal, dermatological, hematologic and bone. Many of the common side effects can be tackled easily with careful monitoring including blood counts, liver enzymes, renal function tests, urinalysis, vitamin levels, mineral levels, lipid profiles, and serum carnitine levels. Some rare and serious side effects reported in the literature include pancreatitis, protein-losing enteropathy, prolonged QT interval, cardiomyopathy and changes in the basal ganglia. These serious complications may need more advanced work-up and immediate cessation of the diet. With appropriate monitoring and close follow-up to minimize adverse effects, KDs can be effective for patients with intractable epilepsy.
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28
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Hong H, Lu X, Wu C, Chen J, Chen C, Zhang J, Huang C, Cui Z. A review for the pharmacological effects of paeoniflorin in the nervous system. Front Pharmacol 2022; 13:898955. [PMID: 36046834 PMCID: PMC9420976 DOI: 10.3389/fphar.2022.898955] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Paeoniflorin, a terpenoid glycoside compound extracted from Paeonia lactiflora Pall, shows preventive and therapeutic effects in various types of nervous system disorders. However, to date, no comprehensive knowledge on the pharmacological effects of paeoniflorin on the nervous system is available online. Clarification of this issue may be useful for the development of paeoniflorin as a new drug for the treatment of nervous system disorders. To this end, the authors summarize the pharmacological aspects of paeoniflorin and its possible mechanisms, such as restoration of mitochondrial function; inhibition of neuroinflammation, oxidative stress, and cellular apoptosis; activation of adenosine A1 receptor, cAMP response element-binding protein (CREB) and extracellular signal-regulated kinase 1/2 (ERK1/2); or enhancement of brain-derived neurotrophic factor and serotonin function, in the prevention of disorders such as cerebral ischemia, subarachnoid hemorrhage, vascular dementia, Alzheimer's disease, Parkinson's disease, depression, post-traumatic syndrome disorder, and epilepsy, by reviewing the previously published literature.
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Affiliation(s)
- Hongxiang Hong
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xu Lu
- Department of Pharmacology, School of Pharmacy, Nantong University, Nantong, Jiangsu, China
| | - Chunshuai Wu
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jiajia Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Chu Chen
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jinlong Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Chao Huang
- Department of Pharmacology, School of Pharmacy, Nantong University, Nantong, Jiangsu, China
| | - Zhiming Cui
- Department of Spine Surgery, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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29
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Eilbert W, Chan C. Febrile seizures: A review. J Am Coll Emerg Physicians Open 2022; 3:e12769. [PMID: 36016968 PMCID: PMC9396974 DOI: 10.1002/emp2.12769] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 01/23/2023] Open
Abstract
Febrile seizures are common, occurring in up to 5% of children in the United States. Frequently perceived by caregivers as a life-threatening event, febrile seizures are a common cause of emergency department visits. The concern for permanent neurologic sequelae and future epilepsy after febrile seizures has resulted in a significant amount of research on these topics. The development of childhood vaccines over the past several decades has led to a significant reduction in childhood bacterial meningitis. This in turn has led to a dramatic change in the evaluation and treatment of febrile seizures. In this review, the different types of febrile seizures as well as the evaluation and prognosis of each are discussed.
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Affiliation(s)
- Wesley Eilbert
- Department of Emergency MedicineCollege of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Chuck Chan
- Department of Emergency MedicineCollege of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
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30
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Crespo M, León-Navarro DA, Martín M. Glutamatergic System is Affected in Brain from an Hyperthermia-Induced Seizures Rat Model. Cell Mol Neurobiol 2022; 42:1501-1512. [PMID: 33492599 PMCID: PMC11421758 DOI: 10.1007/s10571-021-01041-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/11/2021] [Indexed: 12/22/2022]
Abstract
One of the most frequent neurological disorders in children is febrile seizures (FS), a risk for epilepsy in adults. Glutamate is the main excitatory neurotransmitter in CNS acting through ionotropic and metabotropic receptors. Excess of glutamate in the extracellular space elicits excitotoxicity and has been associated with neurological disorders, such as epilepsy. The removal of extracellular glutamate by excitatory amino acid transporters (EATT) plays an important neuroprotective role. GLT-1 is the main EAAT present in the cortex brain. On the other hand, an increase in metabotropic glutamate receptors 5 (mGlu5R) levels or their overstimulation have been related to the appearance of seizure events in different animal models and in temporal lobe epilepsy in humans. In this work, the status of several components of the glutamatergic system has been analysed in the cortex brain from an FS rat model at short (48 h) and long (20 days) term after hyperthermia-induced seizures. At the short term, we detected increased GLT-1 levels, reduced glutamate concentration, and unchanged mGlu5R levels, without neuronal loss. However, at the long term, an increase in mGlu5R levels together with a decrease in both GLT-1 and glutamate levels were observed. These changes were associated with the appearance of an anxious phenotype. These results suggest a neuroprotective role of the glutamatergic components mGlu5R and GLT-1 at the short term. However, this neuroprotective effect seems to be lost at the long term, leading to an anxious phenotype and suggesting an increased vulnerability and propensity to epileptic events in adults.
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Affiliation(s)
- M Crespo
- Department of Inorganic, Organic and Biochemistry, Faculty of Chemical and Technological Sciences, School of Medicine of Ciudad Real, Universidad de Castilla-La Mancha, Regional Centre of Biomedical Research (CRIB), Avenida Camilo José Cela, 10, 13071, Ciudad Real, Spain
| | - D A León-Navarro
- Department of Inorganic, Organic and Biochemistry, Faculty of Chemical and Technological Sciences, School of Medicine of Ciudad Real, Universidad de Castilla-La Mancha, Regional Centre of Biomedical Research (CRIB), Avenida Camilo José Cela, 10, 13071, Ciudad Real, Spain.
| | - M Martín
- Department of Inorganic, Organic and Biochemistry, Faculty of Chemical and Technological Sciences, School of Medicine of Ciudad Real, Universidad de Castilla-La Mancha, Regional Centre of Biomedical Research (CRIB), Avenida Camilo José Cela, 10, 13071, Ciudad Real, Spain
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Shibata A, Kasai M, Hoshino A, Mizuguchi M. Association of IL-1B rs16944 Polymorphism With Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion Is Opposite to That of Febrile Seizures. Front Neurol 2022; 13:891721. [PMID: 35707033 PMCID: PMC9189392 DOI: 10.3389/fneur.2022.891721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAcute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a severe neurologic complication of febrile infectious diseases in children. At the onset, AESD is clinically manifested as febrile status epilepticus. Subsequent damage to the cerebral cortex is ascribed to neurotoxicity. The incidence of AESD is remarkably high in Japan, suggesting the involvement of genetic factors. The expression of interleukin 1 beta (IL-1β), a member of the cytokine family involved in the inflammatory response, is reportedly associated with rs16944, a polymorphism in the upstream region of the IL-1B gene, being higher in TT genotype. Previous association studies of rs16944 with febrile seizures (FS) have demonstrated a significant excess in the TT vs. CC + CT genotype in the Asian population. Here, we conducted a case-control association study of rs16944 in AESD.MethodsWe genotyped rs16944 by Sanger sequencing on 283 patients with AESD. As controls, we used genotyping data of 104 Japanese individuals obtained from the 1,000 Genomes Project. Then, we performed a case-control association study using the chi-square test.ResultsThe ratio of individuals with TT vs. those with CC+CT genotype was significantly lower in AESD than in the controls [p-value 0.021, Odds Ratio (OR) 0.52]. This finding was opposite to that of a previously reported FS.ConclusionThe AESD has a genetic background distinct from FS and is not a severe type of FS.
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Affiliation(s)
- Akiko Shibata
- Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- *Correspondence: Akiko Shibata
| | - Mariko Kasai
- Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ai Hoshino
- Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Mizuguchi
- Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, National Rehabilitation Center for Children With Disabilities, Tokyo, Japan
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Möbius H, Welkoborsky HJ. Vagus nerve stimulation for conservative therapy-refractive epilepsy and depression. Laryngorhinootologie 2022; 101:S114-S143. [PMID: 35605616 DOI: 10.1055/a-1660-5591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Numerous studies confirm that the vagus nerve stimulation (VNS) is an efficient, indirect neuromodulatory therapy with electrically induced current for epilepsy that cannot be treated by epilepsy surgery and is therapy-refractory and for drug therapy-refractory depression. VNS is an established, evidence-based and in the long-term cost-effective therapy in an interdisciplinary overall concept.Long-term data on the safety and tolerance of the method are available despite the heterogeneity of the patient populations. Stimulation-related side effects like hoarseness, paresthesia, cough or dyspnea depend on the stimulation strength and often decrease with continuing therapy duration in the following years. Stimulation-related side effects of VNS can be well influenced by modifying the stimulation parameters. Overall, the invasive vagus nerve stimulation may be considered as a safe and well-tolerated therapy option.For invasive and transcutaneous vagus nerve stimulation, antiepileptic and antidepressant as well as positive cognitive effects could be proven. In contrast to drugs, VNS has no negative effect on cognition. In many cases, an improvement of the quality of life is possible.iVNS therapy has a low probability of complete seizure-freedom in cases of focal and genetically generalized epilepsy. It must be considered as palliative therapy, which means that it does not lead to healing and requires the continuation of specific medication. The functional principle is a general reduction of the neuronal excitability. This effect is achieved by a slow increase of the effectiveness sometimes over several years. Responders are those patients who experience a 50% reduction of the seizure incidence. Some studies even reveal seizure-freedom in 20% of the cases. Currently, it is not possible to differentiate between potential responders and non-responders before therapy/implantation.The current technical developments of the iVNS generators of the new generation like closed-loop system (cardiac-based seizure detection, CBSD) reduce also the risk for SUDEP (sudden unexpected death in epilepsy patients), a very rare, lethal complication of epilepsies, beside the seizure severity.iVNS may deteriorate an existing sleep apnea syndrome and therefore requires possible therapy interruption during nighttime (day-night programming or magnet use) beside the close cooperation with sleep physicians.The evaluation of the numerous iVNS trials of the past two decades showed multiple positive effects on other immunological, cardiological, and gastroenterological diseases so that additional therapy indications may be expected depending on future study results. Currently, the vagus nerve stimulation is in the focus of research in the disciplines of psychology, immunology, cardiology as well as pain and plasticity research with the desired potential of future medical application.Beside invasive vagus nerve stimulation with implantation of an IPG and an electrode, also devices for transdermal and thus non-invasive vagus nerve stimulation have been developed during the last years. According to the data that are currently available, they are less effective with regard to the reduction of the seizure severity and duration in cases of therapy-refractory epilepsy and slightly less effective regarding the improvement of depression symptoms. In this context, studies are missing that confirm high evidence of effectiveness. The same is true for the other indications that have been mentioned like tinnitus, cephalgia, gastrointestinal complaints etc. Another disadvantage of transcutaneous vagus nerve stimulation is that the stimulators have to be applied actively by the patients and are not permanently active, in contrast to implanted iVNS therapy systems. So they are only intermittently active; furthermore, the therapy adherence is uncertain.
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Affiliation(s)
- H Möbius
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, KRH Klinikum Nordstadt, Hannover.,Abt. für HNO-Heilkunde, Kinderkrankenhaus auf der Bult, Hannover
| | - H J Welkoborsky
- Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, KRH Klinikum Nordstadt, Hannover.,Abt. für HNO-Heilkunde, Kinderkrankenhaus auf der Bult, Hannover
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G J K Prakash Raju, Dwajani S., Kannan Rajendran, Adarsh E.. A study of Rationale use of Sodium valproate and Levetiracetam as monotherapy in pediatric patients with Epilepsy at tertiary care hospital. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i1.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Drug utilization studies helps in the understanding of drug usage among patients, as well as the socioeconomic background and rational use of antiepileptics in children with epilepsy.
Objective: The primary aim of this article is to examine the justification for utilizing sodium valproate and Levetiracetam as monotherapy in pediatric epilepsy patients, as well as drug use and prescribing patterns for various kinds of epilepsy.
Materials & Methods:
Pediatric epilepsy patients under the age of 18 who visited the outpatient department, patients who were on sodium valproate, carbamazepine, or Levetiracetam monotherapy for at least 3 months after starting treatment. Demographic details, disease characteristics like type of epilepsy, onset and duration of episode, details of first attack, last attack, frequency and family history related to epilepsy comorbid conditions. Details on the treatment, such as the drug prescribed, the dose, the duration of the treatment, and the dosage, were noted. Magnetic resonance image (MRI) Brain, CT Brain, Electroencephalogram (EEG) was done in selected patients and noted.
Results:
In this study we have total of 91 patients younger than 18 years of age confirmed with epilepsy receiving Sodium valproate, Levetiracetam as Monotherapy. Among them 70.3% were male and 29.6% were females. As per the recent Kuppuswamy scale 64.8% of the patients were from an urban background, whereas 35.1% were from a rural background. On analyzing socioeconomic status we found that 38.5% belong to upper middle class family. Nearly 26 % of the patients were diagnosed with focal seizures and 25% with GTCS. Lesser percentage observed with Rolandic, myoclonic, complex partial, refractory epilepsy. Majority 53.8 % were on Sodium valproate among older AEDs. Among newer AEDs 29.6% of patients received Levetiracetam as monotherapy.
Key words:
Epilepsy, Sodium valproate, Levetiracetam, Monotherapy, Rational use
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Hoogland G, Raijmakers M, Clynen E, Brône B, Rigo JM, Swijsen A. Experimental early-life febrile seizures cause a sustained increase in excitatory neurotransmission in newborn dentate granule cells. Brain Behav 2022; 12:e2505. [PMID: 35191203 PMCID: PMC8933791 DOI: 10.1002/brb3.2505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/25/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022] Open
Abstract
Prolonged febrile seizures (FS) are a risk factor for the development of hippocampal-associated temporal lobe epilepsy. The dentate gyrus is the major gateway to the hippocampal network and one of the sites in the brain where neurogenesis continues postnatally. Previously, we found that experimental FS increase the survival rate and structural integration of newborn dentate granule cells (DGCs). In addition, mature post-FS born DGCs express an altered receptor panel. Here, we aimed to study if these molecular and structural changes are accompanied by an altered cellular functioning. Experimental FS were induced by hyperthermia in 10-days-old Sprague-Dawley rats. Proliferating progenitor cells were labeled the next day by injecting green fluorescent protein expressing retroviral particles bilaterally in the dentate gyri. Eight weeks later, spontaneous excitatory and inhibitory postsynaptic events (sEPSCs and sIPSCs, respectively) were recorded from labeled DGCs using the whole-cell patch-clamp technique. Experimental FS resulted in a robust decrease of the inter event interval (p < .0001) and a small decrease of the amplitude of sEPSCs (p < .001). Collectively the spontaneous excitatory charge transfer increased (p < .01). Experimental FS also slightly increased the frequency of sIPSCs (p < .05), while the amplitude of these events decreased strongly (p < .0001). The net inhibitory charge transfer remained unchanged. Experimental, early-life FS have a long-term effect on post-FS born DGCs, as they display an increased spontaneous excitatory input when matured. It remains to be established if this presents a mechanism for FS-induced epileptogenesis.
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Affiliation(s)
- Govert Hoogland
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein Raijmakers
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Neurophysiology Lab, Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium
| | - Elke Clynen
- Neurophysiology Lab, Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium
| | - Bert Brône
- Neurophysiology Lab, Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium
| | - Jean-Michel Rigo
- Neurophysiology Lab, Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium
| | - Ann Swijsen
- Neurophysiology Lab, Biomedical Research Institute BIOMED, Hasselt University, Hasselt, Belgium
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Mitsuda N, J-P NA, Hosokawa T, Eitoku M, Fujieda M, Suganuma N. Breastfeeding and risk of febrile seizures in the first 3 years of life: The Japan Environment and Children's Study. Brain Dev 2022; 44:203-209. [PMID: 34776268 DOI: 10.1016/j.braindev.2021.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our study was conducted to examine the association between breastfeeding and febrile seizures (FS) in the first 3 years of life. METHODS We analyzed the dataset of the Japan Environment and Children's Study (JECS), which is a birth cohort study undertaken to elucidate the influence of environmental factors on children's health during the fetal period and early childhood. Information on feeding duration and feeding pattern, as well as information on febrile seizures, were obtained from questionnaires sent to mothers/caregivers. We categorized a child as having experienced FS if the child was reported as having been diagnosed with FS in the first 3 years. Modified Poisson regression with a robust error variance was used to estimate the effect of duration of breastfeeding and the risk of FS. RESULTS Of the 84,321 children included in the analysis, 6264 (7.4%) were reported to have experienced FS at least once in the first 3 years of life. Multivariate analyses showed that the risk of FS during the first 3 years of life tended to decrease as the duration of breastfeeding increased. Male sex and frequent fever episodes were also associated with an increased risk of FS. CONCLUSIONS Continued breastfeeding until 2 years of age, the most susceptible age for FS, had a small but protective effect on FS.
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Affiliation(s)
- Naomi Mitsuda
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan.
| | - Naw Awn J-P
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
| | | | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Japan
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Pang Q, Li B, Zhang S, Li J, Gu S. Efficacy of levetiracetam in the treatment of pediatric epilepsy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28882. [PMID: 35212288 PMCID: PMC8878805 DOI: 10.1097/md.0000000000028882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To systematically collect, critically evaluate, and synthesize current evidence with respect to the efficacy, safety, and tolerability of levetiracetam as mono- or adjunctive therapy for children and adolescents with all types of epilepsy. METHODS The presentation of methods and results in this systematic review was performed according to the evaluation guidelines for health care interventions provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. Literature retrieval will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database, China Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Ongoing Clinical Trials Database.The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting and other bias by Cochrane Collaboration's tool. Data synthesis and analyses are performed using RevMan 5.4 software. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION Levetiracetam seems to be effective and safe for the treatment of pediatric epilepsy.
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Oakley LL, Regan AK, Fell DB, Spruin S, Bakken IJ, Kwong JC, Pereira G, Nassar N, Aaberg KM, Wilcox AJ, Håberg SE. Childhood seizures after prenatal exposure to maternal influenza infection: a population-based cohort study from Norway, Australia and Canada. Arch Dis Child 2022; 107:153-159. [PMID: 34187781 PMCID: PMC8908878 DOI: 10.1136/archdischild-2021-322210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether clinical and/or laboratory-confirmed diagnosis of maternal influenza during pregnancy increases the risk of seizures in early childhood. DESIGN Analysis of prospectively collected registry data for children born between 2009 and 2013 in three high-income countries. We used Cox regression to estimate country-level adjusted HRs (aHRs); fixed-effects meta-analyses were used to pool adjusted estimates. SETTING Population-based. PARTICIPANTS 1 360 629 children born between 1 January 2009 and 31 December 2013 in Norway, Australia (New South Wales) and Canada (Ontario). EXPOSURE Clinical and/or laboratory-confirmed diagnosis of maternal influenza infection during pregnancy. MAIN OUTCOME MEASURES We extracted data on recorded seizure diagnosis in secondary/specialist healthcare between birth and up to 7 years of age; additional analyses were performed for the specific seizure outcomes 'epilepsy' and 'febrile seizures'. RESULTS Among 1 360 629 children in the study population, 14 280 (1.0%) were exposed to maternal influenza in utero. Exposed children were at increased risk of seizures (aHR 1.17, 95% CI 1.07 to 1.28), and also febrile seizures (aHR 1.20, 95% CI 1.07 to 1.34). There was no strong evidence of an increased risk of epilepsy (aHR 1.07, 95% CI 0.81 to 1.41). Risk estimates for seizures were higher after influenza infection during the second and third trimester than for first trimester. CONCLUSIONS In this large international study, prenatal exposure to influenza infection was associated with increased risk of childhood seizures.
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Affiliation(s)
- Laura L Oakley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Sarah Spruin
- ICES, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Inger Johanne Bakken
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jeffrey C Kwong
- ICES, Toronto, Ontario, Canada
- Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kari M Aaberg
- The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Allen J Wilcox
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Epidemiology Branch, National Institutes of Health/National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Han W, Jiang L, Song X, Li T, Chen H, Cheng L. VEGF Modulates Neurogenesis and Microvascular Remodeling in Epileptogenesis After Status Epilepticus in Immature Rats. Front Neurol 2022; 12:808568. [PMID: 35002944 PMCID: PMC8739962 DOI: 10.3389/fneur.2021.808568] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 12/17/2022] Open
Abstract
Neurogenesis and angiogenesis are widely recognized to occur during epileptogenesis and important in brain development. Because vascular endothelial growth factor (VEGF) is a critical neurovascular target in neurological diseases, its effect on neurogenesis, microvascular remodeling and epileptogenesis in the immature brain after lithium-pilocarpine-induced status epilepticus (SE) was investigated. The dynamic changes in and the correlation between hippocampal neurogenesis and microvascular remodeling after SE and the influence of VEGF or SU5416 injection into the lateral ventricles at different stages after SE on neurogenesis and microvascular remodeling through regulation of VEGF expression were assessed by immunofluorescence and immunohistochemistry. Western blot analysis revealed that the VEGFR2 signaling pathway promotes phosphorylated ERK and phosphorylated AKT expression. The effects of VEGF expression regulation at different stages after SE on pathological changes in hippocampal structure and spontaneous recurrent seizures (SRS) were evaluated by Nissl staining and electroencephalography (EEG). The results showed that hippocampal neurogenesis after SE is related to microvascular regeneration. VEGF promotion in the acute period and inhibition in the latent period after SE alleviates loss of hippocampal neuron, abnormal vascular regeneration and inhibits neural stem cells (NSCs) ectopic migration, which may effectively alleviate SRS severity. Interfering with VEGF via the AKT and ERK pathways in different phases after SE may be a promising strategy for treating and preventing epilepsy in children.
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Affiliation(s)
- Wei Han
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaojie Song
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Tianyi Li
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hengsheng Chen
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Cheng
- Department of Neurology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Rice SA, Müller RM, Jeschke S, Herziger B, Bertsche T, Neininger MP, Bertsche A. Febrile seizures: perceptions and knowledge of parents of affected and unaffected children. Eur J Pediatr 2022; 181:1487-1495. [PMID: 34873647 PMCID: PMC8648401 DOI: 10.1007/s00431-021-04335-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
UNLABELLED Febrile seizures (FS) in children are common, but little is known about parents' perceptions and knowledge of FS. We interviewed parents of children aged 6 months to 6 years affected by FS (FS group, 65 parents) or unaffected (control group, 54 parents). In the FS group, 32% said they knew their child had an FS when the first event occurred, and 89% described fear when the child had a seizure, with a median intensity of 10/10 (Q25/Q75: 9/10). Related to follow-up, 77% in the FS group (will) observe their child more carefully after the first seizure happened, and 63% (will) give antipyretics earlier at a median temperature of 38.2 °C (100.8 °F). In the FS group, 62% were unaware of FS before the first event (54% of control group did not know about FS thus far, n.s.). In the FS group, 20% would put a solid object in the mouth of a child having a seizure (control group, 39%, p = 0.030), and 92% would administer an available anti-seizure rescue medication (control group, 78%, p = 0.019). In the FS group, 71% feared that children with FS might suffocate (control group, 70%, n.s.). CONCLUSION Information about FS and their management should be more available to improve parents' coping and patient safety. WHAT IS KNOWN • Febrile seizures in children are common. • The prognosis of children suffering from febrile seizures is usually rather good. WHAT IS NEW • Over half of parents had not informed themselves about febrile seizures so far; and only 32% of parents realized their child had a febrile seizure when it occurred. • Most parents described own fear with a median intensity of 10/10; and 63% (will) give antipyretics earlier at a median temperature of 38.2 °C (100.8 °F).
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Affiliation(s)
- Steven Alan Rice
- University Hospital for Children and Adolescents, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, Rostock, 18057 Germany
| | - Ruth Melinda Müller
- University Hospital for Children and Adolescents, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, Rostock, 18057 Germany
| | - Sarah Jeschke
- University Hospital for Children and Adolescents, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, Rostock, 18057 Germany
| | - Birthe Herziger
- University Hospital for Children and Adolescents, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, Rostock, 18057 Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstraße 32, Leipzig, 04103 Germany
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstraße 32, Leipzig, 04103 Germany
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, Rostock, 18057, Germany.
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Christensen KJ, Dreier JW, Skotte L, Feenstra B, Grove J, Børglum AD, Mitrovic M, Cotsapas C, Christensen J. Seasonal Variation and Risk of Febrile Seizures: A Danish Nationwide Cohort Study. Neuroepidemiology 2022; 56:138-146. [PMID: 35051933 PMCID: PMC9018567 DOI: 10.1159/000522065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/30/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Onset of febrile seizures varies with calendar season. However, it has not previously been assessed, how season of birth interacts with age and peak risk of febrile seizures, and whether season of birth correlates with the cumulative risk of febrile seizures at 5 years of age (i.e., when children are no longer of risk of febrile seizures). METHODS We identified all singleton children born in Denmark between 1977 and 2011 who were alive at 3 months of age (N = 2,103,232). We used the Danish Civil Registration System to identify age and sex of the children and the Danish National Patient Register to identify children hospitalized with febrile seizures from 3 months to 5 years of age. Follow-up ended on December 31, 2016, when all children had reached 5 years of age. RESULTS The relative risk of admission with a first febrile seizure varied with calendar month; in February (a winter month in Denmark), the risk was more than doubled (hazard ratio: 2.10 [95% confidence interval [CI]: 2.03-2.18]) compared with August (a summer month in Denmark). The age-specific incidence of a first febrile seizure by birth month identified the highest peak incidence of a first febrile seizure among children born in November (reaching a peak incidence of 350 first admissions with a febrile seizure per 100,000 person months at age 16 months) as compared to children born in July (reaching a peak incidence of 200 first admissions with a febrile seizure per 100,000 person months at age 16 months). However, the cumulative incidence of any admission with febrile seizures before 5 years was not correlated with season of birth (3.69% [95% CI: 3.64-3.74%] for winter births, 3.57% [95% CI: 3.52-3.62%] for spring births, 3.55% [95% CI: 3.50-3.59%] for summer births, and 3.64% [95% CI: 3.59-3.69%] for fall births). DISCUSSION/CONCLUSION The study found a significant seasonal variation in onset of the first febrile seizure and in the age-specific peak incidence of febrile seizures. However, there was no correlation between season of birth and cumulative incidence of febrile seizures at 5 years of age suggesting that children who are predisposed to febrile seizures will eventually go on to experience a febrile seizure regardless of season of birth.
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Affiliation(s)
- Kirstine J. Christensen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Denmark,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Julie W. Dreier
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Denmark
| | - Line Skotte
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jakob Grove
- Department of Biomedicine, Aarhus University, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Anders D. Børglum
- Department of Biomedicine, Aarhus University, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Mitja Mitrovic
- Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Chris Cotsapas
- Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Jakob Christensen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Denmark,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Dzefi-Tettey K, Edzie EM, Brakohiapa E, Kekessie K, Piersson A, Acheampong F, Gorleku P, Nixon H, Asemah A, Kusodzi H. Seizures in children: Spectrum of findings on brain magnetic resonance imaging at the Korle Bu Teaching Hospital, Ghana. WEST AFRICAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.4103/wajr.wajr_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Berseem NF, Khattab ESAEH, Saad DS, Abd Elnaby SA. Role of SCN2A c.56G/A Gene Polymorphism in Egyptian Children with Genetic Epilepsy with Febrile Seizure Plus. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:450-457. [PMID: 34607551 DOI: 10.2174/1871527320666211004123731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/11/2020] [Accepted: 11/30/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Febrile Seizures (FS) are the most common seizures in children younger than 5 years. In the last decade, various coding and noncoding sequence variations of voltage-gated sodium channels SCN2A have been identified in patients with seizures, implying their genetic base. We aimed to evaluate the association between SCN2A c. G/A genetic polymorphism among Egyptian children with febrile seizure plus. METHODS The present cross-sectional study was carried out on 100 epileptic infants and children, attendants of the Neurology Unit, pediatric department, Menoufia University Hospitals (Group Ι). The patients were sub-classified into two groups, according to response to anti-epileptic treatment; Group Ι a (drug responder) and Group Ι b (drug-resistant). Evenly divided number of apparently healthy, age and gender-matched children were selected as controls (Group II). A complete history, throughout the systemic examination and radiological & metabolic assessment, whenever needed was provided, all participants were genotyped for SCN2A rs17183814 polymorphism by Restriction Fragment Length Polymorphism (PCR-RFLP). RESULTS Both of A allele and AA, GA genotypes of SCN2A c. 56 G/A were detected more in patients with febrile seizure plus comparison to the control group with a statistically significant difference at frequencies of 17% and 11% and 12% respectively; OR (CI95%): 10.04 (3.49-28.87) and p <0.001. On classifying epileptic patients into 2 subgroups, carriers of SCN2A rs17183814 AA genotype tended to respond poorly to Anti-epileptic Drugs (AEDs). Moreover, multivariate analysis revealed that rs17183814 A allele and positive family history of epilepsy were considered the highest predicted risk factors for the development of epilepsy; p<0.05. CONCLUSION SCN2A rs17183814 (A) allele was specifically associated with developing febrile seizure plus and could modulate the patient's response to anti-epileptic medications.
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Affiliation(s)
- Naglaa Fathy Berseem
- Genetic and Endocrinology Unit, Department of Pediatric, Menoufia University-Shebeen Elkom, Egypt
| | | | - Dalia S Saad
- Faculty of Medicine, Menoufia University, Shebeen Elkom, Egypt
| | - Sameh A Abd Elnaby
- Pediatric Department, Faculty of Medicine, Menoufia University, Shebeen Elkom, Egypt
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Kloc ML, Marchand DH, Holmes GL, Pressman RD, Barry JM. Cognitive impairment following experimental febrile seizures is determined by sex and seizure duration. Epilepsy Behav 2022; 126:108430. [PMID: 34902661 PMCID: PMC8748413 DOI: 10.1016/j.yebeh.2021.108430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Febrile seizures are the most common type of seizures in children. While in most children the outcome is favorable, children with febrile status epilepticus may exhibit modest cognitive impairment. Whether children with other forms of complex febrile seizure, such as repetitive febrile seizures within the same illness are at risk of cognitive deficits is not known. In this study, we used a well-established model of experimental febrile seizures in rat pups to compare the effects of febrile status epilepticus and recurrent febrile seizures on subsequent spatial cognition and anxiety. METHODS Male and female rat pups were subjected to hyperthermic seizures at postnatal day 10 and were divided into groups of rats with continuous seizures for ≥40 min or recurrent febrile seizures. They were then tested as adults in the active avoidance and spatial accuracy tests to assess spatial learning and memory and the elevated plus maze to measure anxiety. RESULTS Febrile status epilepticus rats demonstrated impaired spatial cognition in active avoidance and spatial accuracy and exhibited reduced anxiety-like behavior in the elevated plus maze. Rats with recurrent febrile seizures did not differ significantly from the controls on any measures. There were also significant sex-related differences with females with FSE performing far better than males with FSE in active avoidance but demonstrating a navigational learning impairment relative to CTL females in spatial accuracy. However, once learned, females with FSE performed the spatial accuracy task as well as CTL females. CONCLUSION There is a duration-dependent effect of febrile seizures on subsequent cognitive and behavioral outcomes. Febrile status epilepticus resulted in spatial cognitive deficits and reduced anxiety-related behaviors whereas rats with recurrent febrile seizures did not differ from controls. Sex had a remarkable effect on spatial cognitive outcome where males with FSE fared worse than females with FSE. The results demonstrate that sex should be considered as a biological variable in studies evaluating the effects of seizures on the developing brain.
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Zaniani NR, Roohbakhsh A, Moghimi A, Mehri S. Protective effect of Toll-like receptor 4 antagonist on inflammation, EEG, and memory changes following febrile seizure in Wistar rats. Behav Brain Res 2021; 420:113723. [PMID: 34923024 DOI: 10.1016/j.bbr.2021.113723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/19/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022]
Abstract
Neuroinflammation and fever are the main triggers in febrile seizures (FS). Focusing on inflammatory pathways and anti-inflammatory drugs could compensate for the limitations of existing medications. The aim of this study is to evaluate the neuroprotective effect of specific antagonizing Toll-like receptor 4 (TLR4), as a prominent inflammatory axis, on the consequences of FS and adulthood using animal models. Complex FS was induced on 9-11 day old male rat pups using a heated chamber. TAK-242, as a specific TLR4 inhibitor, was injected intraperitoneally before seizure induction. Seizure threshold, duration, and spike number were measured by electrocorticography. The levels of inflammatory cytokines, TLR4 protein expression, and oxidative stress markers were detected by enzyme-linked immunosorbent assay, western blotting, malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) assessments in the cortex and hippocampus. Also, spatial and non-spatial memory were evaluated using the novel object recognition test (NORT) and double Y-maze test during adulthood. The results revealed that provoked inflammatory responses in neonate rats, after FS, were associated with the increase of the tumor necrosis factor alpha, interleukin-1β, and enhanced TLR4 protein expression. Meanwhile, based on performed behavioral tests, the inflammatory process was also involved in adulthood memory deficit. Pretreatment with TAK-242 reduced the inflammatory cytokines and TLR4 protein expression in the cortex and hippocampus of neonate rats and improvement in memory deficit in NORT and double Y-maze tasks. Also, pretreatment with TAK-242 elevated seizure threshold, SOD, and CAT activities, and decreased seizure duration and MDA level with no significant change in spike number. TAK-242 possibly controlled FS via inhibiting inflammation.
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Affiliation(s)
- Nosaibeh Riahi Zaniani
- Rayan Research Center for Neuroscience & Behavior, Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Iran
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moghimi
- Rayan Research Center for Neuroscience & Behavior, Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Iran.
| | - Soghra Mehri
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Wolf DC, Desgent S, Sanon NT, Chen JS, Elkaim LM, Bosoi CM, Awad PN, Simard A, Salam MT, Bilodeau GA, Duss S, Sawan M, Lewis EC, Weil AG. Sex differences in the developing brain impact stress-induced epileptogenicity following hyperthermia-induced seizures. Neurobiol Dis 2021; 161:105546. [PMID: 34742878 DOI: 10.1016/j.nbd.2021.105546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
Febrile seizures (FS) are common, affecting 2-5% of children between the ages of 3 months and 6 years. Complex FS occur in 10% of patients with FS and are strongly associated with mesial temporal lobe epilepsy. Current research suggests that predisposing factors, such as genetic and anatomic abnormalities, may be necessary for complex FS to translate to mesial temporal lobe epilepsy. Sex hormones are known to influence seizure susceptibility and epileptogenesis, but whether sex-specific effects of early life stress play a role in epileptogenesis is unclear. Here, we investigate sex differences in the activity of the hypothalamic-pituitary-adrenal (HPA) axis following chronic stress and the underlying contributions of gonadal hormones to the susceptibility of hyperthermia-induced seizures (HS) in rat pups. Chronic stress consisted of daily injections of 40 mg/kg of corticosterone (CORT) subcutaneously from postnatal day (P) 1 to P9 in male and female rat pups followed by HS at P10. Body mass, plasma CORT levels, temperature threshold to HS, seizure characteristics, and electroencephalographic in vivo recordings were compared between CORT- and vehicle (VEH)-injected littermates during and after HS at P10. In juvenile rats (P18-P22), in vitro CA1 pyramidal cell recordings were recorded in males to investigate excitatory and inhibitory neuronal circuits. Results show that daily CORT injections increased basal plasma CORT levels before HS and significantly reduced weight gain and body temperature threshold of HS in both males and females. CORT also significantly lowered the generalized convulsions (GC) latency while increasing recovery time and the number of electrographic seizures (>10s), which had longer duration. Furthermore, sex-specific differences were found in response to chronic CORT injections. Compared to females, male pups had increased basal plasma CORT levels after HS, longer recovery time and a higher number of electrographic seizures (>10s), which also had longer duration. Sex-specific differences were also found at baseline conditions with lower latency to generalized convulsions and longer duration of electrographic seizures in males but not in females. In juvenile male rats, the amplitude of evoked excitatory postsynaptic potentials, as well as the amplitude of inhibitory postsynaptic currents, were significantly greater in CORT rats when compared to VEH littermates. These findings not only validate CORT injections as a stress model, but also show a sex difference in baseline conditions as well as a response to chronic CORT and an impact on seizure susceptibility, supporting a potential link between sustained early-life stress and complex FS. Overall, these effects also indicate a putatively less severe phenotype in female than male pups. Ultimately, studies investigating the biological underpinnings of sex differences as a determining factor in mental and neurologic problems are necessary to develop better diagnostic, preventative, and therapeutic approaches for all patients regardless of their sex.
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Affiliation(s)
- Daniele C Wolf
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada; Département de Neurosciences, Université de Montréal, Québec, Canada.
| | - Sébastien Desgent
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada; Département de Neurosciences, Université de Montréal, Québec, Canada
| | - Nathalie T Sanon
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada
| | - Jia-Shu Chen
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Ciprian M Bosoi
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada
| | - Patricia N Awad
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada
| | - Alexe Simard
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada
| | - Muhammad T Salam
- Laboratoire Polystim, Département de génie électrique, Polytechnique Montréal, Montréal, Québec, Canada
| | - Guillaume-Alexandre Bilodeau
- LITIV Lab., Département de génie informatique et génie logiciel, Polytechnique Montréal, Montréal, Québec, Canada
| | - Sandra Duss
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada
| | - Mohamad Sawan
- Laboratoire Polystim, Département de génie électrique, Polytechnique Montréal, Montréal, Québec, Canada
| | | | - Alexander G Weil
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Département de Pédiatrie, Université de Montréal, Québec, Canada; Département de Neurosciences, Université de Montréal, Québec, Canada; Neurosurgery Service, Department of Surgery, Université de Montréal, Québec, Canada
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Desloratadine Exposure and Incidence of Seizure: A Nordic Post-authorization Safety Study Using a New-User Cohort Study Design, 2001-2015. Drug Saf 2021; 44:1231-1242. [PMID: 34609719 PMCID: PMC8553702 DOI: 10.1007/s40264-021-01106-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/11/2022]
Abstract
Introduction A small number of adverse events of seizure in patients using desloratadine (DL) have been reported. The European Medicines Agency requested a post-authorization safety study to investigate whether there is an association between DL exposure and seizure. Objective The aim was to study the association between DL exposure and incidence of first seizure. Methods A new-user cohort study of individuals redeeming a first-ever prescription of DL in Denmark, Finland, Norway, and Sweden in 2001–2015 was conducted. DL exposure was defined as days’ supply plus a 4-week grace period. DL unexposed periods were initiated 27 weeks after DL prescription redemption. Poisson regression was used to estimate the adjusted incidence rate and adjusted incidence rate ratio (aIRR) of incident seizure. Results A total of 1,807,347 first-ever DL users were included in the study, with 49.3% male and a mean age of 29.5 years at inclusion; 20.3% were children aged 0–5 years. The adjusted incidence rates of seizure were 21.7 and 31.6 per 100,000 person-years during DL unexposed and exposed periods, respectively. A 46% increased incidence rate of seizure was found during DL exposed periods (aIRR = 1.46, 95% confidence interval [CI] 1.34–1.59). The aIRR ranged from 1.85 (95% CI 1.65–2.08) in children aged 0–5 years to 1.01 in adults aged 20 years or more (95% CI 0.85–1.19). Conclusion This study found an increased incidence rate of seizure during DL exposed periods as compared to unexposed periods among individuals younger than 20 years. No difference in incidence rate of seizure was observed in adults between DL exposed and unexposed. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01106-7.
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Klotz KA, Özcan J, Sag Y, Schönberger J, Kaier K, Jacobs J. Anxiety of families after first unprovoked or first febrile seizure - A prospective, randomized pilot study. Epilepsy Behav 2021; 122:108120. [PMID: 34144460 DOI: 10.1016/j.yebeh.2021.108120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Parents of children with a first unprovoked seizure report high levels of stress and anxiety. Little is known however about interventions that might help to reduce anxiety. We aimed to evaluate anxiety of parents and children after a first unprovoked seizure and assess the anxiety-reducing effect of a semi-structured follow-up in a first seizure clinic (FSC). In comparison, parents of children with febrile seizures are also evaluated, as an example of anxiety evolution without follow-up intervention after provoked seizures. STUDY DESIGN In this prospective, interventional study, patients presenting with a first unprovoked seizure were randomized to early care (EC) with follow-up in FSC within 3 weeks and late care (LC), follow-up in FSC after 4 months. Anxiety levels of parents and patients were scored with the State Trait Anxiety Inventory (STAI) after the initial seizure (T0), 3 and 12 months (T1, T2). To assess the effect of the semi-structured follow-up, anxiety scores were compared between the two groups at baseline, at T1 (i.e., after intervention in EC but prior to intervention in LC) and at T2. Parents of children with febrile seizures (FS) were prospectively followed up without intervention. RESULTS Fifty two patients were included (EC n = 18, LC n = 18, FS n = 15). Initial state anxiety in parents was high in all groups. At T1 (i. e. after intervention in EC but not LC) state anxiety was significantly higher in LC (52.2 (16.7) vs. 33.3 (5.3), p < 0.01). This effect persisted after 12 months, despite intervention in LC in the meantime (39.0 (11.7) vs. 28.8 (6.2); p < 0.01)). The effect in children was similar (T1: 40.6 (8.3) vs. 29.8 (5.1); p < 0.05 and T2: 33.5 (4.7) vs. 24.7 (3.6); p < 0.01). State anxiety in FS decreased within 3 months without intervention (50.0 (14.5) to 33.7 (9.2)). CONCLUSIONS A timely and structured follow-up in a FSC offers effective and sustained reduction of anxiety-levels after first unprovoked seizure in children. In contrast, anxiety after a first febrile seizure decreases over time without additional intervention.
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Affiliation(s)
- Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79106 Freiburg, Germany; Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
| | - Jasmin Özcan
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| | - Yusuf Sag
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| | - Jan Schönberger
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79106 Freiburg, Germany; Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
| | - Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Stefan-Meier-Straße 26, 79104 Freiburg, Germany.
| | - Julia Jacobs
- Alberta Children's Hospital, Alberta Children's Research Institute, Hodgekiss Brain Institute, University of Calgary, Section of Pediatric Neurology, Alberta, Canada; Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany.
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Han JY, Han SB. Seizures Related to Influenza in Pediatric Patients: A Comparison with Seizures Associated with Other Respiratory Viral Infections. J Clin Med 2021; 10:jcm10143088. [PMID: 34300253 PMCID: PMC8303985 DOI: 10.3390/jcm10143088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 01/27/2023] Open
Abstract
Although febrile seizures are the most common neurological complications of influenza, there are few studies comparing seizure characteristics and outcomes between patients with influenza and those with other respiratory virus (RV) infections. Medical records of pediatric patients presenting with seizures accompanied by fever, in whom RV infections were identified, were retrospectively reviewed to compare the characteristics and outcomes of seizures with fever due to influenza (n = 97) to those due to other RV infections (n = 113). Patients with influenza were older than those with other RV infections (p < 0.001), and 22.7% of them were aged ≥5 years. Seizure characteristics of complex febrile seizures were observed more frequently in patients with other RV infections than in those with influenza; however, the frequency of epilepsy was comparable between the two groups. For patients with influenza, children aged <5 years and those aged ≥5 years showed similar seizure characteristics and outcomes. Further neurological evaluations should not be based solely on patient age in children with influenza who experience late-onset seizures at ≥5 years of age. Long-term sequelae should be further investigated in these patients.
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Affiliation(s)
- Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-42-220-9218
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Christensen KJ, Dreier JW, Skotte L, Feenstra B, Grove J, Børglum A, Mitrovic M, Cotsapas C, Christensen J. Birth characteristics and risk of febrile seizures. Acta Neurol Scand 2021; 144:51-57. [PMID: 33822360 DOI: 10.1111/ane.13420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Febrile seizure is a common childhood disorder that affects 2-5% of all children, and is associated with later development of epilepsy and psychiatric disorders. This study determines how the incidence of febrile seizures correlates with birth characteristics, age, sex and brain development. METHODS This is a cohort study of all children born Denmark between 1977 and 2011 who were alive at 3 months of age (N = 2,103,232). The Danish National Patient Register was used to identify children with febrile seizures up to 5 years of age. Follow-up ended on 31 December 2016 when all cohort members had potentially reached 5 years of age. RESULTS In total, 75,593 (3.59%, 95% CI: 3.57-3.62%) were diagnosed with febrile seizures. Incidence peaked at 16.7 months of age (median: 16.7 months, interquartile range: 12.5-24.0). The 5-year cumulative incidence of febrile seizures increased with decreasing birth weight (<1500 g; 5.42% (95% CI: 4.98-5.88% vs. 3,000-4,000 g; 3.53% (95% CI: 3.50-3.56%)) and with decreasing gestational age at birth (31-32 weeks; 5.90% (95% CI: 5.40-6.44%) vs. 39-40 weeks; 3.56% (95% CI: 3.53-3.60)). Lower gestational age at birth was associated with higher age at onset of a first febrile seizure; an association that essentially disappeared when correcting for age from conception. CONCLUSIONS The risk of febrile seizures increased with decreasing birth weight and gestational age at birth. The association between low gestational age at birth and age at first febrile seizure suggests that onset of febrile seizures is associated with the stage of brain development.
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Affiliation(s)
- Kirstine J. Christensen
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Julie W. Dreier
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
| | - Line Skotte
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Bjarke Feenstra
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Jakob Grove
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Anders Børglum
- Department of Biomedicine Aarhus University Aarhus Denmark
| | - Mitja Mitrovic
- Department of Neurology Yale School of Medicine New Haven CT USA
| | - Chris Cotsapas
- Department of Neurology Yale School of Medicine New Haven CT USA
| | - Jakob Christensen
- Department of Economics and Business Economics National Centre for Register‐Based Research Aarhus BSS Aarhus University Aarhus Denmark
- Department of Neurology Aarhus University Hospital Aarhus Denmark
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Octavius GS, Handoko TGH, Budiputri CL, Muljono MP, Juliansen A. Factors Predicting the Recurrence of Febrile Seizure in Siloam General Hospital: A Descriptive Analysis. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0041-1731037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractFebrile seizure (FS) is one of the most common pediatric neurologic disorders, affecting 2 to 5% of children between 6 months and 5 years. In 2008 to 2010, almost half of children with FS in Indonesia experienced recurrences. Various factors have been related to potential predictors for FS recurrence. However, available data reported inconsistent results. Considering its high recurrence rate, this study aimed to determine and assess the factors predicting the recurrence of FS. A cross-sectional study was done in Siloam General Hospital, Lippo Village. The study period was from December 2018 to December 2019, and data were obtained through medical records. Out of 60 participants, 41.7% had recurrent FS. No administration of rectal diazepam before admission (odds ratio [OR] = 6.42; 95% confidence interval [CI]: 1.20–34.2, p = 0.027) was a predictive factor of recurrent FS, while female sex (OR = 0.23; 95% CI: 0.64–0.80, p = 0.025) and shorter duration of the first FS (OR = 0.21; 95% CI 0.06–0.69, p = 0.008) were protective factors of recurrent FS. Identification of factors predicting the recurrence of FS is a powerful tool for clinicians. This study showed that no administration of rectal diazepam before admission was correlated with the risk of FS recurrence, while shorter duration of FS and female sex were protective factors of recurrent FS.
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Affiliation(s)
- Gilbert S. Octavius
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Tan G. H. Handoko
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Charista L. Budiputri
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Michelle P. Muljono
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
| | - Andry Juliansen
- Department of Pediatrics, Faculty of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia
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