Yusuf AYDIN, Ebru YILMAZ, Deniz YILMAZ, Mesut KOÇAK, Ali Osman KÖKSAL, Osman ÖZDEMİR, Aslıhan YILMAZ ARASLI

Evaluation of clinical features of 238 cases with febrile convulsion

Amaç: Febril konvülziyon (FK) altta yatan bir merkezi sinir sistemi enfeksiyo- nu olmayan 6 ay ile 5 yaş arasındaki çocuklarda ateşin tetiklediği bir nöbet olarak tanımlanmaktadır. Bu çalışmada, FK tanısı konulan ve tedavi edilen hastaların demografik özellikleri, laboratuar bulguları ve ateş sebepleri ile FK süresini içeren klinik özelliklerini değerlendirmeyi amaçlanmıştır. Yöntem: Mayıs 2009 ve Mayıs 2012 tarihleri arasında FK tanısı konulan 238 hasta çalışmaya alınmıştır. Bu olguların demografik, klinik ve laboratuar verileri değerlendirilmiştir. Bulgular: Yüz otuz dokuz hasta (%58,5) erkek ve 99u (%41,5) kız olup er- kek/kız oranı 1,4 bulunmuştur. İlk kez FK ile getirilen hastaların yaş ortalama- sının 2,2 ± 1,1 olduğu görülmüştür. Hastaların nöbet sırasında rektumdan ölçülmüş olan ortalama vücut sıcaklıkları 38,7 ± 0,5 °C bulunmuştur. Febril konvülziyonlu hastaların 198ine basit tip (%83,2) ve 40ına kompleks tip (%16,8) tanısı konulmuştur. Otuz üç (%13,8) hastada 24 saat içinde ikinci bir nöbet meydana gelmiştir. Ortanca konvülziyon süresi 2 (1-5) dakika hesap- lanmıştır. En sık ateş etiyolojisinin 131 (%55) olguda saptanan üst solunum yolu enfeksiyonu olduğu görülmüştür. Sonuç: Bu çalışma, üst solunum yolu enfeksiyonları gibi benign durumların, FKnın sık nedenleri olduğunu göstermiştir. Bu nedenle bu olgularda yapıla- cak konservatif yaklaşım daha uygundur.

Febril konvülziyonlu 238 olgunun klinik özelliklerinin değerlendirilmesi

Objective: Febrile convulsion (FC) is defined as a seizure triggered by fever in children between 6 months and 5 years of age without an underlying central nervous system infection. In this study, we aimed to evaluate clinical fea- tures including demographics, laboratory findings, and causes of fever with FC duration among inpatients diagnosed and treated for FC. Methods: A total of 238 patients with the diagnosis of FC between May 2009 and May 2012 were included in the study. Demographic, clinical, and labora- tory data of the patients were analyzed. Results: One hundred and thirty nine patients (58.5%) were male and 99 (41.5%) were female, with a male/female ratio of 1.4. Mean age of the patients admitted with a first FC was 2.2 ± 1.1 years. The mean temperature of the patients measured rectally during the seizure was 38.7 ± 0.5 oC. Fe- brile convulsion was diagnosed as simple type in 198 (83.2%) and complex type in 40 (16.8%) of the patients. Thirty three (13.8%) patients developed a second seizure within 24 hours. Median convulsion duration was 2 (1-5) minutes. The most frequent fever etiology was upper respiratory tract infec- tion in 131 (55%) cases. Conclusion: This study demonstrated that benign conditions, such as upper respiratory tract infections, were common causes of FC. A conservative approach should be more appropriate in these cases.

PDF

___

1.Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics 2008; 121: 1281-6.
2.Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34: 592-6.
3.Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia 1994; 35 Suppl 2: S1-6.
4.Fetveit A. Assesment of febrile seizures in children. Eur J Pediatr 2008; 167: 17-27.
5.Rich SS, Annegers JF, Hauser WA, Anderson VE. Complex segregation analysis of febrile convulsions. Am J Hum Genet 1987; 41: 249-57.
6.Nakayama J, Arinami T. Molecular genetics of febrile seizures. Epilepsy Res 2006;70 Suppl 1: S190-8.
7.Nakayama J. Progress in searching for febrile seizure susceptibility genes. Brain Dev 2009; 31: 359-65.
8.Farwell JR, Blackner G, Sulzbacher S, Adelman L, Voeller M. First febrile seizures. Characteristics of the child, the seizure, and the illness. Clin Pediatr (Phila) 1994; 33: 263-7.
9.Wairuiru C, Appleton R. Febrile seizures: an update. Arch Dis Child 2004; 89: 751-6.
10.Ozaydın E, Yasar MZ, Guven A, Degerliyurt A, Vidinlisan S, Kose G. Clinical features and risk factors in 1385 febrile convulsion cases [Turkish article]. Turkish J Pediatr Dis 2011; 5: 11-8.
11.Sen Y, Sengul I, Arslan N, Kabakus N. Febrile convulsions: analysis of 265 cases [Turkish article]. Turkiye Klinikleri J Pediatr 2008; 17: 75-9.
12.Aygun AD, Guvenc H, Koc A. First febrile convulsion: evaluation of 169 cases [Turkish article]. T Klin Pediatr 1995; 4: 16-9.
13.Iwasaki N, Nakayama J, Hamano K, Matsui A, Arinami T. Molecular genetics of febrile seizures. Epilepsia 2002; 43 Suppl 9: 32-5.
14.Audenaert D, Van Broeckhoven C, De Jonghe P. Genes and loci involved in febrile seizures and related epilepsy syndromes. Hum Mutat 2006; 27: 391-401.
15.Johnson EW, Dubovsky J, Rich SS, O'Donovan CA, Orr HT, Anderson VE, Gil-Nagel A, Ahmann P, Dokken CG, Schneider DT, Weber JL. Evidence for a novel gene for familial febrile convulsions, FEB2, linked to chromosome 19p in an extended family from the Midwest. Hum Mol Genet 1998; 7: 63-7.
16.Gérard F, Pereira S, Robaglia-Schlupp A, Genton P, Szepetowski P. Clinical and genetic analysis of a new multigenerational pedigree with GEFS+ (Generalized Epilepsy with Febrile Seizures Plus). Epilepsia 2002; 43: 581-6.
17.Hauser WA, Annegers JF, Anderson VE, Kurland LT. The risk of seizure disorders among relatives of children with febrile convulsions. Neurology 1985; 35: 1268-73.
18.Doose H, Maurer A. Seizure risk in offspring of individuals with a history of febrile convulsions. Eur J Pediatr 1997; 156: 476-81.
19.Aydın OF, Senbil N, Kara C, Bozkurt C, Gurer YKY. Retrospective evaluation of 201 cases with febrile convulsion [Turkish article]. Ankara Universitesi Tip Fakultesi Mecmuasi 2000; 53: 231-5.
20.Sweeney A, Gibbs J, Monteil F, Appleton R, Choonara I. The management of febrile seizures in the Mersey region. Dev Med Child Neurol 1996; 38: 578-84.
21.Berg AT, Shinnar S. Unprovoked seizures in children with febrile seizures: short-term outcome. Neurology 1996; 47: 562-8.
22.Berg AT, Shinnar S, Darefsky AS, Holford TR, Shapiro ED, Salomon ME, Crain EF, Hauser AW. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med 1997; 151: 371-8.
23.Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with febrile seizures. Epilepsia 2013; 54: 2101-7.
24.Hesdorffer DC, Shinnar S, Lewis DV, Nordli DR Jr, Pellock JM, Moshé SL, Shinnar RC, Litherland C, Bagiella E, Frank LM, Bello JA, Chan S, Masur D, Macfall J, Sun S; Consequences of Prolonged Febrile Seizures in Childhood (FEBSTAT) Study Team. Risk factors for febrile status epilepticus: a case-control study. J Pediatr 2013; 163: 1147-51.
25.van Esch A, Steyerberg EW, Berger MY, Offringa M, Derksen-Lubsen G, Habbema JD. Family history and recurrence of febrile seizures. Arch Dis Child 1994; 70: 395-9.
26.Berg AT, Shinnar S, Hauser WA, Alemany M, Shapiro ED, Salomon ME, Crain EF. A prospective study of recurrent febrile seizures. N Engl J Med 1992; 327: 1122-7.
27.Tosun A, Koturoglu G, Serdaroglu G, Polat M, Kurugol Z, Gokben S, Tekgul H. Ratios of nine risk factors in children with recurrent febrile seizures. Pediatr Neurol 2010; 43: 177-82.
28. Veisani Y, Delpisheh A , Sayehmiri K. Familial history and recurrence of febrile seizures; a systematic review and meta-analysis. Iran J Pediatr 2013; 23: 389-95.
29. Chung B, Wong V. Relationship between five common viruses and febrile seizure in children. Arch Dis Child 2007; 92: 589-93.
30. Barlow WE, Davis RL, Glasser JW, Rhodes PH, Thompson RS, Mullooly JP, Black SB, Shinefield HR, Ward JI, Marcy SM, DeStefano F, Chen RT, Immanuel V, Pearson JA, Vadheim CM, Rebolledo V, Christakis D, Benson PJ, Lewis N; Centers for Disease Control and Prevention Vaccine Safety Datalink Working Group. The risk of seizures after receipt of whole-cell pertusis or measles, mumps and rubella vaccine. N Engl J Med 2001; 345: 656-61.
31. Centers for Disease Control and Prevention (CDC). Update: Recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding use of CSL seasonal influenza vaccine (Afluria) in the United States during 2010-11. MMWR Morb Mortal Wkly Rep 2010; 59: 989-92.
32. Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev 2012; 2: CD004407.
33. Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011; 127: 389-94.
34. Jeong KA, Han MH, Lee EH, Chung S. Early postictal electroencephalography and correlation with clinical findings in children with febrile seizures. Korean J Pediatr 2013; 56: 534-9.
35. Shah PB, James S, Elayaraja S. EEG for children with complex febrile seizures. Cochrane Database Syst Rev 2014; 1: CD009196.
36. Millichap JG, Madsen JA, Aledart LM. Studies in febrile seizures. V. Clinical and electroencephalography, forth edition. Billings and Sons Ltd. London and Guildford, 1981.
37. Appleton R, Macleod S, Martland T. Drug management for acute tonic- clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev 2008; 3: CD0001905.
38. Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev 2012; 4: CD003031.
39. Ellenberg JH, Nelson KB. Febrile seizures and later intellectual performance. Arch Neurol 1978; 35: 17-21.