• Clinical and Experimental Pediatrics
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• v.50 no.4
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• pp.376-380
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• 2007

Purpose : Febrile seizures occur in childhood associated with a febrile illness not caused by infections of the central nervous system. Provoked seizures are identified with seizures in association with infections that do not usually affect the brain such as gastroenteritis, except criteria for other febrile seizures in this study. We studied seizures provoked by minor extracranial infections, to contrast them with febrile and provoked seizures. Methods : We retrospectively studied one hundred and twenty children with provoked and febrile seizures who visited Chungbuk National University hospital from January, 2000 to December, 2004. Among these children, 36 patients were determined as provoked seizures and 84 patients as febrile seizures. We compared the distribution of minor infections between the patients with provoked seizures and those with febrile seizures, and studied risk factors of subsequent unprovoked seizures after febrile and provoked seizures associated with minor infections. Results : We analyzed the records of 120 children aged from 1 month to 15 years. The common etiologies of minor infections were gastroenteritis and respiratory infections. In the group of febrile seizures, there was a significantly greater proportion of patients with respiratory infections (58.3%) and a lesser proportion of those with gastroenteritis (25.0%). But there was a higher incidence of gastroenteritis (50.0%) in the provoked group. Comparing the distribution of etiologies between the patients with provoked seizures and those with febrile seizures seemed a significant difference. But, there were no difference between the provoked seizures and febrile seizures in the risk for subsequent unprovoked seizures. Conclusion : In conclusion, the leading cause except brain involvement is gastroenteritis in patients with provoked seizures, and respiratory infection in those with febrile seizures. Thus we need prompt recognition of, and medical attention given to, seizures associated with minor infections.

• Clinical and Experimental Pediatrics
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• v.56 no.12
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• pp.534-539
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• 2013

Purpose: Electroencephalography (EEG) is frequently ordered for patients with febrile seizures despite its unclear diagnostic value. We evaluated the prevalence of abnormal EEGs, the association between clinical findings and abnormal EEGs, and the predictive value of EEG for the recurrence of febrile seizures Methods: Data were collected on 230 children who were treated for febrile seizures at Kyung Hee University Medical Center from 2005 to 2009. EEGs were recorded after 1-2 days of hospitalization when children became afebrile. EEG patterns were categorized as normal, epileptiform, or nonspecific relative to abnormalities. The patients' medical records were reviewed, and telephone interviews with the families of the children were conducted to inquire about seizure recurrence. The relationships between clinical variables, including seizure recurrence, and EEG abnormalities were evaluated. Results: Of the 131 children included, 103 had simple and 28 had complex febrile seizures. EEG abnormalities were found in 41 children (31%). EEG abnormalities were more common in children with complex than simple febrile seizures (43% vs. 28%), but the difference was not statistically significant. Logistical regression analysis showed that having multiple seizures in a 24-hour period was significantly predictive of abnormal EEG (odds ratio, 2.98; 95% confidence interval, 1.0 to 88; P =0.048). The frequency of recurrence did not differ significantly in the normal (31%) and abnormal (23%) EEG groups. Conclusion: Multiple seizures within 24 hours were predictive of abnormal EEG in children with febrile seizures. Abnormal EEG was not predictive of febrile seizure recurrence.

• Clinical and Experimental Pediatrics
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• v.57 no.10
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• pp.440-444
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• 2014

Purpose: Febrile seizures are induced by fever and are the most common type of seizures in children. Although numerous studies have been performed on febrile seizures, their pathophysiology remains unclear. Recent studies have shown that cytokines may play a role in the pathogenesis of febrile seizures. The present study was conducted to identify potential links between serum interleukin-1beta (IL-$1{\beta}$), tumor necrosis factor-alpha (TNF-${\alpha}$), and febrile seizures. Methods: Ninety-two patients with simple or complex febrile seizures (46 patients per seizure type), and 46 controls with comparable age, sex, and severity of temperature were enrolled. Results: The median concentrations of serum IL-$1{\beta}$ in the simple, complex febrile seizure, and control groups were 0.05, 0.1, and 0.67 pg/mL, respectively (P=0.001). Moreover, the median concentrations of TNF-${\alpha}$ in the simple, complex febrile seizure, and control groups were 2.5, 1, and 61.5 pg/mL, respectively (P=0.001). Furthermore, there were significant differences between the case groups in serum IL-$1{\beta}$ and TNF-${\alpha}$ levels (P<0.05). Conclusion: Unlike previous studies, our study does not support the hypothesis that increased IL-$1{\beta}$ and TNF-${\alpha}$ production is involved in the pathogenesis of febrile seizures.

• Clinical and Experimental Pediatrics
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• v.59 no.2
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• pp.74-79
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• 2016

Purpose: Febrile seizure, the most common type of pediatric convulsive disorder, is a benign seizure syndrome distinct from epilepsy. However, as epilepsy is also common during childhood, we aimed to identify the prognostic factors that can predict epilepsy in children with febrile seizures. Methods: The study comprised 249 children at the Korea University Ansan Hospital who presented with febrile seizures. The relationship between the subsequent occurrence of epilepsy and clinical factors including seizure and fever-related variables were analyzed by multivariate analysis. Results: Twenty-five patients (10.0%) had additional afebrile seizures later and were diagnosed with epilepsy. The subsequent occurrence of epilepsy in patients with a history of febrile seizures was associated with a seizure frequency of more than 10 times during the first 2 years after seizure onset (P<0.001). Factors that were associated with subsequent occurrence of epilepsy were developmental delay (P<0.001), preterm birth (P =0.001), multiple seizures during a febrile seizure attack (P =0.005), and epileptiform discharges on electroencephalography (EEG) (P =0.008). Other factors such as the age at onset of first seizure, seizure duration, and family history of epilepsy were not associated with subsequent occurrence of epilepsy in this study. Conclusion: Febrile seizures are common and mostly benign. However, careful observation is needed, particularly for prediction of subsequent epileptic episodes in patients with frequent febrile seizures with known risk factors, such as developmental delay, history of preterm birth, several attacks during a febrile episode, and epileptiform discharges on EEG.

• Clinical and Experimental Pediatrics
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• v.62 no.4
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• pp.131-137
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• 2019

Purpose: Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures. Methods: We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea. Results: During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: $20.8{\pm}16.6months$) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient. Conclusion: Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1403-1410
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• 2002

Purpose : In previous studies, various risk factors for recurrent febrile seizures have been identified. But none of these risk factors alone could sufficiently discriminate children at high or low risk for recurrent seizures. Therefore, we tried to identify patients at high risk of recurrent febrile seizures by combining risk factors. Methods : Two hundred and four children who had been admitted to our hospital from March, 1997 to July, 1999 with their first febrile seizures were enrolled in our study, and followed up over 2 years. We investigated the recurrence rate according to variables such as sex, age at first febrile seizure, family history of febrile seizures or epilepsy, type of the first seizure, neurologic abnormality and EEG abnormality. Results : Family history of febrile seizures and age at first febrile seizure(<12 months) were significant independent risk factors for recurrent febrile seizures. With these two combined factors, four groups were allocated and the recurrence rate by each group was designated as follows: group with no family history of febrile seizures and age at first febrile seizure ${\geq}12$ months (no risk factor), 43.8%; the group with no family history and age <12 months(one risk factor), 61.7%; group with family history and age ${\geq}12$ months(one risk factor), 64.5%; group with family history and age <12 months(two risk factors), 90.4%. Conclusion : A correlation between numbers of risk factors and recurrence rate was present and the children with a family history of febrile seizures and a young age at onset(<12 months) were regarded as a high risk group of recurrence.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.757-760
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• 2007

Purpose : Febrile convulsions (FC) were considered to be a benign seizure syndrome that is distinct from epilepsy. But it is thought that children with complex features i.e., partial or prolonged seizures or multiple episodes of FC would bear a higher risk of developing unprovoked seizures. The aim of this study is to look into the relative significance of each criteria that define complex febrile convulsions (CFC) as a predictor of subsequent epilepsy. Methods : All children were retrospectively identified for a febrile seizure through pediatric departments of the Konyang University Hospital. Information was collected from medical records and interviews with parents. Patients with abnormal neurological examinations at presentation were excluded. Results : This study was performed from March 2000 to December 2003. Sixty-three out of 314 children (20.0%) with febrile convulsion fulfilled the criteria for CFC and forty-four children of them have been followed for 12 months or more. Ten of these (23.2%) had unprovoked seizures for 14-62 months (median $34.2{\pm}11.6$ months). The patients with partial FC showed a trend toward a higher risk (57.1%) of developing epilepsy than the patients with multiple or prolonged febrile convulsions (26.7%, 24.1% respectively). Conclusion : We found that the partial feature of febrile convulsion is associated with subsequent epilepsy.

• Clinical and Experimental Pediatrics
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• v.56 no.2
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• pp.80-85
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• 2013

Purpose: Febrile seizures (FS) are seizures that occur between the age of 6 and 60 months, but its pathophysiology still is not fully understood. There is limited information about the correlation between levels of selenium and leptin with FS. This study aimed to determine the relationship between serum levels of selenium and leptin in children with FS. Methods: This case-control study was conducted in a University Hospital in Shahrekord, Iran, in 2011. The serum levels of selenium and leptin of 25 children with simple febrile seizure (case group) were compared with 25 febrile children without seizure (control group) in acute phase and after three months. The levels of serum selenium and leptin were measured by flame atomic absorption spectrophotometer and enzyme-linked immunosorbent assay method, respectively. Results: In acute phase, the mean serum level of selenium in case and control groups were $95.88{\pm}42.55$ and $113.25{\pm}54.43{\mu}g/dL$, respectively, and difference was not significant (P=0.415), but after three months, this level had a significant increase in both groups (P<0.001). In acute phase, the mean serum leptin level in case and control groups were $0.94{\pm}0.5$ and $0.98{\pm}0.84$ ng/mL, respectively, but difference was not significant (P=0.405). After three months, serum leptin level had no significant change in both groups (P=0.882). Conclusion: These observations suggest that serum levels of selenium and leptin have not specific relation with FS but overllay is lower, however, further study is recommended. Also selenium level in stress and acute phase was significantly lower than recovery phase.

• Clinical and Experimental Pediatrics
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• v.57 no.9
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• pp.384-395
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• 2014

Febrile seizure (FS) is the most common seizure disorder of childhood, and occurs in an age-related manner. FS are classified into simple and complex. FS has a multifactorial inheritance, suggesting that both genetic and environmental factors are causative. Various animal models have elucidated the pathophysiological mechanisms of FS. Risk factors for a first FS are a family history of the disorder and a developmental delay. Risk factors for recurrent FS are a family history, age below 18 months at seizure onset, maximum temperature, and duration of fever. Risk factors for subsequent development of epilepsy are neurodevelopmental abnormality and complex FS. Clinicians evaluating children after a simple FS should concentrate on identifying the cause of the child's fever. Meningitis should be considered in the differential diagnosis for any febrile child. A simple FS does not usually require further evaluation such as ordering electroencephalography, neuroimaging, or other studies. Treatment is acute rescue therapy for prolonged FS. Antipyretics are not proven to reduce the recurrence risk for FS. Some evidence shows that both intermittent therapy with oral/rectal diazepam and continuous prophylaxis with oral phenobarbital or valproate are effective in reducing the risk of recurrence, but there is no evidence that these medications reduce the risk of subsequent epilepsy. Vaccine-induced FS is a rare event that does not lead to deleterious outcomes, but could affect patient and physician attitudes toward the safety of vaccination.

• Journal of the Korean Child Neurology Society
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• v.26 no.4
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• pp.221-226
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• 2018

Purpose: Febrile seizures (FSs) are the most common type of seizure in the first 5 years of life and are frequently associated with viral infections. Influenza infection is associated with a variety of neurological conditions, including FSs. The purpose of this study was to evaluate the clinical implications of influenza infection in FSs. Methods: In total, 388 children with FS were divided into two groups: FS with influenza infection (n=75) and FSs without influenza infection (n=313). Their medical records, including seizure type, frequency, duration, and familial history of FSs or epilepsy, were retrospectively reviewed and the clinical characteristics of the two groups were compared. Results: In total, 75 of the 388 children (19.3%) had FSs associated with influenza infection; such children were significantly older than those with FSs without influenza infection ($34.9{\pm}22.3$ months vs. $24.4{\pm}14.2$ months; P<0.001). The children who had more than two febrile seizures episodes were more prevalent in children with FS with influenza infection [40/75 (53.3%) vs. 92/313 (29.4%); P<0.01]. Children older than 60 months were more likely to have influenza infection compared to those aged less than 60 months [11/22 (50%) vs. 64/366 (17.5%); P=0.001]. Conclusion: Influenza infection may be associated with FSs in older children, and with recurrence of FSs. Its role in the development of afebrile seizures or subsequent epilepsy requires further investigation with long-term follow-up.