Diurnal occurrence of complex febrile seizure and their severity in pediatric patients needing hospitalization

Yamaguchi, Hiroshi; Nagase, Hiroaki; Ishida, Yusuke; Toyoshima, Daisaku; Maruyama, Azusa; Tomioka, Kazumi; Tanaka, Tsukasa; Nishiyama, Masahiro; Fujita, Kyoko; Mariko, Taniguchi Ikeda; Nozu, Kandai; Morioka, Ichiro; Nishimura, Noriyuki; Kurosawa, Hiroshi; Takada, Satoshi; Uetani, Yoshiyuki; Iijima, Kazumoto

doi:10.1016/j.yebeh.2018.01.015

Cited by 10 publications

(11 citation statements)

References 23 publications

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“…[21][22][23] In Japan, where this seizure type is most common, febrile and complex febrile cases are reportedly mostly during the evening hours, especially between 18:00 and 19:00, and the rest at night. 24,25 In our study, patients with febrile seizures generally visited the ED in the afternoon and early morning hours (7 patients between 12:00 and 15:00, 2 patients 17:00-18:00, 2 patients 22:00-23:00, 5 patients 01:00-03:00, and 5 patients 04:00-08:00). We observed no ED visits, especially in the evening hours.…”

Section: Discussionmentioning

confidence: 87%

Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic

Tekin

Durgut

Akoğlu

2022

Journal of Pediatric Epilepsy

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The coronavirus disease 2019 pandemic has led to significant changes in hospital visits worldwide. The admission rates have remarkably decreased. This study investigates the characteristics of 104 patients (54 girls, 50 boys) who presented to our pediatric emergency department (ED) with seizures during the pandemic between May 2020 and May 2021. Regarding seizure type, 84 generalized and 20 focal seizures had occurred. Tonic, tonic–clonic, clonic, and hypomotor seizures were seen in descending order. Thirty-seven patients were diagnosed with epilepsy, and 32 patients with first afebrile, 25 first febrile, and 10 recurrent febrile seizures. No patients had acute symptomatic seizures. In 85 patients, the seizures had stopped before the ED visit; only one lasted >60 minutes. Benzodiazepines were administered as a first-line drug. Demographical features, electroencephalogram (EEG), and cranial imaging findings, laboratory test results, and distribution by month and by the hour of ED visit were analyzed. Study data was in accordance with the literature by seizure types, seizure management, and cranial imaging rates but differed by distribution in terms of month and the hour of ED visit. The EEG abnormality rate was higher among the first afebrile seizure cases. The number of patients with seizures was 69, that is, 0.3% of emergency admissions, for the 4 months of 2019 before the pandemic, and 104, that is, 0.4% of emergency admissions for the whole initial year of the pandemic thereafter. So, the number of patients with seizures had decreased, but their rate had increased, which could be attributed to a decrease in the number of nonurgent presentations to the ED during the pandemic.

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Section: Discussionmentioning

confidence: 87%

Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic

Tekin

Durgut

Akoğlu

2022

Journal of Pediatric Epilepsy

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“…This finding is unlikely to be the consequence of the non-witnessing or under-reporting of FSs that took F I G U R E 1 Time-of-day pattern of CFSs. Graph A: proportion of the 233 CFSs per 4-h interval reported by Mikkronen et al 16 Graphs B-D: proportion, respectively, of the 326, 462, and 352 CFSs, initially quantified per 1-h interval by Yamagucihi et al, 21 Ogihara et al, 22 and Kim et al 23 converted for proper meta-analysis to proportion per 4-h interval. Graphs E-H: proportion, respectively, of 188, 349, 221, and 340 CFSs reported by Manfredini et al, 14 Sharafi et al, 17 Khoda Panahandeh et al, 15 and Mohsenipour et al 18 per 6-h interval.…”

Section: Discussionmentioning

confidence: 99%

“…Medline, Google Scholar, and Cochrane databases were searched for publications in any language using the terms of "childhood febrile seizure" paired with "timeof-day," "24 hour," "diurnal," and "circadian." Eleven potentially relevant articles [13][14][15][16][17][18][19][20][21][22][23] were retrieved, with six of them also addressing monthly or seasonal variation in CFSs. [13][14][15][16][17][18] Therefore, the same databases were further explored using the terms "childhood febrile seizure" paired with "seasonal," "annual," and "circannual"; however, it yielded no additional articles that reported time-of-day data.…”

Section: Literature Reviewmentioning

confidence: 99%

“…(1) To avoid possible bias due to between-study differences in sample size, which varied from 188 14 to 462, 21 data of each publication were re-expressed from the number of CFSs per time interval to the proportion of CFSs per time interval relative to the total number of the CFSs of the respective cohort. (2) To properly conduct the statistical analyses, the time intervals of the eight data series required harmonization, since four of them expressed the proportion of CFSs that occurred per 6-hour interval, 14,15,17,18 three per 1-hour interval, [21][22][23] and one per 4-hour interval. 16 This was accomplished by converting the values of the three investigations that summarized the proportion of CFSs occurring per 1-hour interval into the proportion of CFSs occurring per 4-hour interval.…”

Section: Time Series Analysismentioning

confidence: 99%

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Twenty‐four hour pattern of childhood febrile seizures substantiated by time series meta‐analysis: Circadian medicine perspectives

et al. 2023

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Major objectives of this work were to: (1) substantiate the 24‐hour pattern in the occurrence of childhood febrile seizures (CFSs) by a novel time series meta‐analysis of past reported time‐of‐day data and (2) discuss its potential circadian rhythm‐dependencies. Comprehensive search of the published literature retrieved eight articles that met inclusion criteria. Three investigations were conducted in Iran, two in Japan, and one each in Finland, Italy, and South Korea, representing a total of 2461 mostly simple febrile seizures of children who were on average about 2 years of age. Population‐mean cosinor analysis validated (p < .001) a 24‐hour pattern in the onset of CFSs, with an approximate four‐fold difference in the proportion of children expressing seizures at its peak at 18:04 h (95% confidence interval: 16:40–19:07 h) vs trough at 06:00 h, in the absence of meaningful time‐of‐day differences in mean body temeprarure. The CFS time‐of‐day pattern likely derives from the actions of multiple circadian rhythms, particularly the cytokines that comprise the pyrogenic inflammatory pathway and melatonin that influences the excitation level of central neurons and helps regulate body temperature. Past laboratory animal and patient investigations document that the vulnerability to a seizure by a provoking trigger of the same intensity is not the same but different in a predictable‐in‐time manner during the 24 h as a circadian susceptibility/resistance rhythm. Knowledge of the marked disparity in the time‐of‐day risk of CFSs can be translated into improved prevention, particularly during the late afternoon and early evening when highest, through proper timing of prophylactic interventions.

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“…An additional variable that warrants consideration is seizure severity, which appears to be highest during the day (19). In particular, status epilepticus has been reported to occur most frequently later in the day in infants and in the morning in older children (20,21). For both infants and older children, status epilepticus occurrences appear to diminish at night.…”

Section: Time Of Day and Sleep/wake Effects On Seizures In Epilepsymentioning

confidence: 99%

The Molecular Genetic Interaction Between Circadian Rhythms and Susceptibility to Seizures and Epilepsy

Batterman

Gerstner

et al. 2020

Front. Neurol.

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Seizure patterns observed in patients with epilepsy suggest that circadian rhythms and sleep/wake mechanisms play some role in the disease. This review addresses key topics in the relationship between circadian rhythms and seizures in epilepsy. We present basic information on circadian biology, but focus on research studying the influence of both the time of day and the sleep/wake cycle as independent but related factors on the expression of seizures in epilepsy. We review studies investigating how seizures and epilepsy disrupt expression of core clock genes, and how disruption of clock mechanisms impacts seizures and the development of epilepsy. We focus on the overlap between mechanisms of circadian-associated changes in SCN neuronal excitability and mechanisms of epileptogenesis as a means of identifying key pathways and molecules that could represent new targets or strategies for epilepsy therapy. Finally, we review the concept of chronotherapy and provide a perspective regarding its application to patients with epilepsy based on their individual characteristics (i.e., being a "morning person" or a "night owl"). We conclude that better understanding of the relationship between circadian rhythms, neuronal excitability, and seizures will allow both the identification of new therapeutic targets for treating epilepsy as well as more effective treatment regimens using currently available pharmacological and non-pharmacological strategies.

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Diurnal occurrence of complex febrile seizure and their severity in pediatric patients needing hospitalization

Cited by 10 publications

References 23 publications

Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic

Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic

Twenty‐four hour pattern of childhood febrile seizures substantiated by time series meta‐analysis: Circadian medicine perspectives

The Molecular Genetic Interaction Between Circadian Rhythms and Susceptibility to Seizures and Epilepsy

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