Afebrile benign convulsions with mild gastroenteritis: a new entity?

Abstract

Afebrile seizures in children usually necessitate investigations in order to determine the etiology and estimate the prognosis. Recently, convulsions that are described as benign but afebrile have been documented in children, in association with diarrhea, and are now recognized as a distinct entity. Benign afebrile seizures with mild gastroenteritis are defined as convulsions accompanying symptoms of mild diarrhea without dehydration or electrolyte derangement and without fever before and after the seizures in healthy children without meningitis, encephalitis or encephalopathy. The convulsions are short, symmetrical, generalized tonic-clonic seizures, occurring in clusters. Laboratory studies (full blood count, blood glucose, creatinine, serum electrolytes, cerebrospinal fluid, bacterial and viral cultures) are usually normal, and other investigations (neuroimaging and electroencephalogram) are not necessary. Prognosis is always favorable (normal psychomotor development, no recurrences of seizures), and anticonvulsant therapy is not warranted. Recognition of this benign infantile convulsion avoids extensive evaluation and long-term anticonvulsant therapy; physicians may reassure the parents regarding the lack of long-term sequelae. In conclusion, this type of seizure seems to be a new entity, but it awaits a correct place in the large group of infantile convulsion disorders.

Asymptomatic Viral Gastrointestinal Infection: The Missing Link?

“…1,[4][5][6] The virus most often associated with BISMG is rotavirus, but norovirus, small round structured virus, and others have been reported. [1][2][3][4] Prognosis is favorable.…”

“…1,[4][5][6] The virus most often associated with BISMG is rotavirus, but norovirus, small round structured virus, and others have been reported. [1][2][3][4] Prognosis is favorable. [1][2][3][4][5] In recent reviews, it has been recommended not to even initiate maintenance antiepileptic therapy for 2 main reasons: the apparent ineffectiveness of the medications at aborting seizures acutely in hospital and, more importantly, the benign course reported in the vast majority after the initial episodes.…”

“…CSF samples have revealed viral RNA or specifically viral protein 7, which has been demonstrated in animal models to have an affinity for neurons and to disrupt axonal transport. [2][3][4] This likely causes an imbalance of excitatory neurotransmitter stimulation and also may decrease gabaergic inhibitory activity and thereby lower the seizure threshold. The elevated CSF nitric oxide level found in BISMG suggests a reflexive vasodilatory response in the presence of inflammation.…”

“…2,6 Elevated CSF carnitine levels have been measured in these patients, suggesting dysfunction of the blood-brain-barrier. 1,4 Furthermore, it has been proposed that there is an underlying susceptibility to insult in the developing brain of the infant given the age distribution in BISMG. 2,4,5 Mild, diffuse self-resolving encephalitis would be in keeping with the clinical findings of mixed seizure types and focal origins suggesting multiple transient foci and overall susceptibility of an inflamed developing brain to seize.…”

“…[1][2][3] It has been defined as 1 or more seizures with the following features and associated symptoms [1][2][3][4][5] :…”