Clinical characteristics, treatment, and long-term outcomes in children suffering from benign convulsions with mild gastroenteritis: a retrospective study

Abstract

Background Benign convulsions with mild gastroenteritis (BCWG) is a common condition in children in Asia and is generally not associated with pH or electrolyte imbalances. When BCWG is diagnosed, a lumbar puncture is usually recommended to rule out potential intracranial infections. This study examined the clinical characteristics of BCWG and evaluated the necessity of lumbar puncture. Methods Medical records of children admitted to the First Hospital of Jilin University with BCWG between January 2018 and May 2019 were reviewed and analyzed. Children were stratified by rotavirus positivity or lumbar puncture status. Clinical characteristics and long-term outcomes were compared between groups. Results A total of 51 children were included in the analyses (55.1% rotavirus [HRV] positive). The average age of convulsion onset was 21.12 ± 7.44 months, the male-to-female ratio was 1.8:1, and convulsions occurred primarily between October 2018 and April 2019. The main clinical presentations of BCWG were convulsions, vomiting, diarrhea, and fever. Convulsions occurred predominantly two days after diagnosis of gastroenteritis, were mainly generalized tonic-clonic with 88.2% of children having ≤ 3 convulsions per episode, and had a mean duration of 2.0 minutes (interquartile range [IQR]: 1.0, 3.0). Children with BCWG had mild metabolic acidosis (HCO3− 17.82 ± 3.63 mmol/L) with an elevated anion gap (AG; 20.98 ± 3.00 mmol/L), mild hyponatremia (134.56 ± 2.85 mmol/L), and slightly increased levels of creatine kinase myocardial band (CKMB). HRV + children had more severe acidosis and higher CKMB levels. Cerebrospinal fluid (CSF) samples collected via lumbar puncture were normal. No developmental abnormalities were noted as assessed by the Social Life Ability Scale. Conclusions BCWG is a situation-related seizure, with clinical presentations of tonic-clonic or focal convulsions and mild gastroenteritis (vomiting, diarrhea). Mild metabolic acidosis and hyponatremia may exist. The prognosis of the disease is favorable; lumbar puncture and long-term antiepileptics are unnecessary and should not be recommended.

Comparison of clinical characteristics between cluster and isolated seizures associated with benign convulsions with mild gastroenteritis

“…Moreover, it further leads to unnecessary and expensive investigations and excessive utility of anti-epileptic drugs and even incorrect diagnosis and management. [7] The long-term evolution of children with CwG is confirmed to be an excellent prognosis, with normal psychomotor development and a low risk of relapse and subsequent epilepsy. [8] Previous works tended to focus on the incidence of cluster seizures in CWG, with little detail reported on the specific clinical characteristics of cluster seizures and the differences between isolated seizures.…”

Risk Factors for Benign Convulsions With Mild Gastroenteritis

“…The clinical features and prognosis of CwG have been exhaustively reported in previous studies (5)(6)(7), but only a very few studies have discussed the risk factors of CwG. Are there differences in the characteristics of gastroenteritis symptoms between mild acute gastroenteritis and CwG?…”

Efficacy and safety of phenobarbital for benign convulsions with mild gastroenteritis: A prospective randomized controlled study

“…At present, it is generally considered that long-term anticonvulsant treatment is not necessary. [2][3][4][5][6] However, due to repeated seizures in the acute phase of the disease, it brings great panic to the parents. It is recognized that acute phase treatment is needed.…”

“…At present, it is generally considered that long-term anticonvulsant treatment is not necessary. [2–6]…”