Clinical Characterization of Gastroenteritis-Related Seizures in Children

Abstract

Gastroenteritis-related seizures have increasingly gained attention in recent years. Most cases follow a brief, benign course with very few episodes of seizure recurrence and without development of epilepsy. Published reports usually do not make a distinction between febrile and afebrile patients, and most authors include only nonfebrile convulsions in their reported series. This study evaluated the impact of fever in children presenting with seizures during a mild gastroenteritis episode and found that the presence or absence of fever did not affect seizure characteristics or duration. However, mild hyponatremia affected some seizure features, particularly seizure duration, as hyponatremic children sustained more prolonged seizures than patients with normal serum sodium levels, irrespective of body temperature.

Comparison of Clinical Characteristics Between Febrile and Afebrile Seizures Associated With Acute Gastroenteritis in Childhood

“…We observed several distinct findings between the afebrile and febrile groups. First, both groups had mild hyponatremia; however, serum sodium levels were even lower in the febrile group than in the afebrile group (15,16,18). Zifman et al reported hyponatremia in children with AGE-related seizures, particularly in febrile patients (16).…”

“…First, both groups had mild hyponatremia; however, serum sodium levels were even lower in the febrile group than in the afebrile group (15,16,18). Zifman et al reported hyponatremia in children with AGE-related seizures, particularly in febrile patients (16). It has been postulated that hyponatremia lowers the seizure threshold in children with recurrent febrile convulsions (28,29).…”

“…To date, the majority of CwG studies excluded febrile cases even though febrile seizures sometimes occur during an AGE episode (5,6). There is still a controversy regarding whether febrile seizures themselves during AGE should be placed in the category of CwG (16)(17)(18). On the other hand, febrile seizures, with a peak incidence between 12 and 18 months of age, likely overlap the high susceptible age group of CwG (22, 23).…”

“…To date, there is insufficient data that compares the characteristics of febrile and afebrile seizures during a mild AGE episode. Previous studies suggest that the clinical features of febrile seizures related to AGE may be closer to classical CwG than to simple febrile seizures (14)(15)(16). However, it is still unclear how great of an impact fever has on AGEassociated seizures, and whether febrile AGE-related seizures can be deemed a new subtype (atypical) of CwG or are just a variant of febrile seizure (17,18).…”

Neurological symptoms in hospitalised patients: do we assess hyponatraemia with sufficient care?

“…Despite being a disorder so common, there are few published cases on neurological manifestations in hyponatraemia in children in last 10 years and virtually no series (7)(8)(9)(10)(11)(12)(13)(14)(15).…”