Early risk factors for mortality in children with seizure and/or impaired consciousness accompanied by fever without known etiology

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

doi:10.1016/j.braindev.2018.02.015

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…As seen in our patients, elevated liver enzymes, lactate dehydrogenase, ammonia, creatinine and respiratory acidosis have been reported to be more common in AESD than in febrile seizures. 1 , 4 , 8 , 9 Also, like our patients, diffusely slow EEG with lack of sleep spindles within 48 hours of disease onset has also been considered to be a potential early biomarker of AESD. 7 While there is still no definitive early biomarker of AESD, each case in our series had some combination of these predictive factors.…”

Section: Discussionsupporting

confidence: 57%

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Pediatric Encephalopathy and Complex Febrile Seizures

Yaworski

Alobaidi

Liu

et al. 2022

Clin Pediatr (Phila)

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Section: Discussionsupporting

confidence: 57%

“…Pediatric encephalopathy is a serious condition with an overall mortality rate of ~5%. 1 The AESD is well described in Asian countries. 2 It is the most common pediatric encephalopathy syndrome described in Japan, accounting for 5% to 30% of encephalopathy cases.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Encephalopathy and Complex Febrile Seizures

Yaworski

Alobaidi

Liu

et al. 2022

Clin Pediatr (Phila)

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“…The medical records of children aged 1 month to 15 years who were admitted with SICF at the pediatric intensive care unit in Kobe Children's Hospital, a tertiary referral hospital, between October 2002 and September 2016 were retrospectively reviewed. As in our previous report [1], SICF was defined as the presence of seizures and/or impaired consciousness accompanied by fever without known etiology such as epilepsy, metabolic disorders, structural anomalies in the central nervous system, or central nervous system infection with pleocytosis (cerebrospinal fluid cells: > 8 cells/µL).…”

Section: Subjectsmentioning

confidence: 99%

“…Seizures and/or impaired consciousness accompanied by fever without known etiology (SICF) is common in the pediatric emergency setting. Most of the children with SICF exhibit benign clinical courses and are finally diagnosed with febrile seizures (FS) [1]. However, in some patients with SICF, sequelae persist, with a final diagnosis of acute encephalopathy (AE) [1].…”

Section: Introductionmentioning

confidence: 99%

Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology

Tanaka

Nagase

Yamaguchi

et al. 2019

Brain and Development

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BACKGROUND: Seizures and/or impaired consciousness accompanied by fever without known etiology (SICF) is common in the pediatric emergency setting. No optimal strategy for the management of SICF in childhood currently exists. We previously demonstrated the effectiveness of targeted temperature management (TTM) against SICF with a high risk of morbidity; however, some patients with SICF develop neurological sequelae despite TTM, which necessitate additional neuroprotective treatment. The clinical characteristics of these severe cases have not been studied. Accordingly, the aim of this study was to identify the clinical characteristics of children with SICF who exhibit poor outcomes after TTM. METHODS: The medical records of children admitted to Kobe Children's Hospital (Kobe, Japan) between October 2002 and September 2016 were retrospectively reviewed. Patients with SICF treated using TTM were included and divided into the satisfactory and poor outcome groups. Univariate and multivariate logistic regression analyses were used to compare clinical characteristics and laboratory findings between the two groups. RESULTS: Of the 73 included children, 10 exhibited poor outcomes. Univariate logistic regression analysis revealed that acute circulatory failure before TTM initiation, the use of four or more types of anticonvulsants, methylprednisolone pulse therapy, and an aspartate aminotransferase (AST) level ≥73 IU/L were associated with poor outcomes. Multivariate logistic regression analysis identified an elevated AST level as a significant independent predictor of a poor outcome. CONCLUSIONS: An elevated AST level within 12 h of onset in children with SICF is an independent predictor of a poor outcome after TTM initiated within 24 h of onset.

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“…In most cases, children with seizures and/or impaired consciousness accompanied by fever with unknown etiology (SICF) are diagnosed with febrile seizures (FS) or acute encephalopathy (AE) [ 1 ]. Both of FS and AE are mostly associated with common infectious diseases such as influenza and exanthem subitem; there is a syndrome classification in AE such as acute necrotizing encephalopathy, acute encephalopathy with early biphasic seizures and later reduced diffusion (AESD), hemorrhagic shock and encephalopathy syndrome (HSES), and Reye-like syndrome [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Time course of serum cytokine level changes within 72 h after onset in children with acute encephalopathy and febrile seizures

et al. 2023

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Background Cytokine levels have been measured in acute encephalopathy (AE) to determine its pathology or as a diagnostic biomarker to distinguish it from febrile seizures (FS); however, the dynamics of cytokine level changes have not yet been fully captured in these two neurological manifestations. Thus, we aimed to explore the time course of serum cytokine level changes within 72 h after onset in AE and FS. Methods We retrospectively measured cytokine level in residual serum samples at multiple timepoints in seven children whose final diagnoses were AE or FS. Results The levels of 13 cytokines appeared to increase immediately after onset and peaked within 12–24 h after onset: interleukin (IL)-1β, IL-4 IL-5, IL-6, IL-8, IL-10, IL-17, eotaxin, fibroblast growth factor, granulocyte colony-stimulating factor, interferon gamma, interferon-inducible protein-10, and macrophage chemoattractant protein-1. There were no dynamic changes in the levels of three cytokines (IL-1 receptor agonist, macrophage inflammatory protein-1α, and platelet-derived growth factor-bb) 72 h after onset. Levels of some cytokines decreased to around control levels within 48 h after onset: IL-1β, IL-4, IL-5, IL-17, fibroblast growth factor, and interferon gamma. The levels of most cytokines appeared to be higher in AE, especially in hemorrhagic shock encephalopathy syndrome, than in FS. Conclusions Cytokine levels in both AE and FS change dynamically, such as the levels of several cytokines increased within a few hours after onset and decreased at 12–24 h after onset. Therefore, it will be desirable to make clinical decisions regarding the administration of anti-inflammatory therapy in 24 h after onset in AE.

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Early risk factors for mortality in children with seizure and/or impaired consciousness accompanied by fever without known etiology

Abstract: Elevation of AST within 6 h of onset is independently correlated with mortality in children with SICF. Our result may elucidate earlier intervention for patients with high risk of mortality.

Cited by 5 publications

References 28 publications

Pediatric Encephalopathy and Complex Febrile Seizures

Pediatric Encephalopathy and Complex Febrile Seizures

Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology

Time course of serum cytokine level changes within 72 h after onset in children with acute encephalopathy and febrile seizures

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Early risk factors for mortality in children with seizure and/or impaired consciousness accompanied by fever without known etiology

Abstract: Elevation of AST within 6 h of onset is independently correlated with mortality in children with SICF. Our result may elucidate earlier intervention for patients with high risk of mortality.

Cited by 5 publications

References 28 publications

Pediatric Encephalopathy and Complex Febrile Seizures

Pediatric Encephalopathy and Complex Febrile Seizures

Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology

Time course of serum cytokine level changes within 72 h after onset in children with acute encephalopathy and febrile seizures

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Abstract: Elevation of AST within 6 h of onset is independently correlated with mortality in children with SICF. Our result may elucidate earlier intervention for patients with high risk of mortality.