Iron Deficiency and Acute Seizures: Results from Children Living in Rural Kenya and a Meta-Analysis

Abstract

BackgroundThere are conflicting reports on whether iron deficiency changes susceptibility to seizures. We examined the hypothesis that iron deficiency is associated with an increased risk of acute seizures in children in a malaria endemic area.MethodsWe recruited 133 children, aged 3–156 months, who presented to a district hospital on the Kenyan coast with acute seizures and frequency-matched these to children of similar ages but without seizures. We defined iron deficiency according to the presence of malarial infection and evidence of inflammation. In patients with malaria, we defined iron deficiency as plasma ferritin<30µg/ml if plasma C-reactive protein (CRP) was<50mg/ml or ferritin<273µg/ml if CRP≥50mg/ml, and in those without malaria, as ferritin<12µg/ml if CRP<10mg/ml or ferritin<30µg/ml if CRP≥10mg/ml. In addition, we performed a meta-analysis of case-control studies published in English between January 1966 and December 2009 and available through PUBMED that have examined the relationship between iron deficiency and febrile seizures in children.ResultsIn our Kenyan case control study, cases and controls were similar, except more cases reported past seizures. Malaria was associated with two-thirds of all seizures. Eighty one (30.5%) children had iron deficiency. Iron deficiency was neither associated with an increased risk of acute seizures (45/133[33.8%] cases were iron deficient compared to 36/133[27.1%] controls, p = 0.230) nor status epilepticus and it did not affect seizure semiology. Similar results were obtained when children with malaria, known to cause acute symptomatic seizures in addition to febrile seizures were excluded. However, in a meta-analysis that combined all eight case-control studies that have examined the association between iron deficiency and acute/febrile seizures to-date, iron deficiency, described in 310/1,018(30.5%) cases and in 230/1,049(21.9%) controls, was associated with a significantly increased risk of seizures, weighted OR 1.79(95%CI 1.03–3.09).ConclusionsIron deficiency is not associated with an increased risk of all acute seizures in children but of febrile seizures. Further studies should examine mechanisms involved and the implications for public health.

STUDYING THE RELATION BETWEEN IRON DEFICIENCY ANEMIA & FEBRILE SEIZURES.

“…Regarding the presence of iron deficiency anemia in group A and group B, anemia was diagnosed in 72.0% of group A while in group B anemia was diagnosed in 50.0% there was statistical significant difference between group A and group B presence of iron deficiency anemia with OR of 2.57, 95% CI (0.90-7.34) .These results agree with Singh et al, who found that IDA was 1.9 times more common with patients of febrile convulsion this has also been reported by Idro et al, [17,18]. In Raju and Kumar Iron deficiency was found to be a significant risk factor for Febrile seizures in children of age group 6 months to 5 Years with (P value 0.0008) [9].…”

Is iron deficiency anaemia a risk factor for febrile seizure? A case control study

“…Daod et al Piscane et al and Fallah et al also found serum ferritin to be statistically correlating with febrile seizures. 13,19,27 Vaswani et al, Kumari et al among Indian studies have reported the same correlation between febrile seizures and serum ferritin levels. 17,20 In studies by Bidabadi et al, Yousefchaijan et al and Idro et al, patients did not show any statistical correlation between ferritin levels and febrile convulsions.…”

“…17,20 In studies by Bidabadi et al, Yousefchaijan et al and Idro et al, patients did not show any statistical correlation between ferritin levels and febrile convulsions. 20,22,28 Piscane et al also showed that IDA was 1.9 times more common with patients of febrile convulsion this has also been reported by Idro et al and Fallah et al 13,27,28 Numerous studies have addressed the association between iron deficiency anaemia and febrile seizure in children both in India and abroad. The results, however, have been controversial and even primary researches with high number of cases have failed to provide unequivocal results.…”

Efficacy of zinc sulfate supplement on febrile seizure recurrence prevention in children with normal serum zinc level: A randomised clinical trial

“…Exclusion criteria consisted of receiving a zinc combination or supplementation within the past 2 mo, central nervous system infections, history of previous febrile or afebrile seizure, neurodevelopmental delay, presence of any chronic systemic diseases (endocrine, cardiac, renal, metabolic, malignancy, rheumatologic, etc), iron deficiency, and iron deficiency anemia (anemia was defined as hemoglobin level of less than 10.5 g/dL in 18 mo to 2 y and less than 11.5 g/dL in 2 to 6 y and iron deficiency was defined as serum ferritin level of less than 12 ng/mL if CRP was negative or 1þ, ferritin level of less than 30 ng/mL if CRP was !2þ, or serum iron levels of less than 22 mg/dL) [12].…”