The Child Who Convulses with Fever

Ouellette, Eileen M.

doi:10.1016/s0031-3955(16)33003-6

Cited by 57 publications

(16 citation statements)

References 51 publications

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“…Routine urinalyses are of little value in children with simple febrile seizures and need not be obtained unless indicated for other reasons (eg, in conjunction with a urine culture to identify the source of a fever of un¬ known origin). 5. Skull roentgenograms and EEGs are expensive procedures with very low yields when performed as part of the routine evaluation of children with simple febrile seizures.…”

Section: Recommendationsmentioning

confidence: 99%

The Child With a 'Simple' Febrile Seizure

Gerber¹,

Berliner²

1981

Am J Dis Child

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\s=b\ Febrile seizures are a common pediatric problem, yet there is a great deal of disagreement about the appropriate diagnostic evaluation of a child with this disorder. We reviewed the routine diagnostic tests performed on 100 consecutive children admitted with their first "simple" febrile seizure. The studies performed included lumbar puncture, measurement of blood glucose, serum calcium, serum electrolytes, and BUN levels, blood cell count, urinalysis, skull roentgenograms, and EEG. Though resulting in a significant expense, these routine investigations proved to be of little diagnostic value. Based on this experience and a review of the current literature, we concluded that diagnostic procedures should be performed only when specifically called for by the patient's condition or medical history. (Am J Dis Child 1981;135:431-433) Approximately 3% to 5% of all chil-11 dren will have experienced at least one febrile seizure by the time they enter school.'1 More than 80% of these febrile seizures may be classi¬ fied as "simple": a single, isolated seizure that occurs in a febrile child between 1 month and 7 years of age with no sign of acute neurological disease, lasting 15 minutes or less, and without focal features.' As shown by a recent nationwide survey of pediatricians, there is a great deal of disagreement about the appropriate diagnostic evaluation of children with first febrile seizures.4 Some have recommended that lumbar punctures be performed routinely, along with determinations of blood glucose, serum calcium and phospho¬ rous, electrolyte, and BUN levels. Additionally, blood cell count, urinalysis, skull roentgenograms, and EEG are often routinely performed/'" Re¬ cently, however, the value of these investigations has been seriously questioned.7 * Much of this confusion is attributable to the lack of informa¬ tion on the yield of commonly per¬ formed diagnostic procedures, and perhaps to the failure to distinguish between simple and complex febrile seizures. Lumbar punctures are often per¬ formed on children with febrile sei¬ zures to exclude meningitis as the cause of the seizure. Thirteen percent to 18% of the children with meningitis may initially appear with a febrile seizure, and approximately 40% of these children may have no clinical signs of meningeal irritation." "' The majority of these children without clinical evidence of meningitis were, however, younger than 2 years of age, and a careful differentiation of simple and complex febrile seizures was not attempted by the authors of these reports. Many believe that a history of previous febrile seizures or the iden¬ tification of a potential source of fe¬ ver outside of the CNS preclude the necessity for a lumbar puncture in a child with a febrile seizure. However, a significant number of children with febrile seizures who are diagnosed as having meningitis have a history of previous febrile seizures or a potential source of fever outside of the CNS.!M" Wolf et al reviewed 308 lumbar punctures performed on children with their first febrile...

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Section: Recommendationsmentioning

confidence: 99%

The Child With a 'Simple' Febrile Seizure

Gerber¹,

Berliner²

1981

Am J Dis Child

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“…Febrile seizures are the commonest cause of seizures in early childhood and present before 3 years of age in more than 80% of patients. 21,22 A family history of seizures, usually febrile seizures, is observed in 30% to 50% of cases. 23 A study of 64 samesex twins with febrile seizures, however, suggested that nongenetic factors might play an important role in the pathophysiology of febrile seizures.…”

mentioning

confidence: 99%

Case-Control Study of Primary Human Herpesvirus 6 Infection in Children With Febrile Seizures

Hukin

Farrell²,

MacWilliam

et al. 1998

PEDIATRICS

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ABSTRACT. Rationale. Human herpesvirus 6 (HHV-6) has been demonstrated to be the causative agent in roseola infantum. It has been suggested that HHV-6 may have neurotropic properties and be involved in the pathogenesis of febrile seizures in infants. We describe a case-control study to examine the hypothesis that acute HHV-6 infection occurs more commonly in children with febrile seizures than in controls.Methods. Patients presenting with a first or second febrile seizure between 6 months and 2 years of age were entered in the study. Control patients did not have a seizure but had similar inclusion and exclusion criteria. Specimens were obtained for HHV-6 viral serology and polymerase chain reaction in the acute stage and approximately 2 weeks later. A diagnosis of HHV-6 infection was based on HHV-6-specific IgM and IgG serology and HHV-6 polymerase chain reaction of peripheral blood mononuclear cells and saliva.Results. Eighty-six patients (45 with febrile seizures; 41 controls) were enrolled. The HHV-6 infection status could be determined in only 68 patients (35 with febrile seizures; 33 controls). Acute HHV-6 infection was identified in 15 of 35 febrile seizure patients and in 15 of 33 controls. Evidence of past HHV-6 infection was demonstrated in 13 febrile seizure patients and in 8 controls.Conclusions. The incidence of primary HHV-6 infection is similar in patients with febrile seizures and agematched controls. HHV-6 does not seem to be a major factor in the pathogenesis of first and second febrile seizures. Pediatrics 1998;101(2). URL: http://www. pediatrics.org/cgi/content/full/101/2/e3; human herpesvirus 6, febrile seizures, case-control.ABBREVIATIONS. HHV-6, human herpesvirus 6; RI, roseola infantum; CSF, cerebrospinal fluid; PCR, polymerase chain reaction; PBMN, peripheral blood mononuclear cells; HSV, herpes simplex virus; CMV, cytomegalovirus; EBV, Epstein-Barr virus; ELISA, enzyme-linked immunosorbent assay; IFA, immunofluorescent assay. H uman herpesvirus 6 (HHV-6), a lymphotropic virus, is the causative agent of roseola infantum (RI).1,2 HHV-6 infection is more often associated with a nonspecific febrile illness between 6 months and 2 years of life.3 Seroprevalence studies in Japan, England, and the United States demonstrate that infection with HHV-6 is common.4 -6 HHV-6-specific IgG can be detected in almost all newborns, but the prevalence declines to less than 10% by 4 to 5 months of age, presumably as maternal antibody wanes. 4 The seroprevalence increases to 65% by 1 year of age 6 and to greater than 90% by 13 to 36 months of age. 4,6,7 Accumulating clinical and laboratory evidence suggests that HHV-6, like all other herpesviruses, may have neurotropic properties. RI may be complicated by seizures, encephalopathy, aseptic meningitis, meningoencephalitis, and hemiplegia. Febrile seizures are the commonest cause of seizures in early childhood and present before 3 years of age in more than 80% of patients. 21,22 A family history of seizures, usually febrile seizures, is observed in 30% to 50% o...

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“…La crisis febril predominó, hallazgo también esperado (Relación 1,5:1 a favor de los niños), en el género masculino (59,9%) y en prematuros (45,3%), como consecuencia de la más lenta maduración del sistema nervioso (18,23,24) central en niños de este género y edad . El antecedente familiar (en primer grado) en este estudio parece tener poca importancia en niños con crisis febril, pues menos de 15% de los parientes refirieron presentar esta patología en su infancia, a pesar de ser considerada un trastorno genético (herencia dominante con penetrancia reducida o herencia poligénica), al punto de ser mayor en padres (se registran antecedentes entre 24-40%) y hermanos (se registran antecedentes entre 10-20%, e incluso hasta 80% en gemelos univitelinos) de los niños afectados.…”

Section: Discussionunclassified

“…Respecto al tratamiento anticonvulsivante de la crisis este se aplicó a 56,5% de los niños afectados, pero en ninguno se instauró el tratamiento de mantenimiento, a pesar de la amplia aceptación que se tiene de este como profiláctico sobre la repetición de las crisis febriles, porque, exclusivamente un tercio de los niños así tratados repetirán episodios posteriores, se cree que la negativa a la instauración sean los conocidos efectos adversos del uso crónico de dichas drogas y la experticia del galeno ante la particularidad de cada caso respecto a la consideración del riesgo de recurrencia y de desarrollo de secuelas en crisis (17,(31)(32)(33)(34) futuras , pero de ninguna manera debe ignorarse que la presencia de al menos dos de los siguientes antecedentes sí justifica fehacientemente el establecimiento de la terapia de mantenimiento; el inicio de la crisis durante el primer año de vida, las alteraciones en el examen neurológico y/o del desarrollo psicomotor, crisis prolongadas o atípicas, convulsiones previas con o sin fiebre y antecedentes de (15,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) convulsiones a febriles en los padres o hermanos .…”

Section: Discussionunclassified