Prophylactic Treatment with Valproic Acid or Diazepam in Children with Febrile Convulsions

ABSTRACT. The purpose of this study was to limit prophylactic treatment of children with febrile convulsions to patients who have the highest risk of recurrence. Two hundred and thirty-one children with a first febrile seizure were divided into high- and low-risk groups according to estimated risk of recurrence. All high-risk children were offered treatment with valproic acid. If this was declined they were offered treatment with diazepam instead. Low-risk children were untreated. Valproic acid and diazepam were found to be equally effective in reducing the risk of recurrence of febrile convulsions. By selecting for prophylactic treatment according to estimated risk of recurrence it is possible to reduce the rate of recurrence of febrile seizures in children at high-risk (60%) to the same level as that of untreated low-risk children (23%). Only about half of all children with febrile convulsions need treatment and follow-up according to these criteria.     

Pre- and Perinatal Factors in Febrile Convulsions

Forsgren, L., Sidenvall, R., Blomquist, H. K:son, Heijbel, J. and Nyström, L. (Departments of Neurology, Paediatrics and Epidemiology and Health Care Research, University Hospital, Umeå, Sweden). Acta Paediatr Scand 80: 218, 1991.
In a community based study, 110 children with febrile convulsions (FC) were identified prospectively. Pre- and perinatal risk factors were compared with 213 age and sex matched controls sampled from the community. During pregnancy, proteinuria and preeclampsia/eclampsia Occurred more often in mothers of cases. Premature birth and bilirubinemia ≥ 200 μmol/l were also more common in cases. There were no differences between cases and controls in Occurrence of chronic illnesses in mothers, parents age at birth, birth order, and factors occurring during delivery such as type of anesthesia, Occurrence of acute or elective cesarean section, use of vacuum extraction, mode of presentation, signs of fetal distress in amnion fluid, umbilical problems, abnormalities of fetal heart rate or duration of delivery. Perinatal asphyxia was uncommon and there was no difference between cases and referents. Occurrence of complications during the first neonatal week did not differ between groups.     

A Prospective Incidence Study of Febrile Convulsions

ABSTRACT. A prospective epidemiological study of febrile convulsions (FC) was performed during a 20-month period. 128 children with FCs were identified. The annual first attendance rate and annual incidence rate were 500/100 000 and 460/100 000 respectively, in the age group 0–4 years. The cumulative incidence was 4.1%. FCs were more common among boys, with a male to female ratio of 1.72 to 1. The median and mean age for first FC was for boys 16 and 19.9 months respectively, and for girls 18 and 19.7 months respectively. During an average follow-up period of 20 months, 18% had another FC and 10% had two or more FCs. 8.6% had an initial complicated FC. Four children had FCs within two weeks after being vaccinated by combined vaccine against morbilli, rubella and parotitis. Three of these had earlier had an FC.     

幼年大鼠反复热性惊厥脑损伤的研究

目的：观察反复热性惊厥在幼年大鼠引起的脑损伤。方法：65只16d 龄大鼠随机分为正常对照组、高热对照组和热性惊厥组,利用热水浴诱导惊厥模型。采用Morris水迷宫方法检测大鼠的空间学习记忆能力;采用尼氏染色、TUNEL染色和电镜方法观察神经元损伤情况。结果：热性惊厥组大鼠寻找平台潜伏期较正常对照组明显延长［(8.33±9.83) s vs (4.00±2.96) s］,差异有显著性(P<0.01);尼氏染色未见明显异常;TUNEL染色显示惊厥组大鼠海马区阳性细胞数较正常对照组和高热对照组增加(9.67±5.52 vs 5.08±4.12,9.67±5.52 vs 3.17±3.35),差异有显著性(P<0.05);电镜观察惊厥组大鼠可见线粒体肿胀、嵴模糊或断裂、空泡形成等。结论：在未成年大鼠,反复热性惊厥可引起脑损伤     

Increased Interleukin-1 (IL-1) Production from LPS-Stimulated Peripheral Blood Monocytes in Children with Febrile Convulsions

ABSTRACT. Peripheral blood mononuclear cells (MNC) from 27 children with a febrile convulsion were tested for production of interleukin-1 (IL-1) in culture. MNC stimulated with lipopolysaccharide (LPS) showed a significantly increased production of IL-1 when compared to MNC from children without convulsions but with bacterial infections ( p < 0.001), viral infections ( p < 0.005) or no infection ( p < 0.005). Children who had experienced a febrile convulsion were retested several months later; this time the IL-1 production from LPS-stimulated MNC was not different from controls. These results demonstrate that MNC at the time of febrile convulsions have increased sensitivity to LPS and possibly to other IL-1 inducers; the resulting enhanced IL-1 response from sensitized MNC may have a role in the pathogenesis of febrile convulsions.     

Aetiological Aspects of Febrile Convulsions: Pregnancy and Perinatal Factors

The birth histories of 132 patients admitted to hospital with convulsions in association with febrile illnesses are compared with those of 180 of their sibs. Patients experienced significantly more often threatened abortion, maternal medication during pregnancy, caesarean section, and moderately low birthweight. Male patients had a significant increase in fetal distress, and, in specified circumstances, in neonatal feeding difficulties. Female patients were born significantly more often to very young or elderly mothers. At least one significant factor was recorded in 61% of patients. It is concluded that an abnormal pregnancy or birth history predisposes to febrile convulsions.     

Neurological,Electroencephalographic, and Virological Findings in Febrile Children

Investigations were made of 78 febrile children, 53 with fits and 25 without fits. 53% of the children with fits had viral illnesses. Severe fits were commoner in these children than in those with negative viral findings. Permanent neurological damage and prolonged EEG abnormalities were found significantly more often in children with, than in those without, viral disease, whether or not fits had occurred. The long-term implications are discussed. In addition to viral agents already described as causing neurological complications, the following organisms were found in association with central nervous system disorder: adenovirus 7, respiratory syncytial virus, parainfluenza 2, and C. burnetii (Q fever).     

热性惊厥的治疗和预后

热性惊厥（FS）是小儿最常见的惊厥之一，绝大多数预后良好。多数学者认为，发热时间歇性应用地西泮能降低FS复发率，但不能改善患儿的远期预后；对复杂型FS或频繁FS使用间歇短程预防性治疗无效者，可长期日服抗癫痫药物预防发作；FS患儿若仅有脑电图（EEG）异常放电（临床没有FS复发或发生癫痫的危险因素），不能作为间歇或长期口服抗癫痫药的指征；FS与某些癫痫综合征存在遗传学联系，早期不易与婴儿严重肌阵挛癫痫鉴别，需长期随访。     

高热惊厥患儿血钾、钠、氯、钙、糖变化的意义

目的探讨高热惊厥(FC)患儿血钾、钠、氯、钙、糖的变化及其临床意义。方法采用自动生化测定仪测定41例FC患儿(FC组)、30例发热患儿(发热组)和30例正常儿(正常组)的血钾、钠、氯、钙、糖水平,并进行比较分析。结果FC组血钾、钙水平与发热组之间无明显差异,但均明显低于正常儿(F=5.965,3.048 P<0.01,0.05);FC组血钠明显低于发热组和正常组;血糖则明显高于后两组(F=22.329,22.203 P均<0.001);发热组与正常组血钠、糖均无明显差异;血氯在3组间均无明显差异(F=0.867 P>0.05)。结论小儿FC存在低钾、低钠、低钙和高血糖。在常规治疗时应注意纠正电解质紊乱和高血糖等,以减少FC的复发、减轻脑组织和其他重要脏器的损害。     

The Probable Mechanisms of Brain Damage and Epilepsy in Febrile Convulsions, Singapore- Syndrome and Reye's Syndrome

Current knowledge suggests integration of cerebral perfusion and metabolism as enabling normal neuronal function, and their pertubations explaining the brain damage of hypoxia, hypoglycaemia, hypoperfusion and status epilepticus. Similar mechanisms appear operative in the viral encephalopathies and cause psychomotor dysfunction and epilepsy. A transient inhibition of plasma membrane glucose transport is central to the understanding of the metabolic abnormalities of these encephalopathies, the ensuing cell energy crisis resulting from neuroglycopoenia being evidenced by electroencephalographic changes, lactic and ketoacidosis, hyperuricaemia and ionic aberrations. Failure of Na+ and Ca²⁺ pumps cause cerebral oedema and neuronal death respectively, the selective nature of the latter being due to α-adrenergic vasoconstriction. Management with hyperglycaemia-producing infusions and the judicious use of lactate and steroids can overcome the transport dysfunction and enable complete recovery. The temporal profile of the metabolic aberrations of febrile convulsions, which are the result of adaptation, provide a template supporting this mode of management of the severe encephalopathies.