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.     

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.     

Gamma-Aminobutyric Acid Concentration in Lumbar Cerebrospinal Fluid from Patients with Febrile Convulsions and Controls

ABSTRACT. The cerebrospinal fluid (CSF) concentration of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) was analysed in 41 children with febrile convulsions (FC), 41 febrile controls of similar age (control group 1), and 59 controls, who had no fever and/or were outside the age range for FC (control group 2). A significant correlation between CSF-GABA and age was demonstrated for controls (1 + 2) (r= 0.63, p < 0.00001), as well as for patients with FC (r= 0.42, p= 0.003). Patients with FC did not differ significantly from control group 1 in respect to CSF-GABA. Duration of FC was related to both CSF-GABA and age (GABA: r=−0.29, p < 0.05; age: r =−0.32, p < 0.05). For 56 controls (1 + 2) > 1 year of age, a significant negative correlation between CFC-GABA and body temperature was found (r=−0.34, p = 0.01). The low CSF-GABA in the FC-labile age group, the negative correlation of CSF-GABA to body temperature, and the negative correlation of the duration of FC to both CSF-GABA and age, all indicate that GABA could be of importance in the pathophysiology of FC.     

Proteinuria in Children with Febrile Illnesses

Transient proteinuria in the absence of underlying renal disease was detected in 11 of 198 children (5·6%) admitted to hospital with an acute febrile illness. Proteinuria was noted only in children whose fever was higher than 38·4 °C. Selectivity studies on the protein excreted showed patterns ranging from poorly to highly selective. Initial screening for proteinuria using a dipstick method revealed a high incidence of false positives, of which only about 30% could be confirmed by the sulphosalicylic acid method.The pathophysiology of transient proteinuria in febrile patients is not understood; a number of mechanisms are probably involved. Since fever was the only detected feature common to each of the patients with proteinuria, it seems unlikely that the specific aetiology of the fever is a factor of importance in the pathogenesis of the proteinuria.     

CSF Glucose Concentrations in Infants with Febrile Convulsions and the Possible Effect of Acetaminophen

The present study was done to explore the relationship between the cerebrospinal fluid (CSF) glucose concentration, body temperature, seizure duration, and acetaminophen administration. Retrospective record review of 117 consecutive febrile convulsive infants aging 3 to 18 months admitted to Bahrami Children Hospital were studied. There was a positive correlation between CSF glucose level and body temperature in those who had not taken acetaminophen before admission (r = 0.515, n = 83). CSF glucose levels were significantly higher (P = 0.014) in febrile children (75.33 mg/dL, n =70) as compared with afebrile children (66.16 mg/dL, n = 13). In those administered acetaminophen there was a negative correlation between the CSF glucose level and body temperature (r = - 0.389, P = 0.023, n = 34). CSF glucose concentration was not significantly different (P = 0.076) in those who had taken acetaminophen than those who had not taken. Type of febrile seizure, fever, convulsion duration and multiplicity were not significantly correlated with CSF glucose concentration.