Volume 27, Issue 6 (8-2020)                   RJMS 2020, 27(6): 61-67 | Back to browse issues page

Research code: 5188
Ethics code: IR.IUMS.FMD.REC 1396.9411165016

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Tavasoli A, Farahi S F, Khosroshahi N, Fathi M. The survey of relationship between the first afebrile seizure and Iron deficiency anemia in 3 months to 16 years old children referring to the neurology clinic in Aliasghar children’s hospital during 2017-2019. RJMS. 2020; 27 (6) :61-67
URL: http://rjms.iums.ac.ir/article-1-5944-en.html
Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran , farahifaride@gmail.com
Abstract:   (743 Views)
Background: Seizure is a transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Seizures are described as sudden abnormal neuronal discharges that are clinically manifested by behavioral, autonomic, motor, and sensory disturbances. Seizure is the most common neurologic problem in children. On the other hands, the most common nutritional problem in developing countries is iron deficiency. Due to the high incidence of seizures in children and its role in causing mortality and morbidity in this age group, recognizing and controlling the factors affecting seizures can have a significant impact on reducing mortality and morbidity. After the first seizure of unknown origin in children the risk of recurrence is about 50% and after the second seizure of unknown origin, the risk of recurrence is 80% epilepsy may be diagnosed only after a child has had two or more seizures of unknown origin over a period of more than 24 hours. The term of unknown origin implies that there was no close association between seizures and disease, electrolyte disturbances, fever, or acute brain injury. On the other hand, the most common microelement deficiency is iron deficiency, which affects at least 1.3 percent of the worldchr('39')s population. The most common clinical manifestation of iron deficiency is anemia, but other organs may also be affected. The possibility of lowering the seizure threshold and increasing the risk of seizures by anemia has been investigated in many studies in patients with febrile seizures, but A few studies has pointed to association between iron deficiency and the first unprovoked seizure without fever. Also the results of these studies are controversial. The effects of iron deficiency in an evolving brain include: changes in the evolutionary mechanism of hippocampal neurons, impaired energy metabolism, delayed myelin maturation, decreased visual and auditory stimulus potentials, and changes in synaptic neurotransmitter systems including norepinephrine, dopamine , Glutamate, GABA (gamma aminobutyric acid) and serotonin, which can cause iron deficiency symptoms. The results of some studies have shown that iron deficiency may increase the seizure threshold because iron lipid peroxidation by the brain can lead to seizures. In addition, the uptake and release of dopamine, gamma-aminobutyric acid, and other neurotransmitters by cell membranes can be affected by iron. Therefore, the seizure threshold increases following iron deficiency. Iron deficiency anemia reduces the activity of excitatory neurotransmitters such as monoamine oxidase and aldehyde oxidase, resulting in neuronal stimulation and a lower risk of seizures. Research on the relationship between iron deficiency and seizures has shown conflicting results regarding iron status in children with febrile seizures and non-febrile seizures due to the high prevalence of iron deficiency anemia and Due to the effects of anemia and the possibility of its effect on the occurrence of seizures in children this study was carried out to determine the relation of iron deficiency anemia with first unprovoked seizure
Methods: This study is a case-control study. The study population included 172 children aged 3 months to 16 years old who referred to the neurology clinic of Hazrat Ali Asghar (AS) Childrenchr('39')s Educational and Medical Center in Tehran Sciences due to their first afebrile seizure during 2017-2019. Samples were divided into case and control groups based on the reason of hospitalization Control group included of 86 children (3month-16years old) referring for other causes to this center from 2017-2019. Non-febrile seizures based on clinical manifestations in the form of cyanosis, rotation of the head or eyes, clonic movements of the seizure in the face or limbs, a sensory disturbance such as paraesthesia or localized pain in a specific area, increased tone or stiffness, loose or decreased movements, stiffness and Rhythmic muscle relaxation is defined as a disorder or lack of consciousness without fever before and after a seizure. All selected cases were infants and children with non-febrile seizures for the first time in which there were no underlying problems.The children with fever or any type of chronic systemic disease (cardiac, renal, metabolic, confectious) and the children with the history of using drugs or blood iron transfusion for treatment of anemia were excluded. Cell blood count (CBC), Serum ferritin, iron and total iron binding capacity (TIBC) were measured in all of children. Iron deficiency anemia was diagnosed by the values of CBC, ferritin, serum iron and TIBC based on the Nelson text book of pediatrics.To analyze the data, descriptive analysis including statistical indices of frequency, frequency percentage, mean and standard deviation was used. Also for analytical analysis, demographic findings and mean hemoglobin and ferritin were compared between the control and case groups. Data were analyzed by chi-square and independent T-test and SPSS 22 software and the significance level was considered less than 0.05.
Results: From 172 participants, 73 (%42 ) were girls and 99 (%57) were boys, the average age in case  group was 6.4±3.75 years old, and in control group was 5.79 ±3.65 years old. From 86 patients with seizure 34 (%0.39) were girls and 52 (%0.60) were boys. In case group serum iron average was 55.1±28.4 µg/dl. Hb in 24 persons (%27.9) and ferritin in 14 persons (%16.3) was in the lower limits of normal. In the control group serum iron average was 51.8±25.79 µg/dl. Ferritin in 20 persons (%23.3) and Hb in persons (%27.9) was in the lower limits of normal. In the case group14 persons (%16.3) and in the control group 20 persons (%23.3) had iron deficiency anemia .the difference statistically was meaningless. (P value >0.05)
Conclusion: In this study, the prevalence of iron deficiency anemia in the group with the first febrile seizures of unknown origin was not higher than the group referring to other causes.There was no statistically significant differences between the first unprovoked seizure without fever and iron deficiency anemia in our study. However the more comprehensive studies should be done in this regard.
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Type of Study: Research | Subject: Pediatric Disease

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