Razi Journal of Medical Sciences

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Seizure due to fever is very common during childhood. It can simply be associated with fever without a focus for infection or can be the presenting sign of localized infections, including central nervous system infections. It is difficult to exclude meningitis merely on the basis of physical findings in children with febrile seizure under the age of 18 months. So, performing a lumbar puncture(LP) is a valuable diagnostic procedure in this group. However, despite many clinical studies in this regard, there is still controversy over doing LP. This cross-sectional retrospective study was undertaken to evaluate files of 245 patients with febrile seizure who were between 5 months and 6 years of age and were admitted to the pediatric ward of Hazrat Rasoul Hospital over a period of 5 years(1997-2002). The objective was to study children with febrile seizure to determine the necessity of performing LP in this group. Of 254 patients with mean age of 28.5±18.3 months, 206(84%) had simple febrile seizures, while 39(16%) presented with complex febrile seizure. Analysis of CSF in 9(3.6%) patients were compatible with meningitis. 4 out of 9 patients had bacterial meningitis. Mean age of children with meningitis was 13±4 months. All children with febrile seizure and underlying meningitis were under the age of 18 months and this was their first episode of febrile seizure and none of them had clinical signs of meningitis. In those with meningitis 56.6% had complex febrile seizure. 3(75%) children with bacterial meningitis and 2(40%) of those with aseptic meningitis had complex febrile seizures. Chi2 test results showed a significant relation(Pvalue<0.05) either between type of seizure and incidence of meningitis or type of seizure and incidence of bacterial meningitis. According to this study, meningitis was not a common finding in children with febrile seizure. However, we recommend performing LP in all children with febrile seizure under the age of 18 months. Meningitis should especially be excluded in children with complex febrile seizure.

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In a cross-sectional retrospective study, management of patients with febrile seizure admitted to pediatric ward of Hazrat Rasoul Hospital was evaluated over 1.5 years (Dec. 2002 and Jun. 2004). The objective of this study was to determine whether practice parameters recommended by American Academy of Pediatrics(AAP) have been applied to the management of patients with febrile seizure. The files of 83 patients aged between 6 months and 5 years were reviewed. There were 16(19.2%) patients with complex febrile seizure and 67(80.7%) with simple febrile seizure. Complete blood count(CBC), blood glucose, serum calcium and serum electrolytes were performed for all patients. Lumbar puncture was done in 85%, electroencephalography(EEG) in 33% and CT-scan in 22% of patients. The average length of stay was 3 days. The present study showed that the use of unnecessary investigations such as laboratory & radiologic tests is common, causes significant expense and has little diagnostic value. As a result, investigation should be performed only where there is specific indication regarding patient’s condition and medical history based on practice guidelines suggested by AAP.

Ke

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Background: Febrile seizures (FS) occur in 5% of children with 6 to 60 months ages. Many investigations are being performed, one of them is EEG. This study was done to determine EEG in recurrent simple and complex febrile seizures.

Methods: In this descriptive, cross sectional study, we evaluated 86 patients with recurrent and complex febrile seizure admitted to neurology ward in Ali-Asghar training children hospital between 2008 and 2012. Data were recorded on age, gender, type of seizure (focal, generalized), and family history of febrile seizure, epilepsy, and EEG results.

Results: Eighty six patients had EEG. Mean (SD) age was 24.27±15.28 months. Forty three (50%) cases were 6-18 month of age. Fifty three (62%) cases were male. Thirty three (38.5%) patients had recurrent simple FS and 53 (61.5%) had complex FS. Twenty nine (37.7%) cases had family history of FS and 13(15%) cases had family history of epilepsy. Thirty six percent of cases had abnormal EEGs. Abnormal finding included slow waves (14%), sharp waves (16%) and spike waves (6%). There was significant relation between abnormal EEGs and age (p=0.04), though no meaningful relation with gender, type of seizures and family history of FS or epilepsy.

Conclusion: Seizures during a febrile illness are common in children under 5 years of age. Due to changes in EEG in children with simple, complex, and recurrent FS, performing EEG in these cases is recommended.