Febrile seizures in children between 6 months and less than 5 years

doi:10.21203/rs.3.rs-5070629/v1

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Febrile seizures in children between 6 months and less than 5 years

https://doi.org/10.21203/rs.3.rs-5070629/v1

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Background: A study of the relative prevalence of a common complaint such as febrile seizures, in which a large number of patients are referred to the ambulance department annually.

Methods and materials: Data were collected through clinical history, detailed medical examination, and necessary investigations such as CT, lumbar puncture, and others.

Results: (URI) was the most common foci of infection causing febrile seizure (60.4%), followed by Gastroenteritis (GE) which was (18.8%), while pneumonia was the least common (2.9%) of all cases, also a weak inverse relationship was observed between the patient's age and the duration of the febrile seizure, where the median duration of the febrile seizure was higher in age (24 months or less) which was 9.1 minutes compared to age (more than 24 months) which was 6.2 minutes, with statistical significant (P=0.0018), and a weak direct relationship was observed between the temperature during convulsion and the duration of the febrile seizure, as the median duration of the febrile seizure was higher at a temperature (more than 39 C), reaching 8.3 minutes, compared to a temperature (38-39 C), which reached 7.8 minutes, without statistical significant (P=0.32).

Pediatrics

Febrile

Seizures

Children

Hospital

6 months

5 years

The most common type of seizures, known as febrile seizures (FSs), affects 2–5% of children under the age of five, with a peak incidence at 24 months of age [1]. FSs affect one in 20 to 50 children, making them the most common type of seizures [2]. The International League Against Epilepsy (ILAE) defines febrile seizures as those affecting children aged six months to five years who were previously fever-free and experienced seizures associated with a febrile illness without a known cause (such as a nervous system infection, metabolic disorder, trauma, or poisoning. [3]

The National Institutes of Health (NIH) previously recommended an earlier age limit, but the minimum age in the ILAE definition is lower. According to the NIH Consensus Conference, febrile seizures are a condition typically affecting children aged three months to five years and are accompanied by fever but lack any indication of intracranial infection or a known cause. [1,6]

Febrile seizures are classified based on the duration and frequency of the seizures [7,8]. Simple febrile seizures, which usually last 15 minutes, are caused by a specific infectious illness, such as a respiratory or gastrointestinal infection [9], and more than one seizure can occur during each febrile episode, with a duration ranging from 15 to 30 minutes. [10]

The term febrile status epilepticus (FSE) is usually used to describe seizures lasting more than 30 minutes, and although FSE represents a very small portion of FSs, it accounts for 25–52% of all seizure cases in children. [11,12]

The data were collected through the clinical history, conducting a detailed medical examination, and performing necessary investigations such as a CT scan, lumbar puncture, and others at Damascus Hospital during the year 2023.

Inclusion and Exclusion Criteria:

Inclusion Criteria:

Children aged 6 months to 5 years with normal neurological development who were diagnosed with febrile seizures.

Exclusion Criteria:

Seizures due to a central nervous system infection, metabolic cause, or any lesion or disease in the central nervous system.

Children with a history of seizures during the neonatal period.

Statistical Analyses:

The data were extracted from the forms into an Excel file, and basic statistical analyses were performed, the statistical program SPSS-26 was used, and a predictive value of less than 0.05 (p.value < 0.05) was considered statistically significant.

Descriptive statistics were reviewed based on percentages and graphical representations, in addition to central tendency measures (mean and standard deviation). To test statistical relationships between baseline characteristics, we used the following statistical methods, Chi-square test to compare categorical variables with a normal distribution., One-way analysis of variance (ANOVA) to compare the means of quantitative variables.

Distribution of Cases by Gender

The study included 101 pediatric patients aged 6 months to 5 years with normal neurological development who were diagnosed with febrile seizures. It was observed that males had a higher prevalence of febrile seizures compared to females, accounting for 62.4% of the total study population.

Distribution of Patients by Age Groups

The ages of the study patients ranged from 7 months to 5 years, with a mean age of 26.2 months. The majority of patients were in the age group of 12.1–24 months, accounting for 45.5%, followed by the 24.1–36 months’ age group, representing 20.8%. The least common age group was 48.1–50 months, comprising 7.9% of the total cases.

Distribution by Seizure Type Observed

All patients experienced febrile seizures of the tonic-clonic type, accounting for 100% of the cases, while other types of seizures were absent in the study population.

Distribution of Cases by Generalized or Focal Seizures

Febrile seizures were generalized in the majority of patients, accounting for 99.1% of the cases, while focal seizures were observed in only one case, representing 0.9% of the total.

Distribution by Seizure Duration

The duration of febrile seizures among patients ranged from 2 to 30 minutes, with an average of 7.9 minutes. The maximum duration recorded was 30 minutes in an 18-month-old child suffering from viral pharyngitis, who experienced a generalized tonic-clonic seizure and underwent a lumbar puncture with normal results. In most cases (56.4%), the seizure duration was between 5.1 and 15 minutes, while seizures lasting more than 15 minutes were the least common, accounting for 0.99% of the total cases.

Distribution by Seizure Frequency

Recurrent seizures were observed in 6 cases, accounting for 5.9% of the total cases. The number of recurrent seizures ranged from 2 to 3 times, with an average frequency of 2 to 3 seizures.

Distribution by Patient Temperature During Febrile Seizures

The temperature of patients during febrile seizures ranged from 38 to 40.1°C, with an average of 38.9°C. Most patients had a temperature between 38.6 and 39°C, accounting for 46.5% of cases. This was followed by temperatures between 39.1 and 39.6°C, representing 28.7%. Temperatures above 39.6°C were the least common, occurring in 3.9% of the total cases.

Distribution of Cases by Presence of Fever Before Seizure

Fever prior to the seizure was present in 42 cases, accounting for 41.6% of the total cases. The temperature in these cases ranged from 38 to 38.7°C, with an average of 38.3°C.

Distribution of Cases by Infectious Focus Causing the Seizure

Upper respiratory infection (URI) was the most common infectious focus causing febrile seizures, accounting for 60.4% of cases. This was followed by gastroenteritis (GE) at 18.8%. Pneumonia was the least common, representing 2.9% of the total cases.

Distribution of Cases by Patient History

A positive family history of febrile seizures was present in 23.8% of the cases. Prior febrile seizures were reported in 14.9% of patients, while 85.1% of the cases were experiencing febrile seizures for the first time.

Relationship Between Patient Gender and Seizure Duration

The average duration of febrile seizures was longer in males, at 8.3 minutes, compared to 7.3 minutes in females. However, this difference was not statistically significant.

Relationship Between Patient Age and Seizure Duration

A weak inverse relationship was observed between patient age and the duration of febrile seizures. The average duration of febrile seizures was longer in patients aged 24 months or younger, at 9.1 minutes, compared to 6.2 minutes in patients older than 24 months. This difference was statistically significant.

Relationship Between Temperature During Seizure and Duration

A weak positive relationship was observed between the temperature during the seizure and the duration of febrile seizures. The average duration of febrile seizures was longer at temperatures above 39°C, at 8.3 minutes, compared to 7.8 minutes at temperatures between 38°C and 39°C. However, this difference was not statistically significant.

Relationship Between Patient Gender and Seizure Recurrence

The incidence of recurrent seizures was higher in males, at 7.9%, compared to 2.6% in females. However, this difference was not statistically significant.

Relationship Between Temperature Severity and Seizure Recurrence

The incidence of recurrent seizures was higher at temperatures above 38.5°C, at 6.3%, compared to 4.8% at temperatures equal to or below 38.5°C. Additionally, the average temperature in cases without recurrence was slightly higher, at 38.9°C, compared to 38.8°C in cases with recurrence.

Upper respiratory infection (URI) was the most common infectious focus causing febrile seizures, accounting for 60.4% of cases. Gastroenteritis (GE) followed at 18.8%. Pneumonia was the least common, representing 2.9% of the total cases.

The average duration of febrile seizures was longer in males, at 8.3 minutes, compared to 7.3 minutes in females, with no statistically significant difference. A weak inverse relationship was observed between patient age and the duration of febrile seizures. The average duration was longer in patients aged 24 months or younger, at 9.1 minutes, compared to those older than 24 months, at 6.2 minutes, with a statistically significant difference.

A weak positive relationship was noted between the temperature during the seizure and its duration. The average duration of febrile seizures was longer at temperatures above 39°C, at 8.3 minutes, compared to temperatures between 38°C and 39°C, at 7.8 minutes, with no statistically significant difference.

The study protocol was approved by the Research Ethics Committee of Al-Sham Private University and the relevant ethics committees of Al-Sham Private University, and all procedures performed in the studies involving the participant and subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethics approval and consent to participate

Ethical approval was obtained from the hospital's systematic review board.

Consent for publication:

Not applicable.

Availability of data and materials:

All data produced in the present work are contained in the manuscript

Convict of interest:

The authors declare that they have no convict of interest.

Funding:

This research received no speciﬁc grant from ASPU or any other funding agency in the public, commercial or non-profit sectors.

Acknowledgments:

We are thankful to the management of AL-Sham Private University and Damascus Hospital for their support in the eld of medical training and research.

Millichap JG. The definition of febrile seizures. In: Febrile Seizures, Nelson KB, Ellenberg JH (Eds), Raven Press, New York 1981.
Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51:676.
Subcommittee on Febrile Seizures, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011; 127:389.
Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976; 295:1029.
Hesdorffer DC, Benn EK, Bagiella E, et al. Distribution of febrile seizure duration and associations with development. Ann Neurol 2011; 70:93.
Berg AT, Shinnar S. Complex febrile seizures. Epilepsia 1996; 37:126.
Millichap JG. Febrile Convulsions, Macmillan, New York 1968.
MILLICHAP JG. Studies in febrile seizures. I. Height of body temperature as a measure of the febrile-seizure threshold. Pediatrics 1959; 23:76.
MILLICHAP JG, MADSEN JA, ALEDORT LM. Studies in febrile seizures. V. Clinical and electroencephalographic study in unselected patients. Neurology 1960; 10:643.
Berg AT, Shinnar S, Shapiro ED, et al. Risk factors for a first febrile seizure: a matched case- control study. Epilepsia 1995; 36:334.

The authors declare no competing interests.

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Version 1

posted

You are reading this latest preprint version

Febrile seizures in children between 6 months and less than 5 years

Status:

Version 1

Abstract

Introduction

Methods and materials

Inclusion and Exclusion Criteria:

Inclusion Criteria:

Exclusion Criteria:

Statistical Analyses:

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1