Investigating the incidence of febrile convulsions before and after the COVID-19 pandemic

Febrile convulsion (FC) is the most common type of convulsion observed in children, with an incidence rate of 2-5%. In a child aged 6-60 months with no history of febrile seizures and without signs of intoxication, acute metabolic disorder, or electrolyte imbalance, other than a central nervous system infection, a seizure triggered by fever is defined as febrile convulsion. It typically occurs within the first 24 hours of fever, often associated with viral infections of the upper respiratory tract. On March 11, 2020, the World Health Organization declared the COVID-19 pandemic, with the first case in Turkey reported on the same date. Various infection control measures, such as physical or social distancing rules, mask usage, individual and environmental hygiene measures, and vaccination campaigns, were implemented to prevent the spread of the SARS-CoV-2 virus transmitted through respiratory droplets. With this study, we aimed to determine how the measures taken to prevent the spread of the disease during the COVID-19 pandemic affected the frequency of emergency department visits due to febrile convulsions and to identify changes in the characteristics of patients diagnosed with febrile convulsions before and during the pandemic. Patients who presented to the Akdeniz University Pediatric Emergency Department and were followed up with a diagnosis of febrile convulsion between March 11, 2018, and March 10, 2022, were retrospectively reviewed. The period from March 11, 2018, to March 10, 2020, was defined as the "pre-pandemic period," and the period from March 11, 2020, to March 10, 2022, was defined as the "pandemic period." A total of 259 admissions from 223 patients in the pre-pandemic period and 126 admissions from 119 patients during the pandemic period were examined. The total number of pediatric emergency department visits, which was 85,403 in the pre-pandemic period, decreased by 38.3% to 52,756 during the pandemic period. The number of pediatric emergency department visits associated with FC, which was 259 in the pre-pandemic period, decreased by 51.4% to 126 during the pandemic period. The ratio of emergency department visits followed by FC diagnosis to the total pediatric emergency department visits during the same period was 0.30% (259/85,403) in the pre-pandemic period and 0.23% (126/52,756) during the pandemic period. There were no statistically significant differences between the two periods in terms of gender, demographic characteristics, previous history of FC, family history of seizures, season of seizure occurrence, time of seizure, age at presentation, reason for presentation, method of seizure termination, fever-seizure interval, fever focus, anemia, treatment recommendation at discharge, FC recurrence during follow-up, and conversion to epilepsy rate during follow-up. Although the fever value at presentation was lower during the pandemic period, there was no significant difference in peak fever values. While no significant difference was observed in terms of seizure duration, seizure recurrence within 24 hours, or localization between the two periods, it was observed that the rate of complicated FC significantly increased during the pandemic period compared to the pre-pandemic period. There was no significant difference between the two periods in terms of imaging studies (MR, TFUS, and EEG) performed in the emergency department, but an increase in the rate of CT scans and lumbar punctures (LP) was observed during the pandemic period compared to the pre-pandemic period. There was a significant difference in the rate of neurology consultation and hospitalization between the pandemic and pre-pandemic periods. However, there was no significant difference in hospitalization durations. The rate of post-seizure neurology clinic follow-up increased during the pandemic period. In conclusion, considering the decrease in hospital admissions during the pandemic period, it is thought that adherence to isolation and hygiene rules after the pandemic may reduce the frequency of febrile convulsions in young children.