Demographic and clinical characteristics of patients diagnosed with febrile seizures

ABSTRACT Demographic and Clinical Characteristics of Patients Diagnosed with Febrile Seizures Objective: The most common age-related, benign seizures that occur with fever in childhood are febrile seizures. In infancy and early childhood (in children between six months and five years of age), the type of seizure accompanied by fever, without any disease in the central nervous system and electrolyte irregularity, is defined as febrile seizure (Shinnar etc., 2002).. It is more common in early childhood, when the seizure threshold is low, the tendency to infections is more frequent, and the fever response is more intense. It usually occurs within the first day of an infectious disease that progresses with fever. It is known to occur most frequently with viral infections. It has been determined that it is more common with human herpes simplex virus 6 infections and Shigella gastroenteritis (Mewasingh, 2014).. It is possible to divide it into two classes: simple and complex type. Simple type; It occurs as a generalized seizure and when the temperature is above 38°C, lasts less than 15 minutes, does not recur within 24 hours, and there may be a family history of febrile seizures. In the complicated type, seizures are focal, last longer than 15 minutes, and can recur more than once in 24 hours (Whelan etc., 2017). Studies with a large number of patients are needed to examine the clinical characteristics (duration, type) and causative infectious agents of patients presenting with febrile seizures, to inform the family about this issue, and to follow up the patients. In this study, it was planned to investigate the history and physical examination characteristics that are important in the diagnosis and follow-up of febrile seizures in childhood. In this study, the results were evaluated with a multidisciplinary team approach and it was aimed to contribute to the development of early diagnosis-prevention-intervention programs and to the literature. Materials and Methods: Our retrospective study was conducted at the Child Neurology Clinic of Health Sciences University Ankara Bilkent City Hospital. All patients who applied between December 2019 and December 2021 and had a history of febrile seizures were included in our study. Data required for the current study; After being systematically obtained from the database used in Ankara Bilkent City Hospital Child Health and Diseases hospital, the data obtained for each patient was recorded in the patient data tracking form. IBM Statistical Package for Social Sciences (SPSS), version 26.0 for Windows (SPSS Inc. Chicago, USA) computer package program was used for statistical analysis of the research data. Results: A total of 165 patients were included in the study. The mean age of the patients is 25.5±14.7 months, and the median is 22.0 (3.0-87.0) months. 10.9% of the patients are in the <12 months group, 43% are in the 12-24 months group, 36.4% are in the 24-48 months group, 9.7% are in the ≥ 48 months group and 58.2% 41.8% are boys and 41.8% are girls. BFC was observed in 49.7% of the patients, CFC was observed in 47.3%, and status was observed in 3%. When the cause of fever was evaluated, URTI was observed in 87.3% of the patients, LRTI was observed in 1.2%, UTI was observed in 6.1%, and AGE was observed in 5.5%. JTK type seizures were observed in 81.2% of the patients, focal type seizures in 4.2%, atonic type seizures in 13.3%, and myoclonic type seizures in 1.2%. Seizure duration was found to be <5 minutes in 78% of the patients, 5-30 minutes in 21.3%, and >30 minutes in 0.6%. The first seizure was observed in 58.2% of the patients and the second seizure was observed in 50.3%. Postictal time was found to be <5 minutes in 72.7% of the patients and 5-30 minutes in 27.3%. Recurrence was observed in 60.6% of the patients. The mean value of the number of seizures was 2.4±1.7; The median value is 2 (1-9). The total number of seizures of the patients was 1 in 39.4%, 2 in 21.2%, 3 in 20.6%, 4 in 6.1%, 5 in 5.5%, 3.6% in 3.6%. It is 6 in 1.8%, 7 in 1.2%, 8 in 1.2%, and 9 in 0.6%. When the total number of seizures was grouped, it was observed that 39.4% of the patients had 1 seizure, 41.8% of the patients had 2-3 seizures, and 18.8% of the patients had >3 seizures. 28% of the patients have a birth history, 17.7% have a consanguineous history, and 44.8% have a family history of febrile seizures (Figure 2). Positive neurological examination findings were detected in 18.8%. 31.5% of the patients use levatiracetam, 7.9% use valproate, and 0.6% use phenobarbital (Figure 3). MRI was performed in 42.4% of the patients and EEG was performed in 91.5%. A history of birth was detected in 21% of the patients in the BFK group and in 37.2% of the patients in the KFK group. The frequency of birth history in the CFC group was found to be significantly higher than in the BFK group (p<0.05). MRI was performed in 28% of the patients in the BFK group and in 55.1% of the patients in the CFC group. The frequency of MRI performed in patients in the CFC group was found to be significantly higher than in patients in the CFC group (p<0.05). Of the <12 months group, 44.4% had 1 seizure, 50% had 2-3 seizures, and 5.6% had 3> seizures. In the 12-24 months group, 46.5% had 1 seizure, 36.6% had 2-3 seizures, and 16.9% had 3> seizures. In the 24-48 months group, 31.7% had 1 seizure, 51.7% had 2-3 seizures, and 16.6% had >3 seizures. ≥ 31.3% of the 48-month group had 1 seizure, 18.7% had 2-3 seizures, and 50% had 3> seizures. There was a significant difference between the groups (p<0.05). The median age was 19 (4-60) months in patients without recurrence and 24 (3-87) months in patients with recurrence. Age values were significantly higher in the group with recurrence than in the group without recurrence (p<0.05). 33.8% of those without recurrence and 52% of those with recurrence have a family history. The frequency of family history was significantly higher in the group with recurrence than in the group without recurrence (p<0.05). Discussion-Conclusion: It has been observed that febrile seizures are more common in men and febrile seizures occur most frequently due to upper respiratory tract infections. The relationship of family history with recurrence has been shown as well as its relationship with the first febrile seizure. It is important to understand febrile seizures, which are one of the most common seizures of childhood, and to be well known by health care providers, to manage the patient, to avoid unnecessary examinations, and to inform parents about the prognosis after the seizure. When we look at the studies on febrile seizures, it is seen that retrospective studies are in the majority, and long-term prospective studies starting with healthy children are needed to reveal the risk factors and important factors in the occurrence of febrile seizures. Keywords: Febrile Convulsion, Seizure, Epilepsy, Risk Factors