Benign afebrile cluster convulsions with gastroenteritis: an observational study

Abstract

Backround: The occurrence of afebrile seizures in association with viral gastroenteritis, without dehydration or electrolyte imbalance, is virtually unknown outside Asia. They are reported to have a benign prognosis and not to require specific investigations or therapy. Methods:We report the occurrence of such afebrile convulsions in association with viral gastroenteritis without dehydration or electrolyte imbalance, over a 3-year period, in a cohort of 14 British children. Results:The children (5 males and 9 females, 10 Caucasians and 4 Asians) were aged 9 to 60 months (median 14.5 months). All 14 had a normal neurological examination and normal serum biochemistry. Twelve children had generalised seizures and 2 had, in addition, absence seizures. The number of seizures per child ranged from 1 to 8. Most convulsions were short with 85.7% of children having the longest seizure not longer than 4 minutes. The longest duration for a seizure was 10 minutes and occurred in 2 children. Convulsions did not recur after the first day in 10 children, 3 children had recurrences the second day and one child on the fourth day. No convulsions recurred after 4 days.Cerebrospinal fluid studies, computed tomography and electroencephalogram (EEG) were performed on two children who had prolonged seizures and the results were normal. No pathogenic bacteria were grown in any of the stools. Enzyme immunoassay detection of Rotavirus in the stools was positive in 7 of the 10 children where it was tested. All 14 children recovered spontaneously within a few days. On long-term follow of up to 31 months (median 16 months), none had further convulsions and all had normal development milestones. Conclusions:Afebrile seizures in association with viral gastroenteritis do also occur outside Asia. Recognition of this entity should lead to reassurance of the parents. As in previously published series, investigations such as lumbar puncture, neuroimaging and EEG are usually normal and may not be necessary in most cases. Likewise, published data indicate that long-term anticonvulsant therapy is not usually warranted and the prognosis seems to be reassuring.

Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus

“…13 Las convulsiones afebriles relacionadas con gastroenteritis por rotavirus se han considerado una entidad bien definida. 9,14 La definición de Komori 15 es la siguiente: 1. Convulsiones generalizadas tónico-clónicas de corta duración, que aparecen entre el primero y el quinto día en el curso de una gastroenteritis, generalmente en los meses de invierno, en niños de 6 meses y 3 años, antes sanos.…”

Crisis convulsivas afebriles en el contexto de una gastroenteritis aguda leve

“…Su mayor incidencia es entre los meses de diciembre a marzo 3,8 . Se caracterizan por afectar a niños sanos, sin diferencia entre sexos o con un ligero predominio femenino.…”

“…Característicamente, aparecen en salvas, pudiendo ocurrir entre una y 20 crisis; hasta el 50% de ellas se agrupan en las seis primeras horas y habitualmente se autolimitan tras 48 horas 2,3,8,13 . Son generalmente crisis de corta duración (habitualmente de menos de cinco minutos y es raro que se prolonguen más de diez minutos) 2,3,8,13,14 ; sin embargo, existen casos descritos de hasta 20 minutos de duración e incluso con estatus convulsivo 5,15 . Las crisis parainfecciosas asociadas a gastroenteritis precisan un mayor tiempo de evolución antes de aparecer, se agrupan en las primeras horas y son de menor duración que las asociadas a las infecciones respiratorias 5 .…”

“…-Buen pronóstico global. Es una entidad bien conocida en Asia, aunque poco documentada en otros continentes, lo que hace suponer que esté infradiagnosticada y quizá clasificada como crisis febriles atípicas o epilepsias parciales benignas de la infancia temprana 2,[6][7][8][9] …”

Redefining Outcome of First Seizures by Acute Illness

“…5 Retrospective analyses and case reports have shown that a subset of these seizures may be associated with diarrheal illness and that children who suffer a first seizure associated with a nonfebrile illness may have a lower risk of seizure recurrence compared with children with an unprovoked first seizure. 3,4,[6][7][8][9][10][11][12][13][14][15][16][17] However, prospective, systematically collected data are scarce in regard to the long-term prognosis of children with nonfebrileillness seizures, and few studies have included comprehensive viral testing on children with first-time seizures.…”