Benign Convulsions with Mild Gastroenteritis

Abstract

Benign convulsions with mild gastroenteritis (CwG) are a well-known type of benign seizures that occur in infants and children aged between 6 months and 3 years and are associated with acute (viral) gastroenteritis. The pathogens found in the stool of CwG patients are mostly rotavirus or norovirus, which can result in mild dehydration. Short-lasting seizures (≤5 minutes) occur in clusters within 24 hours, without provoking features such as fever, abnormal laboratory findings in the blood (e.g., hypoglycemia, hyponatremia, or hypocalcemia), or abnormal results in the cerebrospinal fluid (e.g., central nervous system infection). Electroencephalography in CwG patients shows normal or mildly abnormal findings, and brain imaging findings are normal. Affected children develop normally before and after the seizures. The occurrence of seizures does not require the repeated use of first-or second-line intravenous antiepileptic drugs in the acute stage or daily antiepileptic drug medications, since they usually do not recur and have a good prognosis. Patients with CwG rarely have a family history of epilepsy. Although the mean interval between enteric symptom onset and seizure onset in CwG is roughly 2 days, some patients can experience seizures before enteric symptoms, meaning that clinicians should exercise caution during early winter and spring, when the prevalence of CwG is especially high. Additionally, reports of CwG in Korea are roughly as common as in Japan and other East Asian countries, and pediatricians should therefore be familiar with its clinical characteristics and take care not to overprescribe antiepileptic drugs in patients with CwG.

Increasing our understanding of rotavirus-induced central nervous system manifestations

“…6) CwG is the most commonly encountered CNS complication, occurring in previously healthy infants and children aged 6 months to 3 years. 7) It is characterized by afebrile brief tonicclonic seizures between the 1st and 5th sick days of gastroenteritis, tending to occur repetitively over several days. However, the findings of interictal electroencephalography, cerebrospinal fluid (CSF), and brain magnetic resonance imaging (MRI) examina tions are mostly normal.…”

“…1,7) Despite clustered seizures, longterm antiseizure medication is usually not required because of the good prognosis. 7) In addition to CwG, diverse clinicoradiological features related to rotavirus infection in the brain have been re ported, as various brain MRI protocols, such as fluid attenuated inversion recovery and diffusionweighted imaging, have been widely and early applied in clinical settings. 5) Rotavirusinduced CNS complications primarily involve acute encephalopathy with transient and reversible changes rather than acute encephalitis with destructive lesions on MRI.…”

“…CwG is the most commonly encountered CNS complication, occurring in previously healthy infants and children aged 6 months to 3 years [ 7 ]. It is characterized by afebrile brief tonic-clonic seizures between the 1st and 5th sick days of gastroenteritis, tending to occur repetitively over several days.…”

“…It is characterized by afebrile brief tonic-clonic seizures between the 1st and 5th sick days of gastroenteritis, tending to occur repetitively over several days. However, the findings of interictal electroencephalography, cerebrospinal fluid (CSF), and brain magnetic resonance imaging (MRI) examinations are mostly normal [ 1 , 7 ]. Despite clustered seizures, long-term anti-seizure medication is usually not required because of the good prognosis [ 7 ].…”

Frequency of Hypocalcaemia among Children (Age 2-60 Months) Presenting with First Episode of Afebrile Seizures: A Cross Sectional Study

“…There is no need to start anticonvulsions drugs after the first episode of afebrile seizures [6]. Viral gastroenteritis is a well-known cause of afebrile seizures and it is becoming a separate entity [7]. One of the cause of afebrile seizure is hypocalcemia [8].…”