Management of Pediatric Febrile Seizures

Animal models contribute greatly to our understanding of brain development and function as well as its dysfunction in neurological diseases. Epilepsy research is a very good example of how animal models can provide us with a mechanistic understanding of the genes, molecules, and pathophysiological processes involved in disease. Over the course of the last two decades, zebrafish came in as a new player in epilepsy research, with an expanding number of laboratories using this animal to understand epilepsy and to discover new strategies for preventing seizures. Yet, zebrafish as a model offers a lot more for epilepsy research. In this viewpoint, we aim to highlight some key contributions of zebrafish to epilepsy research, and we want to emphasize the great untapped potential of this animal model for expanding these contributions. We hope that our suggestions will trigger further discussions between clinicians and researchers with a common goal to understand and cure epilepsy.

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“…Febrile seizures often occur in children and are symptomatically treated by the administration of antiseizure drugs [59] (Fig. 1).…”

Section: Febrile Seizuresmentioning

confidence: 99%

Past, present and future of zebrafish in epilepsy research

et al. 2021

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“…This study enrolled children with SFS if they met the following conditions: (i) diagnosed with SFS on the basis of the criteria defined by the American Academic of Pediatrics (4,26); (ii) children with gestational age ≥37 weeks; (iii) no history of brain injury, head trauma, and central nervous system infections; and (iv) a time interval between seizure onset and MRI scan of <15 days. The exclusion criteria were as follows: (i) incomplete clinical information on course after seizure onset;…”

Section: Participantsmentioning

confidence: 99%

Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy

Salimeen

Liu

et al. 2021

Front. Neurol.

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Background: Simple febrile seizures (SFS) and epilepsy are common seizures in childhood. However, the mechanism underlying SFS is uncertain, and the presence of obvious variances in white matter (WM) integrity and glymphatic function between SFS and epilepsy remain unclear. Therefore, this study aimed to investigate the differences in WM integrity and glymphatic function between SFS and epilepsy.Material and Methods: We retrospectively included 26 children with SFS, 33 children with epilepsy, and 28 controls aged 6–60 months who underwent magnetic resonance imaging (MRI). Tract-based spatial statistics (TBSS) were used to compare the diffusion tensor imaging (DTI) metrics of WM among the above-mentioned groups. T2-weighted imaging (T2WI) was used to segment the visible Virchow-Robin space (VRS) through a custom-designed automated method. VRS counts and volume were quantified and compared among the SFS, epilepsy, and control groups. Correlations of the VRS metrics and seizure duration and VRS metrics and the time interval between seizure onset and MRI scan were also investigated.Results: In comparison with controls, children with SFS showed no significant changes in fractional anisotropy (FA), axial diffusivity (AD), or radial diffusivity (RD) in the WM (P > 0.05). Decreased FA, unchanged AD, and increased RD were observed in the epilepsy group in comparison with the SFS and control groups (P < 0.05). Meanwhile, VRS counts were higher in the SFS and epilepsy groups than in the control group (VRS_SFS, 442.42 ± 74.58, VRS_epilepsy, 629.94 ± 106.55, VRS_control, 354.14 ± 106.58; P < 0.001), and similar results were found for VRS volume (VRS_SFS, 6,228.18 ± 570.74 mm3, VRS_epilepsy, 9,684.84 ± 7,292.66mm3, VRS_control, 4,007.22 ± 118.86 mm3; P < 0.001). However, VRS metrics were lower in the SFS group than in the epilepsy group (P < 0.001). In both SFS and epilepsy, VRS metrics positively correlated with seizure duration and negatively correlated with the course after seizure onset.Conclusion: SFS may not be associated with WM microstructural disruption; however, epilepsy is related to WM alterations. Seizures are associated with glymphatic dysfunction in either SFS or epilepsy.

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“…Approximately 2–14% of young children with infection and fever may experience at least a single febrile seizure. They occur most commonly between the ages of 12 to 30 months, and are uncommon after the age of 4 years [ 62 , 63 ]. The exact pathophysiology is uncertain, but seizures are not directly related to the magnitude of the fever, nor the rate of temperature increase.…”

Section: Section B Full Guidelinementioning

confidence: 99%

“…The exact pathophysiology is uncertain, but seizures are not directly related to the magnitude of the fever, nor the rate of temperature increase. Treatment of fever does not change the risk of febrile convulsions in susceptible children [ 62 , 64 , 65 ].…”

Section: Section B Full Guidelinementioning

confidence: 99%

“…The majority of febrile seizures are classified as simple (a generalised seizure occurring once in a 24 h period and lasting <10 min). Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection [ 62 ]. Most children who have experienced a simple febrile seizure will gradually return to a normal level of alertness within an hour.…”

Section: Section B Full Guidelinementioning

confidence: 99%

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Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Green

Webb²,

Jeena

et al. 2021

African Journal of Emergency Medicine

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Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

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Management of Pediatric Febrile Seizures

Cited by 87 publications

References 29 publications

Past, present and future of zebrafish in epilepsy research

Past, present and future of zebrafish in epilepsy research

Exploring Variances of White Matter Integrity and the Glymphatic System in Simple Febrile Seizures and Epilepsy

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

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