Risk of low serum levels of ionized magnesium in children with febrile seizure

Abstract

BackgroundSuboptimal intake of magnesium become prevalent due to the modern diet of processed food low in magnesium. Magnesium may modulate seizure activity by antagonizing excitatory calcium influx through the N-methyl-D-aspartate receptor. Although hyponatremia has been reported to be common in febrile seizures, the most common form of seizure, little is known about the status of serum ionized magnesium. We therefore investigated the status of serum ionized magnesium (iMg2+) in children with febrile seizures and compared with controls.MethodsWe included all patients from 1 to 6 years old who had presented with febrile seizure to the pediatric emergency department at the Korea University Guro Hospital from July 2016 to February 2017. The control group comprised patients admitted to the hospital with febrile respiratory tract infections, but with no history of febrile seizure. Clinical data, blood tests, and electroencephalogram (EEG) results were reviewed using the patients’ medical records.ResultsA total of 133 patients with febrile seizure and 141 control patients were analyzed in the present study. As a result, hypomagnesemia (< 0.50 mmol/L) was more common in patients with febrile seizure than in controls (42.9% vs. 6.9%, p < 0.001) and it was an independent risk factor for febrile seizure (OR, odds ratio = 22.12, 95% CI = 9.23–53.02, P < 0.001). A receiver operating curve analysis revealed that serum iMg2+ levels < 0.51 mmol/L predicted the presence of febrile seizures with a sensitivity of 45.1% and a specificity of 92.6% (AUC, area under the curve = 0.731, 95% confidence interval = 0.671–0.791). When the patients with febrile seizure were divided in terms of a serum iMg2+ concentration of 0.51 mmol/L, there was no difference in clinical features.ConclusionsHypomagnesemia was more common and serum iMg2+ level was lower in patients with febrile seizures than in controls. However, further evidence is needed for the causal relationship between low magnesium and febrile convulsions.

Association between serum micronutrient levels and febrile seizures among febrile children in Southern India: A case control study

“…11 The serum magnesium levels in febrile seizure group were lower than controls in the present study, the difference is significant. This was concordant with studies by Sherlin et al, 3 Namakin et al, 4 Salah et al, 24 and Sung -Jin Baek et al 25 A study by Bharathi et al, 22 found a positive correlation between hypomagnesemia to simple febrile seizure, with no significant association between serum magnesium level and atypical febrile seizure in children. However, few studies, 17,23,26 did not support the hypothesis that febrile seizure is related to reduced serum magnesium level.…”

Correlation of serum magnesium levels in febrile convulsions in children: a cross sectional comparative study

“…However, further evidence is needed for the causal relationship between low magnesium and febrile convulsions. 13 Kannachamkandy et al studied 35 children between six months to five years with febrile seizures as cases and 35 children with febrile illnesses without seizures as controls and concluded that high serum copper levels and low serum magnesium levels were significantly associated with febrile seizures. 14 Sherlin et al included children between the ages of 6 months to 5 years with febrile convulsions and found that serum Magnesium levels were low in 32% of the cases with febrile convulsion indicating that serum Magnesium levels has got positive correlation in patients with febrile convulsion.…”

Magnesium deficiency and febrile seizure: A systematic review and meta‐analysis

“…Some studies were excluded because they were not presented each mean ± SD, median, and IQR of magnesium and only presented the frequency of children with magnesium deficiency. Finally, 10 papers were included in the present systematic review 10‐13,18‐23 . All were case‐control or cross‐sectional.…”

“…Finally, 10 papers were included in the present systematic review. [10][11][12][13][18][19][20][21][22][23] process is illustrated in Figure 1. The details of included studies are presented in Table 1.…”

“…8,9 There are several studies evaluating the serum level of magnesium in the febrile seizure. In some studies, the lower serum level of magnesium in children with FS versus febrile children was reported 10,11 while in some ones, no significant difference was reported. 12,13…”