, et al
Redefining outcome of first seizures by acute illness
; doi:

Researchers at Seattle Children’s Research Institute and the Centers for Disease Control and Prevention (CDC) conducted a prospective longitudinal study to determine outcomes in children with first-time seizures associated with acute gastrointestinal illness. Patients aged 6 months through 6 years presenting to the emergency department with a first-time seizure were enrolled. Initial seizures were classified as febrile, nonfebrile-illness, or unprovoked; febrile and nonfebrile-illness seizures were further categorized as associated with acute gastroenteritis or acute nongastrointestinal illness. Stool samples were collected for viral studies and electroencephalograms (EEG) were obtained at the discretion of the treating physicians. Parents of children in the study were contacted monthly for up to five years to collect information on recurrent seizures.

Of the 117 children enrolled, 78 (67%) had febrile seizures, 34 (29%) had nonfebrile-illness seizures, and 5 (4%) had unprovoked seizures. Acute gastroenteritis was associated with nonfebrile-illness seizures more frequently than with febrile seizures (47% and 28%, respectively; P=.05). Children with acute gastroenteritis experienced multiple seizures within the first 24 hours significantly more often than children with nongastrointestinal illness (58% and 27%, respectively; P=.001). Of 38 primary seizures in children with acute gastrointestinal illness none were focal, whereas 9 (12%) of 74 seizures in the nongastrointestinal illness group had focal presentation (P=.02). Children with acute gastroenteritis at first seizure, with or without fever, had fewer future seizure recurrences compared to children with acute nongastrointestinal illnesses. Children with a first nonfebrile-illness seizure were more likely than those with a first febrile seizure to have a stool sample test positive for rotavirus (P=.02) or for norovirus (P=.05). EEGs in nine children with acute gastrointestinal illness were normal in six and showed minor irregularities in three.

The authors conclude that children with first-time seizures associated with acute gastrointestinal illness have a low rate of recurrence and few neurologic complications.

Dr Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Nonfebrile-illness seizures are recognized as a distinct category of provoked seizures associated with viral infections, especially seizures with acute gastrointestinal illness. Compared to children with unprovoked seizures or seizures associated with acute respiratory infections, children with acute gastrointestinal illness and nonfebrile seizures have a lower rate of future seizure recurrence and fewer neurologic complications. In initial reports, the syndrome was called “benign convulsions with mild gastroenteritis.”1 The index seizure is nonfebrile, occurs in previously healthy children who are 6 months to 3 years old, between the first and fifth sick day of viral gastroenteritis, and is associated with normal electrolyte and glucose levels and low recurrence risk. The mechanism of the seizure is unclear. Evidence suggesting a genetic predispositon is weak, only 9% of patients having...

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