Yousuke Higuchi1, Toshihide Kubo2, Toshiharu Mitsuhashi3, Naoko Nakamura4, Ichiro Yokota4, Osamu Komiyama5, Isamu Kamimaki6, Shigenori Yamamoto7, Yasushi Uchida8, Kyoko Watanabe9, Hironori Yamashita9, Shigeki Tanaka10, Kosei Iguchi11, Ryouji Ichimi11, Shinichiro Miyagawa12, Toshimitsu Takayanagi13, Hiroshi Koga14, Akinori Shukuya15, Akiko Saito16, Keizo Horibe16. 1. Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan; Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Okayama, Japan. 2. Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan. Electronic address: kubocchi@okayamamc.jp. 3. Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan. 4. Department of Pediatrics, National Hospital Organization Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan. 5. Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan. 6. Department of Pediatrics, Saitama National Hospital, Wako, Saitama, Japan. 7. Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan. 8. Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Gifu, Japan. 9. Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Fukuoka, Japan. 10. Department of Pediatrics, National Hospital Organization Miechuo Medical Center, Tsu, Mie, Japan. 11. Department of Pediatrics, Mie National Hospital, Tsu, Mie, Japan. 12. Department of Pediatrics, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan. 13. Department of Pediatrics, National Hospital Organization Saga National Hospital, Saga, Saga, Japan. 14. Department of Pediatrics, National Hospital Organization Beppu Medical Center, Beppu, Oita, Japan. 15. Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan. 16. Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya Clinical Research Center, Nagoya, Aichi, Japan.
Abstract
BACKGROUND: We investigated features and responses to treatment in patients with febrile and afebrile convulsions with mild gastroenteritis and characterized convulsions with rotavirus and norovirus gastroenteritis. METHODS: We conducted a prospective, observational study to evaluate patients with febrile and afebrile convulsions with mild gastroenteritis who were hospitalized between November 2011 and March 2014 at 13 facilities in the National Hospital Organization. We classified the patients into two groups: presence or absence of fever. We investigated the background, clinical and laboratory characteristics, viral antigen in stool, and efficacy of anticonvulsant drugs. RESULTS: Of 126 patients enrolled in this study, 50 were febrile (Fc group) and 76 were afebrile (aFc group). A family history of febrile seizures was significantly more frequent in the Fc group than in the aFc group (28.0% vs 9.2%, P = 0.005). Clinical characteristics were similar between the rotavirus and norovirus groups, but fever was significantly more frequent in the rotavirus group (46.2% vs 8.3%, P < 0.001). Serum sodium levels were significantly negatively related to the number of seizures in the aFc group (β = -0.13; 95% confidence interval, -0.24, -0.03; P = 0.01). Carbamazepine was significantly more efficacious than diazepam suppositories in the aFc group (odds ratio = 49.3, 95% confidence interval, 2.35, 1037; P = 0.01). CONCLUSION: Febrile convulsions with mild gastroenteritis show characteristics of both febrile seizures and convulsions with mild gastroenteritis. Carbamazepine is optimal for convulsions with mild gastroenteritis. Clinical features of convulsions with rotavirus and norovirus gastroenteritis are similar, except for fever. Serum sodium levels may play a major role in the onset of convulsions with mild gastroenteritis.
BACKGROUND: We investigated features and responses to treatment in patients with febrile and afebrile convulsions with mild gastroenteritis and characterized convulsions with rotavirus and norovirus gastroenteritis. METHODS: We conducted a prospective, observational study to evaluate patients with febrile and afebrile convulsions with mild gastroenteritis who were hospitalized between November 2011 and March 2014 at 13 facilities in the National Hospital Organization. We classified the patients into two groups: presence or absence of fever. We investigated the background, clinical and laboratory characteristics, viral antigen in stool, and efficacy of anticonvulsant drugs. RESULTS: Of 126 patients enrolled in this study, 50 were febrile (Fc group) and 76 were afebrile (aFc group). A family history of febrile seizures was significantly more frequent in the Fc group than in the aFc group (28.0% vs 9.2%, P = 0.005). Clinical characteristics were similar between the rotavirus and norovirus groups, but fever was significantly more frequent in the rotavirus group (46.2% vs 8.3%, P < 0.001). Serum sodium levels were significantly negatively related to the number of seizures in the aFc group (β = -0.13; 95% confidence interval, -0.24, -0.03; P = 0.01). Carbamazepine was significantly more efficacious than diazepam suppositories in the aFc group (odds ratio = 49.3, 95% confidence interval, 2.35, 1037; P = 0.01). CONCLUSION:Febrile convulsions with mild gastroenteritis show characteristics of both febrile seizures and convulsions with mild gastroenteritis. Carbamazepine is optimal for convulsions with mild gastroenteritis. Clinical features of convulsions with rotavirus and norovirus gastroenteritis are similar, except for fever. Serum sodium levels may play a major role in the onset of convulsions with mild gastroenteritis.