What is the incidence of COVID-19-related febrile seizures in children?

In a recent study published in Journal of Clinical Medicineresearchers investigated the incidence of febrile seizures (FS) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive children.

Background

FS refers to a disorder of neurological conditions common in children aged 6 months to 5 years, in which febrile patients develop seizures without intracranial infection. Notably he has reported febrile seizures in patients with COVID-19 (coronavirus disease 2019) after the emergence of the SARS-CoV-2 omicron variant.

About research

In the current study, researchers determined the incidence of febrile seizures in SARS-CoV-2-positive children.

The study included children aged <5 years who lived in Jeonbuk, South Korea between January 2020 and June 2022 and had confirmed SARS-CoV-2 infection. Data provided by the Security Administration. In addition, data on SARS-CoV-2-positive children who developed FS were available from five hospitals providing care for FS treatment.

The team excluded people with epilepsy, afebrile people, and those without other causes of seizures, such as electrolyte imbalances or structural abnormalities, confirmed by magnetic resonance imaging (MRI) of the brain. To calculate her incidence of COVID-19-related FS, the number of her COVID-19 patients presenting with FS was divided by the total number of her COVID-19 cases in children.

Data on individual demographics, laboratory results, seizure type, seizure duration, EEG findings, and length of hospital stay were also analyzed. A clinical examination was performed on each participant at the time of admission. Additionally, data from her COVID-19 patient with PFS (persistent febrile seizures) were evaluated to assess the impact of SARS-CoV-2 infection on the severity of her FS.

result

Of the 62,722 children under the age of 5 living in Jeonbuk, 53% (n=33,457) were infected with SARS-CoV-2, of which 1.0% (n=476) required hospitalization and 0.2% (n= 64) developed febrile seizures. Of the children with FS, 44 were male (69%) and 20 were female (31%). The mean age of participants who developed febrile seizures was 37 months.

All FS patients developed symptoms after the emergence of SARS-CoV-2 Omicron variants. In the period prior to Omicron COVID-19, 23% of COVID-19 patients (89 out of 381 patients) required hospitalization. Nonetheless, no SARS-CoV-2-positive children were hospitalized with febrile seizures. In addition, 39% of patients (n=25) presented with complex febrile seizures, whereas one child developed febrile status epilepticus.

Of the study participants, 66% (n=42) had first-onset FS, had an average of 2 seizures, and 1 patient reported up to 10 seizure episodes over 3 days. The median duration of FS was 3 minutes, and her longest reported FS duration was 1 hour, he required ventilatory support. His 20% of participants (n = 13) had a close relative with a history of her FS, and her average length of hospital stay was 4 days.

Most of the children with FS did not require hospitalization after ASM admission. However, her 11% (n = 7.0) of FS patients required primary ASM, including intravenous lorazepam (0.10 mg/kg) administration. Two of the seven children required secondary ASM, including intravenous fosphenytoin at 20.0 mg per kg, and one child received continuous intravenous midazolam (5.0 µg per kg per minute). ) required injection.

The majority of children had normal white blood cell counts (7.50 × 10³ It shows a median serological CRP (C-reactive protein) level of 1.7 mg/L. Of the six children with febrile seizures lasting longer than 15 minutes, five were male and four had their first seizure associated with SARS-CoV-2 infection.

All four children had normal brain MRI findings, and 75% (3 children) had slow background activity on EEG analysis. However, none of them showed epileptiform discharge. Despite her longer duration of FS of the participants, only 33% (2 children) required anticonvulsant medication (ASM) and her hospital stay was less than 8 days.

Increases in blood glucose levels of 232.0 milligrams per deciliter and 291.0 milligrams per deciliter were observed in patients requiring ASM. The corresponding patient serologic lactate levels were 3.0 and 26.0 mmol per liter, respectively. All other FS children’s seizure events were found to be self-limiting. Her incidence of COVID-19-related FS may have been higher during periods of omicron predominance due to the greater contagiousness and contagiousness of omicron compared to previously circulating SARS-CoV-2 variants there is.

Conclusion

Based on research findings, febrile seizures may occur in approximately 0.20% of SARS-CoV-2-positive children under 5 years of age and may occur more frequently in males during the omicron-predominant period. In addition, more febrile status epilepticus and complicated febrile seizure cases were associated with Omicron infection.