| Objective: To study clinical features of children with fever related convulsion and explore the common causes of childhood fever related convulsion,while the demographic information,clinical features and causes of hospitalization of the children with febrile convulsion(FC)were analyzed,in order to provide evidences for clinical diagnosis and treatment of fever related convulsion.Methods: All febrile diseases in 416 cases of patients with seizures were from a grade-A and level-B children’s specialist hospital in Fujian province from January to December 2015.The clinical data were collected form the hospital electronic medical record system,which included demographic information(age,gender),medical history(the reasons for hospitalization,onset season,medical history,family history,duration of hospitalization),characteristics of seizures(the causes of convulsions,types of convulsions,number of seizures during the course of the disease,duration of seizures,measures to stop seizures,recurrence,status after the onset),auxiliary examination(blood routine,C-reactive protein,blood biochemistry,cerebrospinal fluid,chest X-ray,EEG and brain imaging information).By a case-control study using the non-blind method,the relationship between convulsions and fever(such as fever convulsion and body temperature or latent period of convulsion,fever and convulsion recurrence),and the clinical features and causes of hospitalization were analyzed in 366 hospitalized children with febrile convulsion.Results:(1)The clinical features of febrile diseases in hospitalized children with convulsion: the age range in total of 416 children was from postnatal 40 days to 9years old.The average age was(25.80±16.53)months old.The ratio of male to female was 1.7:1.The children who were younger than 1 years old accounted for17.8%,1~3 years old accounted for 69.5%,3~5 years old accounted for 9.1%,5~9years old accounted for 3.6%.There were more cases in January and July than the other months.The type of seizures in most cases showed generalized seizures(78.4%),the duration of convulsion in most cases was less than 10min(78.6%).85.3% in all cases appeared single seizure.The onset of 87.0% seizures occurred during the first 24 h after the children had fever,and the body temperatures in63.2% cases were among 39℃ to 41℃ when the seizure attacked.(2)Etiological analysis of hospitalized children: the main causes were febrile seizures,benign infantile convulsions associated with mild gastroenteritis(BICE),intracranial infection,epilepsy combined with infectious diseases,toxic encephalopathy respectively,which accounted for 87.9%,5.3%,2.7%,2.9%,1.2%.The clinical characteristics of convulsion in different febrile diseases were different,such as when seizure attacked the body temperatures of children with FS were(39.2 ±0.78)℃,which were significantly higher than that of children with BICE(38.2±0.51)℃(P<0.01).The seizures in patients with BICE were prone to recurrent seizures,but few of them had long-time seizure.The latent periods from fever to convulsion in the group with FS were(10.8±7.72)h,in which most of them were less than 24 h,while the latent period in the children with intracranial infection was significantly prolonged(55.81±51.90)h(P<0.01).(3)The clinical characteristics of hospitalized children with FS: in 366 hospitalized children with FS,the range of ages were from 40 postnatal days to 7 years old.The average age was(25.32±13.80)months old.The children who were younger than 1 years old accounted for17.2%,1~3 years old accounted for 70.7%,3~5 years old accounted for 10.1%,5~7 years old accounted for 1.9%.The ratio of male to female was 1.8:1.Sporadic cases were found all the year,most in July(15.3%).10.9% cases had a family history of FS,and 1.1% cases had a family history of epilepsy.88% cases had no family history of convulsion.The type of seizures showed generalized seizures accounted for 82.2% and focal seizures accounted for 13.7%,and 4.1%cases began with a focal onset then showed generalized seizures.while the latent period in the children with intracranial infection were significantly prolonged(55.81± 51.90)h(P<0.01).The duration of convulsion in most cases were less than 10 min,of which < 3 min accounted for 53.8% and 3 to 10 min accounted for27.6 %.89.1% cases had only single seizure and 92.5% cases had no seizure recurrence in the first day of onset.98.9% cases had no seizure after they were admitted to hospital.The latent periods from fever to convulsion in 90.1% cases were less than 24 h,in which less than 12 h accounted for 46.2% and 12 h to 24 h accounted for 43.9%.When the seizure attaked,the body temperatures of 95.9%cases were above 38℃ and the body temperatures of 70.2% cases were over 39℃.60.4% cases showed simple febrile seizure(SFS).while 39.6% cases had complex febrile seizure(CFS).The percentage of new cases was 80.3%,while recurrent cases accounted for 19.7%.62.5% recurrent cases were first recurrence.The recurrent cases had more complex clinical phenotype which appeared CFS(χ2=11.2,P<0.001).(4)The causes of FS for initial hospitalization:(1)31(10.5%)cases can not excluded intracranial infection,(2)54(18.4%)cases with primary disease which need to be treated in hospitalization,(3)76(25.9%)cases worried brain damage after seizure,(4)The parents of 119 cases(40.4%)insisted on hospitalization for afraid of convulsion recurrence,(5)The children parents of 14(4.8%)cases wanted further examination for fear of epilepsy.(5)Analysis of the causes of hospitalized cases with FS recurrence:(1)5 cases(6.9%)cannot excluded intracranial infection.(2)The parents of 26 cases(36.1%)insisted on hospitalization for afraid of convulsion recurrence.(3)13 cases(18.1%)with primary disease which need to be treated in hospitalization,(4)14(19.4%)cases worried brain damage after seizure.(5)The parents of 14(19.4%)cases wanted further examination for fear of suffering with epilepsy.For recurrent cases,clinicians thought less about encephalitis,but the parents would more worry about developing into epilepsy compared with newly FS(P<0.001).4.Conclusion:(1)Febrile disease is the most common cause of convulsion in children.The clinical characteristics of febrile diseases caused by different febrile diseases are different,and children aged 1 to 3 years old are more likely to have convulsion.(2)The most common causes of fever related convulsion: febrile convulsion,benign infantile convulsions associated with mild gastroenteritis,intracranial infection,epilepsy combined with infectious diseases and toxic encephalopathy,in which febrile seizure is top reason for hospitalized,which accounted for 87.9%.The respiratory tract infection and gastrointestinal tract infection is a common inducing causes of fever which lead to febrile convulsion.The longer latent periods from fever to convulsion,the more likely intracranial infection.(3)The children with febrile convulsion are characterized by short-time and self-limited convulsion,the majority of them do not need hospitalization.Fear of intracranial infection,convulsion recurrence,outcome of seizures,such as convulsive brain damage,epilepsy,which are the main causes of hospitalized children with febrile convulsion.(4)The clinicians and parents of these children should have correct understanding of clinical features and prognosis of febrile convulsion.To guide parents to master the method of prevention and treatment in pre hospital will help to reduce the hospitalization rate of children with febrile convulsion.It is important way to avoid the waste of medical resources and excessive medical treatment. |
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