Top

BMC Pediatrics

Published in:

Open Access 01-12-2024 | Febrile Seizure | Research

Comparison of clinical characteristics and disease burden of febrile seizures in children with and without COVID-19

Authors: Zhongli Jiang, Cuiyun Fang, Fengyimei Peng, Wei Fan

Published in: BMC Pediatrics | Issue 1/2024

Abstract

Background

Febrile seizures (FS) are the most common seizure disorder in children and a common neurologic complication in children with coronavirus disease 2019 (COVID-19). This study aimed to identify differences in clinical characteristics and disease burden between FS with and without COVID-19.

Materials and methods

We conducted a retrospective analysis of medical data at our hospital from December 2019 to July 2023, focusing on hospitalized patients under the age of 14 diagnosed with FS who underwent COVID-19 polymerase chain reaction (PCR) testing. Descriptive statistics and analysis of variance were employed to compare the COVID-19 and non-COVID-19 groups in terms of clinical characteristics and disease burden.

Results

A total of 514 patients were included, with 106 testing positive for COVID-19 and 408 testing negative. Patients with COVID-19 were older (34.87 ± 6.16 vs. 28.61 ± 11.35 months, P < 0.001) and had a higher proportion of males (79.2% vs. 62.3%, P = 0.001). The COVID-19 group had longer seizure durations (4.57 ± 4.38 vs. 3.22 ± 2.91 min, P = 0.006) and more complex FS (25.5% vs. 15.9%, P = 0.022). Laboratory tests showed lower lymphocyte counts in the COVID-19 group (1.87 ± 1.48 vs. 2.75 ± 1.51 × 103/µL, P < 0.001) and higher creatine kinase levels (158.49 ± 82.89 vs. 110.89 ± 56.11 U/L, P < 0.001). No significant differences were found in hospital costs, length of hospitalization, and intensive care unit admissions.

Conclusion

Clinicians should be knowledgeable about the distinct clinical characteristics of FS in children with COVID-19. Despite distinct features, the prognosis remains favorable and does not require excessive intervention. Ongoing monitoring and research are needed to fully understand the impact of COVID-19 on FS and optimize management strategies.

Leung AK, Hon KL, Leung TN. Febrile seizures: an overview. Drugs Context. 2018;7:212536. https://doi.org/10.7573/dic.212536.CrossRefPubMedPubMedCentral

Subcommittee on Febrile Seizures. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389–94. https://doi.org/10.1542/peds.2010-3318.CrossRef

Capovilla G, Mastrangelo M, Romeo A, Vigevano F. Recommendations for the management of febrile seizures: ad Hoc Task Force of Lice Guidelines Commission. Epilepsia. 2009;50(Suppl 1):2–6. https://doi.org/10.1111/j.1528-1167.2008.01963.x.CrossRefPubMed

Mewasingh LD, Chin RFM, Scott RC. Current understanding of febrile seizures and their long-term outcomes. Dev Med Child Neurol. 2020;62(11):1245–9. https://doi.org/10.1111/dmcn.14642.CrossRefPubMed

Sawires R, Buttery J, Fahey MA, Review of Febrile Seizures. Recent advances in understanding of Febrile Seizure Pathophysiology and commonly implicated viral triggers. Front Pediatr. 2021;9:801321. https://doi.org/10.3389/fped.2021.801321.CrossRefPubMed

Pokorn M, Jevšnik M, Petrovec M, Steyer A, Mrvič T, Grosek Š, et al. Respiratory and enteric virus detection in children. J Child Neurol. 2017;32(1):84–93. https://doi.org/10.1177/0883073816670820.CrossRefPubMed

Han JY, Han SB. Febrile seizures and respiratory viruses determined by Multiplex polymerase chain reaction test and clinical diagnosis. Child (Basel). 2020;7(11):234. https://doi.org/10.3390/children7110234.CrossRef

Valderas C, Méndez G, Echeverría A, Suarez N, Julio K, Sandoval F. Covid-19 and neurologic manifestations: a synthesis from the child neurologist’s corner. World J Pediatr. 2022;18(6):373–82. https://doi.org/10.1007/s12519-022-00550-4.CrossRefPubMedPubMedCentral

Cho SM, White N, Premraj L, Battaglini D, Fanning J, Suen J, et al. Neurological manifestations of Covid-19 in adults and children. Brain. 2023;146(4):1648–61. https://doi.org/10.1093/brain/awac332.CrossRefPubMed

10.

Iijima H, Kubota M, Ogimi C. Change in seizure incidence in Febrile Children with Covid-19 in the era of Omicron variant of concern. J Pediatr Infect Dis Soc. 2022;11(11):514–7. https://doi.org/10.1093/jpids/piac085.CrossRef

11.

Antoon JW, Hall M, Howard LM, Herndon A, Freundlich KL, Grijalva CG, et al. Covid-19 and Acute neurologic complications in children. Pediatrics. 2022;150(5):e2022058167. https://doi.org/10.1542/peds.2022-058167.CrossRefPubMed

12.

Han MJ, Heo JH, Hwang JS, Jang YT, Lee M, Kim SJ. Incidence of febrile seizures in children with Covid-19. J Clin Med. 2023;12(3):1076. https://doi.org/10.3390/jcm12031076.CrossRefPubMedPubMedCentral

13.

Han MS, Kim KM, Oh KJ, Chang JY, Lee SY, Choi JE, et al. Distinct clinical and Laboratory features of Covid-19 in Children during the Pre-delta, Delta and Omicron Wave. Pediatr Infect Dis J. 2023;42(5):423–8. https://doi.org/10.1097/INF.0000000000003872.CrossRefPubMedPubMedCentral

14.

Becker LL, Gratopp A, Prager C, Elger CE, Kaindl AM. Treatment of Pediatric Convulsive Status Epilepticus. Front Neurol. 2023;14:1175370. https://doi.org/10.3389/fneur.2023.1175370.CrossRefPubMedPubMedCentral

15.

China Center for Disease Control and Prevention. Technical Guidelines for Laboratory Testing of Covid-19. https://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/jszl_11815/202003/t20200309_214241.html. Accessed 01 March 2024.

16.

Laçinel Gürlevik S, Günbey C, Ozsurekci Y, Oygar PD, Kesici S, Gocmen R, et al. Neurologic manifestations in children with Covid-19 from a Tertiary Center in Turkey and Literature Review. Eur J Paediatr Neurol. 2022;37:139–54. https://doi.org/10.1016/j.ejpn.2022.02.003.CrossRefPubMedPubMedCentral

17.

LaRovere KL, Riggs BJ, Poussaint TY, Young CC, Newhams MM, Maamari M, et al. Neurologic involvement in children and adolescents hospitalized in the United States for Covid-19 or Multisystem Inflammatory Syndrome. JAMA Neurol. 2021;78(5):536–47. https://doi.org/10.1001/jamaneurol.2021.0504.CrossRefPubMed

18.

Seo MJ, Yum MS, Park JS. Comparison of febrile seizures in children with or without Coronavirus Disease-2019: a single-Center Observational Study. Pediatr Int. 2023;65(1):e15461. https://doi.org/10.1111/ped.15461.CrossRefPubMed

19.

Crespo FI, Mayora SJ, De Sanctis JB, Martínez WY, Zabaleta-Lanz ME, Toro FI, et al. Sars-Cov-2 infection in Venezuelan Pediatric Patients-a single center prospective observational study. Biomedicines. 2023;11(5):1409. https://doi.org/10.3390/biomedicines11051409.CrossRefPubMedPubMedCentral

20.

Ji SQ, Zhang M, Zhang Y, Xia K, Chen Y, Chu Q, et al. Characteristics of Immune and inflammatory responses among different age groups of Pediatric patients with Covid-19 in China. World J Pediatr. 2021;17(4):375–84. https://doi.org/10.1007/s12519-021-00440-1.CrossRefPubMedPubMedCentral

21.

Romero Starke K, Petereit-Haack G, Schubert M, Kämpf D, Schliebner A, Hegewald J, et al. The age-related risk of severe outcomes due to Covid-19 infection: a Rapid Review, Meta-Analysis, and Meta-Regression. Int J Environ Res Public Health. 2020;17(16):5974. https://doi.org/10.3390/ijerph17165974.CrossRefPubMedPubMedCentral

22.

Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender differences in patients with Covid-19: focus on severity and mortality. Front Public Health. 2020;8(152):152. https://doi.org/10.3389/fpubh.2020.00152.CrossRefPubMedPubMedCentral

23.

Kloc M, Ghobrial RM, Kubiak JZ. The role of genetic sex and Mitochondria in response to Covid-19 infection. Int Arch Allergy Immunol. 2020;181(8):629–34. https://doi.org/10.1159/000508560.CrossRefPubMed

24.

Zeng F, Dai C, Cai P, Wang J, Xu L, Li J, et al. A comparison study of Sars-Cov-2 igg antibody between male and female Covid-19 patients: a possible reason underlying different outcome between sex. J Med Virol. 2020;92(10):2050–4. https://doi.org/10.1002/jmv.25989.CrossRefPubMedPubMedCentral

25.

Dhindsa S, Zhang N, McPhaul MJ, Wu Z, Ghoshal AK, Erlich EC, et al. Association of Circulating Sex Hormones with inflammation and disease severity in patients with Covid-19. JAMA Netw Open. 2021;4(5):e2111398. https://doi.org/10.1001/jamanetworkopen.2021.11398.CrossRefPubMedPubMedCentral

26.

Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R, et al. Olfactory Transmucosal Sars-Cov-2 Invasion as a Port of Central Nervous System Entry in individuals with Covid-19. Nat Neurosci. 2021;24(2):168–75. https://doi.org/10.1038/s41593-020-00758-5.CrossRefPubMed

27.

Burks SM, Rosas-Hernandez H, Alejandro Ramirez-Lee M, Cuevas E, Talpos JC. Can Sars-Cov-2 infect the Central Nervous System Via the olfactory bulb or the blood-brain barrier? Brain Behav Immun. 2021;95:7–14. https://doi.org/10.1016/j.bbi.2020.12.031.CrossRefPubMedPubMedCentral

28.

Neumann B, Schmidbauer ML, Dimitriadis K, Otto S, Knier B, Niesen WD, et al. Cerebrospinal fluid findings in Covid-19 patients with neurological symptoms. J Neurol Sci. 2020;418:117090. https://doi.org/10.1016/j.jns.2020.117090.CrossRefPubMedPubMedCentral

29.

Jarius S, Pache F, Körtvelyessy P, Jelčić I, Stettner M, Franciotta D, et al. Cerebrospinal fluid findings in Covid-19: a Multicenter Study of 150 lumbar punctures in 127 patients. J Neuroinflammation. 2022;19(1):19. https://doi.org/10.1186/s12974-021-02339-0.CrossRefPubMedPubMedCentral

30.

Jansen JM, Gerlach T, Elbahesh H, Rimmelzwaan GF, Saletti G. Influenza virus-specific Cd4 + and Cd8 + T cell-mediated Immunity Induced by infection and vaccination. J Clin Virol. 2019;119:44–52. https://doi.org/10.1016/j.jcv.2019.08.009.CrossRefPubMed

31.

Azkur AK, Akdis M, Azkur D, Sokolowska M, van de Veen W, Brüggen MC, et al. Immune Response to Sars-Cov-2 and mechanisms of Immunopathological Changes in Covid-19. Allergy. 2020;75(7):1564–81. https://doi.org/10.1111/all.14364.CrossRefPubMed

32.

Delshad M, Tavakolinia N, Pourbagheri-Sigaroodi A, Safaroghli-Azar A, Bagheri N, Bashash D. The contributory role of lymphocyte subsets, pathophysiology of Lymphopenia and its implication as prognostic and therapeutic opportunity in Covid-19. Int Immunopharmacol. 2021;95:107586. https://doi.org/10.1016/j.intimp.2021.107586.CrossRefPubMedPubMedCentral

33.

Orsucci D, Trezzi M, Anichini R, Blanc P, Barontini L, Biagini C, et al. Increased creatine kinase may predict a worse Covid-19 outcome. J Clin Med. 2021;10(8):1734. https://doi.org/10.3390/jcm10081734.CrossRefPubMedPubMedCentral

34.

Zhang T, Huang WS, Guan W, Hong Z, Gao J, Gao G, et al. Risk factors and predictors Associated with the severity of Covid-19 in China: a systematic review, Meta-analysis, and Meta-Regression. J Thorac Dis. 2020;12(12):7429–41. https://doi.org/10.21037/jtd-20-1743.CrossRefPubMedPubMedCentral

35.

Pitscheider L, Karolyi M, Burkert FR, Helbok R, Wanschitz JV, Horlings C, et al. Muscle involvement in Sars-Cov-2 infection. Eur J Neurol. 2021;28(10):3411–7. https://doi.org/10.1111/ene.14564.CrossRefPubMed

36.

Son YY, Kim GH, Byeon JH, Eun SH, Eun BL. Need for lumbar puncture in children younger than 12 months presenting with simple febrile seizure. Pediatr Emerg Care. 2018;34(3):212–5. https://doi.org/10.1097/pec.0000000000000779.CrossRefPubMed

37.

Guedj R, Chappuy H, Titomanlio L, De Pontual L, Biscardi S, Nissack-Obiketeki G, et al. Do all children who present with a Complex Febrile Seizure need a lumbar puncture? Ann Emerg Med. 2017;70(1):52–e626. https://doi.org/10.1016/j.annemergmed.2016.11.024.CrossRefPubMed

Title: Comparison of clinical characteristics and disease burden of febrile seizures in children with and without COVID-19
Authors: Zhongli Jiang
Cuiyun Fang
Fengyimei Peng
Wei Fan
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Febrile Seizure
COVID-19
Polymerase Chain Reaction
Published in: BMC Pediatrics / Issue 1/2024
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-024-04821-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of clinical characteristics and disease burden of febrile seizures in children with and without COVID-19

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

A case report of classic galactosemia with a GALT gene variant and a literature review

Evaluation of cardiac autonomic dysfunctions in children with type 1 diabetes mellitus

Effect of resilience training on stress, hope and psychological toughness of mothers living with mentally and physically disabled children

Irisin combined index to diagnose central precocious puberty in girls: a cross-sectional study

Iron deficiency in healthy, term infants aged five months, in a pediatric outpatient clinic: a prospective study

Correction: Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low‑income environment