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Araştırma Makalesi
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Febril nöbetler: Ateş sonrası nöbet zamansal sıralamasının bir önemi var mıdır?

Yıl 2019, Cilt: 4 Sayı: 2, 57 - 61, 30.08.2019

Turgay Cokyaman

https://doi.org/10.22391/fppc.491220

Öz

Giriş: 3 ay-6 yaş arası sağlıklı
çocuklarda ateşli hastalık dönemlerinde görülen nöbetlere febril nöbetler
(FN)denilmektedir. FN’lerin çoğunda ateş sonrası nöbet zamansal sıralaması
görülmekte iken bazı vakalarda bu durum görülmemektedir. Bu çalışmada FN’li
hastalarda ateş ve nöbetin zamansal sıralaması ve klinik ve laboratuar
bulguların bu zamansal sıralamaya etkilerinin olup olmadığı araştırılmıştır.

Yöntem: 1 Aralık 2015 ve 1 Nisan 2016
tarihleri arasında FN tanısı alan hastalar çalışmaya alındı. Ateş sonrası nöbet
zamansal sıralaması gösteren vakalar klasik FN olarak sınıflandırıldı. Ateş
sonrası nöbet zamansal sıralaması göstermeyen vakalar ise klasik olmayan FN
olarak sınıflandırıldı. Cinsiyet, yaş, boy, vücut ağırlığı, febril nöbet tipi
(basit, kompleks), daha önce geçirilmiş FN hikayesi varlığı, ailede FN hikayesi
olması, ailede epilepsi varlığı, kalitatif C-reaktif protein (CRP) ve beyaz kan
hücre (WBC) sayısından oluşan kategorik ve sayısal değişkenlerinin klasik ve
klasik olmayan FN’lere etkisi değerlendirildi.

Bulgular: Hastaların %73’ü klasik, %27’si
ise klasik olmayan FN tanısı aldı. Gruplar arası karşılaştırmalarda yalnız WBC
sayısı farklı bulundu ve klasik olmayan FN grubunda anlamlı düzeyde düşüktü.
İkili lojistik regresyon analizi sonucu negatif kalitatif CRP ve düşük WBC
sayısının klasik olmayan FN’ler için anlamlı prediktörler olduğu ortaya çıktı (sırasıyla OR=1,388; 95%CI
1,051-1,834 ve OR=9,021; 95%CI 1,298-62,702).     

Sonuç: Klasik olmayan FN’lerde ateş,
pozitif CRP yanıtı ve WBC sayısı artışı gibi akut inflamatuar yanıtın
göstergeleri görülmeyebilir. Bu tarz vakalarda FN tanısı doğru olsa da tıbbi
isimlendirmeden kaynaklanan hekim ve ebeveyn iletişim sorunları
doğabilmektedir. 

Anahtar Kelimeler

Ateş çocuk nöbet

Kaynakça

  • 1. Duffner PK, Berman PH, Bauman RJ, Fisher PG, Green JL, Schneider S et al. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389-94. https://doi.org/10.1542/peds.2010-3318
  • 2. Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994;35(2):S1-6. https://doi.org/10.1111/j.1528-1157.1994.tb05932.x
  • 3. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child. 2004;89(8):751-6. https://doi.org/10.1136/adc.2003.028449
  • 4. Swaiman K, Ashwal S, Ferriero D, Schor N. Swaiman’s pediatric neurology, 5th edition. Saunders 2011, Part VIII; ch57;p 791.
  • 5. Baumer JH, David TJ, Valentine SJ, Roberts JE, Hughes BR. Many parents think their child is dying when having a first febrile convulsion. Dev Med Child Neurol. 1981;23(4):462-64. https://doi.org/10.1111/j.1469-8749.1981.tb02019.x
  • 6. Flury T, Aebi C, Donati F. Febrile seizures and parental anxiety: does information help? Swiss Med Wkly 2001;131(37-38):556-60. PMID: 11759176
  • 7. Freeman JM. Febrile seizures: a consensus of their significance, evaluation, and treatment. Pediatrics 1980;66(6):1009. PMID:7454463.
  • 8. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologicstudies on epilepsy. Epilepsia. 1993;34(4):592-6. https://doi.org/10.1111/j.1528-1157.1993.tb00433.x
  • 9. Fetveit A. Assessment of febrile seizures in children. Eur J Pediatr. 2008;167(1):17-27. https://doi.org/10.1007/s00431-007-0577-x
  • 10. Armon K, Stephenson T, MacFaul R, Hemingway P, Werneke U, Smith S. An evidence and consensus based guideline for the management of a child after a seizure. Emerg Med J. 2003;20(1):13-20. https://doi.org/10.1136/emj.20.1.13
  • 11. Feng B, Chen Z. Generation of febrile seizures and subsequent epileptogenesis. Neurosci Bull. 2016;32(5):481-92. https://doi.org/10.1007/s12264-016-0054-5
  • 12. Haspolat S, Mihci E, Coskun M, Gumuslu S, Ozben T, Yegin O. Interleukin-1 beta, tumor necrosis factor-alpha, and nitrite levels in febrile seizures. J Child Neurol. 2002;17(10):749-51. https://doi.org/10.1177/08830738020170101501
  • 13. Soltani S, Zare-Shahabadi A, Shahrokhi A, Rezaei A, Zoghi S, Zamani GR, et al. Association of interleukin-1 gene cluster and interleukin-1 receptor polymorphisms with febrile seizures. J Child Neurol. 2016;31(6):673-7. https://doi.org/10.1177/0883073815610429
  • 14. Schuchmann S, Hauck S, Henning S, Grüters-Kieslich A, Vanhatalo S, Schmitz D, et al. Respiratory alkalosis in children with febrile seizures. Epilepsia. 2011;52(11):1949-55. https://doi.org/10.1111/j.1528-1167.2011.03259.x
  • 15. Egri C, Vilin YY, Ruben PC. A thermoprotective role of the sodium channel β1 subunit is lost with the β1 (C121W) mutation. Epilepsia. 2012;53(3):494-505. https://doi.org/10.1111/j.1528-1167.2011.03389.x
  • 16. Nakayama J. Progress in searching for the febrile seizure susceptibility genes. Brain Dev. 2009;31(5):359-65. https://doi.org/10.1016/j.braindev.2008.11.014
  • 17. Blatteis CM, Sehic E, Li S. Pyrogen sensing and signaling: old views and new concepts. Clin Infect Dis. 2000;31(5):168-77. https://doi.org/10.1086/317522
  • 18. Netea MG, Kullberg BJ, Van der Meer JWM. Circulatingcytokines as mediators of fever. ClinInfectDis. 2000;31(5):S178-84. https://doi.org/10.1086/317513
  • 19. Choy M, Dube CM, Ehrengruber M, Baram TZ. Inflammatory processes, febrile seizures, and subsequent epileptogenesis. Epilepsy Curr. 2014;14(1):15-22. https://doi.org/10.5698/1535-7511-14.s2.15
  • 20. Virta M, Hurme M, Helminen M. Increased plasma levels of pro- and anti-inflammatory cytokines in patients with febrile seizures. Epilepsia. 2002;43(8):920-3. https://doi.org/10.1046/j.1528-1157.2002.02002.x
  • 21. Blatteis CM. The onset of fever: new insights into its mechanism. Prog Brain Res. 2007;162:3-14. https://doi.org/10.1016/S0079-6123(06)62001-3
  • 22. Dinarello CA. Infection, fever, and exogenous and endogenous pyrogens: some concepts have changed. J Endotoxin Res. 2004;10(4):201-22. https://doi.org/10.1179/096805104225006129
  • 23. Szekely M, Balasko M, Romanovsky AA. Peripheral neural inputs. Their role in fever development. Ann N Y Acad Sci. 1997;813:427-34. https://doi.org/10.1111/j.1749-6632.1997.tb51728.x
  • 24. van Dam AM, Poole S, Schultzberg M, Zavala F, Tilders FJ. Effects of peripheral administration of LPS on the expression of immunoreactive interleukin-1 alpha, beta, and receptor antagonist in rat brain. Ann N Y Acad Sci.1998;840:128-138. https://doi.org/10.1111/j.1749-6632.1998.tb09557.x
  • 25. Tutuncuoglu S, Kutukculer N, Kepe L, Coker C, Berdeli A, Tekgul H. Proinflammatory cytokines, prostaglandins and zinc in febrile convulsions. Pediatr Int. 2001;43(3):235-9. https://doi.org/10.1046/j.1442-200x.2001.01389.x
  • 26. Rooker S, Jander S, Van Reempts J, Stoll G,Jorens PG, Borgers M, et al. Spatiotemporal pattern of neuroinflammation after impact-acceleration closed head injury in the rat. Mediators Inflamm. 2006;2006(1);90123. https://doi.org/10.1155/MI/2006/90123
  • 27. Choi J, Min HJ, Shin JS. Increased levels of HMGB1 andp ro-inflammatory cytokines in children with febrile seizures. J Neuroinflammation. 2011;8:135. https://doi.org/10.1186/1742-2094-8-135
  • 28. Dube C, Vezzani A, Behrens M, Bartfai T, Baram TZ. Interleukin-1 beta contributes to the generation of experimental febrile seizures. Ann Neurol. 2005;57(1):152-5. https://doi.org/10.1002/ana.20358
  • 29. Balosso S, Maroso M, Sanchez-Alavez M, Ravizza T, Frasca A, Bartfai T, et al. A novel non-transcriptional pathway mediates the proconvulsive effects of interleukin-1 beta. Brain. 2008;131(Pt 12):3256-65. https://doi.org/10.1093/brain/awn271

Febrile seizures: is there a significance of chronological ranking of fever and seizure?

Yıl 2019, Cilt: 4 Sayı: 2, 57 - 61, 30.08.2019

Turgay Cokyaman

https://doi.org/10.22391/fppc.491220

Öz

Introduction:Seizures observed in febrile disease periods in healthy
children aged from 3 months to 6 years are known as febrile seizures (FS).
There is usually a chronological sequence involving seizure following fever in
most FS, but some cases may not follow this pattern. This study investigated
the chronological relation between fever and convulsion and whether clinical
and laboratory findings affect this.

Methods:Patients with FS between 1 December, 2015, and 1 April,
2016, were included in this study. Cases with a regular fever plus seizure
chronological sequence were classified as classical FS. Without a regular
chronological sequence, fever after seizure, were classified as non-classical
FS. The effect on both groups of parameters such as gender, age, height,
weight, type of FS (simple or complex), previous history of FS, family history of FS, family history of epilepsy, qualitative c-reactive protein
(CRP) and white blood cell (WBC) count were evaluated.

Results:Twenty-seven percent of FS were non-classical and 73% were
classical. Negative CRP and low WBC emerged as significant predictors of
non-classical FS at binary logistic regression (OR=1.388, 95% CI 1.051-1.834
and OR=9.021, 95% CI 1.298-62.702, respectively). Other factors such as gender,
age, height, weight, type of FS, previous history of FS, familyhistory of FS, familyhistory of epilepsyhad no effect in terms of nonclassic
FS.







Conclusions:Acute inflammatory response findings such as increased CRP,
WBC and fever may not accompany in non-classical FS. Although the diagnosis of
FS is correct in such cases, misunderstandings may occur between the physician
and parents because of the nomenclature employed.

Anahtar Kelimeler

Fever children seizure

Kaynakça

  • 1. Duffner PK, Berman PH, Bauman RJ, Fisher PG, Green JL, Schneider S et al. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389-94. https://doi.org/10.1542/peds.2010-3318
  • 2. Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994;35(2):S1-6. https://doi.org/10.1111/j.1528-1157.1994.tb05932.x
  • 3. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child. 2004;89(8):751-6. https://doi.org/10.1136/adc.2003.028449
  • 4. Swaiman K, Ashwal S, Ferriero D, Schor N. Swaiman’s pediatric neurology, 5th edition. Saunders 2011, Part VIII; ch57;p 791.
  • 5. Baumer JH, David TJ, Valentine SJ, Roberts JE, Hughes BR. Many parents think their child is dying when having a first febrile convulsion. Dev Med Child Neurol. 1981;23(4):462-64. https://doi.org/10.1111/j.1469-8749.1981.tb02019.x
  • 6. Flury T, Aebi C, Donati F. Febrile seizures and parental anxiety: does information help? Swiss Med Wkly 2001;131(37-38):556-60. PMID: 11759176
  • 7. Freeman JM. Febrile seizures: a consensus of their significance, evaluation, and treatment. Pediatrics 1980;66(6):1009. PMID:7454463.
  • 8. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologicstudies on epilepsy. Epilepsia. 1993;34(4):592-6. https://doi.org/10.1111/j.1528-1157.1993.tb00433.x
  • 9. Fetveit A. Assessment of febrile seizures in children. Eur J Pediatr. 2008;167(1):17-27. https://doi.org/10.1007/s00431-007-0577-x
  • 10. Armon K, Stephenson T, MacFaul R, Hemingway P, Werneke U, Smith S. An evidence and consensus based guideline for the management of a child after a seizure. Emerg Med J. 2003;20(1):13-20. https://doi.org/10.1136/emj.20.1.13
  • 11. Feng B, Chen Z. Generation of febrile seizures and subsequent epileptogenesis. Neurosci Bull. 2016;32(5):481-92. https://doi.org/10.1007/s12264-016-0054-5
  • 12. Haspolat S, Mihci E, Coskun M, Gumuslu S, Ozben T, Yegin O. Interleukin-1 beta, tumor necrosis factor-alpha, and nitrite levels in febrile seizures. J Child Neurol. 2002;17(10):749-51. https://doi.org/10.1177/08830738020170101501
  • 13. Soltani S, Zare-Shahabadi A, Shahrokhi A, Rezaei A, Zoghi S, Zamani GR, et al. Association of interleukin-1 gene cluster and interleukin-1 receptor polymorphisms with febrile seizures. J Child Neurol. 2016;31(6):673-7. https://doi.org/10.1177/0883073815610429
  • 14. Schuchmann S, Hauck S, Henning S, Grüters-Kieslich A, Vanhatalo S, Schmitz D, et al. Respiratory alkalosis in children with febrile seizures. Epilepsia. 2011;52(11):1949-55. https://doi.org/10.1111/j.1528-1167.2011.03259.x
  • 15. Egri C, Vilin YY, Ruben PC. A thermoprotective role of the sodium channel β1 subunit is lost with the β1 (C121W) mutation. Epilepsia. 2012;53(3):494-505. https://doi.org/10.1111/j.1528-1167.2011.03389.x
  • 16. Nakayama J. Progress in searching for the febrile seizure susceptibility genes. Brain Dev. 2009;31(5):359-65. https://doi.org/10.1016/j.braindev.2008.11.014
  • 17. Blatteis CM, Sehic E, Li S. Pyrogen sensing and signaling: old views and new concepts. Clin Infect Dis. 2000;31(5):168-77. https://doi.org/10.1086/317522
  • 18. Netea MG, Kullberg BJ, Van der Meer JWM. Circulatingcytokines as mediators of fever. ClinInfectDis. 2000;31(5):S178-84. https://doi.org/10.1086/317513
  • 19. Choy M, Dube CM, Ehrengruber M, Baram TZ. Inflammatory processes, febrile seizures, and subsequent epileptogenesis. Epilepsy Curr. 2014;14(1):15-22. https://doi.org/10.5698/1535-7511-14.s2.15
  • 20. Virta M, Hurme M, Helminen M. Increased plasma levels of pro- and anti-inflammatory cytokines in patients with febrile seizures. Epilepsia. 2002;43(8):920-3. https://doi.org/10.1046/j.1528-1157.2002.02002.x
  • 21. Blatteis CM. The onset of fever: new insights into its mechanism. Prog Brain Res. 2007;162:3-14. https://doi.org/10.1016/S0079-6123(06)62001-3
  • 22. Dinarello CA. Infection, fever, and exogenous and endogenous pyrogens: some concepts have changed. J Endotoxin Res. 2004;10(4):201-22. https://doi.org/10.1179/096805104225006129
  • 23. Szekely M, Balasko M, Romanovsky AA. Peripheral neural inputs. Their role in fever development. Ann N Y Acad Sci. 1997;813:427-34. https://doi.org/10.1111/j.1749-6632.1997.tb51728.x
  • 24. van Dam AM, Poole S, Schultzberg M, Zavala F, Tilders FJ. Effects of peripheral administration of LPS on the expression of immunoreactive interleukin-1 alpha, beta, and receptor antagonist in rat brain. Ann N Y Acad Sci.1998;840:128-138. https://doi.org/10.1111/j.1749-6632.1998.tb09557.x
  • 25. Tutuncuoglu S, Kutukculer N, Kepe L, Coker C, Berdeli A, Tekgul H. Proinflammatory cytokines, prostaglandins and zinc in febrile convulsions. Pediatr Int. 2001;43(3):235-9. https://doi.org/10.1046/j.1442-200x.2001.01389.x
  • 26. Rooker S, Jander S, Van Reempts J, Stoll G,Jorens PG, Borgers M, et al. Spatiotemporal pattern of neuroinflammation after impact-acceleration closed head injury in the rat. Mediators Inflamm. 2006;2006(1);90123. https://doi.org/10.1155/MI/2006/90123
  • 27. Choi J, Min HJ, Shin JS. Increased levels of HMGB1 andp ro-inflammatory cytokines in children with febrile seizures. J Neuroinflammation. 2011;8:135. https://doi.org/10.1186/1742-2094-8-135
  • 28. Dube C, Vezzani A, Behrens M, Bartfai T, Baram TZ. Interleukin-1 beta contributes to the generation of experimental febrile seizures. Ann Neurol. 2005;57(1):152-5. https://doi.org/10.1002/ana.20358
  • 29. Balosso S, Maroso M, Sanchez-Alavez M, Ravizza T, Frasca A, Bartfai T, et al. A novel non-transcriptional pathway mediates the proconvulsive effects of interleukin-1 beta. Brain. 2008;131(Pt 12):3256-65. https://doi.org/10.1093/brain/awn271
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi (Original Article)
Yazarlar

Turgay Cokyaman 0000-0002-7108-6839

Yayımlanma Tarihi 30 Ağustos 2019
Gönderilme Tarihi 2 Aralık 2018
Kabul Tarihi 2 Mart 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 4 Sayı: 2

Kaynak Göster

APA Cokyaman, T. (2019). Febrile seizures: is there a significance of chronological ranking of fever and seizure? Family Practice and Palliative Care, 4(2), 57-61. https://doi.org/10.22391/fppc.491220
AMA Cokyaman T. Febrile seizures: is there a significance of chronological ranking of fever and seizure? Fam Pract Palliat Care. Ağustos 2019;4(2):57-61. doi:10.22391/fppc.491220
Chicago Cokyaman, Turgay. “Febrile seizures: is there a significance of chronological ranking of fever and seizure?”. Family Practice and Palliative Care 4, sy. 2 (Ağustos 2019): 57-61. https://doi.org/10.22391/fppc.491220.
EndNote Cokyaman T (01 Ağustos 2019) Febrile seizures: is there a significance of chronological ranking of fever and seizure? Family Practice and Palliative Care 4 2 57–61.
IEEE T. Cokyaman, “Febrile seizures: is there a significance of chronological ranking of fever and seizure?”, Fam Pract Palliat Care, c. 4, sy. 2, ss. 57–61, 2019, doi: 10.22391/fppc.491220.
ISNAD Cokyaman, Turgay. “Febrile seizures: is there a significance of chronological ranking of fever and seizure?”. Family Practice and Palliative Care 4/2 (Ağustos2019), 57-61. https://doi.org/10.22391/fppc.491220.
JAMA Cokyaman T. Febrile seizures: is there a significance of chronological ranking of fever and seizure? Fam Pract Palliat Care. 2019;4:57–61.
MLA Cokyaman, Turgay. “Febrile seizures: is there a significance of chronological ranking of fever and seizure?”. Family Practice and Palliative Care, c. 4, sy. 2, 2019, ss. 57-61, doi:10.22391/fppc.491220.
Vancouver Cokyaman T. Febrile seizures: is there a significance of chronological ranking of fever and seizure? Fam Pract Palliat Care. 2019;4(2):57-61.

Family Practice and Palliative Care      ISSN 2458-8865       E-ISSN 2459-1505