Common Causes of Uncommon Seizures

doi:10.1016/j.pediatrneurol.2009.04.011

Pediatric Neurology

Volume 41, Issue 2, August 2009, Pages 83-87

https://doi.org/10.1016/j.pediatrneurol.2009.04.011 Get rights and content

Afebrile seizures associated with rotavirus gastroenteritis, respiratory syncytial virus bronchiolitis, influenza infection, asthma, blood transfusions, and intake of a number of drugs (including theophylline, cephalosporins, metronidazole, and acyclovir) with therapeutic drug levels are uncommonly encountered in clinical practice. Reviewed here are the incidence, etiology, clinical presentation, types, diagnosis, associated electroencephalographic changes, and cranial magnetic resonance imaging findings in the literature, as well as management and prognosis of these seizures.

Introduction

This review considers several clinical settings that are commonly encountered in pediatric practice, but that present with uncommon central nervous system involvement, and with seizures in particular. These include rotavirus gastroenteritis, respiratory syncytial virus bronchiolitis, influenza infection, asthma, blood transfusions, and intake of a number drugs, including theophylline, cephalosporins, metronidazole, and acyclovir.

Section snippets

Rotavirus Gastroenteritis-Associated Seizures

Rotavirus infection is a frequent cause of severe gastroenteritis in childhood. Less recognized is the central nervous system involvement in this disease. Associations with seizures, encephalopathy, and even death have been described [1]. The virus itself has been implicated as a cause of afebrile seizures and encephalopathy in the absence of fluid, electrolyte, and metabolic abnormalities. Direct central nervous system infection is believed to be the most probable pathophysiology of seizures

Conclusion

Seizures encountered in the common clinical settings of rotavirus gastroenteritis, respiratory syncytial virus bronchiolitis, influenza infection, asthma, blood transfusions, and intake of a number of drugs (including theophylline, cephalosporins, metronidazole, and acyclovir) with therapeutic drug levels should be investigated fully for other more plausible causes. These include central nervous system infections with other microorganisms, electrolyte and metabolic disorders, toxic drug levels,

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Hospitalizations associated with pandemic influenza A (H1N1) 2009 in asthmatic children in Japan
2012, Allergology International
The pandemic influenza A (H1N1) 2009 [pdm (H1N1) 2009] spread through the world in 2009, producing a serious epidemic in Japan. Since it was suggested early that asthma is a risk factor for an increased severity of the infection, the Japanese Society of Pediatric Allergy and Clinical Immunology (JSPACI) organized a working group for countermeasures, and investigated asthmatic children admitted to the hospitals for pdm (H1N1) 2009 infection.
An appeal was made on the home page of the JSPACI to medical practitioners to input clinical information about asthmatic and non-asthmatic children (0–19 years) admitted to the hospital with pdm (H1N1) 2009 infection.
A total of 862 children (390 with asthma, and 472 without asthma) from 61 medical centers were registered, and the data of 333 asthmatic children and 388 non-asthmatic children in all were entered in the analyses. The mean age was 7.4 ± 2.9 years in the asthma group and 6.9 ± 3.8 years in the non-asthma group. The percentage of children admitted for respiratory symptoms was significantly higher in the asthma group than in the non-asthma group (p < 0.001). There was no significant difference in the frequency of admission to the ICU or need for mechanical ventilation support between the two groups. No definite trend was detected in the relationship between the severity of asthma and the intensity of asthma attack. Antiviral drugs were administered within 24 hours in about 85% of the patients in both groups.
Asthma may not be a risk factor for severe pdm (H1N1) 2009 infection in children.
Methylxanthine-evoked perturbation of spontaneous and evoked activities in isolated newborn rat hippocampal networks
2015, Neuroscience
Citation Excerpt :
However, such low methylxanthine doses may interfere with ENOs as indicated by qualitative findings by Dzahla et al. (1999). Therefore, we next quantified if CA3-ENOs are affected by 0.1 and 0.5 mM methylxanthine which is slightly above and at the upper limit, respectively, of therapeutic plasma levels (Comer et al., 2001; Korematsu et al., 2008; El-Bitar and Boustany, 2009). Neither theophylline (Figs. 4A, B; six slices) nor caffeine (Figs. 4C, D; six other slices) affected CA3-ENO rate, amplitude and signal baseline, but there was a trend for an increase of all parameters.
Treatment of apnea of prematurity with methylxanthines like caffeine, aminophylline or theophylline can evoke hippocampal seizures. However, it is unknown at which interstitial brain concentrations methylxanthines promote such neonatal seizures or interfere with physiological ‘early network oscillations’ (ENOs) that are considered as pivotal for maturation of hippocampal neural networks. We studied theophylline and caffeine effects on ENOs in CA3 neurons (CA3-ENOs) and CA3 electrical stimulation-evoked monosynaptic CA1 field potentials (CA1-FPs) in sliced and intact hippocampi, respectively, from 8 to 10-days-old rats. Submillimolar doses of theophylline and caffeine, blocking adenosine receptors and phosphodiesterase-4 (PDE4), did not affect CA3-ENOs, ENO-associated cytosolic Ca²⁺ transients or CA1-FPs nor did they provoke seizure-like discharges. Low millimolar doses of theophylline (⩾1 mM) or caffeine (⩾5 mM), blocking GABA_A and glycine receptors plus sarcoplasmic-endoplasmic reticulum Ca²⁺ ATPase (SERCA)-type Ca²⁺ ATPases, evoked seizure-like discharges with no indication of cytosolic Ca²⁺ dysregulation. Inhibiting PDE4 with rolipram or glycine receptors with strychnine had no effect on CA3-ENOs and did not occlude seizure-like events as tested with theophylline. GABA_A receptor blockade induced seizure-like discharges and occluded theophylline-evoked seizure-like discharges in the slices, but not in the intact hippocampi. In summary, submillimolar methylxanthine concentrations do not acutely affect spontaneous CA3-ENOs or electrically evoked synaptic activities and low millimolar doses are needed to evoke seizure-like discharges in isolated developing hippocampal neural networks. We conclude that mechanisms of methylxanthine-related seizure-like discharges do not involve SERCA inhibition-related neuronal Ca²⁺ dysregulation, PDE4 blockade or adenosine and glycine receptor inhibition, whereas GABA_A receptor blockade may contribute partially.
Adverse Drug Reactions and Drug-drug Interactions
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Adverse Drug Reactions and Drug-drug Interactions
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Subsequent Afebrile Seizure in Children Who Have a First Seizure With Fever After 6 Years of Age
2010, Pediatric Neurology
Citation Excerpt :
Third, it may be a single event associated with the acute phase of a systemic viral illness. Several investigators have reported on the potential role of certain neurotropic viruses (notably, human herpes virus 6 and 7, influenza virus, rotavirus, and respiratory syncytial virus) in the development of febrile seizures [9-11]. More recent investigations, however, indicate that the role of these viruses in the pathogenesis of febrile seizures remains unknown [12,13].
The objective was to evaluate the risk and the risk factors associated with subsequent afebrile seizures in 31 children who experienced their first seizure with fever after 6 years of age. The children were classified into two groups. Group I comprised children with their first seizure with fever after 6 years of age (n = 15). Group II comprised children who had febrile seizures before 5 years of age and who had recurrent seizures with fever after 6 years of age (n = 16). Of these 31 children, 7 (22.5%) had subsequent afebrile seizure. The cumulative probability of subsequent afebrile seizure was 13.3% at 6 months and 36 months in group I; in group II, the cumulative probability was 12.5% at 6 months, 18.8% at 18 months, 25% at 24 months, and 31.3% at 36 months. There was no significant difference in the risk for subsequent afebrile seizures between the two groups. There were no risk factors associated with an increased risk of subsequent afebrile seizures. If the first seizure with fever occurred after 6 years of age, this was a significant risk for subsequent afebrile seizure; the risk of seizure recurrence in this group appears to be similar to children who have persistent febrile seizures after 6 years of age, but far below that of children with first epileptic seizure.
Pediatric Metronidazole-Induced Encephalopathy: A Case Report and Review of the Literature
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Review ArticleCommon Causes of Uncommon Seizures

Introduction

Section snippets

Rotavirus Gastroenteritis-Associated Seizures

Conclusion

Brain Dev

Brain Dev

Brain Dev

Brain Dev

Pediatr Neurol

Brain Dev

Brain Dev

Pediatr Neurol

J Biol Chem

Pediatr Neurol

Eur J Paediatr Neurol

Lancet

Med Hypotheses

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Transfus Clin Biol

Crit Care Clin

Neuropharmacology

J Infect

Rotavirus-induced seizures in childhood

J Child Neurol

Rotavirus encephalopathy: pathogenesis reviewed

J Paediatr Child Health

Rotavirus encephalopathy: evidence of central nervous system involvement during rotavirus infection

Pediatr Infect Dis J

Central nervous system involvement in patients with rotavirus gastroenteritis

Scand J Infect Dis

The CNS symptoms of rotavirus infections under the age of two

Klin Padiatr

Rotavirus and central nervous system symptoms: cause or contaminant? Case reports and review

Clin Infect Dis

Acute gastroenteritis-related encephalopathy

J Child Neurol

Suspected rotavirus encephalitis

Arch Dis Child

Aseptic meningitis in an infant with rotavirus gastroenteritis

Pediatr Infect Dis J

Haemorrhagic shock and encephalopathy associated with rotavirus infection

Acta Paediatr

Rotavirus encephalitis: detection of the virus genomic RNA in the cerebrospinal fluid of a child

Pediatr Infect Dis J

The endoplasmic reticulum-associated VP7 of rotavirus is targeted to axons and dendrites in polarized neurons

J Neurocytol

Microtubule-associated protein 2 appears in axons of cultured dorsal root ganglia and spinal cord neurons after rotavirus infection

J Neurosci Res

Afebrile seizures and rotavirus gastroenteritis: an infrequently recognized association

Clin Pediatr (Phila)

Ictal video-EEG recording of three partial seizures in a patient with the benign infantile convulsions associated with mild gastroenteritis

Epilepsia

The spectrum of benign infantile seizures

Epilepsy Res

Review Article
Common Causes of Uncommon Seizures