NEW YORK (Reuters Health) Nov 29 - Children whose first seizure is related to acute gastroenteritis have a good prognosis and low risk of seizure recurrence, according to data from Seattle Children's Hospital.
The findings, published online November 22nd in Pediatrics, don't mean a child with a first-time seizure and a GI infection should be treated less aggressively. But they do show that clinicians should consider the acute illness that accompanies a first seizure when predicting the risk of subsequent seizures, said senior author Dr. Danielle Zerr.
Febrile seizures are the most common type among children and usually have a favorable prognosis. But researchers -- including Dr. Zerr and her colleagues -- have recently been focusing on seizures that occur in conjunction with acute illnesses, not necessarily febrile ones.
In the Seattle study, Dr. Zerr and her colleagues analyzed viral etiologies of associated illnesses in 117 kids having a first seizure between the ages of six months and six years; then they tracked the children for up to 5 years to determine patterns of recurrence.
In email to Reuters Health, Dr. Zerr said the study confirmed that children with a first seizure accompanied by gastroenteritis (within a week before or after the seizure) were at lower risk of seizure recurrence than children who had some other concurrent illness. "In fact," she writes, "gastrointestinal illness appears to be more important than whether or not a fever accompanied the first seizure."
Of the 117 children enrolled in the study, 78 (67%) had febrile seizures, 34 (29%) had seizures associated with non-febrile illnesses, and 5 (4%) had unprovoked seizures, Dr. Zerr writes. Children with nonfebrile seizures were more likely than kids with febrile seizures to have concurrent gastroenteritis (47% vs. 28%; p=0.05).
Recurrence rates were similar in children with or without fever at their first seizure. But kids whose first seizure occurred in combination with acute gastroenteritis had a dramatically lower risk of recurrence (hazard ratio: 0.28). And that held true whether fever was present or not.
Dr. Zerr noted some limitations of the study. "It would have been nice to have had more children with unprovoked seizures as a comparison group," she writes. She also says she and her group wished they could perform broader tests for infectious organisms on all patients.
Some important questions remain, she said. Among them: "We do not understand the mechanism behind the association between gastroenteritis and lower risk of seizure recurrence. It's possible that clinical syndrome or specific organism play a role."