Relationship between Changes in Serum Sodium Level and Seizures Occurrence in Children with Hypernatremic Dehydration

How to Cite This Article: Heydarian F, Rezaeian A. Relationship between Changes in Serum Sodium Level and Seizures Occurrence in Children with Hypernatremic Dehydration. Iran J Child Neurol. 2013 Autumn;7(4): 35- 40. ObjectiveTo assess any relationship between serum sodium changes and seizure occurrence in children aged 2 months to 5 years with hypernatremic dehydration. Materials & MethodsThis cross-sectional study was performed on 63 patients aged 2 months to 5 years from 20 March 2006 to 15 March 2012 at Ghaem Hospital and Dr. Sheikh Hospital in Mashhad, Iran. Patients were divided into 2 groups: case group with hypernatremic dehydration and seizure occurrence, and control group with hypernatremic dehydration and no seizures. ResultsThe mean age of patients was 10.38 (2-48) months. Thirteen patients had seizures, 11 out of them, before admission and 2 during hospital staying. Serum sodium level at admission in those 2 patients with seizure occurrence after hospitalization was 169 (158-180) mmol/L, and in 50 patients without seizure was 162.8 (148-207) mmol/l. Also, the rate of decrease of serum sodium levels in these 2 cases within the first 12 hours after admission was 1.12, and in those without seizure was 0.54 (mmol/L/hour), and it was 0.47 and 0.53 (mmol/l/hour) after 24 hours of admission, respectively. Severe dehydration was seen in 38.5% of cases and 14% of controls. ConclusionThere was not any relationship between changes in serum sodium level and seizure occurrence in children with hypernatremic dehydration. ReferencesOkumura A, Ishiguro Y, Sofue A, Suzuki Y, Maruyama K, Kubota T, et al. Treatment and outcome in patients with febrile convulsion associated with epileptiform discharges on electroencephalography. Brain Dev 2004;26(4):241-4.Heydarian F, Vatankhah H. The role of anemia n first simple febrile seizure in children aged 6 months to 5 years old. Neurosciences (Riyadh) 2012;17(3):226-9.Heydrian F, Ashrafzadeh F, Ghasemian A. Serum zinc level in patients with simle febrile seizure. Iran J Child Neurol 2010;4(2):41-4.Dad MI, Ismael GA, Al-Oufi AA, Al-Mohammadi AH. Clinical pattern of seizures in hospitalized children. Neurosciences (Riyadh) 2003;8(2):107-9.Heydarian F, Ashrafzadeh F, Kam S. Simple febrile seizure: The role of serum sodium levels in prediction of seizure occurrence during the first 24 hours, Iran J Child Neurol 2009;3;31-4.Robertson G, Carrihill M, Hatherill M, Waggir Z,Reynolds L, Argent A. Relationship between fluid management, changes in serum sodium and outcome in hypernatremia associated with gastroenteritis, J Paediatr Child Health 2007;43(4):291-6.De Petris L, Luchetti A, Emma F. Cell volume regulationand transport mechanisms across the brain blood barrier: Implications for the management of hypernatremic states. Eur J pediatr 2000;160(2):71-7.Ross O. The management of extreme hypernatremia secondary to salt poisoning in an infant. Pediatr Anesth 2000;10:110-5.Hatherill M. Rubbing salt in the wound. Arch Dis Child 2004;89(5):414-8.Moritz ML, Ayus JC. Prevention of hospital acquired hyponatremia: A case for using isotonic saline. Pediatrics 2003;111(2):227-30.Taylor D, Durward A. Pouring salt on troubled waters. Arch Dis Child 2004;89(5):411-4.Fang C, Mao J, Dai Y, Xia Y, Fu H, Chen Y, et al. Fluid management of hypernatremic dehydration to prevent cerebral edema: A retrospective case control study of 97 children in China. J Paediatr Child Health 2010;46(6):301-3.El-Bayoumi MA, Abdelkader AM, El-Assmy MMA, Alwakeel AA, El-Tahan HM. Normal saline is a safe initial rehydration fluid in children with diarrhea-related hypernatremia. Eur J Pediatr 2012;171(2):383-8.Arampatzis S, Frauchiger B, FiedlerGM, Leichtle AB, Buhl D, Schwarz C, et al. Characteristics, Symptoms, and Outcome of severe Dysnatremias Present on Hospital Admission. Am J Med 2012;125(11):1125.e1-1125.e7.Chisti MJ, Pietroni MA, Smith JH, Bardhan PK, Salam MA, Predictors of death in under-five children with diarrhea admitted to a critical care ward in an urban hospital in Bangladesh. Am J Med 2012;125(11):1125. e1-1125.e7.Moritz ML, Ayus JC Preventing neurological complications from dysnatremias in children. Pediatr Nephrol 2005;20(12):1687-700.

Serum Zinc Level in Patients with Simple Febrile Seizure

ObjectiveTo evaluate the serum zinc level of the patients with simple febrile seizure and compare them with febrile children without seizure.Materials & MethodsThis prospective case - control study was performed on 60 patients aged 6 months to 6 years from Apr. 2009 to Jan.2010 in Ghaem, Imam Reza and Dr. Sheikh Hospitals in Mashhad. The serum zinc level was assessed and compared between the cases (30 individuals who suffered from simple febrile seizure) and the controls (30 individuals who had fever without seizure).ResultsMean serum zinc level was 663.7 µg /l and 758.33  µg /l in the case group and the control group, respectively (PConclusionIt was revealed that the serum level of zinc was significantly lower in children with simple febrile seizure in comparison with febrile children without seizure.

Proteus Syndrome: A Case Report

ObjectiveProteus Syndrome is an extremely rare, sporadic and progressive disorder. We describe a four-month-old male baby with central nervous system manifestations in this article.Clinical presentationA four-month-old boy was admitted into our hospital with three tonic - clonic generalized seizure attacks which started from the day before admission. Each seizure attack lasted less than 10 minutes and the baby was well between attacks. No fever was detected. On physical examination, abnormal facial features, macrocrania, a wide nasal bridge, overgrowth of the right lower limb, macrodactyly in the third left toe, epidermal nevus on the left side of the abdomen and skin vascular abnormalities were detected. His developmental status was normal. Brain Magnetic Resonance Imaging (MRI) revealed left sided hemihypertrophy, ventricle enlargement and macrocrania on the same side

Gastroenteritis Related Seizure with or without Fever: Comparison Clinical Features and Serum Sodium Level

Objective: To investigate the clinical characteristics and serum sodium level in children with gastroenteritis related seizure with or without fever. Methods: 165 patients aged 6-60 months with gastroenteritis related seizure were studied. Demographic, seizure and gastroenteritis characteristics and laboratory findings were recorded.Results: Among the 165 children 47.3% were female and 52.7% were. Vomiting was 2.7±2.6 and 3.9±1.9 times in febrile and afebrile group. Duration of diarrhea was 1.8±1.8 day and 2.1±1.3 day in febrile and afebrile group (p=0.014). 36% in febrile group and 6.4% in afebrile group experienced seizure within the first 24 hours of gastroenteritis (p<0.001). Seizure in 99.1% in febrile and 93.6% in afebrile group was generalized (p>0.05). Seizure was more than 5 minutes in 51.4% in febrile and 57.4% in afebrile group (p>0.05). Drowsiness after seizure was seen in 72.9% and 60% in febrile and afebrile group (p>0.05). The serum level of sodium was 137.6±3.98 mEq/L and 138.5±3.78 mEq/L in febrile and afebrile group (p>0.05). 26.3% in febrile group and 8.5% in afebrile group had hyponatremia (p=0.012). There was no difference in seizure duration between hyponatremic patients and others (p>0.05). Conclusion: Type, duration of seizure and drowsiness after seizure had not any difference in febrile and afebrile cases. Vomiting and duration of diarrhea before admission was lower in febrile group. Seizure within the first 24 of gastroenteritis was higher in febrile group. Mild hyponatremia in febrile group was higher than afebrile group. No difference in duration of seizure was detected between hyponatremic patients and others

Postdural Puncture Headache: Incidence and Risk Factors in Children Following Intrathecal Chemotherapy

How to Cite this Article: Bani hashem A, Heydarian F, Gharavi M, Khoshnod M. Postdural Puncture Headache: Incidence and Risk Factors in Children FollowingIntrathecal Chemotherapy. Iranian Journal of Child Neurology 2012;6(1):19-22.ObjectiveTo evaluate the incidence and risk factors of development of postdural puncture headache in children who had intrathecal chemotherapy injection.Materials & MethodsTwo-hundred eighty patients (mean age, 7.23±3.92 years) who had intrathecal chemotherapy injection were studied prospectively during 2008-2009 in the pediatric ward of Dr. Sheikh hospital in Mashhad. Patients who had lumbar puncture for their chemotherapy drug injections were assessed daily for four days to detect postdural puncture headache.ResultsThere were 172 (61, 4%) male patients and the remainder were female. Postdural puncture headache was detected in 41 patients (14.6%). The body mass index did not show any significant difference between the two groups. Lumbar puncture (LP) attempts had a significant association with postdural puncture headache. The size and shape of the needle did not have a significant association with postdural puncture headache.ConclusionLP attempts have a significant relationship with postdural puncture headache. References:1. Bolder PM. Postlumbar puncture headache in pediatriconcology patients. Anesthesiology. 1986;65:696-8.2. Ozyalcin NS, Menda F. Regional anesthesia and analgesiaapplications in children and infants – II. Agri 2004;16:29-34, 37-42.3. Oilver A. Dural punctures in children: what should wedo? Paediatr Anaesth. 2002;12:473-7.4. Kokki H, Hendolin H, Turunen M. Postdural punctureheadache and transient neurologic symptoms in childrenafter spinal anaesthesia using cutting and pencil pointpaediatric spinal needles. Acta Anaesthesiol Scand1998;42:1076-82.5. Lowery S, Oliver A. Incidence of postdural punctureheadache backache following diagnostic therapeuticlumbar puncture using a 22G cutting spinal needle, andafter introduction of a 25G pencil point spinal needle.Pediatr Anesth. 2008;18:230-46. Apiliogulari S, Duman A, Gok F, Akilliouglu L.Spinal needle design and size affect the incidence ofposdural puncture headache in children. Pediatr Anesth2010;20:177-82.7. Kokki H, Heikkinen M, Turunen M. Needle design doesnot affect the success rate of spinal anaesthesia or theincidence of postpuncture complications in children. ActaAnaesthesiol Scand 2000;44:210-3.8. Hammond ER, Wang Z, Bhulani N, McArthur JC, LevyM. Needle Type and the risk of post-lumber punctureheadache in the outpatient neurology. Clin J Neurol Sci;306(2011):24-8.9. Lybecker H, Djernes M, Schimidt JF. Postdural punctureheadache (PDPH): onset, duration, severity and associatedsymptoms. An analysis of 75 consecutive patients withPDPH. Acta Anaesthesiol Scand 1995;39:605-12.10. Seeberger MD, Kaufman M, Staender S, Schneider M,Scheidegger D. Repeated dural punctures increase theincidence of postdural puncture headache. Anesth Analg1996;82:302-5.11. Thomas SR, Jamison DR, Muir KW. Randomizedcontrolled trial of atraumatic versus standard needles fordiagnostic lumbar puncture. BMJ 2000;3210:986-90.12. Strupp M, Schueler O, Straube A. Atroumatic Sprotteneedle reduces the incidence of post-lumbar punctureheadaches. Neurology 2001;57:2310-2.13. Kleyweg RP, Hetzberger LI, Carbat PA. Significantreduction in post-lumber puncture headache using an atraumatic needle. Cephalalgia 1998;18:635-7.14. Lybecker H, Moller JT, May O. Incidence and predictionof postural puncture headache. A prospective study of1021 spinal Anesthesias. Anesth Analg 1990;70:389-94.15. Helper S, Preston R. Postdural puncture headache andspinal needle design. Meta analyses. Anesthesiology1994:81:1376-83.16. Parker RK, White PF. A microscopic analysis of cutbevelversus pencil-point spinal needles. Anesth Analg1997;85:1101-4.17. Reina MA, de leon Casasola OA, Lopez A. An in vitrostudy of dural lesions produced by 25-gauge Quinckeand Whitacre needles evaluated by scanning electronmicroscopy. Reg Anesth Pain Med 2000;393-402

Serum Level of Vitamin D and Febrile Seizure? A Clinical Study

Objective:To evaluate the serum level of vitamin D in children aged six to 60 months with febrile seizure and febrile children without the seizureMaterials & MethodsFebrile children aged six to 60 months with or without seizure were studied. Demographic characteristics, serum level of vitamin D, and other laboratory findings were recorded.ResultsAmong the 104 children, 51 patients had fever without a seizure and 53 patients had a febrile seizure. The mean subjects’ age was significantly more in the febrile seizure group compared to the without seizure group (16.26 ± 11.87 versus 26.36 ± 14.11 months, p = 0.001). The mean serum level of vitamin D in the with and withouts eizure groups was 41.92 ± 22.42 and 48.41 ± 15.25 microgram perd eciliter, respectively (p = 0.08). There was no significant correlation between serum level of vitamin D and seizure occurrence (p = 0.07).The mean serum sodium and potassium levels, and platelet count were significantly lower in the febrile seizure group compared to the without seizure group (p < 0.05). There were no significant differences between the two groups regarding hemoglobin, blood sugar, creatinine, blood urea nitrogen, calcium, alkaline phosphatase levels, and white blood cell count (p > 0.05).ConclusionThe serum level of vitamin D in febrile children with or without seizure was normal. The serum level of vitamin D was lower inp atients with the seizure but not statistically significant. More clinical studies are needed to evaluate the relationship between febrile seizurea nd the serum level of vitamin D

Recurrent Seizure during Hospitalization in Children with the First Febrile Seizure: Incidence and Risk Factors

Background: The present study aimed at evaluating the demographic and laboratory factors associated with the recurrent seizure during hospitalization in the children with the first febrile seizure.Methods: This cohort study was performed in Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran, from 2018 to 2019. Totally 483 admitted children aged 6-60 months with the first febrile seizure were included. The repetition of seizure during hospitalization was considered as incidence of recurrent seizure.Results: Among 483 children with the first febrile seizure, recurrent seizure occurred in 57 patients (11.8%). The serum level of potassium, magnesium and calcium in children with recurrent seizure significantly was lower in comparison to the patients without repeated seizure. Complex seizure was the major risk factor for recurrent seizure (relative risk: 377.74, p=0.001). The risk of recurrent seizure decreased with the increase of serum level of potassium, calcium and magnesium. The risk of recurrent seizure increased with the increase of body temperature but not significantly.Conclusion: The incidence rate of recurrent seizure in children with the first febrile seizure was 118 cases per 1000 population. Complex seizure was the main risk factor for the seizure recurrence. Higher serum levels of potassium, calcium and magnesium may decrease the risk of recurrent seizure

Comparison of Verbal Explanations, Graphics, and Film Presentations for Increasing Parental Satisfaction with Lumbar Puncture Performance in Children with Febrile Seizure

AbstractObjective: The present study aimed to determine the effect of training parents by film, poster or graphics, and verbal explanation, on the enhancement of their satisfaction with the performance of this procedure.Materials and Methods: This cross-sectional quasi-experimental study was conducted on the children with febrile seizures referred to the Emergency and Pediatric Wards of hospitals affiliated with Mashhad University of Medical Sciences. They were LP candidates; nonetheless, their parents did not consent to the performance of this procedure. The children were randomly assigned to three groups. In the first group, videos of the location and method of LP were presented to the parents. The second group received this information via posters, and the parents in the third group were given a verbal explanation. Results: The children included 49 (4.54%) females with a mean age of 15 months. There was a significant relationship between the reason for parental refusal of LP and their final satisfaction (P=0.022). There was a significant relationship between parents' satisfaction with the performance of LP and their education (P=0.029). The film method had the lowest chance of success, and the verbal explanation method enjoyed the most remarkable success in enhancing parental satisfaction (P= 0.013).Conclusion: Although the use of posters and videos was less effective than verbal explanation, it increased the satisfaction of LP in some parents. In fact, it is more beneficial to try to alter parental misperceptions of LP in non-emergency situations

Serum vitamin C levels: a comparison between febrile children with or without seizure

Objective: An imbalance has been reported in the oxidant-antioxidant system of infants with febrile convulsion. This study aimed to compare serum vitamin C levels between febrile children with or without seizures. Materials and Method: This multicenter case-control study was conducted on febrile infants and children who were referred to the pediatric emergency wards of Mashhad University of Medical Science. The subjects were equally divided into two febrile groups of case (with seizure) and control (without seizures). Visible Spectrophotometer was used to determine the total vitamin C level.Results: In total, 100 febrile children were included in this study. Based on the results, there was no statistically significant difference between the two groups in terms of age, gender, and family history of febrile convulsion (FC) (P>0.05). The mean vitamin C levels in the case and control groups were 42.73±7.2 and 78.59±11.1 µg/l, respectively. There was a significant difference between the groups regarding the vitamin C level (P<0.001). Regression analysis revealed that age (P=0.74), gender (P=0.66), and family history of febrile convulsion (P=0.52) had not any correlation with vitamin C levels. On the other hand, the vitamin C levels was associated with FC (P=0.001).Conclusion: The serum levels of vitamin C in the children with febrile seizure were lower than those in the control group. Thus, the reduced vitamin C levels can be considered as a predisposing factor for FC

Convulsion Associated with Gastroenteritis

Convulsion with mild gastroenteritis is an afebrile seizure associated with viral gastroenteritis in a healthy child without fever, dehydration, electrolyte imbalance, meningitis, or encephalitis. Convulsion with mild gastroenteritis is more common in children aged 1 to 2 years. Usually, Convulsions are brief generalized tonic colonic type. Most convulsions occur within first 24 hours of illness onset. Rotaviral gastroenteritis is known as the most common type of gastroenteritis associated with Convulsion. Laboratory investigations are normal. Also EEG and neuroimaging are usually normal. Long term antiepileptic treatment is not necessary. It is usually a benign condition with good prognosis and no risk for developing epilepsy in future. Considering this etiology of seizure could prevent supernumerary evaluations and long-term antiepileptic treatment