49 research outputs found
Febrile Seizures: clinical and genetic studies
Febrile seizures are described as a temporary seizure disorder of childhood; the attacks occur
by definition in association with fever and are usually accompanied by sudden tonic-clonic
muscle contractions and reduced consciousness, usually lasting not longer than 5 to 10
minutes. According to the commonly accepted definition of the National Institutes of Health
consensus meeting of febrile seizures in 1980, 'a febrile seizure (an abnormal, sudden,
excessive electrical discharge of neurons [grey malter] which propagates down the neuronal
processes [white matter] to affect an end organ in a clinically measurable fashion) is an event
in infancy or childhood, usually occurring between three months and five years of age,
associated with fever but without evidence of intracranial infection or defined cause. Seizures
with fever in children who have suffered a previous nonfebrile seizure are excluded. Febrile
seizures are to be distinguished from epilepsy, which is characterised by recurrent non febrile
seizures'. 1 In the context of this thesis, fever has been defined as a rectally measured body
temperature of 38.5 °C or higher. Complex febrile seizures have one or more of the foHowing
characteristics: the seizure lasts for more than 15 minutes (prolonged) or 30 minutes or more
(febrile status epilepticus); there are one or more recurrences within 24 hours (multiple type
febrile seizures); the seizure has partial features, i.e. a focal onset of the seizure or a postictal
Todd paresis of facial muscles or Iimbs.
Seizures are referred to as simple, if they last less
than 15 minutes, do not recur within 24 hours (single-type) and are generalised
Randomized,controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences
Randomized,controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences
Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences
OBJECTIVES: Febrile seizures recur frequently. Factors increasing the risk
of febrile seizure recurrence include young age at onset, family history
of febrile seizures, previous recurrent febrile seizures, time lapse since
previous seizure <6 months, relative low temperature at the initial
seizure, multiple type initial seizure, and frequent febrile illnesses.
Prevention of seizure recurrences serves two useful purposes: meeting
parental fear of recurrent febrile seizures in general and reducing the
(small) risk of a long-lasting and eventually injurious recurrent seizure.
In daily practice, children with febrile seizures often are treated with
antipyretics during fever to prevent febrile seizure recurrences. Thus
far, no randomized placebo-controlled trial has been performed to assess
the efficacy of intermittent antipyretic treatment in the prevention of
seizure recurrence. METHODS: We performed a randomized, double-blind,
placebo-controlled trial. Children 1 to 4 years of age who had had at
least one risk factor for febrile seizure recurrence were enrolled. They
were randomly assigned to either ibuprofen syrup, 20 mg/mL, 0.25 mL (= 5
mg) per kilogram of body weight per dose, or matching placebo, to be
administered every 6 hours during fever (temperature, >/=38.5 degrees C).
Parents were instructed to take the child's rectal temperature immediately
when the child seemed ill or feverish and to promptly administer the study
medication when the temperature was >/=38.5 degrees C. Doses were to be
administered every 6 hours until the child was afebrile for 24 hours. The
parents were instructed not to administer any other antipyretic drug to
the child. For measuring rectal temperature, a Philips HP5316 digital
thermometer (Philips, Eindhoven, The Netherlands) was distributed. During
subsequent treatment of the fever episode, parents had to call the
investigator at least once each day to notify the investigator in case of
febrile seizure recurrence. The investigator could be contacted by parents
24 hours per day. The primary outcome was the first recurrence of a
febrile seizure. Kaplan-Meier curves and Cox regression were used for the
statistical analysis. The treatment effect on the course of the
temperature was assessed using analysis of covariance, with temperature at
fever onset as covariate. Two analyses were performed. In an
intention-to-treat analysis, all first recurrences were considered
regardless of study medication compliance. A per-protocol analysis was
limited to those recurrences that occurred in the context of study
medication compliance. RESULTS: Between October 1, 1994, and April 1,
1996, 230 children were randomly assigned to ibuprofen syrup (111
children) or placebo (119 children). Median follow-up time was 1.04 years
(25th-75th percentiles; 0.7-1.8 years) in the ibuprofen group and 0.98
years (0.7-1.6 years) in the placebo group. Of all children, 67 had a
first febrile seizure recurrence, with 31 in the ibuprofen group and 36 in
the placebo group. The 2-year recurrence probabilities were 32% and 39%,
Frequency of fever episodes related to febrile seizure recurrence
The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow-up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR)= 1.8; 95% confidence interval (CI): 1.4-2.4)] and age at study entry (OR=0.6; 95% CI: 0.3-1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure
Fluorescent Cell Barcoding as a Tool to Assess the Age-Related Development of Intracellular Cytokine Production in Small Amounts of Blood from Infants
Fluorescent Cell Barcoding (FCB) is a flow cytometric technique which has been used for assessing signaling proteins. This FCB technique has the potential to be applied in other multiparameter analyses. Since data on antigen (Ag)-specific T-cell immune responses, like intracellular cytokine production, are still lacking in infants because limited blood volumes can be obtained for analysis, the FCB technique could be very useful for this purpose. The objectives of this study were to modify the FCB method to be able to measure multiple Ag-specific cytokine reponses in T-cells upon simultaneous stimulation by various antigens and mitogens in small amounts of blood and to investigate the cytokine pattern of T-cell subsets in healthy infants aged six and twelve months. Blood samples, collected from 20 healthy infants aged six and twelve months, were stimulated in vitro with the antigens: phorbol-myristate-acetate (PMA), purified-protein-derivative (PPD), Tetanus-toxoid (TT), Staphylococcal-enterotoxin-B (SEB), and phytohemagglutinin (PHA). Each stimulus was barcoded by labelling with different intensities of fluorescent cell barcoding (FCB) markers. Intracellular production of interleukin-2, interferon-gamma, and tumor necrosis factor-alpha was measured simultaneously in just one blood sample of 600 µl whole blood. Significant age-related differences in cytokine production were shown for PMA, PHA, and TT in CD4+ T-cells, and for PMA, PHA, SEB, and TT in CD8+ T-cells. The intracellular cytokine production by CD4+ and CD8+ T-cells was higher at twelve months compared to six months of age for all antigens, except for PMA, which was lower at the age of twelve months. Based on the consistency in both T-cell subsets, we conclude that the new FCB method is a promising tool to investigate the age-related development of intracellular cytokine production in infants
Informed consent, parental awareness, and reasons for participating in a randomised controlled study
BACKGROUND: The informed consent procedure plays a central role in
randomised controlled trials but has only been explored in a few studies
on children. AIM: To assess the quality of the informed consent process in
a paediatric setting. METHODS: A questionnaire was sent to parents who
volunteered their child (230 children) for a randomised, double blind,
placebo controlled trial of ibuprofen syrup to prevent recurrent febrile
seizures. RESULTS: 181 (79%) parents responded. On average, 73% of parents
were aware of the major study characteristics. A few had difficulty
understanding the information provided. Major factors in parents granting
approval were the contribution to clinical science (51%) and benefit to
the child (32%). Sociodemographic status did not influence initial
participation but west European origin of the father was associated with
willingness to participate in future trials. 89% of participants felt
positive about the informed consent procedure; however, 25% stated that
they felt obliged to participate. Although their reasons for granting
approval and their evaluation of the informed consent procedure did not
differ, relatively more were hesitant about participating in future.
Parents appreciated the investigator being on call 24 hours a day (38%)
and the extra medical care and information provided (37%) as advantages of
participation. Disadvantages were mainly the time consuming aspects and
the work involved (23%). CONCLUSIONS: Parents' understanding of trial
characteristics might be improved by designing less difficult informed
consent forms and by the investigator giving extra attention and
information to non-west European parents. Adequate measures should be
taken to avoid parents feeling obliged to participate, rather than giving
true informed consent
Maternal use of prednisolone is unlikely to be associated with neonatal adrenal suppression—a single-center study of 16 cases
Maternal use of prednisolone is unlikely to be associated with neonatal adrenal suppression-a single-center study of 16 cases
The use of supra-physiological, exogenous corticosteroids in pregnancy may lead to neonatal adrenal suppression. We report on a single-center, case series study carried out between 2006 and 2014, which included all newborns (n = 16) of mothers using prednisolone >= 10 mg/day during pregnancy. Newborns were routinely assessed according to hospital protocol, with follow-up until 6 weeks after birth. We investigated the clinical symptoms and biochemical findings of adrenal suppression occurring in the newborns. Mean dose of maternal prednisolone was 29.7 +/- A 16.1 mg/day with a mean duration of 18.4 +/- A 15.4 weeks. Five newborns showed hypoglycemia with normal serum cortisol concentrations and urinary steroid profiles. Two newborns had abnormal urinary steroid profiles, probably the result of prematurity, but with adequate adrenal stress response during clinical sepsis. Conclusion: In this retrospective case series, we found no evidence of prolonged effects of maternal prednisolone use during pregnancy on the neonatal hypothalamic-pituitary-adrenal axis