Vascular topology is acutely impacted by experimental febrile status epilepticus

Febrile status epilepticus (FSE) is an important risk factor for temporal lobe epilepsy and early identification is vital. In a rat model of FSE, we identified an acute novel MRI signal in the basolateral amygdala (BLA) at 2 hours post FSE that predicted epilepsy in adulthood. This signal remains incompletely understood and hypothesized that it might derive from changes to vascular topology. Experimental FSE was induced in rat pups and compared to normothermic littermate controls. We examined cerebral vascular topology at 2 hours, using a novel vessel painting and analysis protocol. Blood vessel density of the cortical vasculature was significantly reduced in FSE rats, and this effect was lateralized, as reported for the MRI signal. The middle cerebral artery (MCA) exhibited abnormal topology in FSE pups but not in controls. In the BLA, significant vessel junction reductions and decreased vessel diameter were observed, together with a strong trend for reduced vessel length. In summary, FSE results in acute vascular topological changes in the cortex and BLA that may underlie the acute MRI signal that predicts progression to future epilepsy. The altered vasculature may be amenable to intervention treatments to potentially reduce the probability of progression to epilepsy following FSE.

Niente di speciale, è solo neuroinfluenza!

Seasonal Influenza may occasionally cause severe neurological complications. The paper describes the case of a 5-year-old child with febrile status epilepticus and Influenza B.

Study of Febrile Seizure among Hospitalized Children of a Tertiary Centre of Nepal: A Descriptive Cross-sectional Study

Introduction: Febrile seizure is the commonest cause of seizure in children and appears mostly between 6-60 months of life. The objective of this study is to find out the prevalence of febrile seizure among hospitalized children of a tertiary centre of Nepal. Methods: This is a descriptive cross-sectional study conducted in a teaching hospital of central Nepal, from 2014 January to 2019 December. After obtaining ethical clearance from Institutional Review Committee (Reference number: 2019-038), clinical and demographic data was retrieved from patient record retrospectively and reviewed for completeness and accuracy; those fulfilling the definition of febrile seizure were enrolled in the study. Convenience sampling technique was used. The data was analyzed using Statistical Packages for Social Sciences Version 25. Point estimate is done at 95% Confidence Interval and frequency and proportion was calculated. Results: Out of 4890 cases admitted during the study period, 214 (4.37%) (3.80%-4.94% at 95% Confidence Interval) children were diagnosed with febrile seizure. One hundred thirty one (62%) children had a simple febrile seizure. In majority of the cases, seizure lasted for less than 5 minutes; however, 10 (4.6%) of them presented with febrile status epilepticus, 111 (52%) children had generalised tonic seizure and upper respiratory tract infection was the commonest cause of fever. Conclusions: Prevalence of febrile seizure is significant among hospitalized children and simple febrile seizure is the commonest type. A substantial number of children present in febrile status epilepticus, even though the duration of febrile seizure is brief in most of the cases.

Report of a Child With Febrile Status Epilepticus and Post-COVID Multi-System Inflammatory Syndrome

Multi-system Inflammatory Syndrome in Children (MIS-C) is a post infectious inflammatory syndrome following COVID infection. Previous case series have demonstrated that CNS involvement is less common and presents heterogeneously. The following case describes an infant with an initial presentation of refractory febrile status epilepticus. Genetic testing later showed multiple variants of uncertain significance. The patient met clinical criteria for MIS-C and had a markedly abnormal brain MRI with bilateral diffuse restricted diffusion (anterior > posterior). Clinically, the patient improved with pulse steroids and IVIg. This case highlights the importance of maintaining MIS-C in the differential as a trigger of Febrile Infection Related Epilepsy Syndrome (FIRES) with multi-organ involvement presenting 2-4 weeks after infectious symptoms and COVID exposure.

Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran

Background: Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus. Methods: This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study. Results: The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36% versus 14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology. Conclusion: Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.