MRI and EEG Could Identify Children at Risk for Epilepsy After Febrile Seizures
ScienceDaily (Nov. 7, 2012) — Seizures during childhood fever are usually benign, but when prolonged, they can foreshadow an increased risk of epilepsy later in life. Now a study funded by the National Institutes of Health suggests that brain imaging and recordings of brain activity could help identify the children at highest risk. The study reveals that within days of a prolonged fever-related seizure, some children have signs of acute brain injury, abnormal brain anatomy, altered brain activity, or a combination.
Seizures that occur during the course of a high fever, known as febrile seizures, affect 3 to 4 percent of all children. Most such children recover rapidly and do not suffer long-term health consequences.
However, having one or more prolonged febrile seizures in childhood is known to increase the risk of subsequent epilepsy. Some experts estimate that the risk of later epilepsy is 30-40 percent following febrile status epilepticus (FSE), a seizure or series of seizures that can last from 30 minutes to several hours.
“While the majority of children fully recover from febrile status epilepticus, some will go on to develop epilepsy. We have no way of knowing yet who they will be,” Dr. Shinnar said.
The Consequences of Prolonged Febrile Seizures in Childhood (FEBSTAT) study is focused specifically on FSE and the risk of temporal lobe epilepsy. This is one of the most common forms of epilepsy and is characterized by seizures in the temporal lobe, a brain region important for memory.
Within days of FSE, the children in the study underwent magnetic resonance imaging (MRI) and electroencephalography (EEG). The latter technique uses sensors on the scalp to record brain activity, and is often used to diagnose and monitor epilepsy. The MRI findings were reported in July 2012, and the EEG findings were reported today. Both papers were published in Neurology.
The MRI scans revealed that FSE is sometimes associated with abnormalities in the hippocampus, a peapod-shaped structure within the temporal lobe.
Of 191 children with FSE, 22 (11.5 percent) had signs of hippocampal injury on MRI, and 20 (10.5 percent) had developmental abnormalities of the hippocampus.
Abnormal MRI results were rare among children with simple febrile seizures, defined as lasting 10 minutes or less. Out of 96 children with such seizures, only two (2.1 percent) had developmental abnormalities of the hippocampus and none had signs of brain injury.
Nearly half (45.2 percent) of the children with FSE had abnormal EEG findings. There was also a correlation between the MRI and EEG findings. Children with evidence of acute brain injury after FSE were more than twice as likely to have abnormal EEG findings.
The results suggest that for some children, prolonged febrile seizures injure the brain.
For others, pre-existing abnormalities could make the brain susceptible to febrile seizures. Both of these paths could in turn lead to epilepsy, but that will take more time to confirm, Dr. Shinnar said.
Temporal lobe epilepsy can cause memory loss, and brain scans of adults with the disorder sometimes reveal shrinkage and cell loss within the temporal lobe and hippocampus. Many adults with the disorder also report a history of FSE.
Focal seizures with affective symptoms are a major feature of PCDH19 gene-related epilepsy.
Risk factors for autistic regression: results of an ambispective cohort study.
Department of Child Health Care, Children’s Hospital of Fudan University, Shanghai, China.
A subgroup of children diagnosed with autism experience developmental regression featured by a loss of previously acquired abilities.
The pathogeny of autistic regression is unknown, although many risk factors likely exist.
To better characterize autistic regression and investigate the association between autistic regression and potential influencing factors in Chinese autistic children, we conducted an ambispective study with a cohort of 170 autistic subjects.
Analyses by multiple logistic regression showed significant correlations between autistic regression and febrile seizures (OR = 3.53, 95% CI = 1.17-10.65, P = .025), as well as with a family history of neuropsychiatric disorders (OR = 3.62, 95% CI = 1.35-9.71, P = .011).
This study suggests that febrile seizures and family history of neuropsychiatric disorders are correlated with autistic regression.