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492 Can benign afebrile convulsions associated with mild gastroenteritis be prevented by vaccination?
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  1. Svjetlana Bela Klancir,
  2. I Mrkić Kobal,
  3. G Krakar,
  4. F Sabol,
  5. Kovač Šižgorić,
  6. G Tešović,
  7. M Meštrović,
  8. S Delin,
  9. R Gjergja Juraški,
  10. V Đuranović,
  11. Z Sabol
  1. Poliklinika za dječje bolesti dr. Sabol

Abstract

Background Convulsions during mild viral gastroenteritis (CwG) represent a clinically recognized entity of benign afebrile seizures in children. Recent reports have shown that after the introduction of RV vaccine the incidence of RV-associated CwG decreased.

Aim To evaluate the demographic, electroclinical characteristics and outcome of CwG in children hospitalized in 6 Croatian centers in the period from 2008 to 2018.

This is a multicenter prospective study that included 40 patients hospitalized for CwG (male to female ratio 25:15). We collected medical records including data on gender, personal, family history of epileptic seizures, age on the time of first seizure, clinical type, duration and frequency of seizures, postictal/interictal electroencephalographic (EEG) features, antiepileptic therapy and the results of laboratory analysis (including stool specimens for virus antigens and bacterial stool specimen culture) and brain imaging. Patients follow up was performed in six-motnhs intervals during the first two years and later at intervals of 12-18 months (median time 44.5 months). Seizure types were classified using most current revised ILAE terminology.

Statistical analysis was performed using the SSPS Windows version 15.0 program.

The median age of children at the time of CwG onset was 15.5 months (range: 1 month to 6 years). Rotavirus was the most common cause of diarrhea (85%).

Seizures most frequently occurred (45%) on the third day of the gastrointestinal symptoms. Generalized seizures (90%) were the most common clinical presentation. In a half of patients, the seizures came in clusters.

The attacks usually lasted for less than five minutes (85%). In about half of the patient‘s seizures ceased spontaneously and usually lasted less than five minutes (85%). Abnormal EEG was reported in 6 of 40 patients with CwG (15%). Long-term antiepileptic therapy (phenobarbitone and valproic acid) was prescribed in 12/40 patients (30%) for 1-24 months. During the follow-up period of 37 children with CwG, two children (5.4%) had recurrence of CwG, two patients had febrile seizures and two children developed epilepsy.

Afebrile CwG represent a defined clinical condition with good prognosis and normal psychomotor development in most children. In a small number of cases, the risk of recurrence of CwG may exist, with the risk of the onset of febrile seizures and the development of epilepsy. Considering RV as the most common causative agent of diarrhea associated with convulsions, universal vaccination with RV vaccines should reduce the incidence of morbidity from RV disease and consequently reduce the occurrence of its complications – CwG.

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