Clinical profile of children presenting with ferbrile seizures and febrile status epilepticus at the University Teaching Hospital, Lusaka

Abstract

Febrile seizures (FS) are the most common seizure disorder in childhood. FS and febrile status epilepticus (FSE) are a common presentation at the University Teaching Hospital (UTH) in Lusaka, Zambia. Despite this, the clinical characteristics of children with FS and the associated causes of fever have not been documented. Simple FS have no serious adverse outcome on the neurological development of the child while complex febrile seizures (CFS) have been shown to increase the risk of developing epilepsy. This study sought to document the clinical characteristics of children with FS and FSE as well as document the association of FS/FSE with malaria, HIV and Human herpesvirus-6 (HHV-6) at the UTH, Lusaka, Zambia. This was a case control study carried out in the Department of Paediatrics and Child Health, UTH. Recruitment of participants began in January, 2015 and ended in May, 2016. Participants ages ranged from 6 - 60 months and had a febrile illness with or without FS. Febrile seizures were defined as seizures occurring in febrile children between the ages of 6-60 months who did not have an intracranial infection or history of afebrile seizures. A medical history and physical examination was carried out on eligible participants and blood was drawn for the detection of malaria, HIV and HHV-6.The peak age for the FS was 18-36 months. There was significantly more children with FS than those without seizures in the 18-36 months age group. There was no significant differences in sex distribution as well as temperature level between the two groups. A family history of FS was noted in 14% of the participants with FS compared to 2% in those without seizures.Acute febrile illness without focus was the number one diagnosis associated with FS. Tonsillitis, coryza and malaria were other diagnoses made with malaria accounting for 15 % of the cases with FS and 11% of children with febrile illness. Among the children with FS, 54% had CFS with 13% having FSE. Of the participants with FSE, 52% had acute febrile illness without focus and 24% had malaria. CFS were noted in 56% of the seizures associated with malaria of which 36 % met the criteria for FSE. The HIV prevalence was 2.2% with no significant differences between children with FS and those without seizures. In this study, the clinical characteristics of children with FS and FSE were found to be similar to that described in worldwide studies and in malaria endemic regions. There was a higher incidence of CFS/FSE compared to western reports but similar to what has been documented in other SSA studies. It is recommended to follow up children presenting with CFS/FSE, particularly those associated with malaria, due to the higher risk of developing neurological deficit and epilepsy. The result for HHV-6 differed significantly with world literature and the local studies, therefore a repeat testing is advisable