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ORIGINAL ARTICLE
Year : 2004  |  Volume : 52  |  Issue : 4  |  Page : 463--465

Adult-onset epilepsy and history of childhood febrile seizures: A retrospective study

Mohammad R Mohebbi1, Reza Navipour1, Mojdeh SeyedKazemi2, Hadi Zamanian1, Fatemeh Khamseh2,  
1 Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Neurology, Faculty of Medicine, Tehran Azad University, Tehran, Iran

Correspondence Address:
Mohammad R Mohebbi
No. 37, East Zamzam St., Abouzar Blvd., Pirouzi Ave., 17787, Tehran
Iran

Abstract

BACKGROUND: Children with febrile seizures (FS) are at higher risk of developing epilepsy. There is robust literature on epilepsy with onset in childhood following FS but very little on the same issue in adults. AIMS: We intended to assess the association between adult-onset epilepsy and history of childhood FS. SETTINGS: The neurology clinic of a university hospital. DESIGN: A retrospective study. MATERIALS AND METHODS: Records of 101 consecutive adults (>14 years old) who were referred to our hospital with adult-onset seizures were reviewed and the patients and their families were interviewed to assess the medical history. STATISTICAL ANALYSIS: Chi-square test and Mantel-Haenszel method. RESULTS: Of the 101 patients, 9 were excluded for reasons of bacterial meningitis, recent head trauma, brain tumor, tricyclic antidepressants«SQ» overdose and missing reliable data of the childhood FS event. Thirty-one (33.7%) of the remaining 92 patients had history of FS in the childhood (71% men). Localization-related epilepsies were significantly associated with history of FS [Odds ratio: 3.29; (95% CI, 1.30-8.06)] ( ²= 5.49, df = 1, P=0.012) when compared to other epilepsies and epilepsy syndromes. An initial unprovoked simple partial seizure was also significantly associated with a positive history of FS [Odds ratio: 8.05; (95% CI 2.88-22.45)] ( ²= 15.86, df = 1, P<0.001). CONCLUSIONS: Localization-related epilepsies and partial seizures seem to be associated with a history of FS in childhood. This warrants more investigation to understand the mechanism as well as a possible pathology common in both localization-related epilepsies and FS in the affected probands.



How to cite this article:
Mohebbi MR, Navipour R, SeyedKazemi M, Zamanian H, Khamseh F. Adult-onset epilepsy and history of childhood febrile seizures: A retrospective study .Neurol India 2004;52:463-465


How to cite this URL:
Mohebbi MR, Navipour R, SeyedKazemi M, Zamanian H, Khamseh F. Adult-onset epilepsy and history of childhood febrile seizures: A retrospective study . Neurol India [serial online] 2004 [cited 2020 May 25 ];52:463-465
Available from: http://www.neurologyindia.com/text.asp?2004/52/4/463/13600


Full Text

 Introduction



Febrile seizures (FS) occur in 2-5% of children.[1],[2] There are hardly any epidemiological studies of febrile seizures in the Iranian population. The study from India by Bharucha et al[3] in the Parsi community (those of Iranian descent) reported a frequency of 1.77%. The reported proportion of children with FS who later developed epilepsy was between 2% and 7%.[4] A considerable number of patients may develop epilepsy after 16 years of age.[5] Certain features of FS may be predictive of a particular type of later epilepsy.[5],[6] Molecular genetic studies to date have found several loci for FS on autosomal chromosomes. Partial seizures have also been linked to regions of autosomal chromosomes.[7],[8]

There is robust literature on epilepsy with onset in childhood following FS, but very little on the same issue in adults. In the present study, we evaluated the association between history of childhood FS and adult-onset epilepsy, and also a possible association between history of childhood FS and any specific type of epilepsy and epilepsy syndrome.

 Materials and Methods



This was an observational study with no therapeutic interventions or management. The research committee of the faculty of medicine had approved the study. Written informed consent was obtained from all patients aged 18 years and above and in case of patients aged less than 18 years, informed consent was obtained from the parents.

The study material included 101 consecutive patients with adult-onset (> 14 years old) unprovoked seizures. Patients were recruited from a referral hospital located downtown in Tehran city, from June 2002 to December 2002. All patients were admitted to the hospital. Detailed history and neurological examination was done in all the patients. The medical records, electroencephalograms, and the neuroimaging data of the patients, available from the medical records department of the hospital, were reviewed and the details of their past and present illness were collected. The authors confirmed data regarding the childhood FS event by interviewing personally (no telephonic interview) the patients' mothers or sibs. We made every effort to distinguish between 'FS' and 'seizures with fever'. Seizure with fever was defined as any convulsion in a child of any age with fever of any cause.[9] A single seizure with no focal features and lasting less than 15 minutes in an infant with fever was defined as a simple febrile seizure. Febrile seizure was defined as complex if the above criteria were not fulfilled.[10] The criteria proposed by the International Classification of Seizures[11] and International Epilepsy and Epilepsy Syndromes[12] were considered while classifying the seizure type and epilepsy and epilepsy syndrome. Because of the small number of patients with different epilepsy syndromes, we grouped patients as localization-related, generalized and undetermined epilepsy [Table:1].

The data were evaluated by Chi-square test and the Mantel-Haenszel method was used to obtain the odds ratios using Statistical Package for the Social Sciences (SPSS Inc. Chicago, Illinois) for Windows version 11.0. A P-value of df = 1,P=0.035). Comparison between different groups of epilepsy syndromes showed a significant association between localization-related epilepsies and a history of childhood FS [Odds ratio: 3.24; (95% CI, 1.30-8.06)] ( ²= 5.49, df = 1, P=0.012). Similar association was also found between localization-related and generalized epilepsies after we excluded epilepsies in the undetermined categories. [Odds ratio: 0.37; (95% CI, 0.14-0.95)] ( ²= 4.40, df = 1, P=0.039). Age of onset of epilepsy did not differ significantly between the generalized and localization-related epilepsies. Of the 21 patients with localization-related epilepsies, 17 had a simple partial unprovoked seizure as the initial seizure type. Comparing different groups of epileptic seizures (simple partial, complex partial, and generalized), a significant association was found between an initial simple partial unprovoked seizure and a positive history of FS [Odds ratio: 8.05; (95% CI, 2.88-22.45)] ( ²= 15.86, df = 1, PDr. Elham Hatef, M.D., for her kind help with the statistical analysis. We also thank Dr. Bijan Sadri, M.D., for providing the references.

References

1Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: A metaanalytic review. J Pediatr 1990;116:329-37.
2Consensus Statement. Febrile seizures: long term management of children with fever-associated seizures. Pediatrics 1980;66:1009-12.
3Bharucha NE, Bharucha EP, Bharucha AE. Febrile seizures. Neuroepidemiology 1991;10:138-42.
4Sapir D, Leitner Y, Harel S, Kramer U. Unprovoked seizures after complex febrile convulsions. Brain Dev 2000;22:484-6.
5Trinka E, Unterrainer J, Haberlandt E, Luef E, Unterberger I, Niedermuller U, et al. Childhood febrile convulsions-which factors determine the subsequent epilepsy syndrome? A retrospective study. Epilepsy Res 2002;50:283-92.
6Saltik S, Angay A, Ozkara C, Demirbilek V, Dervent A. A retrospective analysis of patients with febrile seizures followed by epilepsy. Seizure 2003;12:211-6.
7Berkovic SF, Scheffer IE. Genetics of the Epilepsies. Epilepsia 2001;42:16-23.
8Chang BS, Lowenstein DH. Epilepsy. N Engl J Med 2003;349:1257-66.
9Research Unit of Royal College of Physicians and British Pediatric Association, London. Guidelines for the management of convulsions with fever. BMJ 1991;303:634-6.
10Fishman MA: Febrile seizures, In: McMillan JA, DeAngelis CD, Feigin DR, Warshaw JB, editors. Oski's Pediatrics Principles and Practice. Philadelphia: Lippincott William & Willkins; 1999:1949-51.
11Commission on Classification and Terminology of the ILAE. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981;22:489-501.
12Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389-99.
13Knudsen FU. Febrile seizures- treatment and outcome. Brain Dev 1996;18:438-49.
14Hesdorffer DC, Hauser WA. Febrile seizures and the risk of epilepsy. In: Baram TZ, Shinnar S, editors. Febrile Seizures. San Diego: Harcourt Inc; 2002. p. 63.
15Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med 1987;316:493-8.
16Mohebbi MR, Holden KR, Mohammadi M. Peripheral leukocytosis in children with febrile seizures. J Child Neurol 2004;19:47-50.
17Scheffer IE, Berkovic SF. Generalized epilepsy with febrile seizures plus: A genetic disorder with heterogeneous clinical phenotypes. Brain 1997;120:479-90.
18Singh R, Scheffer IE, Crossland K, Berkovic SF. Generalized epilepsy with febrile seizure plus: A common childhood-onset genetic epilepsy syndrome. Ann Neurol 1999;45:75-81.
19Ray BK, Bhattacharya S, Kundu TN, Saha SP, Das SK. Epidemiology of epilepsy - Indian perspective. J Indian Med Assoc 2002;100:322-6.