The Importance of Hyponatremia İn Febrile Seizure

Yıl 2020, Cilt: 18 Sayı: 1, 53 - 62, 15.04.2020

Beril Dilber , Elif Acar Arslan , Sevim Şahin , Gülnur Esenülkü Pınar Özkan Kart Ali Cansu

Öz

INTRODUCTION: Febrile seizure is most common neurological condition in childhood. It is seen as simple, complex febrile seizure and febrile status. Prolonged febrile seizure and electrolyte disturbances cause this condition to worsen and relaps.

MATERIALS and METHODS: Between 2014 and 2018, 537 children (273 children with febrile seizures and 264 children with fever without seizures) were included in the study. Patients were divided into two groups; simple febrile seizure (BFN) and complex febrile seizure (CFN). BFN; single seizure not showing focalness less than 15 minutes; CFN was taken as a recurrent seizure multiple times within> 15 minutes and 24 hours with focal. Electrolyte values were evaluated with venous blood samples at admission with febrile seizures

RESULTS: When logistic regression analysis was performed, regardless of age and gender, patients with sodium values <134.5 were found to be 10.13 times more risky for febrile seizures than those with sodium values <134.5. There was no significant relationship between serum potassium and calcium levels. 66.3% of patients with febrile seizures and 64% of patients with CFN had a sodium value below 134.5 mmol / L. The sensitivity and specificity for crosstabs sodium were 66.3% and 83.7%, and the positive predictive value was 80.8% and 70.6%, respectively. Seizure frequency of patients with moderate hyponatremia (132-133) was proportional to increase in seizure frequency compared to other sodium levels (r = 0.389, r = 0.434, p <0.05).

CONCLUSIONS: In this study; We showed that sodium levels decreased significantly in febrile seizure, low sodium was significant in children with complex febrile seizures and it was a determining risk factor for recurrence of seizures.

Anahtar Kelimeler

Febrile seizures, hyponatremia, sodium levels and recurrence of seizures

Febril Nöbette Hiponatreminin Önemi

Öz

GİRİŞ ve AMAÇ: Febril nöbet çocukluk çağında en sık görülen nörolojik durumdur. Basit, komplike ve febril status olarak görülür. Uzamış febril nöbet ve komplike febril nöbet başta olmak üzere beyinde hasarlanmalar yaratır ve elektrolit bozuklukları bu durumun ağırlaşmasına ve nöbet tekrarlamasına neden olabilir.

YÖNTEM ve GEREÇLER: 2014- 2018 yılları arasında çocuk bölümüne başvuran toplam 6-72 ay arası 537 çocuk (273 çocuk febril nöbet; 264 çocuk ise nöbet olmadan ateş) çalışmaya dahil edildi. Hastalar iki gruba; basit febril nöbet (BFN) ve komplike febril nöbet (KFN) olarak ayrıldı. BFN; tek nöbet 15 dakikanın altında fokalite göstermeyen; KFN ise >15 dakika ve fokalite gösteren 24 saat içinde birden çok kez tekrarlayan nöbet olarak alındı. Febril nöbetle başvuru anında elektrolit değerleri venöz kan örnekleri ile değerlendirildi.

BULGULAR: : Hastaların yaştan ve cinsiyetten bağımsız olarak lojistik regresyon analizi yapıldığında sodyum değeri <134,5 olanlara göre sodyum değeri ≥ 134,5 olanlar febril nöbet riski açısından 10,13 kat daha riskli bulundu. Serum potasyum ve kalsiyum değerleri arasında anlamlı bir ilişki bulunamadı. Febril nöbet geçiren hastaların %66.3‘ünün ve de KFN geçiren hastaların %64’ünün sodyum değeri 134.5 mmol/L altında idi. Crosstabs sodyum için sensivite %66,3 spesifite %83,7 pozitif prediktif değer %80,8 negatif %70,6 idi. Ilımlı hiponatremi değerleri (132-133) olan hastaların nöbet sıklıkları diğer sodyum düzeylerine göre nöbet sıklığındaki artışla orantılı idi (r=0,389, r=0,434, p<0,05).

TARTIŞMA ve SONUÇ: Bu çalışmamızda; febril nöbette sodyum değerlerinin anlamlı olarak düştüğünü, komplike febril nöbeti olan çocuklarda sodyum düşüklüğünün belirgin olduğunu ve nöbetin tekrarlamasında belirleyici risk faktörü olduğunu gösterdik

Anahtar Kelimeler

Febril nöbet, hiponatremi, sodyum düzeyi ve nöbet tekrarı

Kaynakça

• 1. 5. Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121(6):1281–6.
• 2. Patterson JL, Carapetian SA, Hageman JR, Kelley KR. Febrile seizures. Pediatr Ann. 2013; 42(12):249-54
• 3. Fetveit A. Assessment of febrile seizures in children. Eur J Pediatr. 2008;167(1):17-27.
• 4. Sarnat HB, Scantlebury MH. Novel Inflammatory Neuropathology in Immature Brain: (1) Fetal Tuberous Sclerosis, (2) Febrile Seizures, (3) α-B-crystallin, and (4) Role of Astrocytes. Semin Pediatr Neurol. 2017 Aug;24(3):152-60.
• 5. Tuunanen, J., Lukasiuk, K., Halonen, T., Pitkänen, A. 1999. “Status epilepticus-induced neuronal damage in the rat amygdaloid complex: distribution, time-course and mechanisms”, Neuroscience, 94, 473-95.
• 6. Cansu, A., Serdaroğlu, A., Yüksel, D., Doğan. V., Ozkan, S., Hirfanoğlu,T., Senbil, N., Gücüyener, K., Soysal, S., Camurdan , A . Gürer, Y.K. 2007. “Prevalence of some risk factors in children with epilepsy compared to their controls”, Seizure, 16, 338-44
• 7. Pasantes-Morales, H., Tuz, K. 2006. “Volume Changes in Neurons: Hyperexcitability and Neuronal Death”, Contrib Nephrol, 152, 221-40
• 8. Bhardwaj, A. 2006. “Neurological Impact of Vasopressin Dysregulation and Hyponatremi”, Ann Neurol, 59, 229–36
• 9. Anderson, R.J., Chung, H.M., Kluge, R., Schrier, R.W. 1985. “Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin”, Ann Intern Med., 102, 164-8.
• 10. Callahan, M.A., Do, H.T., Caplan, D.W., Yoon-Flannery, K. 2009. “Economic impact of hyponatremia in hospitalized patients: a retrospective cohort study”, Postgrad Med, 121, 186-91
• 11. Saly, V., Andrew, R.D. 1993. “CA3 neuron excitation and epileptiform discharge are sensitive to osmolality”, J Neurophysiol, 69, 2200
• 12. Kim, J., Jung, Y. 2012. “Increased aquaporin-1 and Na+ -K+ -2Cl- cotransporter 1 expression in choroid plexus leads to blood-cerebrospinal fluid barrier disruption and necrosis of hippocampal CA1 cells in acute rat models of hyponatremia”, J Neurosci Res, 90(7), 1437-44
• 13. Coras, R., Pauli, E., Li, J., Schwarz, M., Rössler, K., Buchfelder, M., Hamer, H., Stefan, H.B. 2014. “Differential influence of hippocampal subfields to memory formation: insights from patients with temporal lobe epilepsy”. Brain, 137,1945–57.
• 14. Navidhamidi, M., Ghasemi, M., Mehranfard, N. 2017. “Epilepsy-associated alterations in hippocampal excitability”, Rev Neurosci, 1, 28(3),307-34.
• 15. El-Hassar, L., Esclapez, M., Bernard, C. 2007. “Hyperexcitability of the CA1 hippocampal region during epileptogenesis”, Epilepsia, 48 (5), 131-9.
• 16. Zifman E, Alehan F, Menascu S, Har-Gil M, Miller P, Saygi S, Ozdemir B, Watemberg N. Clinical Characterization of Gastroenteritis-Related Seizures in Children: Impact of Fever and Serum Sodium Levels. J Child Neurol. 2011 Nov;26(11):1397-400
• 17. Y. Yigit, S. Yilmaz, A. Akdogan, H.C. Halhalli, A.E. Ozbek, E.G. Gencer. The role of neutrophil-lymphocyte ratio and red blood cell distribution width in the classification of febrile seizures. European Review for Medical and Pharmacological Sciences 2017; 21: 554-9
• 18. Goksugur, S. B., Kabakus, N., Bekdas, M. & Demircioglu, F. Neutrophil-to-lymphocyte ratio and red blood cell distribution width is a practical predictor for differentiation of febrile seizure types. Eur Rev Med Pharmacol Sci 2014;18, 3380–5
• 19. Ozaydin E, Arhan E, Cetinkaya B, Ozdel S, Değerliyurt A, Güven A, Köse G. Differences in iron deficiency anemia and mean platelet volume between children with simple and complex febrile seizures. Seizure. 2012;21(3):211-4.
• 20. Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of Risk Factors Associated with First Episode Febrile Seizure. J Clin Diagn Res. 2016;10:10-3
• 21. Liu Z, Li X, Zhang M, Huang X, Bai J, Pan Z, Lin X, Yu D, Zeng H, Wan R, Ye X. The role of Mean Platelet Volume/platelet count Ratio and Neutrophil to Lymphocyte Ratio on the risk of Febrile Seizure. Sci Rep. 2018;11;8:15123
• 22. Lewis DV, Shinnar S, Hesdorffer DC, Bagiella E, Bello JA, Chan S, Xu Y, MacFall J, Gomes WA, Moshé SL, Mathern GW, Pellock JM, Nordli DR Jr, Frank LM, Provenzale J, Shinnar RC, Epstein LG, Masur D, Litherland C, Sun S; FEBSTAT Study Team. , 2014, “Hippocampal sclerosis after febrile status epilepticus: the FEBSTAT study. “, Ann Neurol. 75:178-85.
• 23. Navidhamidi, M., Ghasemi, M., Mehranfard, N. 2017. “Epilepsy-associated alterations in hippocampal excitability”, Rev Neurosci, 1, 28(3),307-34.
• 24. Baraban SC ve Schwartzkroin PA: 1998. “Effects of hyposmolar solutions on membrane current of hippocampal interneurons and mossy cells in vitro”. J Neurophysiol, 79, 1108