Diurnal/Seasonal Rhythm of Febrile Convulsion

Yıl 2025, Cilt: 10 Sayı: 2, 35 - 40, 28.05.2025

Cansu Aydın Altuntaş , Halise Akça , Ayşegül Neşe Kurt

https://doi.org/10.70852/tmj.1659914

Öz

Objective: Febrile convulsion (FC) is a type of seizure that occurs with fever in children between 6-60 months. Melatonin, a neurohormone that exhibits diurnal and seasonal fluctuations, can reduce the frequency of seizures and show anticonvulsant effects by influencing the balance between excitatory and inhibitory neurotransmitters. The aim of this study is to determine the clinical characteristics of patients diagnosed with FC and to show the distribution of seizure frequency throughout the day and across seasons. Method: The study retrospectively examined the data of FC patients who presented to Ankara Yıldırım Beyazıt University Yenimahalle Training and Research Hospital Pediatric Emergency and Pediatric Neurology Clinic between 2014 and 2017. The patients’ age, gender, FC type, number of FCs, family history of epilepsy and FC, seizure time, and the month in which the seizure occurred were recorded. Results: The average age of the 409 FC patients included in the study was 27.7±14.9 months, with 67 patients (16%) being under 12 months of age. Male patients (58%) and those experiencing simple febrile convulsions (79%) were in the majority. Of the patients, 306 (75%) had a seizure only once. 296 (72%) of the FCs occurred between 08:00 and 19:59, and no significant relationship was found between the time range of FC occurrence, gender distribution, FC type, and the number of seizures. It was found that children under 12 months of age experienced more seizures during the night hours. Although the frequency of seizures was highest in the winter months, no significant seasonal difference was found. In all seasons, age, gender, FC type, and the number of recurrences were similar. Discussion: The information that the diurnal rhythm of melatonin may affect the frequency of nocturnal seizures provides important insights for the management of FC. However, the anticonvulsant effects of melatonin need to be studied in more detail.

Anahtar Kelimeler

Diurnal Rhythm , Febrile Convulsion , Melatonin , Seasonal Variation

Febril Konvülsiyonun Diurnal/Mevsimsel Ritmi

Öz

Amaç: Febril konvülsiyon (FK), 6-60 ay arasındaki çocuklarda ateşle birlikte görülen nöbetlerdir. Diurnal ve mevsimsel salınım gösteren bir nörohormon olan melatonin, eksitatör ve inhibitör nörotransmitter dengesini etkileyerek nöbetlerin sıklığını azaltıp antikonvülzan etki gösterebilir. Bu çalışmanın amacı FK tanısı alan hastalarımızın klinik özelliklerinin belirlenmesi ve nöbet sıklığının diurnal ve mevsimsel olarak dağılımının gösterilmesidir. Yöntem: Çalışmada, Ankara Yıldırım Beyazıt Üniversitesi Yenimahalle Eğitim Araştırma Hastanesi Çocuk Acil Servis ve Çocuk Nöroloji Polikliniklerine 2014-2017 yılları arasında başvuran FK hastalarının verileri geriye dönük olarak incelendi. Hastaların yaş, cinsiyet, FK tipi, FK sayısı, ailede epilepsi ve FK öyküsü olup olmadığı, nöbet geçirme saati ve nöbet geçirdiği ay kaydedildi. Bulgular: Çalışmaya dahil edilen 409 FK hastasının yaş ortalaması 27,7±14,9 ay, 12 ayın altındaki hasta sayısı 67 (%16) idi. Erkek hastalar (%58) ve basit febril konvülsiyon (%79) geçiren hastalar çoğunluktaydı. Hastaların 306’sı (%75) sadece bir kez konvülsiyon geçirmişti. FK’ ların 296 (%72) tanesi saat 08:00-19:59 aralığında görüldü, FK görülme saat aralığı ile cinsiyet dağılımı, FK tipi ve FK sayısı arasında herhangi bir anlamlı ilişki görülmedi. 12 ay altındaki çocukların gece saatlerinde daha fazla nöbet geçirdiği gösterildi. Nöbet sıklığı en fazla kış aylarında olmasına rağmen mevsimsel olarak anlamlı bir farklılık saptanmadı. Tüm mevsimlerde yaş, cinsiyet, FK tipi ve tekrar sayısı benzerdi. Tartışma: Melatonin diurnal salınımının gece nöbet sıklığını etkileyebileceği bilgisi FK yönetimi için önemli bilgiler sunmaktadır. Ancak, melatoninin antikonvülzan etkisinin daha ayrıntılı şekilde incelenmesi gerekmektedir.

Anahtar Kelimeler

Diurnal Ritim , Febril Konvülsiyon , Melatonin , Mevsimsel Değişim

Kaynakça

• Albertson, T. E., Peterson, S. L., & Stark, L. (1981). The anticonvulsant properties of melatonin on kindled seizures in rats. Neuropharmacology, 20(5), 523-528. https://doi.org/10.1016/0028-3908(81)90043-5
• Allegra, M., Reiter, R. J., Tan, D. X., Gentile, C., Tesoriere, L., & Livrea, M. A. (2003). The chemistry of melatonin’s interaction with reactive species. Journal of Pineal Research, 34(1), 1–10. https://doi.org/10.1034/.1600-079x.2003.02112.x.
• Aydın, L., Gündoğan, N. U., & Yazıcı, C. (2015). Anticonvulsant efficacy of melatonin in an experimental  model of hyperthermic febrile seizures. Epilepsy Research, 118, 49-54. https://doi.org/10.1016/j.  eplepsyres.2015.11.004.
• Barghout, M. S., Al-Shahawy, A. K., El Amrousy, D. M., & Darwish, A. H. (2019). Comparison Between Efficacy of Melatonin and Diazepam for Prevention of Recurrent Simple Febrile Seizures: A Randomized Clinical Trial. Pediatric Neurology, 101, 33–38. https://doi.org/10.1016/j.pediatrneurol.2019.01.010
• Bazil, C. W., Short, D., Crispin, D., & Zheng, W. (2000). Patients with intractable epilepsy have low melatonin, which increases following seizures. Neurology, 55(11), 1746–1748. https://doi.org/10.1212/wnl.55.11.1746
• Borjigin, J., Zhang, L. S., & Calinescu, A. A. (2012). Circadian regulation of pineal gland function. Molecular and Cellular Endocrinology, 349(1), 13-19. https://doi.org/10.1016/j.mce.2011.07.009
• Capovilla, G., Mastrangelo, M., Romeo, A., & Vigevano, F. (2009). Recommendations for the management  of “febrile seizures”: Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia, 50 Suppl 1, 2–6. https://doi.org/10.1111/j.1528-1167.2008.01963.x
• Dabak, O., Altun, D., Arslan, M., Yaman, H., Vurucu, S., Yesilkaya, E., & Unay, B. (2016). Evaluation of Plasma Melatonin Levels in Children With Afebrile and Febrile Seizures. Pediatric Neurology, 57, 51–55. https://doi.org/10.1016/j.pediatrneurol.2015.12.025
• Davis, S., Kaune, W. T., Mirick, D. K., & Chen, C. (2001). Residential magnetic fields, light at night, and risk of breast cancer. American Journal of Epidemiology, 154(7), 591-600. https://doi.org/10.1093/aje/154.7.591
• Dubocovich, M. L., Rivera-Bermudez, M. A., Gerdin, M. J., & Masana, M. I. (2003). Molecular pharmacology, regulation and function of mammalian melatonin receptors. Frontiers in Bioscience, 8, d1093–d1108. https://doi.org/10.2741/1089
• Fauteck, J., Schmidt, H., Lerchl, A., Kurlemann, G., & Wittkowski, W. (1999). Melatonin in epilepsy: First results of replacement therapy and first clinical results. Biological Signals and Receptors, 8(1–2), 105-110. https://doi.org/10.1159/000014577
• Garcia, J., Rosen, G., & Mahowald, M. (2001). Circadian rhythms and circadian rhythm disorders in children and adolescents. Seminars in Pediatric Neurology, 8(4), 229-240. https://doi.org/10.1053/spen.2001.29044
• Guo, J. F., & Yao, B. Z. (2009). Serum melatonin levels in children with epilepsy or febrile seizures. Zhongguo Dang Dai Er Ke Za Zhi, 11(4), 288-290.
• Han, D. H., Kim, S. Y., Lee, N. M., Yi, D. Y., Yun, S. W., Lim, I. S., & Chae, S. A. (2019). Seasonal distribution of febrile seizure and the relationship with respiratory and enteric viruses in Korean children based on nationwide registry data. Seizure, 73, 9–13. https://doi.org/10.1016/j.seizure.2019.10.008
• Herman, J. H. (2005). Chronobiology of sleep in children. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and practice of sleep medicine (4th ed., pp. 85-99). Elsevier Saunders.
• Kennaway, D. J., Goble, F. C., & Stamp, G. E. (1996). Factors influencing the development of melatonin rhythmicity in humans. The Journal of clinical endocrinology and metabolism, 81(4), 1525–1532. https://doi.org/10.1210/jcem.81.4.8636362
• Kim, S. H., Kim, J. S., Jin, M. H., & Lee, J. H. (2017). The effects of weather on pediatric seizure: A single-center retrospective study (2005–2015). Science of the Total Environment, 609, 535-540. https://doi.org/10.1016/j.scitotenv.2017.06.256
• Manfredini, R., Vergine, G., Boari, B., Faggioli, R., & Borgna-Pignatti, C. (2004). Circadian and seasonal variation of first febrile seizures. The Journal of Pediatrics, 145(6), 838–839. https://doi.org/10.1016/j.jpeds.2004.06.079
• Meldrum, B., & Garthwaite, J. (1990). Excitatory amino acid neurotoxicity and neurodegenerative disease. Trends in Pharmacological Sciences, 11(9), 379-387. https://doi.org/10.1016/0165-6147(90)90184-a
• Millichap, J. J., & Millichap, J. G. (2008). Methods of investigation and management of infections causing febrile seizures. Pediatric Neurology, 39(6), 381-386. https://doi.org/10.1016/j.pediatrneurol.2008.07.017
• Mikkonen, K., Uhari, M., Pokka, T., & Rantala, H. (2015). Diurnal and seasonal occurrence of febrile seizures. Pediatric Neurology, 52(4), 424-427. https://doi.org/10.1016/j.pediatrneurol.2015.01.001
• Motta, E., Czuczwar, S. J., Ostrowska, Z., Gołba, A., Sołtyk, J., Norman, R., & Woźniak, G. (2014). Circadian profile of salivary melatonin secretion and its concentration after epileptic seizure in patients with drug-resistant epilepsy: A preliminary report. Pharmacological Reports, 66(3), 492-498. https://doi.org/10.1016/j.pharep.2013.10.006
• Paditz E. (2024). Postnatal Development of the Circadian Rhythmicity of Human Pineal Melatonin Synthesis and Secretion (Systematic Review). Children (Basel, Switzerland), 11(10), 1197. https://doi.org/10.3390/children11101197
• Ogihara, M., Shirakawa, S., Miyajima, T., Takekuma, K., & Hoshika, A. (2010). Diurnal variation in febrile convulsions. Pediatric Neurology, 42(6), 409-412. https://doi.org/10.1016/j.pediatrneurol.2010.02.011.
• Scales, W. E., Vander, A. J., Brown, M. B., & Kluger, M. J. (1988). Human circadian rhythms in temperature, trace metals, and blood variables. Journal of Applied Physiology, 65(4), 1840-1846. https://doi.org/10.1152/jappl.1988.65.4.1840
• Sejima, H., & Ito, M. (1997). Regional excitatory and inhibitory amino acid concentrations. Brain Development. https://doi.org/10.1016/s0387-7604(96)00492-5
• Sharafi, R., Hassanzadeh Rad, A., & Aminzadeh, V. (2017). Circadian Rhythm and the Seasonal Variation in Childhood Febrile Seizure. Iranian Journal of Child Neurology, 11(3), 27–30.
• Smolensky, M. H., Shah, A. P., Fernández, J. R., Sackett-Lundeen, L., & Hermida, R. C. (2023). Epilepsia, 64(7), 1739–1749. https://doi.org/10.1111/epi.17639
• Subcommittee on Febrile Seizures, & American Academy of Pediatrics (2011). Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 127(2), 389–394. https://doi.org/10.1542/peds.2010-3318
• Wong, S. D., Wright, K. P., Jr, Spencer, R. L., Vetter, C., Hicks, L. M., Jenni, O. G., & LeBourgeois, M. K. (2022). Development of the circadian system in early life: maternal and environmental factors. Journal of physiological anthropology, 41(1), 22. https://doi.org/10.1186/s40101-022-00294-0