Laboratory investigations in febrile seizures and risk factors of recurrent eizures within 24 hours at Uttaradit Hospital

Abstract

Background: Febrile seizures (FS) are the most common form of childhood seizures, occurring in association with a fever greater than 38 ºC, in the absence of a central nervous system infection or electrolyte imbalances. FS occurs in children aged 6 months to 5 years, affecting 2% to 5% of children.

Objectives: The aims of this study were to evaluate the results of laboratory tests and the correlation between various factors and multiple seizures during febrile illness within 24 hours.

Methods: A retrospective study was conducted by reviewing the medical records of patients aged 6 months to 5 years who were diagnosed with FS and received treatment at Uttaradit Hospital between January 2018 and December 2021. Data were computerized and statistically analyzed by using SPSS.

Results: A total of 272 patients were diagnosed with febrile seizures. Of these, 60% were male, and the mean age was 21.5 months. The mean body temperature was 39 °C. In this study, we found that 26.5% had anemia, 82.7% had metabolic acidosis, 43.5% had hyponatremia, 2.8% had hypermagnesemia, 0.8% had hypokalemia, while hypernatremia, hypocalcemia, hypercalcemia, and hyperphosphatemia each affected only one patient. Except for hypokalemia, the other conditions were not treated or further investigated. Hyperglycemia was present in 18%, with spontaneous resolution of the elevated sugar levels. No participant had hypoglycemia or elevated creatinine levels. High urine specific gravity was observed in 12.5%, pyuria in 5%, and positive urine cultures in 18%. The group of patients with a body temperature more than 39 °C and sodium more than 135 mEq/L had an approximately 2-fold and 2.6-fold increased risk of recurrent seizure within 24 hours, respectively (OR 2.044, p value 0.045; OR 2.624, p value 0.011, respectively).

Conclusions: This study did not recommend to test electrolytes, calcium, magnesium, phosphorus, blood sugar, liver function tests, or perform kidney function tests in all patients with febrile seizures to find the cause of the seizures, except in cases with suspected electrolyte imbalances and requiring treatment. A complete blood count is a useful test for detecting anemia and the cause of fever. Urinalysis, stool examination, and cerebrospinal fluid analysis should be performed to investigate the cause of fever as necessary. A body temperature more than 39 °C and sodium more than 135 mEq/L are risk factors for recurrent seizures within 24 hours.