Selected Summaries

Risk of Unprovoked Epilepsy seizures' were fully assessed. In this group After Febrile Convulsions mean duration of febrile convulsions was significantly higher in those with (100 ± 133 min) or without (9 ± 19 min) subsequent [Maker J, McLachlan RS. Febrile convulsions: Is development of temporal lobe epilepsy. Other seizure duration the most important predictor of temporal lobe epilepsy? Brain 1995,118: 1521- factors did not differ significantly between the 1528.] groups.

Eleven out of 27 patients with febrile In an attempt to establish an association convulsions had epileptiform activity in EEG between febrile seizures in past and while in all 21 family members without occurrence of non-febrile epilepsy later, the febrile seizures EEGs were normal. All eight authors studied six families each with patients with temporal lobe epilepsy and multiple members (at least 4 per family) who febrile convulsion had focal temporal lobe were affected by febrile convulsions. All six epileptiform activity. Histopathology in 5 of probands developed epilepsy subsequent to these patients, in whom temporal lobectomies occurrence of febrile convulsions. One of the were performed, revealed mesial temporal proband had hemiconvulsion-hemiplegia- sclerosis in all. In another two patients who epilepsy (HHE) syndrome. Clinical did not have surgery, magnetic resonance characteristics of febrile convulsions: age at imaging (MRI) showed hippocampal atrophy onset, total number of febrile convulsions, suggestive of mesial temporal sclerosis. maximum number of febrile convulsions in any one day, duration of the longest febrile In conclusion, authors reported a strong convulsion, occurrence of partial febrile relationship between febrile convulsions and seizure, associated afebrile seizure, and any subsequent unprovoked seizures, especially associated neurological or mental temporal lobe epilepsy consequent to mesial abnormalities, were compared in between temporal sclerosis. They noted that the long family members who did or did not develop duration of febrile convulsion is the most afebrile seizure in later life. important determinant of this association. Electroencephalographic (EEG) studies were performed in 27 patients with history of Comments febrile convulsions and 21 normal family members. Five of the eight patients with Febrile convulsions occur in young temporal lobe epilepsy underwent temporal children who have an individual susceptibility lobectomy. to convulse in a setting of acute fever. The prevalence of these seizures is about 3% in Sixty nine family members had the population at risk. They are rare below 6 seizures, 59 of whom had febrile convulsions. months and above 5 years of age. The typical Eight (13%) family members out of 59 febrile convulsion is usually brief and patients with febrile convulsions developed generalized tonic-clonic in nature(l). temporal lobe epilepsy. Four (7%) had other seizure disorders. However, only one of the Prognosis for children who suffer from 213 family members with no febrile febrile convulsion is a cause of concern for convulsions had temporal lobe epilepsy. It parents. Serious and wide spread neurological took on average 12 ± 12.5 years for temporal damage may follow a prolonged episode of lobe epilepsy to occur after first febrile seizures as in the HHE syndrome. This study seizure. Fifty three (90%) patients with febrile also reported two patients of HHE syndrome.

INDIAN PEDIATRICS 614 VOLUME 33- JULY 1996 SELECTED SUMMARIES

However, the precise relationship between other than temporal lobe epilepsy. febrile convulsion and temporal lobe epilepsy remains debatable. Annegers et al .{2) EEG is not the investigation of choice evaluated the risk of unprovoked seizures in considering structural pathology as sequelae 687 children with febrile convulsions and to febrile seizures. Computed tomography reported 5% rate of unprovoked seizures by 5 (CT) and magnetic resonance imaging would years of age and 7% rate by 25 years of age. be more appropriate. However, EEG still can Some studies do not support this be a useful ancillary investigation capable of association(3). In addition to prolonged suggesting persistent brain pathology (even febrile convulsions especially when when CT scans are reported normal) if it lateralized, repeated convulsions in some demonstrates an abnormality which is illness, onset before 1 year, antecedent persistent. So, serial EEG recordings are more cerebral injury, associated mental handicap, useful rather than a single record(6). In the female sex and family history of epilepsy of present series also, the authors observed EEG genetic origin in first degree relatives are abnormalities in febrile convulsion group some factors which are associated with only. development of later epilepsy, frequently temporal lobe epilepsy(l,4). In this study the An association between febrile seizures authors observed that duration of febrile and hippocampal sclerosis has been noted, but convulsion was the most important factor the precise reason of brain damage is not associated with etiopathogenesis of temporal known. Previous studies have been restricted lobe epilepsy. Prolonged seizures which to histopathological examination of necropsy lasted on an average 100 min each were material. Volumetric MRI study in vivo may significantly more common in those who be an accurate method for measuring the developed temporal epilepsy while febrile volume of the hippocampus and thus convulsions in family members who did not detecting the underlying pathology of develop epilepsy were less than 30 minutes in temporal lobe seizures (7). In this study, MRI duration. Both patients with HHE syndrome in two of three patients who did not have had prolonged febrile convulsion averaging surgery revealed hippocampal increased 120 minutes. Annegers et al .(2) observed that signal and atrophy suggestive of mesial two thirds of those who had unprovoked temporal sclerosis. seizures had more than a single attack and thus suffered from epilepsy. Increasing So, authors have convincingly numbers of febrile seizures, age at onset less confirmed that prolonged febrile seizures than 1 year and focal and prolonged (>30 remained the most important risk factor for min) febrile convulsions were important unprovoked epilepsy in later life; temporal predictive factors. When the factors related to lobe epilepsy being the commonest type of the development of partial epilepsy have been epilepsy. Authors further demonstrated that it looked at separately from those present in might be difficult to treat this type of epilepsy generalized epilepsy, it has been found that and few patients may require 'epilepsy persisting generalized tonic-clonic seizures surgery' at some stage of their lives. It is of occurred significantly more often in children utmost importance to prevent the brain of unskilled parents, where there had been damage by timely and effective treatment of adverse perinatal events and persistent febrile convulsions. Educating parents and neurological-abnormalities where the complex treating physicians about the need for early partial seizures occurred significantly more management is desirable in this context. often when the first febrile convulsion had been prolonged and partial(5). In this series, Ravindra Kumar Garg, four patients of febrile convulsion group had Department of Neurology, KG's Medical College, Lucknow .

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REFERENCES Excellent outcome after surgical treatment. Epilepsia 1993, 34: 878-883 . 1. O'Donohoe NV. Epilepsies of Childhood. 5. Camfield P, Camfield C, Gordon K, Dooley J. Oxford, Butterworth Heinemann Ltd., 1994. What types of epilepsy are preceded by febrile 2. Annegers JF, Hauser WA, Shirts SB, Kurland seizures? A population based study of LT. Factors prognostic of unprovoked seizures children. Dev Med Child Neurol 1994, 36: after febrile convulsions. N Engl J Med 1987, 887-892. 316: 493- 498. 6. Stores G. When does an EEG contribute to the 3. Lee K, Diaz M, Melchior JC. Temporal lobe management of febrile seizures? Arch Dis epilepsy-not a consequence of child hood Child 1991, 66: 554-557. febrile convulsions in Denmark. Acta Neurol 7. Kuks JBM, Cook MJ, Fish DR, Stevens JM, Scand 1981, 63: 231-236. Shorvon SD. Hippocampal sclerosis in 4. Abou-Khalil B, Andermann E, Andermann F, epilepsy and childhood febrile seizures. Olivier A, Quesney LF. Temporal lobe Lancet 1993 342:1391-1394. epilepsy after prolonged febrile convulsions:

NOTES AND NEWS

WORKSHOP ON TUBERCULOSIS IN CHILDREN

This workshop is being organized by Indian Academy of Pediatrics, West Bengal Branch on July 28th, 1996 at Institute of Child Health, Calcutta. For further details please contact: Dr. Tapan Kr. Ghosh, Secretary, IAP Room, IMA House, 53, Creek Row, Calcutta 700 014.

ERRATUM

In the article entitled 'Calcium gluconate-Its unusual complication' by J.K. Lakhani published in the June 1996 issue on pages 510 and 511, the figures 1 and 2 have been interchanged. .

INDIAN PEDIATRICS 616 VOLUME 33- JULY 1996