Goal: Describe the clinical, etiological, and therapeutic characteristics of convulsions in infants and children admitted to the H？pital Spécialisé Mère-Enfant Blanche GOMES in Brazzaville (Congo). Method: A descriptive study with prospective collection from October 1, 2021, to October 31, 2022. Children from 1 month to 17 years old admitted for a convulsive seizure were collected during the study period. Children who died on arrival were excluded. The clinical, paraclinical, therapeutic, and evolutionary parameters were studied. The data was processed by Epi-info version 7.0 software. Results: Out of 1050 pediatric admissions (newborns excluded), 120 (11.43%) cases of convulsive seizures were recorded. The mean age was 4.26 ± four years (range: one month and 16 years old), with a sex ratio of 0.93. Fever was present in 93 (77.5%) patients. In 71 (59.17%) children, the seizure was tonic-clonic and tonic in 36 (30%) cases. The episodes lasted less than 15 minutes in 80 (66.67%) children and more than 15 minutes in the remainder. Generalized seizures accounted for 82.5% of cases, and 59 (49.17%) children presented with impaired consciousness on admission. Seizures were linked to malaria in 58 patients (48.33%), purulent meningitis in 10 (8.33%) cases, febrile seizures (30.83%), and comitiality in 10 cases (8.33%). Anticonvulsants were required in 79 (65.83%) patients. The first-line Diazepam was the most commonly used anticonvulsant (60%). Parenteral anti-malaria treatment was used in 63 patients (52.5%), with artesunate in 95.23% of cases. Antibiotic therapy was administered to 62 (51.66%) patients. The treatment combines an anti-malaria and an antibiotic and was used in 15 patients (12.5%). Fourteen deaths (11.67%) were recorded in the series, including eight (57.14%) for cerebral malaria and four (28.57%) for severe meningitis. Conclusion: Convulsive seizures are frequent in children at the H？pital Spécialisé Mère-Enfant Blanche GOMES. Infectious etiologies remain dominant in our context. Improving hospital care requires proper administration of anticonvulsants, early and appropriate etiological diagnosis and treatment.
References
[1]
Auvin, S., Antonios, M., Benoist, G., Dommergues, M.,-A., Corrard, F., Gajdos, V., Gras Leguen, C., Launey, E., Salaün, A., Titomanlio, L., Vallée, L. and Milh, M. (2017) Evaluation d’un enfant après une crise fébrile: Focus sur trois problèmes de pratique clinique. Archives de pédiatrie, 24, 1137-1146. https://doi.org/10.1016/j.arcped.2017.08.018
[2]
Kaputu Kalala Malu, C., Mafuta Musalu, E., Okitundu Luwa, E., Andjafono, D., Lusamba Muteba, J., Mapatano Mala Ali, N., Kayembe Kalula, T., et al. (2012) Profils evolutifs a court terme des convulsions associees a la fievre chez le nourrisson et le jeune enfant en milieu de soins de sante primaires a kinshasa. African Journal of Neurological Sciences, 31, 23-33.
[3]
Appleton, R., Macleod, S. and Martland, T. (2008) Drug Management for Acute Tonic-Clonic Convulsions Including Convulsive Status Epilepticus in Children. Cochrane Database of Systematic Reviews, No. 3, CD001905. https://doi.org/10.1002/14651858.cd001905.pub2
[4]
Outin, H., Blanc, T. and Vinatier, I. (2009) Prise en charge en situation d’urgence et en réanimation des états de mal épileptiques de l’adulte et de l’enfant (nouveau-né exclu). Recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française. Réanimation, 18, 4-12. https://doi.org/10.1016/j.reaurg.2008.07.008
[5]
McTague, A., Martland, T. and Appleton, R. (2018) Drug Management for Acute Tonic-Clonic Convulsions Including Convulsive Status Epilepticus in Children. Cochrane Database of Systematic Reviews, No. 1, CD001905. https://doi.org/10.1002/14651858.cd001905.pub3
[6]
Diawara, F., Sidibe, T., Keita, N., Maiga, S. and Tostykn, L. (1991) Aspects epidemiologiques des convulsions febriles du nourrisson et de l’enfant dans le service de pediatrie de l’hopital gabriel toure (bamako). Médecined’Afrique Noire, 2, 124-127.
[7]
Nishiyama, M., Yamaguchi, H., Ishida, Y., Tomioka, K., Takeda, H., Nishimura, N., et al. (2020) Seizure Prevalence in Children Aged up to 3 Years: A Longitudinal Population-Based Cohort Study in Japan. BMJ Open, 10, e035977. https://doi.org/10.1136/bmjopen-2019-035977
[8]
Nelson, K.B. and Ellenberg, J.H. (1976) Predictors of Epilepsy in Children Who Have Experienced Febrile Seizures. New England Journal of Medicine, 295, 1029-1033. https://doi.org/10.1056/nejm197611042951901
[9]
Vestergaard, M., Wisborg, K., Henriksen, T.B., Secher, N.J., Østergaard, J.R. and Olsen, J. (2005) Prenatal Exposure to Cigarettes, Alcohol, and Coffee and the Risk for Febrile Seizures. Pediatrics, 116, 1089-1094. https://doi.org/10.1542/peds.2004-2210
[10]
Canpolat, M., Per, H., Gumus, H., Elmali, F. and Kumandas, S. (2018) Investigating the Prevalence of Febrile Convulsion in Kayseri, Turkey: An Assessment of the Risk Factors for Recurrence of Febrile Convulsion and for Development of Epilepsy. Seizure, 55, 36-47. https://doi.org/10.1016/j.seizure.2018.01.007
[11]
Verity, C.M., Butler, N.R. and Golding, J. (1985) Febrile Convulsions in a National Cohort Followed up from Birth. II—Medical History and Intellectual Ability at 5 Years of Age. BMJ, 290, 1311-1315. https://doi.org/10.1136/bmj.290.6478.1311
[12]
Sun, Y., Vestergaard, M., Pedersen, C.B., Christensen, J., Basso, O. and Olsen, J. (2007) Gestational Age, Birth Weight, Intrauterine Growth, and the Risk of Epilepsy. American Journal of Epidemiology, 167, 262-270. https://doi.org/10.1093/aje/kwm316
[13]
Choi, Y.J., Jung, J.Y., Kim, J.H., Kwon, H., Park, J.W., Kwak, Y.H., et al. (2019) Febrile Seizures: Are They Truly Benign? Longitudinal Analysis of Risk Factors and Future Risk of Afebrile Epileptic Seizure Based on the National Sample Cohort in South Korea, 2002-2013. Seizure, 64, 77-83. https://doi.org/10.1016/j.seizure.2018.12.004
[14]
Sun, Y., Vestergaard, M., Christensen, J., Zhu, J.L., Bech, B.H. and Olsen, J. (2006) Epilepsy and Febrile Seizures in Children of Treated and Untreated Subfertile Couples. Human Reproduction, 22, 215-220. https://doi.org/10.1093/humrep/del333
[15]
Sun, Y., Vestergaard, M., Christensen, J., Nahmias, A.J. and Olsen, J. (2008) Prenatal Exposure to Maternal Infections and Epilepsy in Childhood: A Population-Based Cohort Study. Pediatrics, 121, e1100-e1107. https://doi.org/10.1542/peds.2007-2316
[16]
Sun, Y., Strandberg-Larsen, K., Vestergaard, M., Christensen, J., Nybo Andersen, A., Gronbaek, M., et al. (2008) Binge Drinking during Pregnancy and Risk of Seizures in Childhood: A Study Based on the Danish National Birth Cohort. American Journal of Epidemiology, 169, 313-322. https://doi.org/10.1093/aje/kwn334
[17]
Ateşoğlu, M., İnce, T., Lüleci, D., Ergör, A. and Aydın, A. (2018) Sociodemographic Risk Factors for Febrile Seizures: A School-Based Study from Izmir, Turkey. Seizure, 61, 45-49. https://doi.org/10.1016/j.seizure.2018.07.019
[18]
Douglass, L.M., Heeren, T.C., Stafstrom, C.E., DeBassio, W., Allred, E.N., Leviton, A., et al. (2017) Cumulative Incidence of Seizures and Epilepsy in Ten-Year-Old Children Born before 28 Weeks’ Gestation. Pediatric Neurology, 73, 13-19. https://doi.org/10.1016/j.pediatrneurol.2017.05.009
[19]
Herrgård, E.A., Karvonen, M., Luoma, L., Saavalainen, P., Määttä, S., Laukkanen, E., et al. (2006) Increased Number of Febrile Seizures in Children Born Very Preterm: Relation of Neonatal, Febrile and Epileptic Seizures and Neurological Dysfunction to Seizure Outcome at 16 Years of Age. Seizure, 15, 590-597. https://doi.org/10.1016/j.seizure.2006.08.004
[20]
Midha, T., Kumar, N. and Rao, Y. (2019) Risk Factors of Recurrence of Febrile Seizures in Children in a Tertiary Care Hospital in Kanpur: A One Year Follow up Study. Annals of Indian Academy of Neurology, 22, 31-36. https://doi.org/10.4103/aian.aian_472_17
[21]
Sahin, S., Yazici, M.U., Ayar, G., Karalok, Z.S. and Arhan, E.P. (2016) Seizures in a Pediatric Intensive Care Unit: A Prospective Study. Journal of Tropical Pediatrics, 62, 94-100. https://doi.org/10.1093/tropej/fmv076
[22]
Mwipopo, E.E., Akhatar, S., Fan, P. and Zhao, D. (2016) Profile and Clinical Characterization of Seizures in Hospitalized Children. Pan African Medical Journal, 24, Article 313. https://doi.org/10.11604/pamj.2016.24.313.9275
[23]
Ngoungou, E., Quet, F., Dubreuil, C., Marin, B., Houinato, D., Nubukpo, P., et al. (2006) Epidémiologie de l’épilepsie en Afrique subsaharienne: Revue de littérature. Cahiers de Santé, 16, 225-238.
[24]
Preux, P. and Druet-Cabanac, M. (2005) Epidemiology and Aetiology of Epilepsy in Sub-Saharan Africa. The Lancet Neurology, 4, 21-31. https://doi.org/10.1016/s1474-4422(04)00963-9
[25]
Kaputu Kalala Malu, C., Mafuta Musalu, E., Dubru, J., Leroy, P., Tomat, A. and Misson, J.P. (2013) Épidémiologie et caractéristiques des convulsions fébriles de l’enfant. Revue Médicale de Liège, 68, 180-185.
[26]
Sall, M., Kuakuvi, N., Ng Mbaye, S., Martin, Lahlou, L. and Fall, M. (1992) Les convulsions hyper-pyretiques au chu de dakar (A propos de 140 cas recrutés en deux ans). Médecined’Afrique noire 39, 119-121.
[27]
Bistervels, I.M., Kariuki, S.M. and Newton, C.R.J.C. (2016) Risk of Convulsive Epilepsy Following Acute Seizures in Kenyan Children. Epilepsia Open, 1, 112-120. https://doi.org/10.1002/epi4.12013
[28]
Kariuki, S.M., Abubakar, A., Stein, A., Marsh, K. and Newton, C.R.J.C. (2017) Prevalence, Causes, and Behavioral and Emotional Comorbidities of Acute Symptomatic Seizures in Africa: A Critical Review. Epilepsia Open, 2, 8-19. https://doi.org/10.1002/epi4.12035
[29]
Kariuki, S.M., Rockett, K., Clark, T.G., Reyburn, H., Agbenyega, T., Taylor, T.E., et al. (2013) The Genetic Risk of Acute Seizures in African Children with Falciparum Malaria. Epilepsia, 54, 990-1001. https://doi.org/10.1111/epi.12173
[30]
Idro, R., Gwer, S., Kahindi, M., Gatakaa, H., Kazungu, T., Ndiritu, M., et al. (2008) The Incidence, Aetiology and Outcome of Acute Seizures in Children Admitted to a Rural Kenyan District Hospital. BMC Pediatrics, 8, Article No. 5. https://doi.org/10.1186/1471-2431-8-5
[31]
Serem, G.K., Newton, C.R. and Kariuki, S.M. (2015) Incidence, Causes and Phenotypes of Acute Seizures in Kenyan Children Post the Malaria-Decline Period. BMC Neurology, 15, Article No. 180. https://doi.org/10.1186/s12883-015-0444-8
[32]
Kariuki, S.M., Ikumi, M., Ojal, J., Sadarangani, M., Idro, R., Olotu, A., et al. (2011) Acute Seizures Attributable to Falciparum Malaria in an Endemic Area on the Kenyan Coast. Brain, 134, 1519-1528. https://doi.org/10.1093/brain/awr051
[33]
Leung, A.K., Hon, K.L. and Leung, T.N. (2018) Febrile Seizures: An Overview. Drugs in Context, 7, 1-12. https://doi.org/10.7573/dic.212536
[34]
King, D. and King, A. (2014) Question 2: Should Children Who Have a Febrile Seizure Be Screened for Iron Deficiency? Archives of Disease in Childhood, 99, 960-964. https://doi.org/10.1136/archdischild-2014-306689
[35]
Sharawat, I.K. (2016) Evaluation of Risk Factors Associated with First Episode Febrile Seizure. Journal of Clinical and Diagnostic Research, 10, SC10-SC13. https://doi.org/10.7860/jcdr/2016/18635.7853
[36]
Muchohi, S.N., Kokwaro, G.O., Ogutu, B.R., Edwards, G., Ward, S.A. and Newton, C.R.J.C. (2008) Pharmacokinetics and Clinical Efficacy of Midazolam in Children with Severe Malaria and Convulsions. British Journal of Clinical Pharmacology, 66, 529-538. https://doi.org/10.1111/j.1365-2125.2008.03239.x
[37]
Auvin, S. (2012) Convulsions et état de mal convulsif: Prise en charge en urgence. https://sofia.medicalistes.fr/spip/IMG/pdf/convulsions_et_etat_de_mal_convulsif_prise_en_charge_en_urgence.pdf
