Elsevier

Pediatric Neurology

Volume 42, Issue 6, June 2010, Pages 404-408
Pediatric Neurology

Original Article
Rotavirus Gastroenteritis and Seizures in Young Children

https://doi.org/10.1016/j.pediatrneurol.2010.03.002Get rights and content

In this retrospective cohort study, a clinical and administrative database of children hospitalized at Primary Children's Medical Center, Salt Lake City, Utah, between January 1, 2002, and December 31, 2006, was used to identify those with laboratory-confirmed rotavirus infections and at least one seizure. In all, 59 children were identified, 34 of whom (58%) had no other potential medical explanation for their seizures. Of these 34 children, 23 (68%) were afebrile at seizure onset and 11 were febrile. Electroencephalography was performed for 21 of the 34 children (62%); all findings were normal, except for a child with slowing related to cerebral edema. Twenty-six of the 34 children (76%) had neuroimaging studies; all findings were normal, except for the child with cerebral edema and a child with an incidental arachnoid cyst. Twenty of the 34 children (59%) had a lumbar puncture; again, all findings were normal. All 34 children recovered uneventfully, including the 6 children who spent at least 1 day in an intensive care unit. Follow-up data on 27 of these children identified 2 children (7%) who required chronic anticonvulsant therapy. The results indicate that seizures associated with rotavirus infection are a relatively benign neurologic condition in young children. With few exceptions, neurodiagnostic studies do not influence management or outcome.

Introduction

Rotavirus gastroenteritis, a major source of severe diarrheal disease in infants and young children, causes 600,000 deaths, 2 million hospitalizations, and 25 million clinic visits annually worldwide [1], [2], [3]. The management of patients with rotavirus infection focuses on replacing fluid losses and treating abdominal pain. Although neurologic complications are not the primary concern in children with rotavirus infections, seizures have been described in patients with rotavirus infections even in the absence of fever or electrolyte abnormalities. Reports from Asia suggest that the afebrile seizures associated with rotavirus infections produce no adverse sequelae [4], [5], [6], and data from Europe also suggest benign outcomes [7], [8], [9], [10].

This study was designed to describe (1) the natural history of children who had rotavirus infection and at least one seizure during their hospitalization, (2) the results of the neurodiagnostic procedures performed, and (3) the children's outcome. The hypothesis was that children with rotavirus infection and seizures often receive extensive neurodiagnostic evaluations and that these results rarely modify clinical management or outcome.

Section snippets

Setting and Study Population

Approval for this study was obtained from the institutional review board of the University of Utah and Primary Children's Medical Center. Primary Children's Medical Center is owned and operated by Intermountain Healthcare, a not-for-profit corporation. This 271-bed hospital serves as the tertiary care center for children living in the Intermountain region, a large geographic area that includes Utah, western Colorado, and portions of Idaho, Wyoming, and Nevada. Approximately 2 million children

Study Population

During the study interval, 1292 infants and young children with proven rotavirus infections were evaluated at the Primary Children's Medical Center. There were 154 seen in the emergency department; 635 were admitted to inpatient units, 470 were admitted to the short stay unit (known as the Rapid Treatment Unit), and 33 were seen in various outpatient clinics. A distinct seasonality to these infections was observed, with the vast majority (95%) occurring between mid-October and May 1 annually (

Discussion

This study, based on a large series of children admitted to a major pediatric medical center in the western United States, provides useful clinical and neurodiagnostic information regarding rotavirus-associated seizures. The overall prevalence of febrile and afebrile seizures among medically attended children in the present series was 4.6 per 100 rotavirus-infected children (4.6%); the prevalence of febrile seizures was 0.9% (12 children with febrile seizures among 1292 with rotavirus

Conclusions

The present findings indicate that rotavirus is an important cause of seizures, either febrile or afebrile, in young children. Preventing seizures and their potential complications, including the performance of unnecessary diagnostic procedures, is yet another reason to promote comprehensive immunization programs to prevent rotavirus infection in young children [1], [2], [3]. The present findings illustrate that rotavirus can cause seizures not only in infants with underlying neurologic or

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