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Indian Pediatr 2014;51: 585-586 |
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Benign Infantile Seizures with Mild
Gastroenteritis
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Devendra Mishra and Niraj Kumar Nikunj
Department of Pediatrics, MAMC, New Delhi, India.
Email: [email protected]
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Benign infantile seizures with mild gastroenteritis, first described
from Japan in 1982 [1], have been commonly reported from Asia [1-3].
More recently, many cases are also being reported from non-Asian
countries, albeit infrequently [4,5]. Typically, previously healthy
infants aged 6 months to 3 years, present with generalized, afebrile,
isolated or cluster seizures. The laboratory examination, including
blood glucose, serum electrolytes, and CSF, as well as the interictal
EEG and neuroimaging are normal [4,5]. Subsequent recovery from the
episode is complete [4].
An 11-month-old girl presented with a 15-minute
generalized tonic seizure, associated with mild gastro-enteritis of 2
days duration. There was no dehydration, and seizures subsided without
any anti-convulsant treatment. Her serum glucose, electrolytes and ionic
calcium, and hemogram were within normal range. The stool microscopy did
not show pus cells, and bacterial culture did not reveal any organisms.
Studies for Rotavirus were not done. Interictal EEG and MRI were
non-contributory. Development quotient done after three months (using
DASII) was 84. There was no recurrence of seizures, or developmental
delay on follow-up over next 13 months. The final diagnosis made
was Benign infantile seizures with mild gastroenteritis.
This syndrome – recognized only in the last decade –
is still not accepted by the International League Against Epilepsy [6].
Rotavirus has been reported as the most common etiological agent in this
condition in different studies [4,5]. However, other organisms have also
been reported [3], and it has not been possible to attribute the
convulsions to any organism, as yet [2]. The clinical symptoms are
reported to precede the convulsions by an average of 2 days [4], similar
to that in our case.
The importance of recognition of this condition is
that it helps in avoiding unnecessary long term anti-epileptic therapy,
and favorably counsel the parents about the low risk of recurrence of
seizures.
References
1. Uemura N, Okumara A, Negoro T, Watanabe K.
Clinical features of benign convulsions with mild gastroenteritis. Brain
Dev. 2002;24:745-9.
2. Narchi H. Benign afebrile cluster convulsions with
gastroenteritis: an observational study. BMC Pediatr. 2004;4:2.
3. Abe T, Kobayashi M, Arki K, Kodama H, Fujita
Y, Shinozaki T, et al. Infantile convulsions with mild
gastroenteritis. Brain Dev. 2000;22:1367-70.
4. Youssef WF, Ramírez RP, Plana JC, Marfa MP. Benign
afebrile convulsions in the course of mild acute gastroenteritis: a
study of 28 patients and a literature review. Pediatr Emerg Care.
2011;27:1062-4.
5. Caraballo RH, Gañez L, Santos Cde L, Espeche A,
Cersósimo R, Fejerman N. Benign infantile seizures with mild
gastroenteritis: study of 22 patients. Seizure. 2009;18:686-9.
6. Engel J, Jr. Report of the ILAE Classification Core Group.
Epilepsia. 2006;47:1558-68.
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