Title: Low Zinc and Iron Status: A Possible Risk Factor For Febrile Seizure

Authors: Dr P. Lakshmi Kumari, Dr Sasmita Devi Agrawal

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.48

Abstract

Introduction: The International League Against Epilepsy (ILAE) defines a febrile seizure as “a seizure occurring in childhood after one month of age associated with a febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure, and not meeting the criteria for other acute symptomatic seizures.”1 Risk factors for febrile seizures include developmental delay, discharge from a neonatal unit after 28 days, day care attendance, viral infections, a family history of febrile seizures, certain vaccinations, and possibly iron and zinc deficiencies2,3,4,5 by their co-enzyme activity or ability to influence ion channels and receptors.

Objectives: To focus specifically on iron and zinc levels and their correlation to febrile seizure in patients between 06-60 months of age.

Materials and Method: The study was conducted in the Department of Paediatrics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, from November 2016 - October 2018.

Patients presenting with febrile seizures were considered as cases and patients presenting with fever without seizures were taken as controls. A proper history regarding the duration of fever, time of onset of seizure, type of seizure, duration of seizure, past & family history of convulsive disorder was obtained  and  a series of haematological workup was done. Serum ferritin &Serum Zinc levels were also estimated.

Results: The mean haemoglobin levels in cases and controls included in this study was 10.51 ± 1.38 and 11.20 ± 1.53 g/dl respectively. The mean corpuscular haemoglobin in cases and controls included in this study was 25.29 ± 4.01 and 24.39 ± 2.66 pg respectively. The mean serum ferritin in cases and controls included in this study was 25.88 ± 7.57 and 79.85 ± 61.98 ng/ml respectively . The mean serum zinc in cases and controls included in this study was 73.10 ± 44.31and 79.85 ± 61.98 mcg/ml respectively.

Moreover, there was statistical significance observed between haemoglobin, serum ferritin and serum zinc levels of cases and controls (p < 0.01).

Conclusion: The present study has shown that iron and zinc deficiency are few of the predisposing factors for simple and complex febrile convulsions thereby establishing the relationship between zinc deficiency and febrile seizures. 

Keywords: Febrile seizure, serum zinc, iron status.

References

  1. Commission on Epidemiology and Prognosis of the International League against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34:592-6.
  2. Berg AT, Shinnar S, Shapiro ED, Salomon ME, Crain EF, Hauser WA. Risk factors for a first febrile sei­zure: a matched case-control study. 1995;36(4):334-341.
  3. Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev. 2005;(4):CD004407.
  4. Ganesh R, Janakiraman L. Serum zinc levels in chil­dren with simple febrile seizure. ClinPediatr (Phila). 2008;47(2):164-166.
  5. Hartfield DS, Tan J, Yager JY, et al. The association between iron deficiency and febrile seizures in child­hood. ClinPediatr (Phila). 2009;48(4):420-426.
  6. DeUngria M, Rao R, Wobken JD, Luciana M, Nelson CA, Georgieff MK. Perinatal iron deficiency decreases cytochrome c oxidase (CytOx) activity in selected regions of neonatal rat brain. Pediatric Research 2000;48:169–76.
  7. Beard JL, Erikson KM, Jones BC. Neurobehavioral analysis of developm-ental iron deficiency in rats. Behavioral Brain Research 2002; 134(1–2):517–24.
  8. DeMaeyer E, Adiels-Tegman M. The prevalence of anemia in the world. World Health Statistics Quarterly 1985; 38:302–16.
  9. Florentino RF, Guirriec RM. Prevalence of nutritional anemia in infancy and childhood with emphasis on developing countries. In: Stekel A, editor. Iron nutrition in infancy and childhood. New York: Raven Press; 1984. p. 61–74.
  10. Freire W. Strategies of the Pan American Health Organization–World Health Organization for the control of iron deficiency in Latin America. Nutrition Reviews 1997; 55:183–8.
  11. Stoltzfus R. Defining iron-deficiency anemia in public health terms: a time for reflection. Journal of Nutrition 2001; 131(2S-2):565S–7S.
  12. Ganesh R, Janakiraman L. Serum zinc levels in children with simple febrile seizure. ClinPediatr (Phila) 2008; 47:164–6.
  13. Van den Berg BJ, Yerushalmy J. Studies on convulsive disorders in young children. The incidence of febrile and nonfebrile convulsions by age and other factors. Pediatr Res. 1969; 3:298-304.
  14. Matsuo M, Sasaki K, Ichimaru T, Nakazato S, Hamasaki Y. Increased IL-1beta production from dsRNA-stimulated leukocytes in febrile seizures. Pediatr Neurol. 2006 Aug. 35(2):102-6.
  15. Gatti S, Vezzani A, Bartfai T. Mechanisms of fever and febrile seizures: putative role of the interleukin-1 system. Baram TZ, Shinnar S. Febrile Seizures. San Diego, Ca: Academic Press; 2002. 169-88.
  16. Haspolat S, Mihci E, Coskun M, Gumuslu S, Ozben T, Yegin O. Interleukin-1beta, tumor necrosis factor-alpha, and nitrite levels in febrile seizures. J Child Neurol. 2002 Oct. 17(10):749-51.
  17. Kumari PL, Nair MK, Nair SM, Kailas L, Geetha S. Iron deficiency as a risk factor for simple febrile seizures--a case control study. Indian Pediatr. 2012; 49:17–19.
  18. Daoud AS, Batieha A, Abu-Ekteish F, et al. Iron status: a possible risk factor for the first febrile seizure. Epilepsia. 2002;43(7):740–3.
  19. Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D'Apuzzo A, et al. Iron deficiency anaemia and febrile convulsions: case-control study in children under 2 years. BMJ 1996;313(7053):343.
  20. Dawn SH, Jonatan T, Jerome Y, Don S. The association between iron deficiency and febrile seizures in childhood. ClinPediatr. 2009;48:420-6.
  21. Sherjil A, Saeed Z, Shehzad S, Amjad R. Iron deficiency anaemia-a risk factor for febrile seizures in children. J Ayub Med Coll Abbottabad. 2010;22(3):71-3.
  22. Sampathkumar P, Kannan KS. A comparative study of serum zinc levels in children with febrile seizures and children with fever without seizures in an urban referral hospital. International Journal of Contemporary Pediatrics. 2018 Apr 20;5(3):977-82.

Corresponding Author

Dr Sasmita Devi Agrawal

Professor and Head of Department of Pediatrics, HMCH

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