Association between iron deficiency and febrile seizures

• Greek children with FS have lower levels of plasma ferritin than controls.
• They also demonstrate higher levels of TIBC than controls.
• These findings implied an association with ID although Hb levels were non-significantly higher.
• In children with complex FS, plasma ferritin levels are significantly lower than controls.
• In the same group of children, TIBC levels are significantly higher than controls.
• Cases in which the index FS was a recurrence were more likely to be ID than those with a first seizure.
• These cases had a higher Hb and MCHC than those with a first seizure.

ObjectiveThe relationship between iron status and febrile seizures has been examined in various settings, mainly in the Developing World, with conflicting results. The aim of this study was to investigate any association between iron deficiency and febrile seizures (FS) in European children aged 6–60 months.DesignProspective, case–control study.SettingGreek population in Thessaloniki.Patients50 patients with febrile seizures (cases) and 50 controls (children presenting with fever, without seizures).InterventionsNone.Main outcome measuresHaematologic parameters (haemoglobin concentration, haematocrit, mean corpuscular volume, red cell distribution width), plasma iron, total iron-binding capacity, plasma ferritin, transferrin saturation and soluble transferrin receptors were compared in cases and controls.ResultsPlasma ferritin was lower (median [range]: 42.8 (3–285.7) vs 58.3 (21.4–195.3 ng/ml; p = 0.02) and Total Iron Binding Capacity (TIBC) higher (mean [Standard Deviation] 267 [58.9] vs 243 [58.45] μg/dl, p = 0.04) in cases than in controls. Results were similar for 12 complex FS cases (ferritin 30 (3–121 vs 89 (41.8–141.5 ng/lL; TIBC 292.92 [68.0] vs 232.08 [36.27] μg/dL). Iron deficiency, defined as ferritin <30 ng/ml, was more frequent in cases (24%) than controls (4%; p = 0.004). Ferritin was lower and TIBC higher in 18 with previous seizures than in 32 with a first seizure although haemoglobin and mean cell haemoglobin concentration were higher.ConclusionsEuropean children with febrile seizures have lower Ferritin than those with fever alone, and iron deficiency, but not anaemia, is associated with recurrence. Iron status screening should be considered as routine for children presenting with or at high risk for febrile seizures.