Epidemiology and diagnostic and therapeutic management of febrile seizures in the Italian pediatric emergency departments: A prospective observational study

- To our knowledge this is the first study assessing prevalence and epidemiologic characteristics of FS in the Italian pediatric population. The results of our study are sometimes in line with current literature data, even if mostly highlighted some interesting topics of research on international level, evidencing a higher prevalence of CFSs in children younger than 12 months of age and opening a new research scenario on the involvement of the blood brain barrier vulnerability in children affected by FS under 12 months of age.
- Experimental studies, leaded in the 80s, showed that the Central Nervous System (CNS) homeostasis was constitutively altered in case of seizures lasting more than 30 min. In regards, literature data suggest to shorten the time of seizure duration, in order to reduce CNS risk factors. On the other hand, further studies showed that a single epileptic event usually resolve within 2-5 min, while those critical events lasting more than 10-15 min show a higher risk not to be spontaneously resolved. Therefore, the importance for an adequate diagnosis and prompt treatment of CFSs, above all in the youngest.
- In our study, most of the children experienced simple FS (71.65%). Among the 68 (25.37%) patients with complex FS, 11 were 6-12 month-old, accounting for 45.83% of all the infants with FS in the younger age group. No therapy has been administered at home in 76.12% patients; 23.51% of them received endorectal diazepam and only 1 patient received buccal midazolam. At arrival at ED, no therapy was necessary for 70.52% patients; 50.63% received endorectal diazepam and 17.72% an i.v. bolus of midazolam. Among patients who had not receive any therapy, 4.61% of children had seizures lasting more than 10 min.
- On a national level, our study showed the need of a diagnostic standardized work-up to improve the management of FS at ED, in line with an improvement of the cost/benefit ratio. Moreover further efforts should be done to innovate in the therapeutic field, achieving a better education on FS pre-hospitalization treatment and introducing the use of new drugs, such as oral midazolam, as standard CSF resolution therapy in Paediatric ED.

AimFebrile seizures (FS) involve 2-5% of the paediatric population, among which Complex FS (CFS) account for one third of accesses for FS in Emergency Departments (EDs).The aim of our study was to define the epidemiology, the clinical, diagnostic and therapeutic approach to FS and CFSs in the Italian EDs.MethodsA multicenter prospective observational study was performed between April 2014 and March 2015.Patients between 1 and 60 months of age, randomly accessing to ED for ongoing FS or reported FS at home were included. Demographic features and diagnostic-therapeutic follow-up were recorded. FS were categorized in simple (<10 min), prolonged (10-30 min) and status epilepticus (>30 min).ResultsThe study population consisted of 268 children. Most of the children experienced simple FS (71.65%). Among the 68 (25.37%) patients with complex FS, 11 were 6-12 month-old, accounting for 45.83% of all the infants with FS in the younger age group.No therapy has been administered at home in 76.12% patients; 23.51% of them received endorectal diazepam and only 1 patient received buccal midazolam.At arrival at ED, no therapy was necessary for 70.52% patients; 50.63% received endorectal diazepam and 17.72% an i.v. bolus of midazolam.Blood tests and acid-base balanced were performed respectively in 82.09% of cases. An electroencephalogram at ED was performed in 21.64% of patients. Neuroimagings were done in 3.73% of cases. A neurologic consultation was asked for 36 patients (13.43%).Conclusionthis is the first study assessing epidemiologic characteristics of FS in the Italian pediatric population, evidencing a higher prevalence of CFSs in children younger than 12 months of age and opening a new research scenario on the blood brain barrier vulnerability. On a national level, our study showed the need for a diagnostic standardized work-up to improve the cost/benefit ratio on CFS management.