The Association between Serum Sodium Levels and Febrile Seizures Recurrence: Is the Degree of Hyponatremia a Risk Factor?

Abstract

Febrile seizures are common disorders in childhood. We evaluated the serum electrolyte levels and the associated factors in children with single and recurrent febrile seizures in 24 hours period of hospitalization. The medical records of children who were clinically diagnosed with febrile seizures and hospitalized were retrospectively revealed and analyzed. Data were collected for children aged 1 to 6 years including demographic parameters and serum electrolyte levels. A total of 244 children were enrolled in the study in which 209 were diagnosed with single febrile seizures and 35 of them with recurrent febrile seizures. Serum sodium levels were significantly lower in children with recurrent febrile seizure (138.5 ± 2.38 and 134.2 ± 3.55, p < 0.001). Correlation analysis revealed that mild hyponatremia is associated with recurrence of febrile seizure within 24 hours. However, receiver-operating characteristics analysis for hyponatremia showed lower sensitivity (50.3%) and specificity (43.1%) values for optimal cutoff value of 133.5 mmol/L of serum sodium level. Our study suggested that serum sodium levels were significantly lower in children with recurrent febrile seizures. However, because of its lower sensitivity and specificity values, mild hyponatremia cannot be used as an indicator for febrile seizure recurrence.

Keywords

febrile seizure - recurrence - serum sodium levels - risk factor - children

Authors' Contributions

E.K.A. and A.M.E. designed the study and wrote the manuscript. A.M.E. collected and analyzed the data. All authors read and approved the final manuscript.

Ethical Approval

This is a retrospective study. The authors assert that all procedures contributing to this study comply with the ethical standards of the Turkish Council of Medical Research and with the Helsinki Declaration of 1975, as revised in 2008, and has been approved by the local institutional committee of Dr. Ali Kemal Belviranlı Obstetrics and Children Hospital.

Publication History

Received: 14 October 2020

Accepted: 03 December 2020

Article published online:
11 February 2021

• References

• 1 Farrell K, Goldman RD. The management of febrile seizures. BCMJ 2011; 53: 268-273
• 2 Duffner PK, Berman PH, Baumann RJ. et al. Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011; 127 (02) 389-394
• 3 Kiviranta T, Airaksinen EM. Low sodium levels in serum are associated with subsequent febrile seizures. Acta Paediatr 1995; 84 (12) 1372-1374
• 4 Hugen CA, Oudesluys-Murphy AM, Hop WC. Serum sodium levels and probability of recurrent febrile convulsions. Eur J Pediatr 1995; 154 (05) 403-405
• 5 Maksikharin A, Prommalikit O. Serum sodium levels do not predict recurrence of febrile seizures within 24 hours. Paediatr Int Child Health 2015; 35 (01) 44-46
• 6 Thoman JE, Duffner PK, Shucard JL. Do serum sodium levels predict febrile seizure recurrence within 24 hours?. Pediatr Neurol 2004; 31 (05) 342-344
• 7 Heydarian F, Ashrafzadeh F, Kam S. Simple febrile seizures: the role of serum sodium levels in prediction of seizure recurrence during the first 24 hours. Iran J Child Neurol 2009; 3: 31-34
• 8 Nickavar A, Hasanpour H, Sotoudeh K. Validity of serum sodium and calcium screening in children with febrile convulsion. Acta Medica Iranica 2009; 47: 229-231
• 9 Baek SJ, Byeon JH, Eun SH, Eun BL, Kim GH. Risk of low serum levels of ionized magnesium in children with febrile seizure. BMC Pediatr 2018; 18 (01) 297
• 10 Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. BMJ 1991; 303 (6814): 1373-1376
• 11 Tanaka M, Natsume J, Hamano SI. et al. The effect of the guidelines for management of febrile seizures 2015 on clinical practices: nationwide survey in Japan. Brain Dev 2020; 42 (01) 28-34
• 12 Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics 1996; 97 (05) 769-772 , discussion 773–775
• 13 Balestrino M, Somjen GG. Concentration of carbon dioxide, interstitial pH and synaptic transmission in hippocampal formation of the rat. J Physiol 1988; 396: 247-266
• 14 Millichap JG. Studies in febrile seizures. II. Febrile seizures and the balance of water and electrolytes. Neurology 1960; 10: 312-321
• 15 Chiarelli F, De Palma C, Verrotti A, Lombardi G, Domizio S. Electrolytic changes in febrile convulsions [in Italian]. Pediatr Med Chir 1985; 7 (02) 249-252
• 16 Kiviranta T, Tuomisto L, Airaksinen EM. Osmolality and electrolytes in cerebrospinal fluid and serum of febrile children with and without seizures. Eur J Pediatr 1996; 155 (02) 120-125
• 17 Nadkarni J, Binaykiya I, Sharma U, Dwivedi R. Role of serum sodium levels in prediction of seizure recurrence within the same febrile illness. Neurology Asia 2011; 16: 195-197
• 18 Halawa I, Andersson T, Tomson T. Hyponatremia and risk of seizures: a retrospective cross-sectional study. Epilepsia 2011; 52 (02) 410-413