Is vitamin D deficiency a risk factor in the occurrence and recurrence of febrile convulsions in children?
DOI:
https://doi.org/10.18203/2349-3291.ijcp20242739Keywords:
FSs, Recurrence, Vitamin D deficiency, Under five aged childrenAbstract
Background: Febrile seizure (FS) is the commonest childhood seizure. Our aim was to evaluate low Serum 25(OH) vitamin D level (vitamin D) as a risk factor for FS and whether vitamin D supplementation reduces its recurrence.
Methods: A prospective cohort of children aged 6-60 months with FS (cases) and children with fever ≤3 days without seizures (controls) were recruited over a 2-year period. Vitamin D level was measured; those with low levels (<20 ng/ml) were treated with vitamin D for 3 months. Telephonic follow up was done upto 3 months regarding compliance, thereafter, upto 24 months for seizure recurrence.
Results: 259 children (125 cases,134 controls) were recruited. Overall, 90 children (34.7%) had low vitamin D level. There was no difference between cases and controls with low vitamin D levels (p=0.37). 22 (17.6%) children had seizure recurrence. Of this serum vitamin D level was low in 2 (9.1%) while 20 (90.9%) had sufficient levels (p=0.021). The odds ratio for FS recurrence was 5.8 times higher among cases with normal vitamin D level (>20 ng/ml).
Conclusions: There was no difference in mean vitamin D levels between cases and controls. However, there was significantly lower seizure recurrence in children who had low vitamin D level at presentation and had received vitamin D therapy. We postulate that treatment with vitamin D may reduce risk of FS recurrence even in those with serum vitamin D level in the “sufficient” range as per the recommended guidelines. Larger RCTs are needed to confirm these findings.
References
Mikati MA, Tchapyjnikov D. Febrile Seizures. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier. 2020;12071-9.
Berg AT. Febrile seizures and epilepsy: the contributions of epidemiology. Paediatr Perinat Epidemiol. 1992;6(2):145-52.
Singh V, Sharma P, Dewan D. Association of vitamin D levels with simple febrile seizures in under-five children: a case-control study. Int J Contemporary Pediatr. 2019;6(2):365.
Bhat JA, Bhat TA, Sheikh SA, Wani ZA, Ara R. Status of 25-hydroxy Vitamin D level in simple febrile seizures and its correlation with recurrence of seizures. Avicenna J Med. 2020;10(1):6-9.
Rathi N, Rathi A. Vitamin D, and child health in the 21st century. Indian Pediatr. 2011 Aug;48(8):619-25.
Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metabol. 2016;101(2):394-415.
Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, Balasubramanian S et al. Prevention and Treatment of Vitamin D and Calcium Deficiency in Children and Adolescents: Indian Academy Pediatrics (IAP) Guidelines. Indian Pediatr. 2017;54(7):567-73.
Surve S, Chauhan S, Amdekar Y, Joshi B. Vitamin D deficiency in Children: An update on its Prevalence, Therapeutics and Knowledge gaps. Indian J Nutri. 2017;4(3):167.
Cashman KD, Sheehy T, O’Neill CM. Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review. Eur J Nutr. 2019;58(1):433-53.
Khadilkar A, Kajale N, Oza C, Oke R, Gondhalekar K, Patwardhan V et al. Vitamin D status and determinants in Indian children and adolescents: a multicentre study. Sci Rep. 2022;12:16790.
Hossain MI, Khanam W, Adnan MA, Mawa J, Ahmed I, Mondol MTI. Association of serum vitamin D levels and simple febrile seizures in children. Int J Contemp Pediatr. 2023;10:266-71.
Çığrı E, İnan FÇ. Comparison of Serum Selenium, Homocysteine, Zinc, and Vitamin D Levels in Febrile Children with and without Febrile Seizures: A Prospective Single-Center Study. Children (Basel). 2023;10(3):528.
Heydarian F, Bakhtiari E, Golmakani H, Fakhr Ghasemi N, Heidarian M. Serum Level of Vitamin D and Febrile Seizure? A Clinical Study. Iran J Child Neurol. 2020;14(3):77-82
Mohammadi M, Baleghi Y, Salehiomran M, Hajiahmadi M, Poornasrollah M, Alijanpour P, et al. Evaluation of Vitamin D Level in Children with Febrile Seizure Referred to Amirkola Children's Hospital, Babol. Glob Pediatr Health. 2023;10:2333794X231198390.
Bağcı Z. Comparison of Serum Vitamin D levels in febrile children with and without seizure. Nöbeti̇n Eşlik Etti̇ği ̇ ve Etmedi ̇ ği ̇ Febri ̇ l Çocuklarda Serum D ̇ Vitami ̇ ni ̇ Düzeyleri ̇ ni ̇ n Karş ̇ ılaştırılması. Bozok Tıp Dergisi. 2021;11(3):50-5.
Julies P, Jacobs B. Hypocalcaemic convulsions due to vitamin D deficiency may masquerade as simple febrile convulsions. Archives of Disease in Childhood. 2011;96(1):A68.
Miri Aliabad G, Khajeh A, Fayyazi A, Safdari L. Clinical, Epidemiological and Laboratory Characteristics of Patients with Febrile Convulsion. J Compr Ped. 2013;4(3):134-7.
Alhaidari HM, Babtain F, Alqadi K, Bouges A, Baeesa S, Al-Said YA. Association between serum vitamin D levels and age in patients with epilepsy: a retrospective study from an epilepsy center in Saudi Arabia. Ann Saudi Med. 2022;42(4):262-8.
Harms LR, Burne THJ, Eyles DW, McGrath JJ. Vitamin D and the brain. Best Pract Res Clin Endocrinol Metabol. 2011;25(4):657-69.
Shariatpanahi G, Paprooschi N, Yaghmaei B, Sayarifard F, Sayarifard A. Exploring Vitamin D in Children with Febrile Seizure: A Preliminary Study. Int J Pediatr, 2018;6(9):8233-9.
Zhang X, Liu Z, Xia L, Gao J, Xu F, Chen H, et al. Clinical features of vitamin D deficiency in children: A retrospective analysis. J Steroid Biochemistr Molecular Biol. 2020;196:105491.
Eyles DW, Smith S, Kinobe R, Hewison M, McGrath JJ. Distribution of the Vitamin D receptor and 1α-hydroxylase in the human brain. J Chemical Neuroanatomy. 2005;29(1):21-30.
Fong CY, Kong AN, Poh BK, Mohamed AR, Khoo TB, Ng RL, et al. Vitamin D deficiency and its risk factors in Malaysian children with epilepsy. Epilepsia. 2016;57(8):1271-9.
Holló A, Clemens Z, Kamondi A, Lakatos P, Szűcs A. Correction of vitamin D deficiency improves seizure control in epilepsy: a pilot study. Epilepsy Behav. 2012;24(1):131-3.
Georgieva V, Kamolvit W, Herthelius M, Lüthje P, Brauner A, Chromek M. Association between vitamin D, antimicrobial peptides and urinary tract infection in infants and young children. Acta Paediatr. 2019;108(3):551-6.
Ginde AA, Mansbach JM, Camargo CA. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-90.
Millichap JG, Millichap JJ. Role of viral infections in the etiology of febrile seizures. Pediatr Neurol. 2006;35(3):165-72.
Lee CY, Lee NM, Yi DY, Yun SW, Lim IS, Chae SA. Iron Deficiency Anemia: The Possible Risk Factor of Complex Febrile Seizure and Recurrence of Febrile Seizure. Child Neurol. 2018;26(4):210-4.