BREAKING! South Korean Physicians Warn That Incidence Of Febrile Seizures In Children With COVID-19 Increasing With The Emergence Of Omicron Variants!
South Korean medical researchers from Jeonbuk National University Medical School, Wonkwang University Medical Center, Gunsan Medical Center, the Presbyterian Medical Center and Design Medical Center in a new study have found that with the emergence of the Omicron variant and its various sub-lineages, the incidence of febrile-seizures has increased among children tested positive for COVID-19. Alarmingly, most of these seizures were more serious and were categorized as complex febrile seizures or CFS.
A febrile seizure is a convulsion in a child that's caused by a fever. The fever is often from an infection. Febrile seizures occur in young, healthy children who have normal development and haven't had any neurological symptoms before.
During a febrile seizure, there is typically loss of consciousness (black outs), twitching or jerking of arms and legs, breathing difficulty and foaming at the mouth. The child may look strange for a few moments, then stiffen, twitch and roll their eyes. They may be unresponsive for a short time, or have changes in their breathing or skin color. Most febrile seizure usually lasts for less than 5 minutes.
What was concerning to the study team was that after the of the Omicron surge, febrile seizures occurred more frequently and became more complex especially in boys.
The study team aimed to investigate the incidence of febrile seizures (FS) associated with coronavirus disease 2019 (COVID-19) in children and examine the variation in these incidences after the Omicron surge.
The total number of confirmed COVID-19 cases aged below 5 years residing in the Jeonbuk province from January 2020 to June 2022 was obtained from official data released by the Korean government.
During the same period, data regarding febrile seizure (FS) patients with COVID-19 were obtained from all local hospitals capable of febrile seizure (FS) treatment in Jeonbuk. The data were analyzed retrospectively.
The study data showed that the number of children under 5 years of age in Jeonbuk was 62,772, of which 33,457 (53.2%) were diagnosed with COVID-19 during the study period.
The study findings showed that of these, 476 patients (1.4%) required hospitalization and 64 (0.19%, 44 boys: 20 girls) developed febrile seizures (FS).
Interesting, it was found that until 2021, before the Omicron surge, 23.4% of the patients (89 of 381) required hospitalization, but no children with COVID-19 were hospitalized for febrile seizure (FS).
Worryingly however, after the Omicron surge in 2022, 16.5% of hospitalized children (64 of 387) experienced febrile seizures (FS), despite the decline in hospitalization rates among COVID-19 patients (1.2%).
What was worse was that twenty-five patients (39.1%) had what is termed as complex febrile seizures, and one (1.6%) presented with febrile status epilepticus. Another forty-two patients (65.6%) experienced first-time FS, with an average of 1.5 convulsive events.
The study team warned that initially during the COVID-19 pandemic, the incidence of febrile seizures was approximately only 0.19%; however, after the emergence of the Omicron variant and its various sub-lineages, febrile seizures or FS occurred more frequently and became more complex.
The study findings were published on a preprint server and is currently being peer reviewed.
The study findings clearly showed that after the Omicron surge, 16.5% of hospitalized patients (64 of 387,) had febrile seizures, despite the hospitalization rate dropping to 1.2% (387 of 33,057).
These study findings concur with the findings of a study conducted in South Africa, which reported that 20% of hospitalized patients with the Omicron variant aged below 19 years experienced seizures.
It should be noted that infections with the human herpesvirus-6 and influenza A virus are also common causes of febrile seizures (FS).
This is the first study to show that the Omicron variant and its emerging sub-lineages can also be a common cause of febrile seizures or FS.
In the study, the mean age of patients with febrile seizures due to COVID-19 was 36.7 ± 15.0 months, which was older than the peak age of FS, which is 18–20 months.
It was also found that 39.1% of patients with febrile seizures had complex febrile seizures or CFS, and 1.6% of them had febrile status epilepticus or FSE, which is also higher than the average 25%–30% incidence of CFS.
A previous study reported the characteristics of 16 pediatric patients with seizures due to COVID-19 after the Omicron surge. Six patients (38%) presented with focal seizures and eight patients (50%) presented with status epilepticus.
That study however reported a higher rate of status epilepticus than that found in the South Korean study as per the criteria for status epilepticus (seizures lasting more than 5 minutes).
Lead author, Dr Min Jeong Han from Jeonbuk National University Medical School told Thailand Medical News
, “Eleven children (17.2%) had seizures lasting more than 5 minutes in our study, which also indicated that neurological symptoms occurred more frequently than in the previous COVID-19 variants.”
He further warned, “Overall, our study findings also confirmed that the Omicron variant could also be a common cause of FS, and CFS, and FSE were more frequent at an older age. The findings of this study may be due to the increase in the total number of confirmed COVID-19 cases; however, the findings suggest the possibility of the Omicron variant leading to poor neurologic clinical outcomes, even though the disease severity is less than that associated with the previous variants.”
According to the study team, the biggest advantage of this study was that the incidence of febrile seizures or FS among confirmed COVID-19 patients could be calculated based on government statistical records rather than inpatient population organizations. The data then only showed only 0.19% of children with COVID-19 developed FS.
This can be considered an advantage of previous COVID-19 research in which inpatients were the target population. It should be noted that the existing reports on febrile seizures related to COVID-19 were also studies on hospitalized patients.
The study team said that their study findings may contribute to strengthening the basis for predicting the incidence of FS in the general COVID-19 population. It is thought that the number of FS cases among children under the age of 5 years can be predicted.
The study team found that the incidence of FS was more than doubled in 68.8% of boys compared to girls, and most of the patients who had PFS were boys, although there was no significant difference in the incidence of COVID-19 infection and hospitalization according to sex within 10%.
Past studies before the Omicron surge suggested lower incidences of FS among Korean children, and the possibility that the incidence of FS may increase after the Omicron pandemic should not be neglected.
The study team noted that one of the study limitations is that the precise incidence may differ because of the loss of patients who received medical care at primary hospitals and those who did not receive treatment at all. Additionally, selection bias may have occurred because the studies were conducted in only one province in Korea. Nationwide research is needed to estimate the incidence rate of FS more accurately by comparing the number of patients diagnosed with FS and COVID-19 simultaneously in all hospitals across the country.
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