Original Article
Para-infectious seizures: A retrospective multicentre study
Crisis parainfecciosas: estudio retrospectivo multicéntrico
David Conejo Morenoa,
, Cristina Rodríguez Fernándezb, Irene Ruíz Ayúcar de la Vegac, Saturnino Ortiz Madinaveitiad, Antonio Hedrera Fernándeze, Esther Maldonado Ruizf, Aranzazu Hernández Fabianc, María Montesclaros Hortigüela Saetaa, Ramón Cancho Candelae
Corresponding author
a Hospital Universitario de Burgos, Burgos, Spain
b Hospital Universitario de León, León, Spain
c Hospital Universitario de Salamanca, Salamanca, Spain
d Hospital Santa Bárbara de Soria, Soria, Spain
e Hospital Universitario Río Hortega, Valladolid, Spain
f Hospital Rio Carrión de Palencia, Palencia, Spain
Read
7760
Timeswas read the article
2471
Total PDF
5289
Total HTML
Share statistics
array:24 [ "pii" => "S2341287916301387" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.01.012" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "2056" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2016;85:300-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1791 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 1145 "PDF" => 501 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403316000333" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2016.01.023" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "2056" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2016;85:300-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4913 "formatos" => array:3 [ "EPUB" => 125 "HTML" => 3866 "PDF" => 922 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Crisis parainfecciosas: estudio retrospectivo multicéntrico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "300" "paginaFinal" => "304" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Para-infectious seizures: A retrospective multicentre study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1069 "Ancho" => 1484 "Tamanyo" => 81019 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relación edad-etiología en las crisis parainfecciosas.GEA: gastroenteritis aguda; IRVA: infección respiratoria de vías altas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David Conejo Moreno, Cristina Rodríguez Fernández, Irene Ruíz Ayúcar de la Vega, Saturnino Ortiz Madinaveitia, Antonio Hedrera Fernández, Esther Maldonado Ruiz, Aranzazu Hernández Fabian, María Montesclaros Hortigüela Saeta, Ramón Cancho Candela" "autores" => array:9 [ 0 => array:2 [ "nombre" => "David" "apellidos" => "Conejo Moreno" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "Rodríguez Fernández" ] 2 => array:2 [ "nombre" => "Irene" "apellidos" => "Ruíz Ayúcar de la Vega" ] 3 => array:2 [ "nombre" => "Saturnino" "apellidos" => "Ortiz Madinaveitia" ] 4 => array:2 [ "nombre" => "Antonio" "apellidos" => "Hedrera Fernández" ] 5 => array:2 [ "nombre" => "Esther" "apellidos" => "Maldonado Ruiz" ] 6 => array:2 [ "nombre" => "Aranzazu" "apellidos" => "Hernández Fabian" ] 7 => array:2 [ "nombre" => "María Montesclaros" "apellidos" => "Hortigüela Saeta" ] 8 => array:2 [ "nombre" => "Ramón" "apellidos" => "Cancho Candela" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287916301387" "doi" => "10.1016/j.anpede.2016.01.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916301387?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316000333?idApp=UINPBA00005H" "url" => "/16954033/0000008500000006/v1_201611301127/S1695403316000333/v1_201611301127/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287916301351" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.10.006" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "2038" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2016;85:305-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1510 "formatos" => array:3 [ "EPUB" => 133 "HTML" => 1017 "PDF" => 360 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Contribution of <span class="elsevierStyleSmallCaps">Anales de Pediatría</span> to the international visibility of Spanish paediatric research in the Web of Science (2010–2014)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "305" "paginaFinal" => "311" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Contribución de <span class="elsevierStyleSmallCaps">Anales de Pediatría</span> a la visibilidad internacional de la investigación pediátrica española en la Web of Science (2010–2014)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María-Francisca Abad-García, Aurora González-Teruel, Gonzalo Solís Sánchez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María-Francisca" "apellidos" => "Abad-García" ] 1 => array:2 [ "nombre" => "Aurora" "apellidos" => "González-Teruel" ] 2 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Solís Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316000151" "doi" => "10.1016/j.anpedi.2016.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316000151?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916301351?idApp=UINPBA00005H" "url" => "/23412879/0000008500000006/v1_201611291247/S2341287916301351/v1_201611291247/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287916301211" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.10.004" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "2127" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2016;85:291-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1778 "formatos" => array:3 [ "EPUB" => 127 "HTML" => 1094 "PDF" => 557 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "299" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reducción de la enterocolitis necrosante tras la introducción de un protocolo de alimentación enteral basado en la evidencia en recién nacidos de muy bajo peso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tomás Sánchez-Tamayo, María Gracia Espinosa Fernández, Laura Affumicato, María González López, Verónica Fernández Romero, María Concepción Moreno Algarra, Enrique Salguero García" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Tomás" "apellidos" => "Sánchez-Tamayo" ] 1 => array:2 [ "nombre" => "María Gracia" "apellidos" => "Espinosa Fernández" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Affumicato" ] 3 => array:2 [ "nombre" => "María" "apellidos" => "González López" ] 4 => array:2 [ "nombre" => "Verónica" "apellidos" => "Fernández Romero" ] 5 => array:2 [ "nombre" => "María Concepción" "apellidos" => "Moreno Algarra" ] 6 => array:2 [ "nombre" => "Enrique" "apellidos" => "Salguero García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316302168" "doi" => "10.1016/j.anpedi.2016.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302168?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916301211?idApp=UINPBA00005H" "url" => "/23412879/0000008500000006/v1_201611291247/S2341287916301211/v1_201611291247/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Para-infectious seizures: A retrospective multicentre study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "300" "paginaFinal" => "304" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "David Conejo Moreno, Cristina Rodríguez Fernández, Irene Ruíz Ayúcar de la Vega, Saturnino Ortiz Madinaveitia, Antonio Hedrera Fernández, Esther Maldonado Ruiz, Aranzazu Hernández Fabian, María Montesclaros Hortigüela Saeta, Ramón Cancho Candela" "autores" => array:9 [ 0 => array:4 [ "nombre" => "David" "apellidos" => "Conejo Moreno" "email" => array:1 [ 0 => "dconejo@saludcastillayleon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cristina" "apellidos" => "Rodríguez Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Irene" "apellidos" => "Ruíz Ayúcar de la Vega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Saturnino" "apellidos" => "Ortiz Madinaveitia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Antonio" "apellidos" => "Hedrera Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Esther" "apellidos" => "Maldonado Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Aranzazu" "apellidos" => "Hernández Fabian" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "María Montesclaros" "apellidos" => "Hortigüela Saeta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Ramón" "apellidos" => "Cancho Candela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario de León, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Santa Bárbara de Soria, Soria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Universitario Río Hortega, Valladolid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital Rio Carrión de Palencia, Palencia, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Crisis parainfecciosas: estudio retrospectivo multicéntrico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1069 "Ancho" => 1484 "Tamanyo" => 81396 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Association between age and aetiology in parainfectious seizures. AGE, acute gastroenteritis; URTI, upper respiratory tract infection.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Parainfectious seizures are afebrile convulsive seizures associated with mild infectious diseases, such as acute gastroenteritis (AGE) without electrolyte imbalance or signs of dehydration, or upper respiratory tract infections (URTIs).<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1–5</span></a> They were first described in 1982 by Morooka in Japan.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> Since then, they have been the subject of numerous studies and case series, especially in the Asian region.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,4,6–8</span></a> However, they are still little known in Spain.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2,5,9,10</span></a> This lack of knowledge leads to their underdiagnosis and to performance of a large number of unnecessary diagnostic tests to determine their aetiology and make a diagnosis and prognosis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1–10</span></a> The aims of this study were to determine the incidence of parainfectious seizures in hospitals of Castilla y León and analysing the main characteristics of these seizures, their treatment, and their natural history.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a retrospective descriptive study by collecting data for all children aged less than 14 years admitted to six hospitals in the autonomous community of Castilla y León over a period of three years (January 2012 to January 2015) with a diagnosis of convulsive seizure. The inclusion criteria were: single or multiple afebrile seizure (maximum temperature, 37.9<span class="elsevierStyleHsp" style=""></span>°C) associated with mild disease such as upper respiratory tract infection or AGE without electrolyte imbalances or clinical signs of dehydration; normal psychomotor development prior to admission, and diagnostic tests with unremarkable results. We excluded all patients with fever before, after or during the seizure, a prior diagnosis of epilepsy or a history of psychomotor delay (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The variables we analysed in the sample under study were sex, family and personal history of disease, type of infection, seizure semiology, diagnostic tests and their results, antiepileptic drugs (AEDs) used (first-line drugs at the emergency department and drugs used during admission and for maintenance after discharge), and subsequent outcome during followup at paediatric neurology clinics.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study included 38 patients aged between 3 months and 8 years (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, 2.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.8 years); 47% were male and 53% female. Only 9% of patients had a past personal history of typical febrile seizures. As for family history, 10.5% of the patients had first-degree relatives with epilepsy, and only 2.6% had a first-degree relative with a history of febrile seizures during childhood.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The time that elapsed between the onset of infectious disease and the development of convulsive seizures was nearly two days on average (mean, 43.8<span class="elsevierStyleHsp" style=""></span>h), and ranged between 2<span class="elsevierStyleHsp" style=""></span>h and 7 days.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mean number of seizures was 2.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.8, and this number ranged between a single seizure to a cluster of 10 episodes. The duration of seizures ranged between less than one minute and twenty minutes (mean, 3.24<span class="elsevierStyleHsp" style=""></span>min). The most frequent type of seizure was generalized tonic-clonic seizures (58%), followed by tonic seizures (18%).</p><p id="par0035" class="elsevierStylePara elsevierViewall">As for intercurrent infection, out of the 38 patients, 32% had upper respiratory tract infections and 68% AGE. Acute gastroenteritis was the most frequent aetiology in all age groups save for infants aged 6 months to 1 year (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), in whom URTIs were more frequent. Out of the 26 stool cultures and analyses performed, <span class="elsevierStyleItalic">Salmonella</span> was isolated in one, <span class="elsevierStyleItalic">Campylobacter</span> in one, adenovirus in one, and rotavirus, which was the most frequent aetiologic agent in our sample, in five. Only five nasopharyngeal aspirate specimens from patients with URTIs were analysed, of which one tested positive for influenza type A and one other for rhinovirus.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Blood samples were collected for a complete blood count (CBC) and metabolic panel on arrival to the emergency department in 97% of children, and the results were unremarkable in 76% of them. An electroencephalogram (EEG) was performed during admission in 76% of the patients, detecting slow activity in 14% and irritative activity in 20%, with normal activity in all others (60%). Thirteen children (34%) underwent lumbar punctures for analysis, the results of which were normal. Neuroimaging tests were performed in 37% of the children, the most frequent being cranial MRI (21% of the total), and the results were normal in all.</p><p id="par0045" class="elsevierStylePara elsevierViewall">When it came to treatment, 63.2% of the patients did not need AED therapy, and only 15.8% required more than one AED. Twenty-one percent required AED therapy to control their seizures in the emergency department, where benzodiazepines (diazepam or midazolam) were used in all cases, with rectal diazepam being used most frequently.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Subsequently, 28.9% of admitted patients required AED therapy for repetitive seizures, and the most frequently used drug was valproic acid, followed by levetiracetam and phenytoin. At discharge, only six patients (16%) remained on oral AED therapy, half of them with valproic acid and half with levetiracetam, with one patient on combined therapy with both.</p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients were re-evaluated in a paediatric neurology clinic, and more than 90% had favourable outcomes. Two of the patients went on to develop epilepsy and had secondarily generalized partial seizures. Another patient developed symptoms of autism.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We analysed the potential differences between two subgroups corresponding to the type of infection: AGE or URTI (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In patients that had AGE, the time elapsed from onset to the development of seizures was of 50.41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>48.24<span class="elsevierStyleHsp" style=""></span>h, and in patients with an URTI, it was 27.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>51.35<span class="elsevierStyleHsp" style=""></span>h; the difference between these two aetiologies was statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.037). The number of seizures was greater in children with AGE (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, 2.44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.91) compared to children with URTIs (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, 1.45<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.69), and the duration of seizures was shorter in children with AGE compared to children with URTIs (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, 2.52<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.83 for AGE and 4.91<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.72 for URTIs), although the difference was not statistically significant.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Parainfectious seizures or convulsive seizures associated with mild infectious diseases, such as AGE or URTI, have not been described as such in the classification of epilepsy and epileptic syndromes of the International League against Epilepsy, although it has been suggested that they be included under the heading of special syndromes, as has been done with febrile convulsions.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> They are disease processes that have been studied little in Spain, but thoroughly analysed in Asia.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,4,6–8</span></a> To date, most of the case series studied in Spain have found an association between parainfectious seizures and AGE.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2,10,12–16</span></a> These studies, such as the one conducted by Lacasa Maseri et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> included patients with febrile seizures as well as patients with afebrile seizures. However, our study only included patients with afebrile seizures.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Our sample included a total of 38 patients, so it is the largest sample of its kind in Spain up to date.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2,9,13–16</span></a> The series of Lara Herguedas et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> found that parainfectious seizures developed in the context of AGE in 67.6% of their sample and of URTIs in 32.4%, figures that are practically identical to those found in our study, of 68% and 32%, respectively. As reported in most of the literature, rotavirus was the aetiological agent identified most frequently in our study.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1–10,12–17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Some of the published studies only included patients aged between 6 months and 5 years.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,12</span></a> Our study, however, did not exclude patients aged less than 6 months, and we observed that the outcomes in these patients were similar to those reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2,10,12–16</span></a> The median age of patients in our study at the time of seizure onset was 25 months, which is similar to the findings of other authors in Spain.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2,9,13–16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">It is common for seizures to cluster during a single course of infection, but this is not a necessary criterion for diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1–10,12–16</span></a> In fact, we found that 44.7% of our patients had a single seizure. When it came to seizure semiology, the seizures observed most frequently were tonic-clonic (58%), followed by tonic seizures (18%), and most had a short duration. These results are consistent with those of studies conducted in both Europe and Asia.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,4,9,12–16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">When it came to the characteristics of the seizures based on the type of infection, we found a statistically significant difference in the time elapsed from the onset of infection to development of seizures, which was longer in patients with AGE. Also, patients with AGE had repeated seizures more frequently and shorter seizures compared to patients with URTIs (these differences were not statistically significant). These results are consistent with those reported in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5,9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The diagnostic tests performed in the patients included blood testing with a CBC and metabolic panel in 97%, with unremarkable results in most. Lumbar punctures were performed in 34% of the patients and neuroimaging tests in 31% (most frequently an MRI, which was ordered in 21% of the patients), mostly for the purpose of ruling out infections of the central nervous system (meningitis and encephalitis) and structural lesions that could cause provoked or symptomatic seizures. These data are similar to those reported in the study by Lara Herguedas et al.,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> in which the results of all tests were normal. This evinces the large number of tests that are conducted in Spain and do not contribute any relevant information in the assessment of parainfectious seizures.</p><p id="par0095" class="elsevierStylePara elsevierViewall">When it comes to the management of seizures, there is a generalized trend in the literature in reporting seizures that are refractory to treatment whose control requires two or more drugs.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,4,7,10,12–14</span></a> We did not observe this in our study, as 63.2% of the patients did not need AED therapy and only 15.8% required more than one drug.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Of all the patients with a diagnosis of parainfectious disease reviewed in our study, only 76.3% were discharged with this diagnosis, while the rest received it during followup at a specialty clinic. All patients were followed up at a paediatric neurology clinic, and most had favourable outcomes. Neurologic symptoms were only observed in three patients, two of whom had partial epilepsy and one symptoms of autism. This amounts to 8% of the patients and is consistent with the results reported in the literature,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,8,9,14,18</span></a> which show that most patients have normal outcomes after developing parainfectious seizures. In Spain, Lara Herguedas et al. also observed the later development of partial epilepsy in one child and language delay in another in their series of 34 patients.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> The seizures of these patients had not differed in any way from the parainfectious seizures of the rest of the patients. We did not find any variable associated with a poor prognosis.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion, it is essential for us to be aware of the existence of parainfectious seizures to be able to make a clinical diagnosis, preventing the unnecessary use of diagnostic tests and treatments, and to offer an accurate prognosis as regards its benign outcome and low rate of recurrence.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres763803" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec765185" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres763804" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec765184" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-23" "fechaAceptado" => "2016-01-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec765185" "palabras" => array:7 [ 0 => "Para-infectious seizures" 1 => "Afebrile seizure" 2 => "Seizures" 3 => "Gastroenteritis" 4 => "Respiratory infection" 5 => "Rotavirus" 6 => "Antiepileptic drug" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec765184" "palabras" => array:6 [ 0 => "Convulsión afebril" 1 => "Crisis" 2 => "Gastroenteritis" 3 => "Infección respiratoria" 4 => "Rotavirus" 5 => "Fármaco antiepiléptico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Para-infectious seizures are afebrile seizures that are associated with mild infections, and occur in children with no pre-existing neurological illness. They are still little known in our environment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multicentre retrospective study was conducted that included patients with normal psychomotor development and had presented with one or more seizures in the context of a mild afebrile infection.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 38 patients (47% male, 53% female) were included in the study over a period of three years (2012–2015). The mean age was 2.1 years. A previous history of febrile seizures was found in 7.9% of them. Mean number of seizures per patient was 2.2, with 57.9% of them being tonic-clonic seizures. The mean duration of seizures was 3.2<span class="elsevierStyleHsp" style=""></span>min. An EEG was performed during admission in 73.7% of cases. Lumbar punctures were performed in 34.2% of cases. All were normal. Neuroimaging tests were carried out in 36.9% of cases. Brain MRI was the imaging test performed in most cases (21.1%), with no any pathological findings. The most frequent infection found was acute gastroenteritis (68%), followed by upper respiratory tract infection (32%). Almost two-thirds (63.2%) of patients did not require anticonvulsant medication. Rectal diazepam was the most frequently used drug in emergencies. Intravenous medication was required by 28.9% of patients due to repeated seizures. The most frequently used drug in the non-emergency setting was valproic acid. Anticonvulsant treatment was continued after discharge in 16% of patients. Para-infectious seizures was the diagnosis in 76.3% of cases when discharged.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Knowledge of para-infectious seizures, their clinical diagnosis and benign course is crucial, as this would avoid further testing and unnecessary treatments.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las crisis parainfecciosas son crisis convulsivas afebriles en el contexto de infecciones banales en niños sin afectación neurológica, siendo aún una patología poco conocida en nuestro medio.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo multicéntrico donde se incluye a pacientes con crisis única o múltiple en el contexto de una infección banal afebril, con desarrollo psicomotor normal.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se recogió a 38 pacientes (47% varones, 53% mujeres) en un periodo de 3 años (2012-2015) con edad media de 2,1 años. El 7,9% presentaba antecedentes de crisis febriles. La media de crisis por paciente fue de 2,2, siendo el 57,9% crisis tónico-clónicas generalizadas, con una duración media de 3,2 min. Se realizó electroencefalograma durante su ingreso al 73,7%. Se efectuó punción lumbar en un 34,2% (todas normales) y prueba de neuroimangen en el 36,9%, siendo la más realizada la RM craneal en el 21,1%, sin hallazgos patológicos. El proceso infeccioso más frecuente (68%) fue tener gastroenteritis aguda seguida de la infección respiratoria de vías altas (32%). El 63,2% no precisó medicación anticomicial. En urgencias el fármaco más usado fue el diazepam rectal. Posteriormente, debido a la agrupación de crisis, un 28,9% de los casos precisó administración de fármacos por vía intravenosa (el más usado fue el ácido valproico), manteniéndose en el 16% tratamiento antiepiléptico al alta. El 76,3% de los pacientes fue diagnosticado al alta de crisis parainfecciosas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Es fundamental el conocimiento de las crisis parainfecciosas, su diagnóstico clínico y evolución benigna, ya que su identificación evita la realización de pruebas complementarias y tratamientos innecesarios.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Conejo Moreno D, Rodríguez Fernández C, Ruíz Ayúcar de la Vega I, Ortiz Madinaveitia S, Hedrera Fernández A, Maldonado Ruiz E, et al. Crisis parainfecciosas: estudio retrospectivo multicéntrico. An Pediatr (Barc). 2016;85:300–304.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1069 "Ancho" => 1484 "Tamanyo" => 81396 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Association between age and aetiology in parainfectious seizures. AGE, acute gastroenteritis; URTI, upper respiratory tract infection.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Exclusion criteria \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Children with convulsive seizures associated with mild infectious diseases, such as AGE or an URTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Children with signs of meningitis, encephalitis or acute encephalopathy associated to infection (changes in consciousness in the presence or absence of focal neurologic signs) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Single or multiple convulsive seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Children with disorders of psychomotor development or a history of epilepsy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum axillary temperature of 37.9<span class="elsevierStyleHsp" style=""></span>°C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillary temperature equal to or greater than 38<span class="elsevierStyleHsp" style=""></span>°C \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1261729.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Inclusion and exclusion criteria in the study.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AED, antiepileptic drug; AGE, acute gastroenteritis; URTI, upper respiratory tract infection.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AGE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">URTI \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.06 (1.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.35 (2.15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time elapsed to development of seizure (hours)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.41 (48.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.55 (51.35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of seizures<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.44 (1.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.45 (0.69) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of seizures (minutes)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.52 (1.83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.91 (5.72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AED therapy, yes/no (percentage) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3/66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.5/54.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1261728.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Median (standard deviation).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of parainfectious crisis in children with AGE and URTIs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crisis convulsivas asociadas a gastroenteritis: estudio de incidencia y análisis clínico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Lacasa Maseri" 1 => "J.M. Ramos Fernández" 2 => "D. Moreno Pérez" 3 => "A. Urda Cardona" 4 => "J. Martínez Antón" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2013" "volumen" => "79" "paginaInicial" => "162" "paginaFinal" => "166" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0100" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crisis convulsivas afebriles en el contexto de una gastroenteritis aguda leve" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.R. García Luzardo" 1 => "N. Rodríguez Calcines" 2 => "S. Pavlovic Nesic" 3 => "S. Serrano Perdomo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "403" "paginaFinal" => "409" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0105" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features of benign convulsions with mild gastroenteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Uemura" 1 => "A. Okumura" 2 => "T. Negoro" 3 => "K. Watanabe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Brain Dev" "fecha" => "2002" "volumen" => "24" "paginaInicial" => "745" "paginaFinal" => "749" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12453597" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0110" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "‘Benign convulsions with mild gastroenteritis’ —a world wide clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Uemura" 1 => "A. Okumura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.braindev.2004.09.001" "Revista" => array:5 [ "tituloSerie" => "Brain Dev" "fecha" => "2005" "volumen" => "27" "paginaInicial" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15626548" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0115" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revisión crisis parainfecciosas de enero del 2012 a marzo del 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Hernández Frutos" 1 => "D. Conejo Moreno" 2 => "I. Arribas Montero" 3 => "M. Hortigüela Saeta" 4 => "M.L. Angulo García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2015" "volumen" => "82" "paginaInicial" => "195" "paginaFinal" => "197" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0120" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Convulsions and mild diarrhea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Morooka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Shonika Rinsho" "fecha" => "1982" "volumen" => "23" "paginaInicial" => "131" "paginaFinal" => "137" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0125" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of antiepileptic drugs in patients with benign convulsions with mild gastroenteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Okumura" 1 => "N. Uemura" 2 => "T. Negoro" 3 => "K. Watanebe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0387-7604(03)00121-9" "Revista" => array:6 [ "tituloSerie" => "Brain Dev" "fecha" => "2004" "volumen" => "26" "paginaInicial" => "164" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15030904" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0130" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign convulsions with mild gastroenteritis: a report of 10 recent detailing clinical varieties" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Komoro" 1 => "M. Wada" 2 => "M. Eto" 3 => "H. Oki" 4 => "K. Aida" 5 => "T. Fuijimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Brain Dev" "fecha" => "1995" "volumen" => "17" "paginaInicial" => "3347" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0135" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crisis parainfecciosas en el niño: estudio retrospectivo de 34 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Lara Herguedas" 1 => "J.J. Garcia Peñas" 2 => "M.L. Ruiz Falcó" 3 => "L.G. Gutiérrez Solana" 4 => "A. Duat Rodríguez" 5 => "M.L. Arrabal Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "321" "paginaFinal" => "325" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18368673" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0140" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Convulsiones benignas durante gastroenteritis leve por rotavirus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Cancho Candela" 1 => "A. Peña Valenceja" 2 => "C. Alcalde Martín" 3 => "M. Ayuso Hernández" 4 => "O. Medrano Sánchez" 5 => "C. Ochoa Sangrador" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "230" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19714552" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0145" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proposal for revised classification of epilepsies and epileptic syndromes" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Commission on classification and terminology of the International League Against Epilepsy" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Epilepsia" "fecha" => "1989" "volumen" => "30" "paginaInicial" => "389" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2502382" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0150" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asociación entre gastroenteritis aguda leve y convulsiones afebriles benignas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Regueras Santos" 1 => "C. Iglesias Blázquez" 2 => "C. Rodríguez Fernández" 3 => "L. Fernández Pérez" 4 => "A. Jiménez González" 5 => "V. Recio Pacual" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Bol Pediatr" "fecha" => "2010" "volumen" => "50" "paginaInicial" => "21" "paginaFinal" => "24" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0155" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Una asociación poco frecuente aunque bien definida" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Rotavirus y crisis convulsivas" "etal" => false "autores" => array:6 [ 0 => "I. Martí" 1 => "G. Cilla" 2 => "M. Gomáriz" 3 => "J. Eizaguirre" 4 => "C. García Pardos" 5 => "E.G. Pérez Yarza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2010" "volumen" => "73" "paginaInicial" => "70" "paginaFinal" => "73" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0160" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estado epiléptico asociado a una gastroenteritis leve por rotavirus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Fernández Fernández" 1 => "M. Madruga Garrido" 2 => "B. Blanco Martínez" 3 => "M. Rufo Campos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2008" "volumen" => "69" "paginaInicial" => "263" "paginaFinal" => "266" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0165" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Convulsiones benignas durante gastroenteritis leve: a propósito de 2 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Gómez Lado" 1 => "M. García Reboredo" 2 => "L. Monasterio Corral" 3 => "M. Bravo Mata" 4 => "J. Eirís Puñal" 5 => "M. Castro Gago" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2005" "volumen" => "63" "paginaInicial" => "558" "paginaFinal" => "560" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0170" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign afebril convulsions in the Course of mild acute gastroenteritis: a study of 28 patients and a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Fasheh Youssef" 1 => "R. Pino Ramírez" 2 => "J. Campistol Plana" 3 => "M. Pineda Marfa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0b013e31823b45b3" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "1062" "paginaFinal" => "1064" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22068069" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0175" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are afebrile seizures associated with minor infections a single seizure category? A hospital-based prospective cohort study on outcomes of first afebrile seizure in early childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Zhang" 1 => "J. Ma" 2 => "X. Gan" 3 => "N. Xiao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/epi.12651" "Revista" => array:6 [ "tituloSerie" => "Epilepsia" "fecha" => "2014" "volumen" => "55" "paginaInicial" => "1001" "paginaFinal" => "1008" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24861704" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0180" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Afebrile seizures associated with minor infections: comparison with febrile seizures and unprovoked seizures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.L. Lee" 1 => "H.T. Ong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pediatrneurol.2004.03.022" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2004" "volumen" => "31" "paginaInicial" => "157" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15351013" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008500000006/v1_201611291247/S2341287916301387/v1_201611291247/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008500000006/v1_201611291247/S2341287916301387/v1_201611291247/en/main.pdf?idApp=UINPBA00005H&text.app=https://www.analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916301387?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 66 | 35 | 101 |
| 2024 September | 85 | 45 | 130 |
| 2024 August | 157 | 65 | 222 |
| 2024 July | 154 | 41 | 195 |
| 2024 June | 121 | 39 | 160 |
| 2024 May | 113 | 33 | 146 |
| 2024 April | 109 | 30 | 139 |
| 2024 March | 78 | 23 | 101 |
| 2024 February | 74 | 27 | 101 |
| 2024 January | 75 | 25 | 100 |
| 2023 December | 143 | 27 | 170 |
| 2023 November | 88 | 39 | 127 |
| 2023 October | 67 | 34 | 101 |
| 2023 September | 54 | 29 | 83 |
| 2023 August | 60 | 13 | 73 |
| 2023 July | 84 | 22 | 106 |
| 2023 June | 61 | 30 | 91 |
| 2023 May | 93 | 21 | 114 |
| 2023 April | 61 | 20 | 81 |
| 2023 March | 112 | 22 | 134 |
| 2023 February | 70 | 19 | 89 |
| 2023 January | 67 | 17 | 84 |
| 2022 December | 83 | 39 | 122 |
| 2022 November | 66 | 33 | 99 |
| 2022 October | 73 | 59 | 132 |
| 2022 September | 54 | 31 | 85 |
| 2022 August | 56 | 49 | 105 |
| 2022 July | 39 | 35 | 74 |
| 2022 June | 53 | 47 | 100 |
| 2022 May | 55 | 38 | 93 |
| 2022 April | 35 | 35 | 70 |
| 2022 March | 80 | 55 | 135 |
| 2022 February | 53 | 30 | 83 |
| 2022 January | 62 | 33 | 95 |
| 2021 December | 58 | 40 | 98 |
| 2021 November | 86 | 44 | 130 |
| 2021 October | 131 | 73 | 204 |
| 2021 September | 90 | 40 | 130 |
| 2021 August | 66 | 69 | 135 |
| 2021 July | 47 | 43 | 90 |
| 2021 June | 69 | 63 | 132 |
| 2021 May | 59 | 47 | 106 |
| 2021 April | 191 | 91 | 282 |
| 2021 March | 63 | 35 | 98 |
| 2021 February | 33 | 23 | 56 |
| 2021 January | 40 | 52 | 92 |
| 2020 December | 32 | 32 | 64 |
| 2020 November | 29 | 14 | 43 |
| 2020 October | 58 | 12 | 70 |
| 2020 September | 89 | 24 | 113 |
| 2020 August | 67 | 24 | 91 |
| 2020 July | 47 | 13 | 60 |
| 2020 June | 40 | 11 | 51 |
| 2020 May | 68 | 22 | 90 |
| 2020 April | 31 | 17 | 48 |
| 2020 March | 32 | 27 | 59 |
| 2020 February | 37 | 20 | 57 |
| 2020 January | 35 | 20 | 55 |
| 2019 December | 32 | 30 | 62 |
| 2019 November | 27 | 12 | 39 |
| 2019 October | 27 | 25 | 52 |
| 2019 September | 30 | 15 | 45 |
| 2019 August | 22 | 17 | 39 |
| 2019 July | 32 | 17 | 49 |
| 2019 June | 36 | 39 | 75 |
| 2019 May | 32 | 46 | 78 |
| 2019 April | 45 | 20 | 65 |
| 2019 March | 38 | 25 | 63 |
| 2019 February | 41 | 9 | 50 |
| 2019 January | 44 | 24 | 68 |
| 2018 December | 43 | 28 | 71 |
| 2018 November | 46 | 36 | 82 |
| 2018 October | 50 | 32 | 82 |
| 2018 September | 30 | 18 | 48 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 19 | 1 | 20 |
| 2018 March | 20 | 0 | 20 |
| 2018 February | 13 | 0 | 13 |
| 2018 January | 129 | 0 | 129 |
| 2017 December | 130 | 0 | 130 |
| 2017 November | 28 | 0 | 28 |
| 2017 October | 18 | 0 | 18 |
| 2017 September | 14 | 0 | 14 |
| 2017 August | 7 | 0 | 7 |
| 2017 July | 14 | 0 | 14 |
| 2017 June | 16 | 10 | 26 |
| 2017 May | 21 | 6 | 27 |
| 2017 April | 13 | 5 | 18 |
| 2017 March | 17 | 11 | 28 |
| 2017 February | 10 | 6 | 16 |
| 2017 January | 6 | 7 | 13 |
| 2016 December | 31 | 29 | 60 |
| 2016 November | 0 | 7 | 7 |
Show all
