pituitrin and Seizures--Febrile

Febrile seizures are a common occurrence in young children with incidence rates varying from 3-14%, depending on the geographic region. Studies have suggested that an elevated temperature is a factor in their development, though other factors may synergistically lower the seizure threshold. While it is recognized that excessive or rapid dilute fluid intake can cause seizures in young children, and in adults during strenuous physical activity, less focus has been paid to its involvement during febrile illnesses. Young children are more vulnerable to the development of febrile seizures due to their small skull size relative to brain volume. In animals, reduced serum sodium levels have been shown to lower the threshold to convulsive stimuli, while hypertonic saline has been shown to rapidly reverse these effects. Similarly vasopressin, frequently elevated during acute infections, enhances fluid retention and may also be a precipitating factor for febrile seizures. Although an elevated temperature may augment seizure risk, antipyretics have not been shown to prevent them. In fact, some may increase seizure risk through a reduction in urine output. It has long been observed that fluid retention occurs during febrile infections, followed by diuresis during convalescence. This characteristic observation led to recommendations for restricted fluid intake during acute infections dating back more than 2,000 years. Only recently has there been a return to restricted fluid intake for patients with potentially reduced free water excretion. Further studies are required to determine the role of the overall fluid balance in the etiology of childhood febrile seizures.

Topics: Analgesics, Non-Narcotic; Animals; Body Water; Child; Drinking; Humans; Seizures, Febrile; Sodium; Vasopressins

Primary blood coagulation and wound sealing are orchestrated by von Willebrand factor (VWF), a large multimeric glycoprotein. Upon release of arginine vasopressin (AVP), VWF containing high molecular weight multimers is secreted. By measuring copeptin, the C-terminal part of the AVP prohormone, we recently found strongly increased AVP levels in children with febrile seizures (FS) as compared to children with fever but without seizures. It is unknown if increased AVP levels in FS are of any biological function. Therefore, our a priori hypothesis was that children with FS have increased VWF parameters in parallel with higher AVP levels.. We conducted a prospective, cross-sectional study of children aged between 6 months and 5 years. Children that presented at our emergency department with fever or a recent FS (within four hours) were evaluated to be included to the study. We measured serum copeptin and VWF parameters, including analyses of VWF:Antigen (WVF:Ag), VWF:collagen binding activity (VWF:CB) and VWF multimers in children with FS, febrile infections without seizures and additionally, in a non-febrile control group.. We included 54 children in our study, 30 with FS, 10 in the febrile control group, and 14 in the non-febrile control group. Serum copeptin levels were significantly higher in children with FS (median [IQR] 24.73 pmol/l [13.65-68.65]) compared to the febrile control group (5.66 pmol/l [4.15-8.07], p = 0.002) and the non-febrile control group (4.78 pmol/l [3.33-5.3], p<0.001). VWF:CB levels were also significantly higher in children with FS (VWF:CB 2.29 U/ml [1.88-2.97]) as compared to the febrile (VWF:CB 1.41 U/ml [1.27-1.93], p = 0.048) and the non-febrile control group (VWF:CB 1.15 U/ml [0.98-1.21], p<0.001). VWF:Ag tended to be higher in children with FS compared to both control groups. Multivariate regression analysis revealed FS and copeptin as major determinants of VWF:CB.. Our results suggest that increased secretion of AVP in children with FS is associated with higher plasma levels of VWF parameters. Especially VWF:CB may serve as additional biomarker in the diagnosis of FS.

Topics: Biomarkers; Child, Preschool; Cross-Sectional Studies; Female; Fever; Glycopeptides; Humans; Infant; Male; Neurophysins; Prospective Studies; Protein Precursors; Seizures, Febrile; Vasopressins; von Willebrand Diseases; von Willebrand Factor

When pyrogenic substances are injected intravenously into experimental animals, a sequence of events is set in motion which involves the hypothalamus and perhaps other portions of the diencephalon to produce a febrile response. We now present evidence that the brain produces its own endogenous antipyretic which may serve as a means of controlling the extent of the fever. When arginine vasopressin is perfused through the lateral septal area of the hypothalamus of the sheep, fever is suppressed. Vasopressin alone does not lower normal body temperature when perfused through this region of the brain. In addition, evidence is provided to indicate that vasopressin is released within the lateral septal area during the febrile response. It is concluded that, in fever, arginine vasopressin may be released in the lateral septal area of the brain and serve as an endogenous antipyretic. Results indicate that, following an initial application of vasopressin into the brain itself, a subsequent similar administration of vasopressin produces seizure-like activity. Therefore, it is suggested that this release of arginine vasopressin may contribute to the production of febrile convulsion.

Topics: Animals; Animals, Newborn; Arginine Vasopressin; Body Temperature Regulation; Female; Fever; Guinea Pigs; Hypothalamus; Pregnancy; Pyrogens; Rats; Seizures, Febrile; Septum Pellucidum; Sheep; Vasopressins

Topics: Child, Preschool; Female; Humans; Hyponatremia; Infant; Male; Prospective Studies; Retrospective Studies; Seizures, Febrile; Sodium; Vasopressins

Topics: Animals; Arginine Vasopressin; Child; Humans; Seizures; Seizures, Febrile; Vasopressins

In a study of 23 children admitted to hospital with a febrile convulsion, mild hyponatraemia was found on 8 occasions. In 6 of these cases there was evidence of inappropriate secretion of antidiuretic hormone. The hyponatraemia is unlikely to be the cause of the convulsion, but probably predisposes the child to a subsequent convulsion during the same febrile illness.

Topics: Child, Preschool; Humans; Hyponatremia; Infant; Osmolar Concentration; Prospective Studies; Seizures; Seizures, Febrile; Vasopressins