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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 2  |  Page : 156-159

Serum zinc status in febrile seizures


1 Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt

Date of Submission11-Aug-2018
Date of Acceptance23-Oct-2018
Date of Web Publication27-Feb-2019

Correspondence Address:
Mohammad H.M Al-Emam
Kafr El Batteikh, Al Rekabeiah, Damietta, 34516
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AZMJ.AZMJ_82_18

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  Abstract 

Background Febrile seizures (FS) are the single most common type of seizures seen in children between 6 and 60 months of age. There has been a conflict about the role of zinc in FS.
Aim The aim of this study was to determine whether there are any changes in serum zinc level in children with FS.
Patients and methods This study included 100 infants and children aged between 6 and 60 months who were divided into two groups: group I included 50 patients with FS as a case group (study group) and group II included 50 patients with fever without seizures as a control group. Both groups were age and sex matched. Serum zinc level was estimated in all patients by colorimetric test kit.
Statistical analysis Data were analyzed using the statistical package for social sciences, version 17. P value less than 0.05 was significant.
Results FS levels were significantly reduced in case group when compared with control group (76.72±10.99 vs. 133.80±33.44 μg/dl, respectively). P value was less than 0.001.
Conclusion Serum zinc level was significantly reduced among children with FS compared with febrile children without seizures. Zinc deficiency can be considered as a risk factor for FS and expected to have a role in the pathogenesis of FS.

Keywords: febrile seizures, fever, serum zinc level


How to cite this article:
Sakr MM, Abdel-Aal MI, Emran TM, Al-Emam MH. Serum zinc status in febrile seizures. Al-Azhar Assiut Med J 2018;16:156-9

How to cite this URL:
Sakr MM, Abdel-Aal MI, Emran TM, Al-Emam MH. Serum zinc status in febrile seizures. Al-Azhar Assiut Med J [serial online] 2018 [cited 2020 Jul 6];16:156-9. Available from: http://www.azmj.eg.net/text.asp?2018/16/2/156/253095


  Introduction Top


Febrile seizures (FS) are the single most common type of seizures seen in children between 6 to 60 months of age [1]. Its incidence is 2–5% worldwide [2]. Risk factors of FS include male sex; family history of FS; a body temperature of 38°C or higher; underlying cause of fever; antenatal complications; low serum calcium (Ca), sodium (Na), and blood sugar; microcytic hypochromic anemia [1]; and vaccination [3]. Genetic predisposition is thought to be a major contributor [4].

Zinc plays key roles in the neurotransmission activity. Zinc inhibits gamma amino butyric acid-A receptors, reducing their inhibitory action. The effect of zinc in the excitatory glutamate receptors, however, is more complex [5]. Furthermore, zinc potentiate glycine-mediated current and regulates voltage-gated Ca channels and Na, potassium (K), and chloride channels. Research on the role of zinc in seizures has revealed both proconvulsant and anticonvulsant effects, probably depending on its dose [5]. Sreenivasa et al. [6] reported that serum zinc level was lower in children with simple FS as compared with children with febrile illness without seizures.

The aim of this work was to determine whether there are any changes in serum zinc level in children with FS.


  Patients and methods Top


This study included 100 infants and children aged between 6 and 60 months and divided into two groups: group I included 50 patients with FS as a case group and group II included 50 patients with fever without seizures as a control group. Our study had the approval of the committee of ethics in Damietta Faculty of Medicine, Al-Azhar University, and an informed consent was taken from patients families. Both groups were age and sex matched. The study was carried out at Pediatrics Department, Faculty of Medicine, Al-Azhar University Hospital, Damietta, during the period from December 2016 to October 2017.

Inclusion criteria were age from 6 to 60 months, both sexes, patients with simple FS, and normal anthropometric measurements. We excluded patients on zinc supplement, patients with apparent neurological disturbance other than FS, and patients with failure to thrive. FS were defined as seizures that occur between the age of 6 and 60 months with a temperature of 38°C or higher, that are not the result of central nervous system infection or any metabolic imbalance, and that occur in the absence of a history of prior afebrile seizures. Simple FS is a primary generalized, usually tonic-clonic attack associated with fever, lasting for a maximum of 15 min, and not recurrent within a 24-h period [2].

Each included child was submitted to full history taking including age, sex, consanguinity, and seizure details including type of seizure, duration of seizure, duration of postictal sleep if present, recurrence within 24 h, symptoms suggesting the preliminary diagnosis of febrile illness accompanying FS, past history of similar condition, head trauma, cerebrovascular accidents, vaccination history and possible relation to FS, family history of FS, and predominant pattern of nutrition and zinc supplementation.

All studied cases were also submitted to complete clinical examination including respiratory rate, heart rate, body temperature, body weight, length, head circumference, evaluation of nutritional status according to National Center for Health Statistics percentiles, signs suggesting zinc deficiency, and complete medical examination including chest, cardiac, abdominal, and neurological examination.

Taking all aseptic precautions, 5 ml of blood was taken from a venipuncture using 22-G sterile needles, within 24 h of contact with patients in both groups. One milliliter was put in EDTA tube for complete blood count, and the remaining was put in a sterile plain tube for determination of serum zinc, Na, K, and Ca and blood glucose. Serum zinc was estimated by colorimetric test kit according to the previously described method [7]. Normal reference value for zinc in children was 72–115 μg/dl [8].

Statistical analysis

Data were analyzed using statistical package of social sciences (SPSS) version 17 (Chicago, USA: SPSS Inc.) for windows. P value less than 0.05 was considered statistically significant [9].


  Results Top


Both groups were age and sex matched and of normal anthropometric measurements. The mean age of case group was 28.9±12.92 versus 30.48±14.80 months in control group. There were 26 male and 24 female involved in each group. The results of our study showed no significant difference between both groups regarding consanguinity, residence, positive family history, temperature, heart rate, and respiratory rate ([Table 1]).
Table 1 Demographic data and vital signs of studied cases

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There was a statistically significant decrease of mean serum zinc level in study when compared with control group (76.72±10.99 vs. 133.80±33.44 μg/dl, respectively), with P value less than 0.001 ([Table 2] and [Figure 1]).
Table 2 Serum zinc levels among studied groups

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Figure 1 Boxplot graphic representation of serum zinc among studied groups.

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Serum zinc levels were below normal in 26.0% of all studied children; all children with decreased serum zinc levels were in the study group, representing 52.0% of this group; and there was a significant increase of children with decreased serum zinc in the study group when compared with control group (52.0 vs. 0.0%, respectively) ([Table 3]).
Table 3 Frequency of decreased serum zinc levels in both groups

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There was a positive (proportional) significant correlation between zinc and each of hemoglobin and K. No significant correlation was found between serum zinc and heart rate, respiratory rate, body temperature, seizure duration, random blood glucose, serum Na, ionized Ca, or other hematological values. There was no significant relation between zinc value and each of consanguinity, preliminary diagnosis, and family history.


  Discussion Top


Our results regarding serum zinc levels in study as compared with control group were consistent with many previous studies such as Ehsanipour et al. [10] in Rasoul-e-Akram Hospital; Heydarian et al. [11]; Ganesh et al. [12]; Lee and Kim [13]; Salehiomran and Mahzari [14]; Sreenivasa et al. [6]; and Shokrzadeh et al. [15].However, in one report by Cho et al. [16] from Korea in Pusan Hospital, there was no significant difference between serum zinc level of children with FS and that of control group. This difference from our results may be because of their small sample size (study was performed on 11 patients in each group).

The results of Garty et al. [17] as well did not support the hypothesis that FS are related to reduced cerebrospinal fluid zinc concentration. This might be because of delayed cerebrospinal fluid sampling after the febrile illness in their study. Kafdar et al. [18] also reported that their findings did not support the hypothesis that FS is related to reduced serum zinc concentration.


  Conclusion Top


Serum zinc level was significantly reduced among children with FS compared with febrile children without seizures. Zinc deficiency can be considered as a risk factor for FS and expected to have a role in the pathogenesis of FS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of risk factors associated with first episode febrile seizure. J Clin Diagn Res 2016; 10:SC10–SC13.  Back to cited text no. 1
    
2.
Mikati MA, Hani AJ. Febrile seizures. In: Kliegman RM, Stanton BF, Geme JWS III, Schor NF, Behrman RE, ed. Nelson textbook of pediatrics [Chapter 593]. 20 ed. Philadelphia, PA. Elsevier 2016. 2829.  Back to cited text no. 2
    
3.
Sun Y, Christensen J, Hviid A, Li J, Vedsted P, Olsen J et al. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and haemophilus influenzae. JAMA 2012; 307:823–831.  Back to cited text no. 3
    
4.
Khair AM, Elmagrabi D. Febrile seizures and febrile seizure syndromes: an updated overview of old and current knowledge. Neurol Res Int 2015; 2015:849341.  Back to cited text no. 4
    
5.
Gower-Winter SD, Levenson CW. Zinc in the central nervous system: from molecules to behavior. Biofactors 2012; 38:186–193.  Back to cited text no. 5
    
6.
Sreenivasa B, Sunil KP, Manjunatha B. Role of zinc in febrile seizures. Int J Contemp Pediatr 2015; 2:137–140.  Back to cited text no. 6
    
7.
Gattoo I, Harish R, Hussain SQ. Correlation of serum zinc level with simple febrile seizures: a hospital based prospective case-control study. Int J Pediatr 2015; 3:509–515.  Back to cited text no. 7
    
8.
Alves CX, Brito NJN, Vermeulen KM, Lopes MMGD, Franca MC, Bruno SS et al. Serum zinc reference intervals and its relationship with dietary, functional, and biochemical indicators in 6- to 9-year-old healthy children. Food Nutr Res 2016; 60:10.  Back to cited text no. 8
    
9.
Pannerselvam K, Raju P, Mani S, Reddy SM, Sekar P. Serum zinc levels in children with simple febrile seizures. Int J Contemp Pediatr 2015; 2:424–427.  Back to cited text no. 9
    
10.
Ehsanipour F, Taher MT, Harandy MV, Kani K. Serum zinc level in children with febrile convulsion and its comparisonwith that of control group. Iran J Pediatr 2009; 19:65–68.  Back to cited text no. 10
    
11.
Heydarian F, Ashrafzadeh F, Ghasemian A. Serum zinc level in patients with simple febrile seizure. Iran J Child Neurol 2010; 4:41–44.  Back to cited text no. 11
    
12.
Ganesh R, Janakiraman L, Meenakshi B. Serum zinc levels are low in children with simple febrile seizures compared with those in children with epileptic seizures and controls. Ann Trop Paediatr 2011; 31:345–349.  Back to cited text no. 12
    
13.
Lee JH, Kim JH. Comparison of serum zinc levels measured by inductively coupled plasma mass spectrometry in preschool children with febrile and afebrile seizures. Ann Lab Med 2012; 32:190–193.  Back to cited text no. 13
    
14.
Salehiomran MR, Mahzari M. Zinc status in febrile seizure: a case-control study. Iran J Child Neurol 2013; 7:20–23.  Back to cited text no. 14
    
15.
Shokrzadeh M, Abbaskhaniyan A, Rafati M, Mshhadikabr M, Arab A. Serum zinc and copper levels in children with febrile convulsion. Pharm Biomed Res 2016; 2:19–24.  Back to cited text no. 15
    
16.
Cho WJ, Son BH, Kim SW. Levels of sodium and zinc concentration in febrile convulsion. J Korean Child Neurol Soc 1999; 7:214–219.  Back to cited text no. 16
    
17.
Garty BZ, Olomucki R, Lerman St, Nitzan M. Cerebrospinal fluid zinc concentration in febrile convulsion. Arch Dis Child 1995;73:338–341.  Back to cited text no. 17
    
18.
Kafdar I, Akıncı AB, Pekün F, Adal E. The role of serum zinc level in febrile convulsion etiology. J PedInf 2012; 6:90–93.  Back to cited text no. 18
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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