The incidence of febrile-seizures has increased among children tested positive for COVID-19

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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.

The study findings were published on a preprint server and is currently being peer reviewed.
https://www.researchsquare.com/article/rs-2116645/v1

We observed a significant increase in the number of patients with FS from December 2021, when the Omicron variant was first reported in Korea (Table 1).18

Until 2021, prior variants of COVID-19 were associated with severe disease and a 20.5% hospitalization rate among the infected patients; however, no FS was observed (Figure 1, Table 1).

Conversely, after the Omicron surge, 16.5% of hospitalized patients (64 of 387, Figure 1) had FS, despite the hospitalization rate dropping to 1.2% (387 of 33,057). This result concurs 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.19

Human herpesvirus-6 or influenza A virus, which are common causes of FS, also led to a 10–20% incidence of FS in hospitalized patients.20,21 Thus, this study provides more evidence that the Omicron variant can also be a common cause of FS.

The mean age of patients with FS due to COVID-19 was 36.7 ± 15.0 months, which was older than the peak age of FS, which is 18–20 months.22,23 Furthermore, 39.1% of patients with FS had CFS, and 1.6% of them had FSE, which is also higher than the average 25%–30% incidence of CFS.24,25 In 2022, Apirada et al. reported the characteristics of 16 pediatric patients with seizures due to COVID-19 after the Omicron surge.26

Six patients (38%) presented with focal seizures and eight patients (50%) presented with status epilepticus. However, a higher rate of status epilepticus than that found in our study was reported per the criteria for status epilepticus (seizures lasting more than 5 minutes). 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.

Overall, this study 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, they 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.

The biggest advantage of this study was that the incidence of FS among confirmed COVID-19 patients could be calculated based on government statistical records rather than inpatient population organizations. 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.27,28

To the best of our knowledge, the existing reports on FS related to COVID-19 were also studies on hospitalized patients.14,16 Our study 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.

Additionally, we 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%.

Previous studies before the Omicron surge suggested lower incidences of FS among Korean children,13 and the possibility that the incidence of FS may increase after the Omicron pandemic should not be neglected.

In this study, we investigated all hospitals where FS treatment was available in Jeonbuk province. However, one of the 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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