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Iron deficiency and acute seizures: Results from children living in rural kenya and a meta-analysis

Iron deficiency and acute seizures: Results from children living in rural kenya and a meta-analysis
Iron deficiency and acute seizures: Results from children living in rural kenya and a meta-analysis

Background: There are conflicting reports on whether iron deficiency changes susceptibility to seizures. We examined the hypothesis that iron deficiency is associated with an increased risk of acute seizures in children in a malaria endemic area. Methods: We recruited 133 children, aged 3-156 months, who presented to a district hospital on the Kenyan coast with acute seizures and frequency-matched these to children of similar ages but without seizures. We defined iron deficiency according to the presence of malarial infection and evidence of inflammation. In patients with malaria, we defined iron deficiency as plasma ferritin<30mg/ml if plasma C-reactive protein (CRP) was<50mg/ml or ferritin<273mg/ml if CRP≥50mg/ ml, and in those without malaria, as ferritin<12mg/ml if CRP<10mg/ml or ferritin<30mg/ml if CRP≥10mg/ml. In addition, we performed a meta-analysis of case-control studies published in English between January 1966 and December 2009 and available through PUBMED that have examined the relationship between iron deficiency and febrile seizures in children. Results: In our Kenyan case control study, cases and controls were similar, except more cases reported past seizures. Malaria was associated with two-thirds of all seizures. Eighty one (30.5%) children had iron deficiency. Iron deficiency was neither associated with an increased risk of acute seizures (45/133[33.8%] cases were iron deficient compared to 36/133[27.1%] controls, p = 0.230) nor status epilepticus and it did not affect seizure semiology. Similar results were obtained when children with malaria, known to cause acute symptomatic seizures in addition to febrile seizures were excluded. However, in a meta-analysis that combined all eight case-control studies that have examined the association between iron deficiency and acute/febrile seizures to-date, iron deficiency, described in 310/1,018(30.5%) cases and in 230/1,049(21.9%) controls, was associated with a significantly increased risk of seizures, weighted OR 1.79(95%CI 1.03-3.09). Conclusions: Iron deficiency is not associated with an increased risk of all acute seizures in children but of febrile seizures. Further studies should examine mechanisms involved and the implications for public health.

1932-6203
Idro, Richard
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Gwer, Samson
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Williams, Thomas N.
35087fc8-4ba4-4730-94cb-db91ff13d58b
Otieno, Tuda
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Uyoga, Sophie
193e068c-0f43-438a-b371-44b228c7666a
Fegan, Gregory
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Kager, Piet A.
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Maitland, Kathryn
7b0df537-2272-4de9-be93-91deb73beb72
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Neville, Brian G.R.
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Newton, Charles R.J.
efad95f0-8647-440e-aeae-527f30d0cac7
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Gwer, Samson
6418bf02-004a-489f-b8b6-6fee801ec692
Williams, Thomas N.
35087fc8-4ba4-4730-94cb-db91ff13d58b
Otieno, Tuda
d24c1add-1bd8-4fbe-80de-8807ea19b280
Uyoga, Sophie
193e068c-0f43-438a-b371-44b228c7666a
Fegan, Gregory
665c804f-5687-40f3-b40c-ccd88540f7aa
Kager, Piet A.
18df5c25-535a-4855-b085-83c91f895dcb
Maitland, Kathryn
7b0df537-2272-4de9-be93-91deb73beb72
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Neville, Brian G.R.
7d4a7d56-e223-4cf4-8e8b-c1be5ddce55b
Newton, Charles R.J.
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Idro, Richard, Gwer, Samson, Williams, Thomas N., Otieno, Tuda, Uyoga, Sophie, Fegan, Gregory, Kager, Piet A., Maitland, Kathryn, Kirkham, Fenella, Neville, Brian G.R. and Newton, Charles R.J. (2010) Iron deficiency and acute seizures: Results from children living in rural kenya and a meta-analysis. PLoS ONE, 5 (11), [e14001]. (doi:10.1371/journal.pone.0014001).

Record type: Article

Abstract

Background: There are conflicting reports on whether iron deficiency changes susceptibility to seizures. We examined the hypothesis that iron deficiency is associated with an increased risk of acute seizures in children in a malaria endemic area. Methods: We recruited 133 children, aged 3-156 months, who presented to a district hospital on the Kenyan coast with acute seizures and frequency-matched these to children of similar ages but without seizures. We defined iron deficiency according to the presence of malarial infection and evidence of inflammation. In patients with malaria, we defined iron deficiency as plasma ferritin<30mg/ml if plasma C-reactive protein (CRP) was<50mg/ml or ferritin<273mg/ml if CRP≥50mg/ ml, and in those without malaria, as ferritin<12mg/ml if CRP<10mg/ml or ferritin<30mg/ml if CRP≥10mg/ml. In addition, we performed a meta-analysis of case-control studies published in English between January 1966 and December 2009 and available through PUBMED that have examined the relationship between iron deficiency and febrile seizures in children. Results: In our Kenyan case control study, cases and controls were similar, except more cases reported past seizures. Malaria was associated with two-thirds of all seizures. Eighty one (30.5%) children had iron deficiency. Iron deficiency was neither associated with an increased risk of acute seizures (45/133[33.8%] cases were iron deficient compared to 36/133[27.1%] controls, p = 0.230) nor status epilepticus and it did not affect seizure semiology. Similar results were obtained when children with malaria, known to cause acute symptomatic seizures in addition to febrile seizures were excluded. However, in a meta-analysis that combined all eight case-control studies that have examined the association between iron deficiency and acute/febrile seizures to-date, iron deficiency, described in 310/1,018(30.5%) cases and in 230/1,049(21.9%) controls, was associated with a significantly increased risk of seizures, weighted OR 1.79(95%CI 1.03-3.09). Conclusions: Iron deficiency is not associated with an increased risk of all acute seizures in children but of febrile seizures. Further studies should examine mechanisms involved and the implications for public health.

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Accepted/In Press date: 17 September 2010
Published date: 16 November 2010

Identifiers

Local EPrints ID: 429375
URI: http://eprints.soton.ac.uk/id/eprint/429375
ISSN: 1932-6203
PURE UUID: 3ca28d9a-bc1c-41cf-a958-3f8f85537984
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 26 Mar 2019 17:30
Last modified: 07 Oct 2020 01:46

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Contributors

Author: Richard Idro
Author: Samson Gwer
Author: Thomas N. Williams
Author: Tuda Otieno
Author: Sophie Uyoga
Author: Gregory Fegan
Author: Piet A. Kager
Author: Kathryn Maitland
Author: Fenella Kirkham ORCID iD
Author: Brian G.R. Neville
Author: Charles R.J. Newton

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