The Serum Sodium Levels and

Recurrence of Simple Febrile Seizure

During The First 24 Hours in Children
(Mohammadreza Salehiomran, Hadis Ebrahimzadeh, Mahmoud Hajiahmadi, 2018)

By :
Dian Jabal Rachman Bey
C105192005
 ABSTRACT
• Background :
Febrile seizure (FS) is one of the most common neurologic disorders in children.
Electrolyte imbalance especially hyponatremia may have an important role in
trigerring the febrile seizure. The measure of serum electrolytes will be useful in
predicting the further seizure. The aim of this study was to investigate the
effect of relative hyponatremia (RH) on the risk of recurrent febrile seizures.
• Methods :
This prospective study was performed on 334 children (6-60 months) with
convulsions, referred to Amirkola children’s Hospital. The patients were divided
into three groups: simple febrile seizure (SFS), complex febrile seizure (CFS)
and seizure without fever. In each group, the serum sodium was measured at
the beginning of the admission and followed for 24 hours, and electrolyte
imbalance was evaluated in seizure recurrences. Data were analyzed using
SPSS-16 (students’s t-test and logistic regression).
 ABSTRACT
• Results :
Of the 334 children, 105 (31,7%) and 229 (68,3%) patients were female and
male, respectively. The mean serum sodium-levels in patients with SFS, CFS
and control group were 136.64, 134.91 and 137.38 meq/l, respectively (p<0.05),
but potassium and calcium levels were in the normal range. CFS group had a
significant RH in comparison to SFS group (p<0.05).
• Conculsions :
The serum sodium level was significantly lower in simple and complex seizures
compared to the control group. Measurements of serum sodium levels and
hyponatremia diagnosis have a key role on predicting the FC occurrence dan
recurrence. Therefore, physicians should be careful to administer the serums
and inject the solutions for children with fever.
• Keywords :
Children, Febrile Seizure, Fever, Hyponatremia, Seizures
 INTRODUCTION

Body
temperatur
e > 38 0C
Without
6 months to
infection in
5 years old
CNS

Febrile
Seizure
• The incidence  5 cases per 1000 children annually
• Two-four percent of children experiences FC during the first 6 years of life
• Almost one third of them  recurrent episodes.
 FEBRILE SEIZURE

01 Simple Seizures 02 Complex Seizures

Generalized tonic-clonic movements Focal movements

Less than 15 minutes More than 15 minutes

Without recurrence in the first of 24 hours More than once in the first of 24 hours
 Measurement of serum
sodium, calcium, Variations in serum
Pathophysiology of FC has phosphorus, electrolyte levels will
not been demonstrated magnesium,zinc and iron increase the susceptibility
conclusively levels in children with to seizures and reccurent of
febrile convulsion could be FC during childhood
helpful.
Serum sodium deficiency
as a higher risk of
reccurence of FC or
convulsion in the first 24 Relative hyponatremia (RH)
hours of simple FC as predictor of the likelihood
of FC in children
 METHODS
• 334 children between 6 – 60 months in Amirkola Hospital in 2014 –
Participants 2015
• All children with fever (axillary temperature >38 0C) and convulsions

• First group : children with first febrile seizure without cns infection or
any other defined cause of seizure
• Second group : recurrent febrile convulsion (complex)
Categorization • Group control : seizure disorder without fever during the same period
• The exclusion criteria
• The demographic characteristics and serum electrolyte status

• SPSS 16
Data Analyze • Student’s t test
• Logistic regression
 RESULTS
Recurrent Seizure
Among 271
Participants The Mean Serum
children, 63 (23.2%)
Sodium Level
334 children; 229 patient had
(68,3%) boys and SFS group : 136.65 recurrent seizure in
105 (31,7%) girls CFS group : 135 first 24 hours.
between 6 months Control : 137.38 Hiponatremia
– 5 years old significantly
responsible for that
(p = 0,016)

The Mean Age Serum Sodium

Level
SFS group :
28.8+15.3 SFS group and CFS
CSF group : group was
23.06+12.26 significant lower
Control : 35.65+16 than control group
(p<0.05)
DISCUSSION
In this Study :
 CFS group had significant relative
hyponatremia (RH) in comparison to SFS
group
 No significant effect of gender on the
occurrence of FC.
 The mean sodium serum level was
significantly lower in SFS and CFS groups
than control
 RH had a significant effect on seizures
recurrence in CFS group
 The presence of RH was observed in 37
(17.78%) children with SFS and 20 (31.7%)
children with CFS.
 The RH and low serum sodium level
indicated the significant relationship with
febrile seizure occurrence.
 DISCUSSION

Maksikharin et al.
The frequency of febrile seizure Nickavar et al. and Hugen et al.
was occurred in 57.5% of boys,
30 % and 28% of children with FS
but without any significant
had recurrent seizures
difference

Thoman et al. and Heydariyan et

Thoman et al., Heydariyan et al.,
al.
The serum sodium level was
Nickavar et al.
There was a significant difference lower in the group with
between the mean serum sodium recurrence, which was not
level and SFS or CFS in children statistically significant
 DISCUSSION

Hugen et al.
The probability of a repeat
convulsion within the same
febrile periode appeared to be
significantly related to the
sodium level

Kiviranta et al. Maksikharin et al.

The sodium level were lower in The serum sodium level had no
children with complicated significant difference between
convulsions compared to those SFS (134.94 mg.dl) and CFS
having simple convulsions. children (134.49 mg/dl)
Limitation & Advantage
 Limitation  limited size of the study population and

targeted groups

 Advantage  to evaluate serum sodium levels in

healthy children in addition to children with febrile

seizure
 CONCLUSIONS

• The serum sodium level was significantly lower in simple and complex
seizures than the control group. Measurement of serum sodium levels on
predicting the recurrence of febril convulsion was succesfull, so the level of
sodium serum has a significant role in the creation of febrile convulsion.
Thus, administration of injectable solutions for children with fever should be
considered carefully.
 Telaah Kritis Jurnal

The Serum Sodium Levels and Recurrence of Simple Febrile Seizure

During The First 24 Hours in Children
(Mohammadreza Salehiomran, Hadis Ebrahimzadeh, Mahmoud Hajiahmadi, 2018)

No Hal yg Dinilai Chek list penilaian Ya Tidak

1. Judul Makalah a. Apakah judul tidak terlalu panjang atau pendek? 
b. Apakah judul menggambarkan isi utama penelitian? 
c. Apakah judul cukup menarik? 
d. Apakah judul menggunakan singkatan selain yang 
baku?

2 Abstrak a. Apakah merupakan abstrak satu paragraf, atau

abstrak terstruktur? terstruktur
b. Apakah sudah tercakup komponen IMRAC
(Introduction, methods, Results, Conclusion?) 
c. Apakah secara keseluruhan abstrak informatif? 
d. Apakah abstrak lebih dari 250 kata? <250
No Hal yg Dinilai Chek list penilaian Ya Tidak

3 Pendahuluan a. Apakah mengemukakan alasan dilakukannya penelitian? 

b. Apakah menyatakan hipotesis atau tujuan penelitian? 
c. Apakah pendahuluan didukung oleh pustaka yang kuat & 
relevan?

4 Metode a. Apakah disebutkan desain, tempat & waktu penelitian? 

b. Apakah disebutkan populasi sumber (populasi 
terjangkau)?
c. Apakah kriteria pemilihan (inklusi & eksklusi) dijelaskan? 
d. Apakah cara pemilihan subjek (teknik sampling) 
disebutkan?
e. Apakah perkiraan besar sampel disebutkan & disebut pula 
alasannya?
f. Apakah perkiraan besar sampel dihitung dengan 
menggunakan rumus yang sesuai?
No Hal yg Dinilai Chek list penilaian Ya Tidak

e. Apakah dijelaskan subyek yang drop out dengan 

alasannya?
f. Apakah semua hasil di dalam tabel disebutkan dalam 
naskah?
g. Apakah semua outcome yang penting disebutkan 
dalam hasil?
h. Apakah subyek yang drop out diikutkan dalam analisis? 
i. Apakah disertakan hasil uji statistik (x2,t) derajat
kebebasan (degree of freedom), dan nilai p? 
j. Apakah dalam hasil disertakan komentar & pendapat? 

6 Diskusi a. Apakah semua hal yang relevan dibahas? 

b. Apakah dibahas keterbatasan penelitian, dan
kemungkinan dampaknya terhadap hasil? 

c. Apakah disebutkan kesulitan penelitian, penyimpangan 

dari protokol, dan kemungkinan dampaknya terhadap
hasil?
No Hal yg Dinilai Chek list penilaian Ya Tidak

d. Apakah pembahasan dilakukan dengan

meghubungkannya dengan teori dan hasil penelitian 
terdahulu?
e. Apakah dibahas hubungan hasil dengan praktek klinis? 
f. Apakah disertakan kesimpulan utama penelitian? 
g. Apakah kesimpulan didasarkan pada data penelitian? 
h. Apakah efek samping dikemukakan dan dibahas? 
i. Apakah disebutkan hasil tambahan selama 
diobservasi?
j. Apakah disebutkan generalisasi hasil penelitian? 
k. Apakah disertakan saran penelitian selanjutnya, 
dengan anjuran metodologis yang tepat?
 Telaah Kritis Jurnal Untuk Menilai VIA (Validity, Importance, Applicability)

The Serum Sodium Levels and Recurrence of Simple Febrile Seizure During The First
24 Hours in Children
(Mohammadreza Salehiomran, Hadis Ebrahimzadeh, Mahmoud Hajiahmadi, 2018)
 Menilai bukti klinis EBM jurnal Ini :

VALIDITY

1. Apakah awal penelitian didefinisikan dengan jelas? Iya

2. Apakah menyatakan desain penelitian dengan jelas ? Iya, dinyatakan oleh peneliti bahwa desain
penelitiannya adalah prospektif
3. Apakah pembanding dinyatakan dengan jelas? Iya
4. Apakah pemantauan (follow up) pasien dilakukan cukup Panjang dan lengkap ? Tidak
5. Apakah diidentifikasi dengan jelas kelompok dengan prognosis yang berbeda ? Iya
6. Apakah outcome dinilai dengan kriteria objektif ? Iya
 VALIDITY
METODE PICO

•Patient, Population, Problem

334 orang anak dengan kejang yang terdiri dari 105 orang laki-laki dan 229 orang perempuan , mulai umur 6 bulan – 60 bulan.

•Intervention
Dilakukan pengukuran kadar sodium serum Ketika pertama kali masuk dan di follow up selama 24 jam. Imbalance elektrolit dievaluasi pada kejang yang berulang.

•Comparison
Dibagi menjadi 3 kelompok perbandingan. Kelompok Pertama yaitu anak-anak dengan diagnosa kejang demam sederhana, kelompok dua yaitu anak-anak dengan
diagnose kejang demam kompleks, dan kelompok kontrol yaitu anak-anak dengan diagnosa kejang tanpa demam.
•Outcome
Kadar sodium serum lebih rendah pada kelompok dengan kejang demam sederhana dan kejang demam kompleks dibandingkan dengan kelompok kontrol.
Mengukur kadar sodium serum dan diagnosis hyponatremia memiliki peran penting dalam memprediksi terjadinya kejang demam dan kekambuhannya.
 IMPORTANCE

1. Apakah outcome / hasil dipaparkan secara jelas( hasil uji statistik

dengan hasil nilai p)? Iya
2. Seberapa besarkah ketepatan estimasi outcome yang didapat
dengan nilai OR, RR, PR dengan nilai 95% Cl (interval
kepercayaan) ? Sesuai dengan nilai OR dengan nilai 95% CI.
 APPLICABILITY

1. Apakah karakteristik pasien kita mirip dengan subjek yang diteliti? Iya,ada beberapa
pasien yang dirawat dengan kondisi seperti pasien di penelitian ini
2. Apakah bukti ini akan mempunyai pengaruh yang penting secara klinis terhadap
kesembuhan pasien kita tentang apa yang telah ditawarkan / diberikan kepada pasien
kita? Iya
3. Apakah simpulan tentang hasil studi tersebut berguna bagi pasien dalam tatalaksana
secara keseluruhan? Iya, sangat berguna
THANK YOU