Convulsions with mild gastroenteritis (CwG) or benign infantile convulsions associated with mild gastroenteritis (BICE) are most common in patients with convulsions associated with mild gastroenteritis and no previous meningitis, encephalitis, or encephalopathy.
Infantile convulsions associated with mild gastroenteritis (BICE) are usually seen in children with convulsions associated with mild acute gastroenteritis and who are previously healthy, without meningitis, encephalitis, or encephalopathy. The child is usually not significantly dehydrated, does not have electrolyte or acid-base balance disturbances, may have a low fever, and may have one or more convulsions during the course of the disease.
Since then, the disease has been reported in Asian countries and regions, European countries, the United States, and South American countries, and in recent years, there has been an increasing trend of domestic and international studies, but it is mainly seen in Asian populations.
1.Etiology
Most commonly seen in rotavirus, norovirus, etc., so every year rotavirus enteritis epidemic season gastroenteritis-related convulsions significantly higher incidence. Other viruses such as coxsackievirus, culex virus, enteric adenovirus are also important pathogens, and a few children can also be induced by bacterial infections such as Campylobacter jejuni, Shigella spp. and Salmonella spp. The etiology is unknown, perhaps gastroenteritis lowers the convulsion threshold and reactive convulsions occur, and a genetic factor cannot be excluded.
2.Incidence
The incidence of gastroenteritis-related convulsions in North China accounts for 1.78% of all hospitalized children with gastroenteritis, and some scholars reported 68 cases of convulsions in 1936 children with acute gastroenteritis in Hong Kong, accounting for about 3.5%. The incidence of gastroenteritis-related convulsions in children with rotavirus enteritis is even higher, with some reports reaching 7.7%.
3. Clinical features
Most of the cases occur in infants and children aged 6 to 24 months with no previous history of convulsions, mostly for the first time. The main manifestations are: early nausea, vomiting, frequent vomiting in a few children, some children can be accompanied by low fever, followed by diarrhea, mostly watery diarrhea, most of the convulsions occur within 1 day of the disease, 50% of the seizures within 6 hours, may occur only in the vomiting convulsions; mainly non-febrile convulsions, can also be manifested as hypothermic convulsions (body temperature is generally below 38 ℃), with or without The clinical situation is more common with generalized tonic-clonic seizures, but also focal seizures or only gaze, with short seizure duration, lasting 25s~2min, relieved within 5 minutes in 85% of cases. 52% of cases are cluster seizures and 48% are isolated convulsions. Cluster seizures are 2-8 times and last 24-48 hours.
4. Diagnosis
(1) Previously healthy infants and children from 6 months of age to 3 years of age;
(2) Mild gastroenteritis with non-febrile convulsions, may have mild dehydration, but no significant acidosis or electrolyte disturbances;
(3) Convulsions can be single or multiple episodes in the course of a single illness;
(4) EEG is normal during the interictal period without abnormal discharge;
(5) Serum electrolytes, blood glucose and cerebrospinal fluid examination are normal;
(6) The disease is mostly self-limiting and has a good prognosis.
The diagnosis of mild gastroenteritis with convulsions is not considered with the following conditions
5.Differential diagnosis
6.Treatment
Since the disease is mostly benign, it is usually treated symptomatically in the acute stage, such as reducing or removing triggering factors, keeping quiet, preventing disorders of water, electrolytes, acid-base balance, protecting the gastrointestinal mucosa, regulating intestinal flora, and stopping vomiting and diarrhea. If necessary, anticonvulsant treatment can be given.
7.Prognosis
The long-term follow-up data of most scholars at home and abroad have not seen any obvious sequelae of this disease, and the growth and intelligence of the children have not been affected; recurrence is rare, and only when gastroenteritis; its prognosis is good, and it will not develop into epilepsy, and long-term oral treatment with anticonvulsant drugs is generally unnecessary.