Background: Most convulsions during infections in otherwise healthy children are simple febrile seizures. Prognosis is good and routine performance of extensive laboratory investigations is not warranted.
Children with rotavirus gastroenteritis can present with clinically worrisome afebrile cluster convulsions. We present two such cases.
Cases: Two afebrile boys (17 and 19 months old) were admitted to our hospital because of convulsions. Both had 4 recurrent seizures within 5-10 hours, each lasting less than 15 minutes. One patient had
2 generalized tonic-clonic and 2 generalized tonic convulsions, while the other had 2 lateralized convulsions with right upper limb tonic movements and loss of consciousness followed by two generalized toncio-.clonic seizures. Both patients experienced gastrointestinal symptoms prior to the convulsions: one had vomiting and diarrhea 8 hours before the first convulsion; the other had developed acute mild gastroenteritis 2 days before admission. Both patients had rotavirus found in stools. None of them was dehydrated neither had electrolyte or other laboratory abnormalities. They were given iv phenytoin after the 3rd convulsion. Both patients left hospital within 3 days without anti-epileptic treatment. Follow-up has been uneventful.
Discussion: Rotavirus associated convulsions in children are known, although mostly described in Asia. They are usually described as short-lived, tonic-clonic or partial seizures, occurring in cluster within
24 hours, at any time during the rotavirus gastroenteritis, sometimes even before its onset. Digestive symptoms may be mild, preventing clinicians to link up the convulsions to an afebrile benign 33 S SWISS MED WKLY 2 0 0 8 ; 1 3 8 (Suppl 1 6 4 ) · www. smw. ch Poster presentations gastroenteritis. The relationship between the virus and the neurological symptoms is not clear. Prognosis is generally good.
Rotavirus infections are common; «rota» seizures apparently not. Clinicians should be aware of "rota" seizures to refrain from wrong epilepsy diagnosis, overinvestigation and useless long term treatment.