Introduction: Iron plays an important role in synthesis of various neurotransmitters in the brain. Iron deficiency, by altering neurotransmitter levels, may predispose children with iron deficiency to increased risk of febrile seizures.

Aims and Objectives: To study the role of iron deficiency as a risk factor for febrile seizures in children 6 to 60 months of age and to identify the peak age group of febrile seizures.

Methods: Case control study conducted in a tertiary care hospital in South India from October 2016 to children between 6 to 60 months of age admitted with febrile seizure were included as cases (n=50) and age matched children admitted with short febrile illness without seizures as controls (n=50). Complete haemogram, serum iron and ferritin levels were compared between the cases and controls. Iron deficiency was defined as Hb< 11g/dl and serum ferritin < 30ng/ml in the presence of fever (as per WHO guidelines).

Results: 74% of the cases had low serum ferritin levels compared to 20% among the controls (p=0.001). Mean serum ferritin levels were significantly low in cases compared to controls (28.6ng/ml Vs 92.1µg/L). Also mean haemoglobin concentration (11.2 Vs 12.1, P value 0.004), mean MCV (67.9 Vs 77.8, P value 0.000) were significantly low and mean TIBC levels were significantly high (468.3 Vs 315.2, P value 0.002) in febrile seizure group than in the control group. The febrile seizures were common in the age group between 1year and 3 years.

Conclusion: Children with low iron stores are at higher risk for febrile seizures.

Keywords: Iron Deficiency, Febrile Seizures.

1. Mikati MA, Hani AJ. Febrile Seizures. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW (eds.). Nelson Textbook of Paediatrics, 20^th edition Philadelphia: Elsevier; 2016. p.2829.
2. Jones T, Jacobsen SJ. Childhood Febrile Seizures: Overview and Implications. Int J Med Sci2007; 4(2): 110-14.
3. Richard Sills. Iron-Defciency Anaemia. . In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW (eds.). Nelson Textbook of Paediatrics, 20th edition Philadelphia: Elsevier; 2016. P.2323
4. Hartfeld D. Iron defciency is a public health problem in Canadian infants and children. Paediatr Child Health. 2010;15(6):347-50. PubMed PMID: 21731416; PubMed Central PMCID: PMC2921732.
5. Idro R, Gwer S, Williams TN, Otieno T, Uyoga S, et al. (2010) Iron Deficiency and Acute Seizures: Results from Children Living in Rural Kenya and a MetaAnalysis. PLoS ONE 5(11): e14001. doi:10.1371/journal.pone.0014001
6. Gupta S, Agarwal N, Maheshwari M: Iron Deficiency as a Risk Factor for Febrile Seizures – A case Control Study. People’s Journal of Scientific Research.2015;8(2):37-40.
7. Kumari PL, Nair MK, Nair SM, Kailas L, Geetha S. Iron Deficiency as Risk factor for Simple Febrile Seizures- A case control study. Indian Paediatrics. 2012 Jan; 49(1): 17-19.
8. Rajwanti KV, Praveen GD, Swati K, Ghosh K. Iron deficiency as a risk factor for first febrile seizure. Indian Pediatrics. 2010;47:437-9.
9. Waheed N, Butt MA. Iron status: is there a role in febrile seizures? J Ayub Med Coll 2012 Jul-Dec;24(3-4):128-30. PMID: 24669632
10. Heydarian F, Vatankhah H. The role of anaemia in first simple febrile seizure in children aged 6 months to 5 years old. Neurosciences (Riyadh). 2012 Jul; 17(3):226-9.
11. Yousefichaijan P, Eghbali A, Rafeie M, Sharafkhah M, Zolfi M, FirouzifarM.The relationship between iron deficiency anaemia and simple febrile convulsion in children. J PediatrNeurosci. 2014 May-Aug; 9(2): 110–114. doi: 4103/1817-1745.139276. PubMed ID:25250062
12. Kobrinsky NL, Yager JY, Cheang MS, Yatscoff RW, Tenenbein M. Does Iron Deficiency raise the seizure threshold? J Child Neurol.1995; 10(2):105-109
13. Daoud A S, Batieha  A, Abu-Ekteish  F, Gharaibeh  N, Ajlouni  S, Hijazi  Iron  Status:  A  Possible  Risk  Factor  for  the  First  Febrile  Seizure.Epilepsia. 2002 Jul; 43(7):740-3.PMID: 12102677 
14. Derakhshanfar H, Abaskhanian A, Alimohammadi H, ModanlooKordi M. Association between iron deficiency anaemia and febrile seizure in children. Med Glas (Zenica). 2012 Aug; 9(2):239-42.
15. Vestergaard M, Obel C, Henriksen TB, Christensen J, Madsen KM, Ostergaard JR, Olsen J. The Danish National Hospital Register is a valuable study base for epidemiologic research in febrile seizures. J ClinEpidemiol.2006; 59(1): 61-6.
16. Berg A.T., Shinnar S., Shaprio E.D., et al.: Risk factors for a first febrile seizure: A matched case-control study. Epilepsia, 1995; 36: 334-41.
17. Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D’Apuzzo A, et al. Iron Defciency Anaemia and Febrile Convulsions: Case-control Study in Children under 2 Years. BMJ 1996; 313 (7053):343.
18. Fallah R, Trinandazi B, Ferdoian F, Fadavi N. Iron deficiency and iron deficiency anaemia in children with first attack of seizures and in healthy control group; a comparative study. Iran J Child Neurol 2014; 8(3):18–23.

Dr Shiv Narayan Panda

Assistant Professor, Department of Paediatrics, Command Hospital Air Force, Bangalore-560007, Karnataka, India