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FEBRILE INFECTION-RELATED EPILEPSY SYNDROME in Nepal

FEBRILE INFECTION-RELATED EPILEPSY SYNDROME

Febrile infection-related epilepsy syndrome (FIRES) is an infrequent, severe, and potentially deadly childhood epileptic syndrome. It can be described as potentially deadly or infrequent catastrophic epileptic encephalopathy. The characteristics of FIRES are repeated seizures, and febrile illness but no signs of infections.

FIRES was previously to refer to this syndrome in children aged three to fifteen years old. A healthy child that may have been ill in the last few days or with a lingering fever goes into a state of continuous seizures. Medical diagnostic tests may initially return no clear diagnosis and may not detect any obvious swelling on the brain. The syndrome is very rare: it may only affect 1 in 1,000,000 children.

It can be assumed that FIRES is associated with metabolic problems, infection, and autoimmune disorders. Affected patients have an unremarkable neurological history and, in close relation with a febrile illness (mainly upper respiratory tract infection or, less frequently, gastroenteritis), abruptly develop several seizures. Electroencephalography (EEG) abnormalities in the hyperacute phase of FIRES. FIRES is characterized by the onset of fever between 24 hours and 2 weeks before the onset of SE and the fever has usually resolved when the seizures start.

SIGN AND SYMPTOMS

FIRES start with a febrile illness up to two weeks before seizure onset. The clinical characteristic of FIRES is the onset of fever before the onset of SE. The fever gradually decreases and then subsides when the seizures occurred. These seizures damage the frontal lobe's cognitive brain function such as memory and sensory abilities. behavioral disorders, memory issues, sensory changes, and possibly death.

  • Behavioral abnormality
  • Cough
  • Developmental regression
  • Focal-onset seizure
  • Headache
  • Lethargy
  • Pain in muscle
  • Sinus inflammation 
  • EEG abnormality
  • Fever
  • Myalgia

DIAGNOSIS

FIRES can be diagnosed by the below-mentioned examinations:

  • Complete physical examination
  • Thorough medical history evaluation
  • Assessment of signs and symptoms
  • Laboratory tests
  • Imaging studies

MANAGEMENT

Ketogenic diet is effective in some cases, with efficacy ranging from 16% to over 85%. The features of the ketogenic diet are high protein and low carbohydrate. It has a good success rate for those who are suffering from refractory seizures. The effects of the diet are raises of fatty acids, inflection of glycemia, and comparative limitations in calories. Ketogenic diet can work as an anticonvulsant as well as anti-inflammation. If the KD can start early, it would help for effective and long-term management of epilepsy. KD may not only have an anticonvulsant effect (e.g., through the production of decanoic acid which induces a direct inhibition of the post-synaptic excitatory AMPA) but also anti-inflammatory. Early introduction of a KD could be effective not only during the acute phase but also in long-term epilepsy management.

HOMOEOPATHIC TREATMENT

Homeopathic medicines are the medicines which are given to the people by using drugs in a smaller quantity. Homeopathic medicines are considered as safe and also effective remedy for treating any disease. These homeopathic remedies don't cause any side effects as they are made from the products obtained naturally. These medicines help in treating the diseases from their roots and also they provide effective results. Many homeopathic medicines are there which help in the treatment of FIRES disease.

BELLADONNA: Belladonna is best for febrile convulsions. There is spasm followed by nausea and vomiting. The face flushed and skin is hot.

ARTEMESIA VULGARIS : Artemesia vulgaris is best for Petit mal epilepsy without an aura. Artemesia is effective for epilepsy of childhood in girls at puberty. Here the fits are caused by violent emotions, the convulsions come close together and then follows a long interval of rest.

BUFO RANA : Bufo rana is best for epilepsy in feeble minded children or prematurely senile. Bufo rana is effective for epilepsy due to masturbation or sexual excesses. Seizures occur at night during sleep, more or less connected with the sexual sphere. Mouth wide open before an attack and dropping of the jaw after the attack. Urine passes involuntarily after the attack. It is best for epilepsy of females who have attacks of seizures during menses.

OENANTHE CROCATA: Oenanthe crocata is prescribed for epilepsy where sudden and complete unconsciousness with terrible convulsions. Epilepsy after nonappearance of menses in young girls, worse at the time when menses should have appeared. There is vomiting, tympanitis and semipriapism during the attack. The face is swollen and red with frothing of the mouth