Febrile seizures are defined as the sudden onset of a motor discharge originating in the brain, which may be persistent or transient, occurring in a febrile context with loss of consciousness. This definition encompasses not only seizures caused by a simple rise in temperature (hyperpyretic seizure) but also seizures resulting from direct damage to the brain [1]. Seizures represent the most frequent medical emergency in pediatrics and are the subject of often passionate debate regarding their etiology, risk factors, and therapeutic management [1]. Their frequency varies between 3% and 38% [2][3]. The nature of these febrile seizures, however, remains a subject of controversy [2]-[4].

They are either the consequence of cerebral dysfunction induced by fever (cases of febrile seizures) or the symptomatology of a true epileptogenic encephalopathy, infectious or non-infectious. They are the subject of debate regarding etiology, risk factors, and therapeutic management [1]. The prognosis depends on the cause, the type of febrile seizure, the neurological background, and the promptness of treatment. Management combines symptomatic treatment with well-conducted etiological treatment.

In Guinea, little data is available on febrile seizures in children; therefore, we undertook this study, the main objective of which was to investigate the etiologies of febrile seizures in children aged 1 month to 15 years in the pediatric department of the Nzérékoré Regional Hospital.

This was a prospective, descriptive, cross-sectional study conducted over a six-month period, from June 6 to December 6, 2018, in the pediatric department of the N’Zérékoré Regional Hospital, located 1000 km from Conakry in southern Guinea. This department has a threefold mission: training, research, and patient care.

We included all children aged 1 month to 15 years admitted for febrile seizures confirmed by questioning and/or physical examination, with the consent of their parents or legal guardian. Children over 15 years of age and those with non-febrile seizures were excluded.

We conducted a 6-month prospective, descriptive, cross-sectional study during which we recorded 125 patients admitted for febrile seizures out of a total of 1800 hospitalizations, representing a hospital frequency of 6.94%. Our results are similar to those of Dembélé A et al. in Mali [5], who reported a prevalence of 8.4%. However, our results are significantly lower than those of M. J. Alao et al. [6] in Benin and Diawara et al. [7] in Mali, who found prevalences of 16.88% and 16.58%, respectively.

The majority of our patients (68%) came from urban centers. Our results are lower than those of Sidibé MD et al. [8], who found that 82.86% of patients came from urban areas. This result could be explained by the fact that the N’Zérékoré Regional Hospital is located in the heart of the city, with a high population density, thus facilitating access in the event of a health emergency.

We observed a predominance of seizures in children aged between 1 month and 5 years (89.60%), with a mean age of 2.99 ± 1.46 years and a range of 2 months to 15 years. The male-to-female ratio was 1.31. Several studies in the sub-region had noted an age lower than 36 months [2][3]. Our results are comparable to those of Diawara N. et al. [2] in Bamako, who found a predominance of febrile seizures in children aged 12 to 24 months. This could be explained by the immaturity of the central nervous and immune systems, which makes these children particularly vulnerable. Data from the literature indicate that febrile seizures account for 2 to 5% of cases [9]. The authors suggest that the high incidence in young children is due to the immaturity of the autonomic nervous system [10]. It is clear that age-related cerebral immaturity plays a major role in triggering febrile seizures in response to the various stresses occurring during an infectious disease.

All our patients experienced one or two episodes of febrile seizures, representing 100% of cases. Data from the literature indicate that febrile seizures account for 2% to 5% of cases [9]. Ear, nose, and throat (ENT) disorders are common in our countries due to climatic variations and, above all, increasing overcrowding in our cities.

On admission, the majority of patients had a temperature that fluctuated between 38.5˚C and 39˚C, i.e. 92% of cases, and those who had a temperature above 39.5˚C were 8%.

Our results are significantly higher than those of Dembélé et al. in Mali, who found that 42.1% of cases in children had a temperature between 38.5˚C and 39.4˚C, and those of Sall et al. in Senegal [11], who recorded similar results with 43.3% of temperatures between 38.5˚C and 39.4˚C and 36.3% above 39.5˚C. However, Kaputu et al. [12] noted a temperature above 39˚C in 57.8% of cases.

Almost all patients experienced complex generalized seizures, 94.4% of which were tonic-clonic, lasting more than 5 minutes. Our results are considerably higher than those found by Dembélé et al. in Mali [5], who found that generalized seizures were the most frequent, at 65.8% of cases, and primarily tonic-clonic seizures in 64.7%. In contrast, M J Alao et al. [6] in Benin found a predominance of localized seizures in 50.30% of cases.

All patients underwent a thick blood smear, and it was positive in 90.4% of cases. Our results are comparable to those of Dembélé et al. [5], who reported that 72.2% had a positive thick blood smear. Guinea is part of the area of high malaria endemicity in sub-Saharan Africa, with the presence of the Plasmodium falciparum species and high mortality, especially among children under five.

The most common etiologies of febrile seizures in this study were cerebral malaria and bacterial meningitis, accounting for 90.4% and 35.2% of cases, respectively. Our results are superior to those found by Nkombo MN et al. in Congo, who found that cerebral malaria was identified as the cause of febrile seizures in 62% of cases at the University Clinics of Lubumbashi, compared to 52.5% of cases at the Sendwe General Referral Hospital [13]. Djoman Aspi. et al. in Abidjan [14] found that the etiologies of febrile seizures were dominated by severe malaria in its convulsive (47.6%) and neurological (25%) forms, followed by bacterial meningitis (13.1%).

Neurological signs are characteristic of Plasmodium falciparum malaria [15]. Seizures are frequent, even in cases of uncomplicated infection. The seizures are generally generalized and may precede the onset of a coma. These crises are most often reversible but associated with significant neurodevelopmental sequelae: stroke, cognitive disorders and increased risk of epilepsy [16].

These results could be explained by the fact that we are in a malaria-endemic zone and Guinea is part of the African meningitis belt; therefore, malaria and meningitis are the main causes of febrile seizures in children. Despite malaria prevention measures such as the use of long-lasting insecticidal nets, malaria remains the leading cause of hospitalization in children in Africa, a finding consistent with those reported by Hogan B [17] in Ghana, Kiemde in Burkina Faso [18], and José Francisco Fernandes in Gabon [19].

The most frequently prescribed anticonvulsant was diazepam 100%. Our result is similar to that found by Bisimwa Mushagalusa et al. in the Democratic Republic of Congo, who recorded 100% diazepam use [8]. Paracetamol was the most frequently used antipyretic and/or analgesic in 68.8% of cases.

Our results are similar to those of Dembele A et al. in Mali [5], who found that 67.7% of cases involved the use of antipyretics in combination with anticonvulsants, compared to 55% for Bisimwa Mushagalusa et al. [18].

The most frequently used molecules for etiological treatment were antimalarials and antibiotics, at 90.4% and 57.6%, respectively. Our results are significantly higher than those of Dembele A et al. in Mali [5], who reported that antimalarials (67.3%) and antibiotics (22.9%) were the most frequently used etiological treatments.

In our study, the outcome was favorable without neurological sequelae in 93.6% of cases. We recorded 3 deaths, representing 2.4%. This rate was significantly lower than that of Dembélé A et al. in Mali [5] who found 41.6% deaths and that of Diawara et al. [7] who found 20.3% deaths.

Febrile seizures are a frequent reason for consultations and hospitalizations in children aged 1 month to 15 years at the Pediatric Department of the N’Zérékoré Regional Hospital. The main causes of febrile seizures were cerebral malaria and bacterial meningitis. The outcome was favorable without sequelae in the majority of our patients. Improved prevention and management of common infectious diseases will help reduce the still very high mortality rate of febrile seizures.