Can Serum Levels of C-Reactive Protein (CRP), Interleukin-6 and Copeptin Discriminate between Simple and Complex Febrile Seizures?

Objectives: To evaluate serum levels of C-reactive protein (CRP), Interleukin-6 (IL-6) and copeptin in children with febrile seizure (FS) and their ability to discriminate between simple (SFS) and complex FS (XFS).

Patients and Methods: The study included 80 febrile children; 40 did not develop febrile seizure (FC), 29 developed SFS and 11 developed XFS. The study also included 10 healthy children as negative control (NC). Clinical evaluation included full history taking, general examination and neurological examination to evaluate patients' general conditions and to confirm inclusion criteria. On admission; body temperature was measured and a venous blood sample was obtained for determination of complete blood count (CBC.) and ELISA estimation of serum CRP, IL-6 and copeptin.

Results: Male-to-female ratio was 2.64:1 and frequency of family history of FS was 17.5%. At admission; body temperature was significantly higher in febrile patients with significantly higher temperature in FS patients than in FC patients. Haemoglobin (Hb.) concentration of febrile patients was significantly lower than NC children with significantly lower Hb. Conc. in FS patients compared to FC patients. Serum CRP, IL-6 and copeptin levels and TLC were significantly higher in febrile patients compared to NC children and in FS patients compared to FC patients. Receiver operating characteristic (ROC) curve analysis defined high serum copeptin, IL-6, CRP, at admission body temperature, low Hb. Conc. and high total leucocytic count (TLC) as predictors for FS, in decreasing order of significance. Regression analysis defined high serum copeptin and IL-6 as the persistently significant predictors for FS among febrile patients and XFS among FS patients, respectively.

Conclusion: FS are associated with significantly altered immune and neuroendocrinal responses to infection. Extent of induced alterations correlates with severity of infection. Elevated serum levels of copeptin and IL-6 could discriminate febrile children susceptible to develop seizure. Elevated serum IL-6 could discriminate patients liable to develop XFS.