Febrile seizures and increased stress sensitivity in children: How it relates to seizure characteristics

• Published in: Epilepsy & behavior Vol. 95; pp. 154 - 160
• Main Authors: Thébault-Dagher, Fanny, Lafontaine, Marc-Philippe, Knoth, Inga Sophia, Deguire, Florence, Sheppard, Emilie, Cook, Ramona, Lagacé, Maryse, Gravel, Jocelyn, Lupien, Sonia, Lippé, Sarah
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019
• Subjects: Convulsion; Corticosteroid; Cortisol; Epilepsy; HPA axis; SES; Corticosteroid; AUCi; Convulsion; ANOVA; EEG; Epilepsy; Cortisol; HPA axis; FS
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2019.03.022

Studies suggest that the relationship between seizures and stress starts early in life. However, evidence of long-term altered stress reactivity following early-life seizures is lacking. Our objectives were to assess alterations in stress hormone reactivity in children with past febrile seizures (FS) and investigate how these alterations relate to clinical characteristics.
This case–control study compared a convenience sample of children with simple FS (n = 24), complex FS (n = 18), and matched healthy controls (n = 42). Stress was induced by electrode placement for an electroencephalography (EEG) exam. Salivary cortisol to stress, using three samples collected before and after the stressor, was compared between groups and sex. The relationship between stress reactivity and clinical characteristics (i.e., FS duration, age at first FS, time since the last FS) was investigated.
Cortisol reactivity to stress was significantly different depending on study groups, F(1, 78) = 6.415, p = 0.003, η2p = 0.141, but not sex nor was there a significant interaction between group and sex (p ≥ 0.581). Participants with simple FS showed higher cortisol reactivity to stress (M = 14.936, Standard deviation (SD) = 26.852) compared with those with complex FS (M = −4.663, SD = 18.649, p = 0.015) and controls (M = −3.817, SD = 18.907, p = 0.003). There was no significant difference between participants with complex FS and controls (p > 0.999). Stress reactivity was not linked to clinical characteristics.
Children with past simple FS showed greater changes in salivary cortisol following stress, suggesting enhanced stress sensitivity. As similar results were not found in a population with complex FS, our study shows that stress alterations are not caused by seizure severity. Future studies are needed to investigate whether stress sensitivity may be premorbid to simple FS and may contribute to simple FS incidence.
•Human studies showing a seizure–stress relationship in early childhood are lacking.•History of simple febrile seizures is associated with increased stress sensitivity.•Increased stress sensitivity is not a cause of febrile seizure severity.