I read with interest the original article entitled ‘’Prenatal
exposure to maternal infections and epilepsy in childhood: a population-
based cohort study’’ in the Pediatrics 2008; 121(5):e1100-7. Sun Y et al.
undertook a population-based cohort study analysis of 90 619 singletons
who were born between September 1997 and June 2003 in the Danish National
Birth Cohort and followed them up to December 2005. They described that
Information on maternal infections during pregnancy (cystitis,
pyelonephritis, diarrhea, coughs lasting >1 week, vaginal yeast
infection, genital herpes, venereal warts, and herpes labialis) was
prospectively reported by mothers in 2 computer-assisted telephone
interviews in early and midgestation; information on maternal cystitis and
pyelonephritis during late period of pregnancy was also collected in a
third interview after birth (1). However, causes of the patients’ coughs
were not presented. Cough is a reflex action of the respiratory tract that
is used to clear the upper airways. Chronic cough lasting for more than 8
weeks is common in the community. The causes include cigarette smoking,
exposure to cigarette smoke, and exposure to environmental pollution,
especially particulates. Diseases causing chronic cough include asthma,
eosinophilic bronchitis, gastro-oesophageal reflux disease, postnasal drip
syndrome or rhinosinusitis, chronic obstructive pulmonary disease,
pulmonary fibrosis, and bronchiectasis (2). So, I believe that all the
coughs could not be related to infectious causes and that therefore it can
not be generalized about the maternal infections due to coughs.
On the other hand, all the diarrheas could not be related to infectious
causes. However, a number of disorders may cause this condition, including
a malabsorption syndrome and various enteropathies. Information on other
infections in their study may have been based on symptoms or clinical
examinations. Sun Y et al. indicates an association between some types of
maternal infection and the risk for epilepsy in childhood.
However, Ehrenstein et al. concluded that prolonged gestation is a risk
factor for early epilepsy; the added increase in risk for instrument-
assisted and cesarean deliveries could be attributable to factors that are
related to both birth complications and epilepsy (3). On the other hand,
Cansu et al. showed an increased risk for epilepsy with a history of
atypical febrile seizure (21.97-fold), severe and moderate head injury
(27.76- and 7.09-fold respectively), CNS infection (4.76-fold), history of
epilepsy in first-, secondary third-degree relatives (6.42-, 3.09- and
2.66-fold, respectively), presence of maternal hypertension (4.31-fold),
an apgar score ≤6 at any time (7.78-fold) and neonatal jaundice
(3.12-fold). Abnormal neurological signs increased the epilepsy risk 5.92
times (4).
I think that it should be researched further risk factors in children with
epilepsy by means of laboratory investigations during pregnancy and
postnatal period.
References
1. Sun Y, Vestergaard M, Christensen J, Nahmias AJ, Olsen J. Prenatal
exposure to maternal infections and epilepsy in childhood: a population-
based cohort study. Pediatrics. 2008;121(5):e1100-7.
2. Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic
cough. Lancet. 2008;371(9621):1364-74.
3.Ehrenstein V, Pedersen L, Holsteen V, Larsen H, Rothman KJ, Sørensen HT.
Postterm delivery and risk for epilepsy in childhood. Pediatrics.
2007;119(3):e554-61.
4. Cansu A, Serdaroğlu A, Yüksel D, Doğan V, Ozkan S, Hirfanoğlu T, Senbil
N, Gücüyener K, Soysal S, Camurdan A, Gürer YK. Prevalence of some risk
factors in children with epilepsy compared to their controls. Seizure.
2007;16(4):338-44.
Conflict of Interest:
None declared
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