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FROM THE AMERICAN ACADEMY OF PEDIATRICS:
Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures
Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures
Pediatrics 2008; 121: 1281-1286 [Abstract] [Full text] [PDF]
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[Read P3R] Febrile Seizures and Brugada Syndrome
Robert M Campbell   (20 June 2008)

Febrile Seizures and Brugada Syndrome 20 June 2008
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Robert M Campbell,
Physician
Children's Healthcare of Atlanta Sibley Heart Center

Send letter to journal:
Re: Febrile Seizures and Brugada Syndrome

campbellr{at}kidsheart.com Robert M Campbell

I read with interest the American Academy of Pediatrics Clinical Practice Guideline entitled Febrile Seizures: Clinical Practice Guidelines for the Long-term Management of the Child with Simple Febrile Seizures, Volume 121, Number 6, June 2008. As a pediatric cardiologist interested in pediatric sudden cardiac death, I think the issue of Brugada syndrome, a recently described cardiac ion channelopathy, should be raised. It is now well recognized that febrile illness may provoke syncope in children suffering from Brugada syndrome. This syncope, and the subsequent tonic- clonic seizure-like activity, results from a complex polymorphic ventricular tachycardia.

While I am not advocating that every child suffering a febrile seizure should have ECG evaluation and/or cardiac evaluation, I think it is important that pediatricians and emergency room physicians providing front-line care for children with febrile illnesses be made aware of Brugada syndrome. The role of a thorough patient and family history for sudden expected and unexplained cardiac death at a young age (<50 years of age); unexplained seizure disorder; unexplained syncope; or specifically for Brugada syndrome should be emphasized during the evaluation of these children. A worrisome family history should provoke a more thorough evaluation for possible Brugada syndrome in a child with febrile illness and seizure/syncope.

An improved awareness of this rare genetic disorder may prevent the worst case scenario of sudden cardiac death.

REFERENCES * Porres JM, Brugada J, Urbistondo V, Garcia F, Reviejo K, Marco P. Fever unmasking the Brugada syndrome. Pacing Clin Electrophysiol. 2002;25:1646- 1648. * Vincent P, Denjoy I, Neregakku Om Amirault J, Sacher F, Mansourati J, Babuty D, Villain E, et.al. Clinical aspects and prognosis of Brugada syndrome in children. Circulaton. 2007;115:2042-2048. * Antzelevitch C, Brugada R. Fever and Brugada syndrome. Pacing Clin Electrophysiol. 2002;25:1537-1539. * Kum LC, Fung JW, Sanderson JE. Brugada syndrome unmasked by febrile illness. Pacing Clin Electrophysiol. 2002;25:1660-1661.

Conflict of Interest:

None declared