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Long-term recurrence and acute seizure clustering in children with convulsions with mild gastroenteritis: a systematic review and meta-analysis.

  • 2026-07-04
  • European journal of pediatrics 185(7)

Study Design

Type
Meta-Analysis
Sample size
n = 302
Population
children with convulsions with mild gastroenteritis (CwG)
Methods
Systematic review and meta-analysis (PRISMA 2020), searched five databases from inception to March 25, 2026, random-effects models
To evaluate acute and long-term recurrence in children with convulsions with mild gastroenteritis (CwG) and to identify candidate factors associated with long-term relapse. This PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO CRD420261348817) searched five databases from inception to March 25, 2026. Observational studies of children with CwG reporting recurrence-related outcomes were included. Random-effects models were used for all pooled analyses. Twenty-one studies (3,302 participants) were included. The primary pooled long-term relapse rate was 9.8% (95% CI 5.2%-17.7%; I2 = 88.5%); a sensitivity analysis excluding two studies with broader recurrence definitions yielded 6.1% (95% CI 4.9%-7.5%; I2 = 0.0%). Age below 18 months (OR 3.99, 95% CI 1.78-8.91; I2 = 0.0%) and family history of convulsions (OR 4.74, 95% CI 2.23-10.06; I2 = 0.0%) were each associated with long-term recurrence in exploratory pooled analyses of crude odds ratios from two studies. Acute multiple seizures occurred in 57.2% of children (95% CI 47.0%-66.9%; I2 = 86.5%); children with multiple seizures were younger (mean difference - 3.41 months, 95% CI - 6.06 to - 0.75) and had lower serum sodium (- 1.30 mmol/L, 95% CI - 2.42 to - 0.17) than those with a single seizure.

Conclusion

Long-term relapse occurred in approximately 6%-10% of children with CwG, depending on the recurrence definition (9.8% primary estimate; 6.1% sensitivity estimate). Age below 18 months and family history were each associated with relapse in exploratory two-study analyses; given crude, unadjusted estimates and very low certainty, these should be regarded as hypothesis-generating candidate factors rather than validated predictors.

What is known

• CwG generally has a favourable neurological prognosis, but recurrence remains a concern for clinicians and families. • Acute seizure clustering and later relapse are distinct outcomes, yet previous studies often analysed them together.

What is new

• Long-term relapse was uncommon but not negligible, whereas acute clustering was common during the index illness. • Younger age, family history, and lower serum sodium were hypothesis-generating candidate factors requiring prospective validation.

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