Ictal electroencephalograms (EEGs) were recorded in six patients (2 male, 4 female; ages 14 mo to 38 mo) with afebrile convulsions and mild gastroenteritis (CwG), in a study at Nagoya, Japan. None had febrile convulsions. A family history of CwG was positive in 2 patients, and the twin of one patient had a history of febrile seizures. A cluster of seizures occurred within 1 -3 days of the onset of gastroenteritis, Rotavirus antigen test in the stool was positive in 2 patients. Seizures began as partial, and clinical manifestations included loss of responsiveness, arrest of movement, cyanosis, lateral eye deviation, and hemifacial convulsion. A generalized tonic-clonic convulsion occurred in 5 patients. Ictal EEGs showed focal low amplitude fast activity, beginning in the occipital area in 3 patients, and parietal, central, or frontal in the remaining 3. The focal discharge evolved into a secondary generalized seizure. Seizures were controlled with phenobarbital, lidocaine, or carbamazepine. At follow-up (mean 39 mo, range 17-62 mo) interictal EEGs and psychomotor development were normal. [1]

COMMENT. Convulsion with mild gastroenteritis (CwG) is a frequent seizure disorder in Japan [2]. Previously described as generalized, the seizures appear to be partial with secondary generalization. CwG presents in previously healthy infants or young children aged 6 months to 3 years. Seizures are afebrile and occur in clusters in close relation to the onset of diarrhea. Laboratory results including electrolytes, glucose, and CSF are normal, ictal EEG is focal and secondary generalized, the interictal EEG is normal, and the outcome benign. In the above study, no reports of neuroimaging are included. Rotavirus was the likely cause in 2 of the 6 patients.

Usually affecting Japanese children, CwG is now known to occur outside Asia. A study of 14 children with the syndrome is reported from the UK [3]. The gastroenteritis was considered viral, and Rotavirus was detected by enzyme immunoassay in the stools of 7 of 10 patients tested. Stool culture was negative for pathogenic bacteria. CSF and computed tomography, performed on 2 patients with prolonged seizures, were negative. On long-term follow-up, none had recurrence of seizures and all had normal development. The seizure mechanism is unknown, and CNS complications are not generally described with Rotavirus infection (AAP Redbook). In the absence of fever, electrolyte and glucose abnormalities, a viral neurotropism, similar to that suggested for HHV-6 in febrile seizures (Hall CB et al, 1994; Millichap JG and JJ, 2006), might be considered.