Researchers at Seattle Children’s Research Institute and University of Washington report a prospective longitudinal study of children who presented with a first-time seizure associated with a viral infectious illness. Of 117 children in the study, 78 (67%) had febrile seizures, 34 (29%) had non-febrile seizures, and 5 (4%) had unprovoked seizures. Acute gastroenteritis was associated with nonfebrile-illness seizures more frequently than febrile seizures (47% cf 28%, respectively, P=0.05). Children with acute gastroenteritis experienced multiple seizures within the first 24 hours significantly more often than children with febrile seizures (58% and 27%, respectively, p=0.001). None of the 38 primary seizures with acute gastrointestinal illness had focal presentation, compared with 9 (12%) of 74 seizures in the nongastrointestinal illness group (p=0.02). Children with acute gastroenteritis at first seizure, regardless of fever, had fewer seizure recurrences compared with children with other acute illnesses. Children with a first nonfebrile-illness seizure were more likely than those with a first febrile seizure to have a stool sample test positive for rotavirus (p=0.02) and for norovirus (p=0.05). EEGs in 9 children with acute gastrointestinal illness were normal in 6 and showed minor irregularities in 3. 
COMMENT. Nonfebrile illness seizures are regarded as a distinct category of provoked seizures associated with a viral infection, frequently acute gastrointestinal. The acute gastrointestinal illness nonfebrile seizure has a lower rate of seizure recurrence and few neurologic complications. The mechanism of the seizure is unclear. Fever was absent in the 24 hours before or 2 hours after the first seizure in 58% of children with gastrointestinal illness-associated seizures in the above study.