Five patients with a history of seizures in the first year of life, occurring within 24 hours of DPT vaccination, were subsequently tested positive for SCN1A, and with support of genetic testing were diagnosed with Dravet syndrome, in a report from San Antonio Military Medical Center; Northwestern University School of Medicine, Children's Memorial Epilepsy Center, Chicago; Baylor College of Medicine, and Texas Children's Hospital, Houston, TX. Recurrent seizures in the first year of life were febrile and afebrile, generalized and unilateral, and often prolonged. After 1 year, seizures were often partial, myoclonic, and atypical absence. They were intractable to medication. Later, patients were often developmentally delayed, cognitively impaired and sometimes autistic. MRI was negative. The case report is intended to raise awareness of Dravet syndrome and aid in the early recognition and diagnosis. [1]

COMMENT. Dravet syndrome is a rare genetic epileptic encephalopathy, recognized by ILAE as severe myoclonic epilepsy of infancy, and associated with mutations in SCN1A gene (neuronal sodium channel). Seizure onset is in the first year of life, and is often provoked by fevers. In the above cases, the close temporal relation of the pertussis vaccination to the first seizure may indicate a triggering effect [2]. Fever alone is an unlikely precipitating factor, since the first seizure was afebrile in 2 of the 5 patients. Patients with seizures that have a close temporal relation to vaccination and are followed by frequent recurrences should be tested for SCN1A mutation. Mutations in the SCN1A gene are found in up to 80% of cases of Dravet syndrome. [3]