Authors' reply

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7066.1205b (Published 09 November 1996) Cite this as: BMJ 1996;313:1205
  1. Alfredo Pisacane,
  2. Renato Sansone,
  3. Nicola Impagliazzo,
  4. Angelo Coppola,
  5. Paolo Rolando,
  6. Alfonso D'Apuzzo,
  7. Ciro Tregrossi
  1. Senior lecturer Postgraduate trainee Postgraduate trainee Postgraduate trainee Dipartmento di Pediatria, Universita Degli Studi di Napoli Federico II, 5–80131 Naples, Italy
  2. Paediatric consultant Paediatrician Paediatrician Divisione di Pediatria, Ospedale di Castellammare di Stabia, Naples

    EDITOR,—The suggestion that potential confounders such as lead poisoning and coeliac disease might be responsible for the association that we reported between iron deficiency anaemia and febrile convulsions is important. Because of the characteristics of our study, however, no data are available from the clinical records that might indicate whether lead poisoning or coeliac disease was present in some of the cases.

    Nevertheless, even though iron deficiency anaemia has been associated with both these conditions, febrile convulsions have not. Seizures without fever can occur as a clinical manifestation of lead encephalopathy and of coeliac disease in association with cerebral calcification. However, children with febrile seizures are usually children who are well before and after the fit, and afebrile convulsions are uncommon among them.

    We are now studying prospectively a large group of children admitted with their first febrile seizure to some hospitals in greater Naples. All of them had a good nutritional status both at the time of the seizure and one year later, with no clinical signs of lead poisoning or coeliac disease. Moreover, when only those children with a haemoglobin concentration of>110 g/l were considered, iron deficiency was considerably more common among cases than controls. That could mean that iron deficiency rather than anaemia is associated with febrile seizures. Obviously, the points raised in the letters about our report need attention, and no claim of causation should be made before more studies have been carried out.

    Finally, we regret that the reason for the exclusion of 10 cases (the fact that no haematological data were available from the clinical records) did not appear in the final manuscript.

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