AMC Tsang, PKS Chan, LCK Low

Objective To review the clinical and laboratory features of children with neurological symptoms that occurred with rotavirus diarrhoea.

Method This is a retrospective review of 1031 children admitted to Queen Mary Hospital over a eight year period (1987-1994) who were diagnosed to suffer from rotavirus diarrhoea by demonstration of rotavirus in the stool using either electron microscopy or enzyme-linked immunosorbent assay. The clinical and laboratory features as well as the outcomes were analyzed.

Results Of 1031 children with rotavirus diarrhoea, 21 (2%) presented with generalised tonic-clonic convulsions. All were below 3 years of age, with 13 boys and 8 girls. 12 of them had one single episode of generalised convulsion of less than 15 minutes and 9 had prolonged and/or recurrent convulsions. 10 (47.6%) patients were afebrile at the time of convulsions, 5 of which had recurrent convulsions. Lumbar puncture performed in 16 patients did not reveal any abnormalities. Computerized tomography scanning of the brain performed in S patients with prolonged and recurrent seizures were normal. Electroencephalogram performed in 8 patients showed generalised bursts of slow waves discharges in 3 patients with recurrent afebrile seizures. Significant disturbance in serum electrolytes and pH was found in the patient with status epilepticus who had transient cortical blindness, but recovered fully afterwards. There was no mortality. On follow up, none developed epilepsy.

Conclusion Convulsions in a child with gastroenteritis and no or low grade fever should alert the physician to the possibility of rotavirus infection. This review suggests the relatively benign nature of rotavirus-associated convulsions.