Long-term recurrence and acute seizure clustering in children with convulsions with mild gastroenteritis: a systematic review and meta-analysis.

Authors

Ling Zou, Feng Li, Hongyu Li, Zhihong Su

Published in

European journal of pediatrics. Volume 185. Issue 7. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

To evaluate acute and long-term recurrence in children with convulsions with mild gastroenteritis (CwG) and to identify candidate factors associated with long-term relapse. This PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO CRD420261348817) searched five databases from inception to March 25, 2026. Observational studies of children with CwG reporting recurrence-related outcomes were included. Random-effects models were used for all pooled analyses. Twenty-one studies (3,302 participants) were included. The primary pooled long-term relapse rate was 9.8% (95% CI 5.2%-17.7%; I2 = 88.5%); a sensitivity analysis excluding two studies with broader recurrence definitions yielded 6.1% (95% CI 4.9%-7.5%; I2 = 0.0%). Age below 18 months (OR 3.99, 95% CI 1.78-8.91; I2 = 0.0%) and family history of convulsions (OR 4.74, 95% CI 2.23-10.06; I2 = 0.0%) were each associated with long-term recurrence in exploratory pooled analyses of crude odds ratios from two studies. Acute multiple seizures occurred in 57.2% of children (95% CI 47.0%-66.9%; I2 = 86.5%); children with multiple seizures were younger (mean difference - 3.41 months, 95% CI - 6.06 to - 0.75) and had lower serum sodium (- 1.30 mmol/L, 95% CI - 2.42 to - 0.17) than those with a single seizure.
Long-term relapse occurred in approximately 6%-10% of children with CwG, depending on the recurrence definition (9.8% primary estimate; 6.1% sensitivity estimate). Age below 18 months and family history were each associated with relapse in exploratory two-study analyses; given crude, unadjusted estimates and very low certainty, these should be regarded as hypothesis-generating candidate factors rather than validated predictors.
• CwG generally has a favourable neurological prognosis, but recurrence remains a concern for clinicians and families. • Acute seizure clustering and later relapse are distinct outcomes, yet previous studies often analysed them together.
• Long-term relapse was uncommon but not negligible, whereas acute clustering was common during the index illness. • Younger age, family history, and lower serum sodium were hypothesis-generating candidate factors requiring prospective validation.

PMID:
42400644
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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