Effects of Febrile and Afebrile Seizures on Oxidant State in Children Saadet Akarsu, MD*, Seval Yilmaz, DVM † , Sema Ozan, DVM † , Abdullah Kurt, MD*, Fulya Benzer, PhD † , and M. Kaya Gurgoze, MD* No comparative studies have addressed the oxidant and antioxidant states of blood and cerebrospinal fluid. To reveal this differential state, the study was designed to identify the seizure type with the worse prognosis by determining erythrocyte arginase and erythrocyte catalase, plasma and cerebrospinal fluid malondialdehyde, and plasma and cerebrospinal fluid nitric oxide levels. Study groups were classified as febrile (group 1, n  21), afebrile (group 2, n  21), and control (group 3, n  41, subdivided as 3a, febris positive, convulsion negative, and 3b, febris negative, convulsion negative). Levels of erythrocyte arginase, erythrocyte catalase, plasma malondialde- hyde, cerebrospinal fluid malondialdehyde, plasma nitric oxide, and cerebrospinal fluid nitric oxide levels were determined for all groups. A difference was detected between the control and febrile seizure groups with respect to erythrocyte catalase and plasma and cerebrospinal fluid levels of nitric oxide (P < 0.05). Both febrile states and convulsions influence oxidative mechanism. Oxidative stress- generating potential differs for febrile and afebrile seizures. In afebrile seizures, greater levels of oxida- tive stress might affect prognosis adversely. This phenomenon can be interpreted in terms of fever as a protective factor against possible neurological damage during convulsive seizures. © 2007 by Elsevier Inc. All rights reserved. Akarsu S, Yilmaz S, Ozan S, Kurt A, Benzer F, Gurgoze MK. Effects of febrile and afebrile seizures on oxidant state in children. Pediatr Neurol 2007;36: 307-311. Introduction Neuronal trauma in diseases of the central nervous system is due to inflammatory and oxidative mechanisms, together with direct toxicity of bacterial components [1]. Reactive oxidant species generated during inflammatory processes cause endothelial cell damage [2]. Reactive oxidant species and lipid peroxidation play a role in destructive mechanism in acute and chronic cerebral diseases [3]. Seizures trigger a variety of biochemical processes, includ- ing an influx of extracellular calcium, activation of mem- brane phospholipases, and liberation of free fatty acids, diacylglycerols, eicosanoids, lipid peroxides, and free radi- cals. These lipid metabolites, along with abnormal ion ho- meostasis, may be involved in cell injury and cell death [4]. Studies pertaining to the effects of increments in body temperature on oxidative stress have been conducted. Levels of malondialdehyde, which has protective effects on heat- induced oxidative stress, were found to be elevated. Heat stress increases not only activities of reactive oxidant species, but also levels of protein-degrading enzymes [5]. There are no comparative study data available related to oxidant and antioxidant states of blood and cerebrovascu- lar fluid. The present study was designed to reveal this differential state and to identify the seizure type with the worse prognosis by determining levels of erythrocyte arginase and erythrocyte catalase, plasma and cerebrospi- nal fluid malondialdehyde, and plasma and cerebrospinal fluid nitric oxide. Patients and Methods Febrile convulsions (seizures) are defined as “medical conditions associated with fever generally seen in infants aged between 3 months and 5 years, without any possible etiology for convulsions or presence of intracranial infections” [6]. Cases conforming with this definition con- stitute febrile convulsive disorders. The afebrile seizure group consisted From the *Department of Pediatrics, Faculty of Medicine, and the † Department of Biochemistry, Faculty of Veterinary Medicine, Fırat University, Elazig, Turkey. Communications should be addressed to: Dr. Akarsu; Fırat U ¨ niversitesi; Fırat Tıp Merkezi; 23119 Elazig; Turkey. E-mail: aksaadet@yahoo.com Received August 14, 2006; accepted January 15, 2007. 307 © 2007 by Elsevier Inc. All rights reserved. Akarsu et al: Seizures and Oxidant State doi:10.1016/j.pediatrneurol.2007.01.010 ● 0887-8994/07/$—see front matter