Étiologies des Convulsions Fébriles Chez l’Enfant de Un à 59 Mois dans le Service des Urgences Pédiatriques du CHU Gabriel Toure

RESUME Introduction. Les convulsions febriles constituent le probleme neurologique le plus frequent de la pediatrie. Au Mali, les donnees epidemiologiques sur les types et la frequence des convulsions febriles sont insuffisantes Objectif. Le but de notre travail etait d’etudier les etiologies des convulsions febriles chez les enfants de 1 a 59 mois dans le service des urgences pediatriques du CHU-Gabriel Toure. Materiels et Methodes. Il s’agit d’une etude transversale prospective, descriptive qui s’est deroulee dans le service des urgences pediatriques du CHU-Gabriel Toure de janvier a decembre 2014 (soit 12 mois). Nous avons realise un echantillonnage exhaustif de tous les enfants âges de 1 mois a 59 mois admis pour convulsion febrile reconnue par l’interrogatoire et/ou par l’examen physique. Resultats. Pendant la periode de l’etude, 266 cas de convulsions febriles ont ete recenses et 1854 patients ont ete hospitalises soit une frequence de 14,34 %. Les enfants de 12 a 59 mois etaient les plus representes (75.6%). Le sex ratio garcons-filles etait de 1,31. Les manifestations cliniques dominantes etaient les convulsions tonico-cloniques (64.7%), les convulsions toniques (20.3%) et les convulsions cloniques (15%). Selon leur nature, les convulsions etaient complexes dans 65.8% des cas et simples dans 34.2%. Les etiologies des convulsions etaient dominees par le neuropaludisme (69.9%), la meningite bacterienne (14.7%) ; les convulsions hyperpyretiques (9%.). Les anticonvulsivants les plus utilises ont ete le diazepam, le phenobarbital, et l’association diazepam+phenobarbital. Nous avons enregistre 56.1% de guerison sans sequelles et 41.6% de deces. Le neuropaludisme et la meningite ont ete les affections les plus letales. Conclusion. Les convulsions febriles sont un motif frequent de consultation et d’hospitalisation chez les enfants de moins de 5 ans a Bamako. Les crises generalisees sont les plus frequentes. Les etiologies sont dominees par le neuropaludisme, les convulsions hyper pyretiques et les meningites. La letalite encore elevee doit etre reduite par l’amelioration de la prevention et de la prise en charge des pathologies infectieuses. ABSTRACT Introduction. Febrile seizures are the most common neurological problem in pediatrics in Mali. Epidemiological data on the types and frequency of febrile seizures are lacking. Objectives. The purpose of our study was to describe the etiologies of febrile seizures in children aged 1 to 59 months in the pediatric emergency department of Gabriel Toure. Materials and Methods. This was a prospective, cross sectional descriptive study that took place in the pediatric emergency department of Gabriel Toure from January 2014 to December 2014. We conducted an exhaustive sampling of all children from 1 month to 59 months admitted for febrile seizure recognized by the interrogation and / or physical examination. Results: During our study period, 266 cases of febrile seizures were identified and 1854 patients were hospitalized, representing a frequency of 14.34% of our hospitalizations. Children from 12 months to 59 months were the most represented (75.6%). The sex ratio was 1.31. The dominant clinical manifestations were tonic-clonic convulsions (64.7%), tonic convulsions (20.3%) and clonic convulsions (15%). According to their nature, convulsions were complex in 65.8% of cases and simple in 34.2%. Etiologies of seizures were varied and dominated by neurological malaria (69.9%), bacterial meningitis (14.7%); hyperpyretic convulsions (9%). The most widely used anticonvulsants were diazepam, phenobarbital, and the combination of diazepam + phenobarbital. We recorded 56.1% of healing without sequelae and 41.6% of deaths during our series. Neurological malaria and meningitis were the most lethal conditions. Conclusion. Febrile seizures are frequent in pediatric emergency departments of Mali. Generalized tonic-clonic convulsions are the commonest presentation. The main etiologies are neurological malaria, bacterial meningitis and hyper pyretic convulsions. The high lethality of this disease could be reduced by amelioration in the prevention and management of pediatric infectious diseases.