Association between Serum Ferritin Levels and Simple Febrile Seizures in Children: A Hospital-Based Case-Control Study

Background: Febrile seizures are among the most common neurological disorders encountered during early childhood. Although simple febrile seizures are generally benign, several nutritional and haematological factors have been proposed to influence seizure susceptibility. Iron deficiency may alter neurotransmitter metabolism, neuronal energy production and brain development, potentially lowering the seizure threshold. Serum ferritin is an important indicator of body iron stores. This study evaluated the association between serum ferritin levels and simple febrile seizures in children. Methods: A prospective hospital-based case-control study was conducted in the Paediatric Intensive Care Unit of a tertiary care centre at Puducherry over a period of 18 months after approval from the Scientific Research Committee and Institutional Ethics Committee. Children aged 6 months to 5 years presenting with simple febrile seizures were included as cases, while children with febrile illness without seizures were included as controls. A total of 160 children were analysed, comprising 80 cases and 80 controls. Complete blood count, serum iron, serum ferritin and total iron-binding capacity (TIBC) were assessed. Statistical analysis was performed using SPSS version 23.0. Categorical variables were analysed using the chi-square/Fisher's exact test and continuous variables using independent t-test or Mann-Whitney U test as appropriate. Spearman's rank correlation was used for correlation analysis. A p value <0.05 was considered statistically significant. Results: The majority of children with simple febrile seizures were aged 1–3 years (52.5%). Pallor was significantly more common among cases than controls (17.5% vs 2.5%, p=0.001). Cases had significantly lower serum iron [61 (5073.75) µg/dL vs 68.50 (50.50–86.50) µg/dL, p=0.048] and serum ferritin [19.65 (12.88–28.58) ng/mL vs 36.80 (22.8351.98) ng/mL, p=0.001], whereas TIBC was significantly higher [320 (276.25–368.75) µg/dL vs 246.50 (210–286) µg/dL, p=0.001]. Haemoglobin, RBC count and MCH were significantly lower among cases, while RDW-CV and platelet count were significantly higher. Serum ferritin was significantly lower among children with pallor and was negatively correlated with TIBC and length of hospital stay. Conclusion: Children with simple febrile seizures demonstrated significantly lower serum ferritin and serum iron levels and higher TIBC compared with febrile controls. The findings support an association between depleted iron stores and simple febrile seizures. Early recognition and management of iron deficiency may have potential clinical relevance in children presenting with febrile seizures.