Iron deficiency, febrile seizures and brain development.

Iron deficiency anemia is one of the most prevalent micronutrient deficiencies in young children in India and other parts of the world, and it is strongly associated with persistent cognitive and motor delays even after the anemia and iron deficit have been repaired. Madan, et al. [1] reported recently that children aged 6-23 months with moderate to severe iron deficiency anemia had lower mental and psychomotor scores that persisted to as long as 19 years of age. These children also had lower scholastic achievement and needed more special education assistance than iron sufficient children. These impairments may be related to several effects of iron deficiency in the developing brain including altered development of neurons in the hippocampus that encodes memories, impaired energy metabolism, delayed maturation of myelin, and slowed visual and auditory evoked potentials [2]. Iron deficiency has also been associated with alterations in synaptic neurotransmitter systems including norepinephrine, dopamine, serotonin, glutamate and gamma-aminobutyric acid (GABA). In addition, a paper by Kumari, et al. [3] in this issue of Indian Pediatrics provides evidence that iron deficiency is also a risk factor for febrile seizures in children 6 months to three years of age. This carefully done case-control study with a large sample size showed a highly significant association between iron deficiency and febrile seizures. As expected, a family history of febrile seizures or epilepsy in first degree relatives was also linked to the occurrence of febrile seizures in these children. The findings are consistent with another recent case-control study from Kenya of children 3-156 months of age, which reported that iron deficiency is a risk factor for simple febrile seizures but not for other types of acute seizures [4]. An important practical lesson from this study is that preventing iron deficiency may be an effective way to reduce the incidence of febrile seizures.