Keywords
Afebrile seizures - Camphor poisoning - Camphor fits - Acute symptomatic seizures
1
Introduction
Afebrile seizure in infants and toddlers warrant a thorough investigation that may
include electroencephalogram (EEG), brain imaging, and metabolic work-up. Etiology
for seizures has therapeutic and prognostic implications. We report a child who had
afebrile seizures following camphor ingestion. We suspect that camphor usage in the
community is largely unrecognized.
2
Case reports
Case 1: An 11-month-old male child was bought immediately following a generalized seizure.
There was no history of fever or trauma. Birth history and developmental milestones
were normal. Past and family history was non contributory. The child was drowsy and
had no meningeal signs or focal deficits. Soon after presentation, child vomited and
vomitus had camphoraceous odor. This intrigued us, on further enquiring parents told
they had a religious ceremony at home few hours before in which they had ignited camphor
for flame as a ritual. They further emphasized that child had mistakenly consumed
two camphor cubes. His metabolic parameters, EEG and computerized tomography head
scan were normal. Child was managed conservatively and discharged on third day.
3
Discussion
Camphor is a white crystalline substance with a characteristic, penetrating odor and
a pungent, aromatic taste.[1] Camphor was originally obtained by distillation of the bark from the camphor tree,
Cinnamomum camphora. Today, it is produced synthetically from turpentine oil. It has been used historically
as an aphrodisiac, contraceptive, abortifacient, analeptic, lactation suppressant,
cardiac and central nervous system stimulant, cold remedy, muscle and joint liniment,
and rodent repellant.[2] Camphor is rarely used as a flavoring for dessert dishes, there are recipes on internet
and in culinary textbooks which mentions adding pinch of camphor to add to the flavor
of dishes.[3]
[4] Camphor traditionally forms an important part of all religious ceremonies. In any
holy rituals camphor flame (called Aarti) is shown to deities. Camphor is active ingredient
of many over the counter products like pain relief ointments, sprays, vaporizers;
decongestants containing four to 11% camphor.[2]
Camphor intoxication can cause seizures, confusion, irritability, and neuromuscular
hyperactivity. Other adverse effects include tachycardia, urinary retention, albuminuria
and elevations of liver enzymes. The toxic dose ranges from 50 to 500 mg/kg bodyweight.[5]
[6] Topical camphor even may trigger seizure when it is applied in massive quantities
especially in infants and toddlers.[7] In extreme cases, even topical application of camphor may lead to hepatotoxicity.[8]
[9]
The exact mechanism of camphor induced seizures is not known. In fact camphor was
first used to induce seizures in human being for treatment of mania.[10] There is no specific antidote for camphor toxicity and treatment is largely supportive.
Stomach wash is of no use as it gets rapidly absorbed. Seizures in adults and children
can usually be managed with the use of benzodiazepines and/or barbiturates.
In country like India camphor is ubiquitous in every household and is easily available
across all grocery stores. One should create awareness about camphor fits and potential
toxic effects of camphor. Parents should be discouraged from topical application of
camphorated indigenous medications in neonates and toddlers. Its use in edibles should
be discouraged. It should be kept away from reach of children since it may be consumed
in mistake of sugar. Encountering a toddler with afebrile seizures primary care physician
or pediatricians should enquire about any rituals at home, use of camphor in recipes
or using camphorated indigenous medications. By the time these children reach a specialist
for work-up of these seizures, it may be too late for the parents to recollect and
confirm. This will help avoiding unnecessary evaluation of seizure and also aid for
definitive management.
