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Published on: August 14, 2017
Increased von Willebrand factor parameters in children with febrile seizures
Astrid Pechmann1, Sven Wellmann2, Benjamin Stoecklin2
1Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Insights
Children with febrile seizures (FS) show higher arginine vasopressin (AVP) levels, linked to increased von Willebrand factor (VWF) parameters. VWF collagen binding activity (VWF:CB) may help diagnose FS.
Area of Science:
- Pediatrics
- Hematology
- Endocrinology
Background:
- Von Willebrand factor (VWF) orchestrates blood coagulation and wound sealing.
- Arginine vasopressin (AVP) release stimulates secretion of high molecular weight VWF multimers.
- Elevated AVP levels, indicated by copeptin, were observed in children with febrile seizures (FS).
Purpose of the Study:
- To investigate the biological function of increased AVP levels in children with FS.
- To test the hypothesis that children with FS have elevated VWF parameters alongside higher AVP levels.
Main Methods:
- Prospective, cross-sectional study of children aged 6 months to 5 years.
- Inclusion criteria: fever or recent FS (within 4 hours).
- Measured serum copeptin and VWF parameters (VWF:Ag, VWF:CB, VWF multimers) in FS, febrile control, and non-febrile control groups.
Main Results:
- Significantly higher serum copeptin levels in children with FS compared to both control groups (p<0.001).
- Significantly higher VWF:CB levels in children with FS compared to both control groups (p=0.048).
- Multivariate analysis identified FS and copeptin as key determinants of VWF:CB.
Conclusions:
- Increased AVP secretion in children with FS is associated with elevated plasma VWF parameters.
- VWF:collagen binding activity (VWF:CB) may serve as an additional biomarker for diagnosing FS.
Introduction:
Primary blood coagulation and wound sealing are orchestrated by von Willebrand factor (VWF), a large multimeric glycoprotein. Upon release of arginine vasopressin (AVP), VWF containing high molecular weight multimers is secreted. By measuring copeptin, the C-terminal part of the AVP prohormone, we recently found strongly increased AVP levels in children with febrile seizures (FS) as compared to children with fever but without seizures. It is unknown if increased AVP levels in FS are of any biological function. Therefore, our a priori hypothesis was that children with FS have increased VWF parameters in parallel with higher AVP levels.
Methods:
We conducted a prospective, cross-sectional study of children aged between 6 months and 5 years. Children that presented at our emergency department with fever or a recent FS (within four hours) were evaluated to be included to the study. We measured serum copeptin and VWF parameters, including analyses of VWF:Antigen (WVF:Ag), VWF:collagen binding activity (VWF:CB) and VWF multimers in children with FS, febrile infections without seizures and additionally, in a non-febrile control group.
Results:
We included 54 children in our study, 30 with FS, 10 in the febrile control group, and 14 in the non-febrile control group. Serum copeptin levels were significantly higher in children with FS (median [IQR] 24.73 pmol/l [13.65-68.65]) compared to the febrile control group (5.66 pmol/l [4.15-8.07], p = 0.002) and the non-febrile control group (4.78 pmol/l [3.33-5.3], p<0.001). VWF:CB levels were also significantly higher in children with FS (VWF:CB 2.29 U/ml [1.88-2.97]) as compared to the febrile (VWF:CB 1.41 U/ml [1.27-1.93], p = 0.048) and the non-febrile control group (VWF:CB 1.15 U/ml [0.98-1.21], p<0.001). VWF:Ag tended to be higher in children with FS compared to both control groups. Multivariate regression analysis revealed FS and copeptin as major determinants of VWF:CB.
Conclusions:
Our results suggest that increased secretion of AVP in children with FS is associated with higher plasma levels of VWF parameters. Especially VWF:CB may serve as additional biomarker in the diagnosis of FS.
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