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Short-term outcomes of children with febrile status epilepticus
S Shinnar1, J M Pellock, A T Berg
1Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY 10467, USA.
Insights
Febrile status epilepticus (SE) in children has low short-term risks. Children with febrile SE were more likely to have neurological abnormalities and a family history of epilepsy compared to those with simple febrile seizures.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pediatrics
Background:
- Febrile status epilepticus (SE) is the most severe form of febrile seizures.
- Understanding the characteristics and outcomes of febrile SE is crucial for managing febrile seizures.
- Previous studies have not fully elucidated the specific risk factors and short-term sequelae associated with febrile SE.
Purpose of the Study:
- To compare the clinical characteristics and short-term outcomes of children with febrile SE to those with first-time simple febrile seizures.
- To identify potential risk factors associated with febrile SE.
- To assess the short-term morbidity and mortality of febrile SE.
Main Methods:
- Prospective identification of 180 children (1 month-10 years) with febrile SE over 10 years in Bronx, NY, and Richmond, VA.
- Comparison with 244 children with their first febrile seizure (non-SE) from a Bronx-based prospective study.
- Data collection included age, seizure duration, focal features, neurological status, and family history.
Main Results:
- The mean age for febrile SE and comparison groups was similar (1.92 vs. 1.85 years).
- Prolonged SE durations were observed: 30-59 min (58%), 60-119 min (24%), and ≥120 min (18%).
- Children with febrile SE showed higher rates of neurological abnormality (20% vs. 5%), neonatal seizure history (3% vs. 0%), and family history of epilepsy (11% vs. 5%), but lower family history of febrile seizures (15% vs. 27%).
Conclusions:
- Short-term morbidity and mortality associated with febrile SE are low.
- Distinct clinical and historical differences exist between children experiencing febrile SE and those with simple febrile seizures.
- Further long-term follow-up is needed to understand the relationship between prolonged febrile seizures and mesial temporal sclerosis.
Abstract:
Febrile status epilepticus (SE) represents the extreme end of the complex febrile seizure spectrum. If there are significant sequelae to febrile seizures, they should be more common in this group. We have prospectively identified 180 children aged 1 month to 10 years who presented with febrile SE over a 10-year period in Bronx, New York, and Richmond, Virginia. They were compared with 244 children who presented with their first febrile seizure (not SE) in a prospective study done in the Bronx. The mean age of the children with febrile SE was 1.92 years, and of the comparison group, 1.85 years. Duration of SE was 30-59 min in 103 (58%), 60-119 min in 43 (24%), and > or =120 min in 34 (18%). Focal features were present in 64 (35%) of cases. There were no deaths and no cases of new cognitive or motor handicap. Children with febrile SE were more likely to be neurologically abnormal (20% vs. 5%; p < 0.001), to have a history of neonatal seizures (3% vs. 0; p = 0.006) and a family history of epilepsy (11% vs. 5%; p = 0.05) and less likely to have a family history of febrile seizures (15% vs. 27%; p = 0.01) than were children in the comparison group. The short-term morbidity and mortality of febrile SE are low. There are differences in the types of children who have febrile SE compared with those who experience briefer febrile seizures. Long-term follow-up of this cohort may provide insight into the relationship of prolonged febrile seizures and subsequent mesial temporal sclerosis.