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Febrile seizures: clinical characteristics and initial EEG
N Sofijanov1, S Emoto, M Kuturec
1National Institute of Neurological Disorders and Stroke, Bethesda, Maryland 20892.
Insights
Children with febrile seizures are more likely to have abnormal electroencephalogram (EEG) results if they are older, have had multiple seizures, or experienced focal seizures. These clinical factors predict EEG abnormality in pediatric patients.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Febrile seizures are common in children.
- Electroencephalogram (EEG) classification aids in understanding neurological conditions.
Purpose of the Study:
- To investigate the association between clinical characteristics and EEG findings in children with febrile seizures.
- To identify predictors of abnormal EEG results in this pediatric population.
Main Methods:
- Retrospective analysis of 676 children with febrile seizures.
- EEG classification based on paroxysmal abnormalities (spikes, sharp waves, spike-wave complexes).
- Logistic regression to identify leading predictors of abnormal EEGs.
Main Results:
- 22% of children had abnormal initial EEGs.
- Focal seizures, longer seizure duration, and a higher number of previous febrile seizures were associated with EEG abnormality.
- Older age at EEG and a history of previous febrile seizures showed a linear relationship with abnormal EEG likelihood.
Conclusions:
- Older age, number of previous febrile seizures, preexisting motor abnormality, and focal seizures are key predictors of abnormal initial EEGs in children with febrile seizures.
- These findings are crucial for risk stratification and management in pediatric neurology.
Abstract:
We examined the relationship between clinical characteristics and EEG classification in all children with febrile seizures examined at the University Pediatric Clinic, Skopje, Yugoslavia between 1982 and 1984. This is the only facility in Macedonia providing EEG or neurologic consultation for children. EEGs were classified as paroxysmally abnormal if they contained spikes, sharp waves, or spike-wave complexes considered abnormal for age. In all, 22% of the 676 children had an abnormal initial EEG. The most common basis for classification as abnormal was spike-wave complexes greater than 3 Hz; the next most common basis was the presence of spikes. Birth weight, gender, accompanying illness, and family history of seizures, and whether the index seizure was single or multiple were not associated with differences in rate of abnormal EEG. Clinically focal index seizures and longer duration were associated with EEG abnormality. Number of previous febrile seizures was associated with an increasing rate of EEG abnormality, from 18% in children with no previous seizures to 63% in those with four or more previous seizures. Age at EEG was linearly related to likelihood of paroxysmal EEG abnormality, both for the total cohort and for the 376 children with no previous seizures. In the total cohort, logistic regression identified leading predictors of abnormal initial EEG to be older age, number of previous febrile seizures, preexisting motor abnormality, and focal seizures. For children with a first febrile seizure, leading predictors were focal seizure, older age, and preexisting motor abnormality.