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Risk factors for febrile status epilepticus: a case-control study
Dale C Hesdorffer1, Shlomo Shinnar, Darrell V Lewis
1Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, NY.
Insights
Identifying risk factors for first febrile status epilepticus (FSE) in children with febrile seizures (FS) is crucial. Younger age, lower temperature, and longer fever duration are key predictors of FSE development.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pediatrics
Background:
- Febrile seizures (FS) are common in children.
- Febrile status epilepticus (FSE) is a prolonged form of FS with potential for adverse outcomes.
- Identifying risk factors for FSE is essential for early intervention and prevention.
Purpose of the Study:
- To determine the risk factors associated with the development of a first febrile status epilepticus (FSE) in children who experience a first febrile seizure (FS).
Main Methods:
- A case-control study design was employed, comparing children with a first FSE to those with simple FS and complex FS not FSE.
- Data were collected from the Consequences of Prolonged Febrile Seizures in Childhood and Columbia cohorts using identical questionnaires.
- Risk factors were analyzed using logistic regression, with consistent MRI protocols and seizure phenomenology assessments.
Main Results:
- FSE was associated with younger age, lower temperature, and longer duration of recognized fever before the seizure compared to simple FS.
- Female sex, structural temporal lobe abnormalities, and a family history of FS were also linked to FSE.
- Compared to other complex FS, FSE showed associations with low temperature and prolonged fever recognition, with younger age being significant.
Conclusions:
- FSE in children appears to result from a lower seizure threshold (younger age, lower temperature) and impaired seizure duration regulation.
- Clinicians should recognize these risk factors, as FSE episodes can be missed.
- Further research is needed to develop preventative strategies for FSE.
Objective:
To identify risk factors for developing a first febrile status epilepticus (FSE) among children with a first febrile seizure (FS).
Study Design:
Cases were children with a first FS that was FSE drawn from the Consequences of Prolonged Febrile Seizures in Childhood and Columbia cohorts. Controls were children with a first simple FS and separately, children with a first complex FS that was not FSE. Identical questionnaires were administered to family members of the 3 cohorts. Magnetic resonance imaging protocol and readings were consistent across cohorts, and seizure phenomenology was assessed by the same physicians. Risk factors were analyzed using logistic regression.
Results:
Compared with children with simple FS, FSE was associated with younger age, lower temperature, longer duration (1-24 hours) of recognized temperature before FS, female sex, structural temporal lobe abnormalities, and first-degree family history of FS. Compared with children with other complex FS, FSE was associated with low temperature and longer duration (1-24 hours) of temperature recognition before FS. Risk factors for complex FS that was not FSE were similar in magnitude to those for FSE but only younger age was significant.
Conclusions:
Among children with a first FS, FSE appears to be due to a combination of lower seizure threshold (younger age and lower temperatures) and impaired regulation of seizure duration. Clinicians evaluating FS should be aware of these factors as many episodes of FSE go unnoticed. Further work is needed to develop strategies to prevent FSE.
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