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Prognostic factors for subsequent epilepsy in children with febrile seizures
Efterpi Pavlidou1, Christos Panteliadis
1Pediatric Neurology Department, A.H.E.P.A Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Epilepsy can develop in children after febrile seizures (FS), with risk factors including complex FS, later onset, family history, and multiple episodes. Focality is a key predictor, especially with recurrent FS.
Area of Science:
- Pediatrics
- Neurology
- Epileptology
Background:
- Febrile seizures (FS) affect a significant number of children.
- Epilepsy developing after FS is a concern, with prior estimates ranging from 2% to 7%.
Purpose of the Study:
- To prospectively identify prognostic factors for epilepsy development in children with a history of FS.
- To establish a predictive profile for long-term epilepsy risk following febrile seizures.
Main Methods:
- A prospective study followed a large cohort of children experiencing their first FS.
- Data collected included family history, FS characteristics (age of onset, complexity, focality, recurrence), and fever details.
- Children were monitored regularly and at each FS recurrence.
Main Results:
- Epilepsy was diagnosed in 5.4% of the 560 children with a first FS.
- Key risk factors identified included complex FS (3.6x risk), FS onset after age 3 (3.8x risk), positive family history of epilepsy (7.3x risk), and multiple FS episodes (10x risk).
- Focality during the first and second FS recurrences significantly increased epilepsy risk (9.7x and 11.7x, respectively), and remained the sole significant factor for further recurrences.
Conclusions:
- Complex FS, later age of onset, family history, and multiple FS episodes are significant predictors of epilepsy.
- Focality is a critical prognostic indicator, particularly with recurrent FS, and remains significant long-term.
- Developing a prognostic profile for children with FS is crucial for targeted follow-up and management.
Objective:
Epilepsy following febrile seizures (FS) has been estimated between 2% and 7%. It concerns a prospective study in a large sample of children with a long-term follow-up. The aim of this study is to identify the prognostic factors that can lead children with FS to epilepsy.
Methods:
Children with a first episode of FS were included. We gathered information about prenatal and perinatal history, family history of FS and epilepsy in first- and second degree relatives, age at the time of the initial FS, dates of FS recurrences, focality, duration of the FS and recurrent episodes within the same febrile illness, height and duration of fever prior to the seizure, cause of the fever, and frequency of febrile illnesses. Patients were seen every 4-6 months and also at each recurrence.
Key Findings:
A group of 560 children with a first FS met all entry criteria. Epilepsy was recorded at 5.4%. Statistical analysis was performed between children with epilepsy and those with no afebrile seizure. We analyzed FS recurrences in accordance with the occurrence of epilepsy. From the third FS recurrence and beyond, only focality continued to have prognostic value.
Significance:
Main prognostic factors for the development of epilepsy after FS are: (1) complex FS that increased the risk for epilepsy 3.6 times, (2) age at onset of FS beyond the third year of life that raised the risk 3.8 times, (3) positive family history of epilepsy 7.3 times, and (4) multiple episodes of FS about 10 times. Focality at the first and the second FS recurrence increased the risk of epilepsy about 9.7 and 11.7 times, respectively. Focality was the only factor that continued to be significant in further FS recurrences. A prognostic profile of each child with FS would be very useful for the follow-up of these children.
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