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Epilepsy and mental retardation following febrile seizures in childhood
1Department of Neurology, Southern California Permanente Medical Group, Los Angeles.
Insights
Following initial febrile seizures in children, subsequent afebrile seizures occurred in 3.5% and mental retardation in 1%. Phenobarbital did not prevent epilepsy, indicating no evidence that preventing recurrent febrile convulsions reduces afebrile seizures or intellectual disability.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Febrile seizures are common in childhood.
- Understanding long-term outcomes like afebrile seizures and mental retardation is crucial for pediatric neurology.
- Identifying risk factors for progression from febrile to afebrile seizures is important for early intervention.
Purpose of the Study:
- To determine the incidence of subsequent afebrile seizures and mental retardation after an initial febrile convulsion in an unselected pediatric group.
- To identify predictors and characteristics of children who develop afebrile seizures or mental retardation.
- To evaluate the efficacy of phenobarbital in preventing epilepsy and intellectual disability.
Main Methods:
- Prospective follow-up of an unselected cohort of children after their first febrile convulsion.
- Detailed clinical assessment including neurological examination, developmental assessment, and family history.
- Analysis of seizure types, recurrence, and long-term outcomes including epilepsy and mental retardation.
- Evaluation of phenobarbital's effect on seizure recurrence and long-term neurological outcomes.
Main Results:
- Subsequent afebrile seizures occurred in 3.5% of children, with generalized major seizures being most common.
- Mental retardation was observed in 1% of the cohort.
- Afebrile seizures typically developed within five years of the initial febrile convulsion.
- Risk factors for afebrile seizures included neonatal abnormalities, family history of mental retardation, focal initial febrile convulsions, and pre-existing psychomotor delay.
- Phenobarbital significantly reduced recurrent febrile seizures but did not decrease the incidence of epilepsy or mental retardation.
- Children with mental retardation often had prior psychomotor delays and shorter seizure durations.
Conclusions:
- The incidence of afebrile seizures and mental retardation following an initial febrile convulsion is relatively low.
- Certain clinical factors predict the development of afebrile seizures.
- Daily phenobarbital administration is ineffective in preventing the development of epilepsy or mental retardation, despite reducing febrile seizure recurrence.
- Current evidence does not support the routine use of phenobarbital for preventing long-term neurological sequelae of febrile seizures.
Abstract:
In an unselected group of children who were seen following an initial febrile convulsion, the frequency of subsequent afebrile seizures was 3.5% and of mental retardation 1%. The most common afebrile seizure type was generalized major (86%). About 3/4 of the children who developed afebrile seizures did so by three years and all by five years following the initial febrile seizure. The children with afebrile seizures differed from those without afebrile seizures in the frequency of neonatal abnormality, family history of mental retardation, focal initial febrile convulsions, and delay in psychomotor milestones before the initial febrile seizure. Only about 1/3 of the children who developed afebrile seizures ever had a recurrent febrile convulsion and none had complex recurrent febrile seizures. Half the children with mental retardation had histories of delay in psychomotor milestones prior to the initial febrile seizure, and no child with mental retardation had any seizure longer than five minutes. The administration of daily phenobarbital did not reduce the frequency of epilepsy, in spite of a significant reduction in the incidence of recurrent febrile seizures. There remains no evidence that the prevention of recurrent febrile convulsions significantly decreases the frequency of afebrile seizures or mental retardation.