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Risk factors of epilepsy in children with complex febrile seizures: A retrospective cohort study
Piyatida Jongruk1, Natrujee Wiwattanadittakul2, Kamornwan Katanyuwong2
1Pediatric Department, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand.
Insights
Children with complex febrile seizures face higher epilepsy risks. Key risk factors include prolonged seizures, developmental delay, EEG abnormalities, and abnormal neuroimaging, necessitating close monitoring.
Area of Science:
- Pediatric Neurology
- Epileptology
- Childhood Seizure Disorders
Background:
- Febrile seizures are common in children, with complex febrile seizures posing a greater risk for subsequent epilepsy.
- Previous research on risk factors for epilepsy following complex febrile seizures yielded inconsistent results.
- Identifying specific risk factors is crucial for early intervention and improved outcomes in affected children.
Purpose of the Study:
- To identify significant risk factors for the development of epilepsy in children diagnosed with complex febrile seizures.
- To provide a clearer understanding of predictors for epilepsy in this pediatric population.
- To inform clinical practice regarding the monitoring and management of children with complex febrile seizures.
Main Methods:
- A cohort of 248 children aged 3-72 months with complex febrile seizures was studied.
- Data collected included demographics, seizure characteristics, electroencephalogram (EEG) findings, and neuroimaging results.
- Cox regression-survival analysis was employed to assess risk factors for subsequent epilepsy.
Main Results:
- 22.1% of children developed epilepsy. Significant risk factors identified were prolonged seizures (>15 min), developmental delay, epileptiform discharges on EEG, and abnormal neuroimaging (CT/MRI).
- Factors such as age at onset, fever characteristics, seizure recurrence within 24 hours, focal seizures, abnormal neurological exams, and family history did not show a significant association with epilepsy development in this cohort.
- Prolonged seizures (HR: 2.475) and developmental delay (HR: 4.476) were notably strong predictors of subsequent epilepsy.
Conclusions:
- Prolonged seizures (or febrile status epilepticus), developmental delay, EEG epileptiform discharges, and abnormal neuroimaging are key risk factors for epilepsy in children with complex febrile seizures.
- The presence of these identified risk factors warrants close clinical attention and monitoring.
- This study contributes to a better understanding of epilepsy development following complex febrile seizures, aiding in risk stratification and management.
Background:
Febrile seizures are the most common seizures in children. Children with complex febrile seizures have a higher risk of subsequent epilepsy compared with children with simple febrile seizures. Multiple risks factors for epilepsy, including focal status epilepticus, family history of epilepsy, neurodevelopmental abnormalities and abnormal electroencephalogram findings, have been found with inconsistent results. The aim of this study is to identify risk factors for developing epilepsy in children with complex febrile seizures.
Methods:
The study included 248 children aged 3-72-months, diagnosed with complex febrile seizures at Chiang Mai University Hospital. Demographic data, seizure characteristics, electroencephalogram and neuroimaging findings were identified, and assessed to establish whether they were risk factors for subsequent epilepsy.
Results:
Fifty-five patients (22.1%) had subsequent epilepsy. Using Cox regression-survival analysis, factors associated with epilepsy were prolonged seizures >15 min (P = 0.006; Hazard Ratio (HR): 2.475; 95% Confidence Interval (CI): 1.294-4.735), developmental delay (P = 0.019; HR: 4.476; 95% CI: 2.280-15.646), epileptiform discharges on electroencephalogram (P = 0.023; HR: 1.391; 95%CI: 1.174-1.876), and abnormal neuroimaging (computed tomography or magnetic resonance imaging; P = 0.028; HR: 1.355; 95% CI: 1.034-1.776). Age at onset, peak febrile temperature, duration between the onset of fever and the occurrence of seizure, recurrent seizures within 24 h, focal seizures, abnormal neurological exams and family history of febrile seizure or epilepsy were not associated with increased risk of subsequent epilepsy in this study.
Conclusions:
Risk factors associated with increased risk of epilepsy in children with complex febrile seizures are prolonged seizures or febrile status epilepticus, developmental delay, electroencephalogram epileptiform discharges, and abnormal neuroimaging. Their presence would merit close clinical monitoring.
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