Early Seizure Recurrence in Children Admitted for Nonfebrile Seizures in the Emergency Department: A Prospective Study
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Updated: Sep 6, 2025
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Juliette Ropars1,2, Elise Sacaze1, Lydie Abalea3
1Pediatric Department, CHU de Brest, Brest, France.
Insights
Acute seizure recurrence is common in children with nonfebrile seizures, with nearly 20% experiencing recurrence within 24 hours. Younger children under 5 years old face a higher risk, necessitating observation in the emergency department (ED).
Area of Science:
- Pediatric Neurology
- Emergency Medicine
Background:
- Acute seizure recurrence in children presenting with nonfebrile seizures to the emergency department (ED) is a significant clinical concern.
- Understanding the rate, timing, and risk factors is crucial for effective ED management and patient disposition.
Purpose of the Study:
- To determine the incidence, temporal pattern, and risk factors associated with acute seizure recurrence in children admitted to the ED for nonfebrile seizures.
Main Methods:
- A multicenter prospective study involving 181 children (28 days to 15 years) presenting with nonfebrile seizures to the ED of three hospitals.
- Follow-up was conducted to evaluate acute seizure recurrence within 24 hours and analyze associations with potential risk factors.
Main Results:
- Overall, 19.9% of children experienced acute seizure recurrence.
- Half of recurrences occurred within 2 hours, and 70% within 6 hours of ED arrival.
- Children younger than 5 years and those with prior seizure recurrence in the ED had a significantly increased risk of acute recurrence.
Conclusions:
- Early seizure recurrence is frequent in pediatric nonfebrile seizures, particularly in younger children.
- The findings support the need for observation of children with nonfebrile seizures in the ED, especially the young.
- Further research with larger cohorts is recommended to identify additional risk factors and refine ED management strategies.
Objective:
This study was aimed to determine the rate, timing, and risk factors of acute recurrence of seizures in the children admitted for nonfebrile seizure in the emergency department (ED).
Methods:
This multicenter prospective study was conducted in the ED of three hospitals. All consecutive visits of children aged 28 days to 15 years who attended the ED for a nonfebrile seizure for 1 year were included in the study and prospectively followed. The rate of acute seizure recurrence within 24 hours was evaluated and association with potential risk factor was tested. Timing of seizure recurrence was assessed.
Results:
A total of 181 ED visits were enrolled. Overall, 19.9% (36/181) of children presented acute seizure recurrence, 50% of seizure recurrence occurred during the 2 hours after ED arrival and 70% within 6 hours. Multivariable analysis showed that age of <5 years and seizure recurrence in the emergency department were associated with a significant increase in acute recurrence risk.
Conclusion:
Early seizure recurrence is common in children with nonfebrile seizure, with younger children at higher risk. Based on these findings, acute recurrence risk after a nonfebrile seizure should justify to observe the children admitted for a nonfebrile seizure in the ED, especially young children. A larger study should analyze other risk factors associated with increased risk of acute seizure recurrence and help ED management.
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