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Predictors of recurrent febrile seizures. A prospective cohort study
A T Berg1, S Shinnar, A S Darefsky
1Department of Biological Sciences, Northern Illinois University, DeKalb, USA.
Insights
Recurrent febrile seizures are common in children. Key predictors like age at onset and family history help identify children at high risk for recurrence after a first febrile seizure.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pediatrics
Background:
- Febrile seizures are common in childhood, affecting approximately 2-5% of children.
- Understanding recurrence risk is crucial for clinical management and parental counseling.
Purpose of the Study:
- To determine the incidence of single and multiple recurrent febrile seizures.
- To identify predictors for febrile seizure recurrence.
Main Methods:
- Prospective cohort study of 428 children experiencing their first febrile seizure.
- Follow-up for at least 2 years with parental interviews and medical record review.
Main Results:
- 31.8% of children experienced recurrent febrile seizures.
- Predictors for recurrence included young age at onset, family history of febrile seizures, low fever in the ED, and short delay between fever onset and seizure.
- A predictive model using these factors stratified risk effectively.
Conclusions:
- Recurrences of febrile seizures are frequent in children.
- A combination of four key factors can effectively predict the risk of recurrence after an initial febrile seizure.
Objectives:
To define the risk and identify predictors of single and multiple recurrent febrile seizures.
Methods:
Children (n = 428) with first febrile seizures were prospectively identified and followed for 2 or more years. Parents were interviewed soon after their children's first febrile seizure and were called every 3 months to ascertain recurrent febrile seizures. Medical records of first and recurrent seizures were reviewed for additional information.
Results:
A total of 136 children (31.8%) experienced recurrent seizures: 73 (17.1%) had only 1 recurrence, 38 (8.9%) had 2 recurrences, and 25 (5.8%) had 3 or more recurrences. Young age at onset, a history of febrile seizures in a first-degree relative, low degree of fever while in the emergency department, and a brief duration between the onset of fever and the initial seizure were strong independent predictors of recurrent febrile seizures. With these 4 factors combined, it is possible to define groups of children having very high and very low probabilities of having any recurrences (> 70% vs < 20%), having 2 or more recurrences (> 60% vs < 10%), and having 3 or more recurrence (12% vs about 0%). In children who had at least 1 recurrence, age at the time of the first recurrence and a family history of epilepsy were predictors of subsequent recurrences.
Conclusions:
In children who have had a first febrile seizure, recurrences are common. The risk for 1 or more recurrences can be meaningfully predicted at the time of the initial febrile seizure with a combination of the 4 factors identified in this study.