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[The clinical study of the first febrile convulsion in children with brain-damage]
1Division of Pediatrics, Johoku Branch Hospital, Tokyo Metropolitan Kita Medical Rehabilitation Center for the Handicapped, Tokyo.
Insights
Children with neurological disorders experiencing febrile convulsions have a 39% risk of developing epilepsy. Early EEG findings and anticonvulsant drugs did not prevent epilepsy, but pre-existing neurological issues indicated higher risk.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Context:
- Febrile convulsions are common in children.
- Understanding long-term epilepsy risk after febrile convulsions is crucial for patient management.
Purpose:
- To investigate the incidence and predictors of epilepsy following febrile convulsions in children with pre-existing neurological disorders.
- To evaluate the efficacy of EEG and anticonvulsant medications in preventing epilepsy.
Summary:
- This study followed 49 children with neurological disorders after febrile convulsions for a mean of 6.8 years.
- Epilepsy developed in 39% of patients, with 80% occurring within 2 years.
- Pre-existing neurological abnormalities were identified as a significant risk factor for epilepsy.
- Electroencephalogram (EEG) findings before or after the initial febrile convulsion, including in children under three, did not predict subsequent epilepsy.
- Anticonvulsant drug administration showed no definitive preventive effect on epilepsy development.
- Medical therapy is recommended once epilepsy is established, as prophylactic measures are unclear.
Impact:
- Identifies pre-existing neurological abnormality as a key risk factor for epilepsy post-febrile convulsion.
- Highlights the limited predictive value of early EEG in this population.
- Suggests that treatment for epilepsy should commence after its development rather than prophylactically.
- Indicates that children with neurological disorders and epilepsy can have a good prognosis, even with severe brain damage.
Abstract:
Forty-nine patients with cerebral palsy, mental retardation, or other congenital neurological disorders who had experienced febrile convulsions and had no previous nonfebrile seizures were presented. They were followed for 1.6 years to 15 years (mean: 6.8 years) after the initial febrile convulsion. The incidence of subsequent epilepsy (two or more afebrile seizures) was 39%, and 80% of them developed epilepsy within 2 years after the first febrile convulsion. The paroxysmal discharges on EEG recorded prior to or after the first febrile convulsion did not predict the occurrence of later epilepsy. Also under 3 years of age, EEG findings led to the same result. There was no definite evidence that administration of anticonvulsive drugs prevented later epilepsy. Pre-existing neurological abnormality was identified as a risk factor for epilepsy, and was an indication of persistent medication. There is no clear prophylactic procedure against long-lasting attacks. Accordingly, medical therapy can be started when epilepsy has developed. Patients with very severe brain damage who could not move except lying comprised only 6% of all cases, and 69% of the epilepsy patients were well controlled. They showed a good prognosis as compared with children with brain-damage in general with epilepsy.