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Temperature, age, and recurrence of febrile seizure
M van Stuijvenberg1, E W Steyerberg, G Derksen-Lubsen
1Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Recurrent febrile seizures in children are predicted by young age at fever onset, high temperature at fever onset, and temperature during the fever episode. Half of recurrences happen within 2 hours of fever onset.
Area of Science:
- Pediatric neurology
- Clinical research
Background:
- Febrile seizures are common in children.
- Predicting recurrence is crucial for management.
Purpose of the Study:
- To identify predictors of recurrent febrile seizures.
Main Methods:
- Retrospective analysis of data from a randomized controlled trial.
- Included 230 children at risk for febrile seizure recurrence.
- Collected data on temperature, seizure recurrence, and patient characteristics.
Main Results:
- 67 recurrences observed across 509 fever episodes.
- Predictors identified: short interval since last seizure (<6 months), younger age at fever onset, and higher temperature at fever onset.
- Recurrences within 2 hours of fever onset had lower median temperatures.
Conclusions:
- Younger age, higher fever temperature, and shorter interval between seizures increase recurrence risk.
- Half of recurrent febrile seizures occur within the first 2 hours of fever.
- Temperature during seizure is higher for later recurrences.
Objective:
Prediction of a recurrent febrile seizure during subsequent episodes of fever.
Design:
Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen syrup to prevent febrile seizure recurrences.
Setting:
Two pediatric hospitals in the Netherlands.
Patients:
A total of 230 children with an increased risk of febrile seizure recurrence.
Main Outcome Measure:
Seizure recurrence during a subsequent fever episode.
Results:
A total of 509 episodes of fever were registered with 67 recurrences; 35 (52%) recurrences within the first 2 hours after fever of onset had a lower median temperature (39.3 degrees C) than 32 (48%) after more than 2 hours of fever (40.0 degrees C, P<.001). Poisson regression analysis resulted in 3 univariably significant (P<.05) predictors of a recurrence of seizure during a subsequent episode of fever. In a multivariable model, they were corrected for their correlation: interval between the last previous seizure and fever of onset less than 6 months (relative risk= 1.3 [95% confidence interval: 0.8-2.4]), age at fever of onset (relative risk=0.7 [95% confidence interval: 0.5-1.0] per year increase) and temperature at fever of onset (relative risk = 1.7 [95% confidence interval: 1.1-2.8] per degree Celsius increase).
Conclusions:
Half of the recurrent seizures occur in the first 2 hours after fever of onset of a subsequent fever episode. If seizure recurs at a later time, the temperature at seizure is higher compared with recurrences occurring in the first 2 hours of fever. Young age at fever of onset, high temperature at fever of onset, and high temperature during the episode of fever are associated with an increased risk of a recurrent febrile seizure at the moment that a child with a history of febrile seizures has fever again.