Prognostic factors for subsequent epilepsy in children with febrile seizures

Abstract

SUMMARYObjective: Epilepsy following febrile seizures (FS) has been estimated between 2% and 7%. It concerns a prospective study in a large sample of children with a long-term follow-up. The aim of this study is to identify the prognostic factors that can lead children with FS to epilepsy. Methods: Children with a first episode of FS were included. We gathered information about prenatal and perinatal history, family history of FS and epilepsy in first-and second degree relatives, age at the time of the initial FS, dates of FS recurrences, focality, duration of the FS and recurrent episodes within the same febrile illness, height and duration of fever prior to the seizure, cause of the fever, and frequency of febrile illnesses. Patients were seen every 4-6 months and also at each recurrence. Key Findings: A group of 560 children with a first FS met all entry criteria. Epilepsy was recorded at 5.4%. Statistical analysis was performed between children with epilepsy and those with no afebrile seizure. We analyzed FS recurrences in accordance with the occurrence of epilepsy. From the third FS recurrence and beyond, only focality continued to have prognostic value. Significance: Main prognostic factors for the development of epilepsy after FS are: (1) complex FS that increased the risk for epilepsy 3.6 times, (2) age at onset of FS beyond the third year of life that raised the risk 3.8 times, (3) positive family history of epilepsy 7.3 times, and (4) multiple episodes of FS about 10 times. Focality at the first and the second FS recurrence increased the risk of epilepsy about 9.7 and 11.7 times, respectively. Focality was the only factor that continued to be significant in further FS recurrences. A prognostic profile of each child with FS would be very useful for the follow-up of these children.

Predictive value of paroxysmal EEG abnormalities for future epilepsy in focal febrile seizures

“…Sapir found epilepsy on follow-up in 45% patients with focal FS [11]. Clinical focality of the seizure alone has been reported to be the main prognostic factor that increases the risk of epilepsy 9.7 times at the first recurrence of FS [12]. A similar, but less striking impact of focality was also found in our study.…”

“…A similar, but less striking impact of focality was also found in our study. On the other hand, like Pavlidou [12], we found no correlation between seizures, recurring within 24 h and the development of epilepsy. The relative risk of epilepsy in patients with prolonged seizures was not substantially higher compared to the risk of the whole subgroup of patients with complex FS in our study.…”

Seizures and Epilepsy: An Overview for Neuroscientists

“…After a simple febrile seizure, the risk for epilepsy later in life is only slightly higher than for the general population, 2%. The risk of developing epilepsy after febrile seizures varies up to 9% and is greatest if the child has preexisting neurologic impairment, such as developmental delay or cerebral palsy, a family history of epilepsy, or a complicated febrile seizure ( prolonged, focal, recurrent) (Pavlidou and Panteliadis 2013). …”

Risk factors for transition of febrile convulsions to epilepsy

“…Согласно эпидемиологическим данным, ФС -наиболее частое проявление предрасположенности к эпи-лепсии в детском возрасте, у больных эпилепсией ФС в анамнезе встречаются в 15-25% случаев. У детей с ФС в анамнезе показатель трансформации ФС в эпилепсию не превышает 2-10% [1,2].…”

“…Вопрос о факторах риска пе-рехода ФС в эпилепсию наиболее актуален для родителей при определении прогноза ФС у детей. Этой проблеме по-священы работы многих авторов [1][2][3][4][5][6][7]. Ряд исследователей считают, что семейный анамнез по эпилепсии, сложный ха-рактер припадка и наличие нарушений в нервно-психиче-ском развитии в раннем возрасте -факторы, очевидно по-вышающие риск развития эпилепсии после ФС [7][8][9][10].…”