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Multicenter Study
. 2016 Jul;57(7):1042-7.
doi: 10.1111/epi.13418. Epub 2016 Jun 6.

Risk factors for subsequent febrile seizures in the FEBSTAT study

Dale C Hesdorffer  1 , Shlomo Shinnar  2 , Daniel N Lax  2 , John M Pellock  3 , Douglas R Nordli Jr  4 , Syndi Seinfeld  3 , William Gallentine  5 , L Matthew Frank  6 , Darrell V Lewis  5 , Ruth C Shinnar  2 , Jacqueline A Bello  7 , Stephen Chan  8 , Leon G Epstein  4 , Solomon L Moshé  2 , Binyi Liu  1 , Shumei Sun  9 ; FEBSTAT study team
Collaborators, Affiliations
Multicenter Study

Risk factors for subsequent febrile seizures in the FEBSTAT study

Dale C Hesdorffer et al. Epilepsia. 2016 Jul.

Abstract

Objectives: To identify risk and risk factors for developing a subsequent febrile seizure (FS) in children with a first febrile status epilepticus (FSE) compared to a first simple febrile seizure (SFS). To identify home use of rescue medications for subsequent FS.

Methods: Cases included a first FS that was FSE drawn from FEBSTAT and Columbia cohorts. Controls were a first SFS. Cases and controls were classified according to established FEBSTAT protocols. Cumulative risk for subsequent FS over a 5-year period was compared in FSE versus SFS, and Cox proportional hazards regression was conducted. Separate analysis examined subsequent FS within FSE. The use of rescue medications at home was assessed for subsequent FS.

Results: Risk for a subsequent FSE was significantly increased in FSE versus SFS. Any magnetic resonance imaging (MRI) abnormality increased the risk 3.4-fold (p < 0.05), adjusting for age at first FS and FSE and in analyses restricted to children whose first FS was FSE (any MRI abnormality hazard ratio [HR] 2.9, p < 0.05). The risk for a second FS of any type or of subsequent FS lasting >10 min over the 5-year follow-up did not differ in FSE versus SFS. Rectal diazepam was administered at home to 5 (23.8%) of 21 children with subsequent FS lasting ≥10 min.

Significance: Compared to controls, FSE was associated with an increased risk for subsequent FSE, suggesting the propensity of children with an initial prolonged seizure to experience a prolonged recurrence. Any baseline MRI abnormality increased the recurrence risk when FSE was compared to SFS and when FSE was studied alone. A minority of children with a subsequent FS lasting 10 min or longer were treated with rectal diazepam at home, despite receiving prescriptions after the first FSE. This indicates the need to further improve the education of clinicians and parents in order to prevent subsequent FSE.

Keywords: Febrile seizure recurrence; Simple febrile seizure; Status epilepticus.

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Conflict of interest statement

Disclosures: The authors report no conflict of interest with respect to this manuscript. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

Figure 1
Figure 1
Risk for a subsequent FSE after a first FS that was FSE compared to a first SFS
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