April 1997

Predictors of Recurrent Febrile SeizuresA Prospective Cohort Study

Author Affiliations

From the Department of Biological Sciences, Northern Illinois University, DeKalb (Dr Berg); the Departments of Neurology (Dr Shinnar) and Pediatrics (Drs Shinnar, Salomon, and Crain) and The Comprehensive Epilepsy Management Center (Dr Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; The Gertrude H. Sergievsky Center, Columbia University, New York, NY (Drs Shinnar and Hauser); and the Departments of Epidemiology and Public Health (Ms Darefsky and Drs Holford and Shapiro) and Pediatrics (Dr Shapiro), Yale University, New Haven, Conn.

Arch Pediatr Adolesc Med. 1997;151(4):371-378. doi:10.1001/archpedi.1997.02170410045006

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 recurrences (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.Arch Pediatr Adolesc Med. 1997;151:371-378