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Predictors of Recurrent Febrile Seizures:  A Prospective Cohort Study

Anne T. Berg, PhD; Shlomo Shinnar, MD, PhD; Amy S. Darefsky, MPH; Theodore R. Holford, PhD; Eugene D. Shapiro, MD; Morton E. Salomon, MD; Ellen F. Crain, MD, PhD; Allen W. Hauser, MD
Arch Pediatr Adolesc Med. 1997;151(4):371-378. doi:10.1001/archpedi.1997.02170410045006.
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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

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