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Intellectual and Behavioral Outcomes After Febrile Seizures
Am Fam Physician. 1998 Oct 1;58(5):1188.
Although most children with a history of febrile seizures do not have subsequent seizures or epilepsy as they grow older, data suggest that some of these children may have permanent cognitive deficits, including mental retardation. Verity and colleagues with the Child Health and Education Study evaluated the long-term intellectual and behavioral outcomes of children with a history of febrile seizures.
This British study initially enrolled 16,163 children born during the same week in April 1970. Intellectual and behavioral assessments were conducted when the children were five and 10 years of age. A total of 381 children (212 boys and 169 girls) with febrile convulsions were assessed. The children and their mothers, teachers, community care nurses and physicians completed questionnaires. The mothers were specifically asked about any history of “convulsions, fits or seizures.” Affirmative answers to these questions were confirmed by hospital and physician records. Children were further stratified according to whether they had simple or complex febrile seizures, the latter defined as lasting more than 15 minutes or having a focal component.
The authors chose 102 different measures to assess intellectual and behavioral outcomes. Some of these measures were the full-scale IQ test, academic progress, speech and language development, attention span, motor coordination and self-esteem.
Of the 381 children evaluated, 287 had a history of simple seizures, and 94 had a history of complex seizures. No significant differences existed between the seizure group and control children with regard to parents' social class, level of education, housing, race or ethnic background.
Only four of the 102 measures in the children with febrile seizures showed a significant difference from those in the control group. On the maternal questionnaire, children with a seizure history were reported to be more impulsive or excitable. The mothers also rated these children as more anxious compared with the ratings of mothers from the control group. On the children's questionnaire, 2.6 percent of those in the seizure group reported not doing well in gym class compared with 2.0 percent of the control group.
Finally, the children with febrile seizures actually had better reading skills than did the control children. There were no notable differences among the children who had simple seizures or complex seizures in terms of academic progress or intellectual abilities. Another analysis compared the outcomes in children with only one seizure versus outcomes in children with more than one seizure. Children who had more than one episode of simple febrile seizures had better reading skills than those with only one seizure episode.
The authors conclude that childhood febrile seizures, including complex seizures, do not result in long-term adverse effects on intellectual or behavioral development. This information should be reassuring to both clinicians and parents of children with a history of febrile seizures.
Verity CM, et al. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med. June 11, 1998;338:1723–8.
Copyright © 1998 by the American Academy of Family Physicians.
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