Predicting the Likelihood of a Recurrent Febrile Seizure

Aaron Saguil; Jessica Servey

Apr 15, 2020 Issue

Point-of-Care Guides

Predicting the Likelihood of a Recurrent Febrile Seizure

AARON SAGUIL, MD, MPH, and JESSICA SERVEY, MD, MHPE, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Am Fam Physician. 2020 Apr 15;101(8):497-478.

Author disclosure: No relevant financial affiliations.

Clinical Question

In children presenting with a simple febrile seizure, is it possible to determine the likelihood of a recurrent febrile seizure?

Evidence Summary

Febrile seizures occur in children with fever who do not have a history of epilepsy or central nervous system infection.1 Febrile seizures are classified as simple (generalized, lasts less than 15 minutes, and occurs once in 24 hours) or complex (focal, lasts longer than 15 minutes, or recurs within 24 hours). They affect 2% to 5% of children six months to five years of age and can be associated with almost any infectious etiology.1

Although febrile seizures are usually benign and self-limited, up to one-third of patients will have a recurrence.1 Being able to predict the likelihood of recurrent seizures would be helpful in addressing parents' concerns about their child having another seizure and assist physicians in counseling parents on the appropriate aftercare.

In the 1980s and 1990s, a cohort of young children who had febrile seizures were followed for recurrent seizures.2 Multiple potential predictors of recurrence were noted: the patient's temperature when the seizure occurred, duration of fever prior to the seizure, patient age, family history of febrile seizures, family history of epilepsy, presence of a neurodevelopmental abnormality, patient sex, patient race, type of seizure (simple or complex), and duration of seizure. In a multivariate analysis, the investigators found that younger age, family history of febrile seizures, shorter duration of fever, and lower temperature were all independently associated with an increased likelihood of recurrent seizure. From this, Berg and colleagues constructed a four-variable clinical decision rule to predict the likelihood of seizure recurrence (Table 1).2

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TABLE 1.

Clinical Decision Rule for Predicting Recurrent Febrile Seizures

Risk factor	Points
Age younger than 18 months	1
Body temperature less than 104°F (40°C) at the time of the seizure	1
Duration of fever less than one hour	1
Family history of febrile seizure	1
Total	______
Risk of recurrent febrile seizure
0 points = 13% 1 point = 23% 2 points = 32% 3 points = 62% 4 points = 76%

Information from reference 2.

TABLE 1.

Clinical Decision Rule for Predicting Recurrent Febrile Seizures

Risk factor	Points
Age younger than 18 months	1
Body temperature less than 104°F (40°C) at the time of the seizure	1
Duration of fever less than one hour	1
Family history of febrile seizure	1
Total	______
Risk of recurrent febrile seizure
0 points = 13% 1 point = 23% 2 points = 32% 3 points = 62% 4 points = 76%

Information from reference 2.

Overall, the risk of a recurrence after febrile seizure is 32%. Most patients who have a recurrence will have only one additional episode (54%), although 28% will have two recurrences and 18% will have three or more recurrences. Among those having recurrent seizures, 75% will have them within one year.2

Studies conducted in other countries have also found predictors of recurrent febrile seizures. A Greek study showed that younger age at the time of the seizure, complex febrile seizure, and family history of febrile seizures predicted recurrence.3 A Turkish study found that recurrent febrile

Address correspondence to Aaron Saguil, MD, MPH, at aaron.saguil@usuhs.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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1. Whelan H, Harmelink M, Chou E, et al. Complex febrile seizures—a systematic review. Dis Mon. 2017;63(1):5–23....

2. Berg AT, Shinnar S, Darefsky AS, et al. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med. 1997;151(4):371–378.

3. Pavlidou E, Tzitiridou M, Kontopoulos E, et al. Which factors determine febrile seizure recurrence? A prospective study. Brain Dev. 2008;30(1):7–13.

4. Tosun A, Koturoglu G, Serdaroglu G, et al. Ratios of nine risk factors in children with recurrent febrile seizures. Pediatr Neurol. 2010;43(3):177–182.

5. Kumar N, Midha T, Rao YK. Risk factors of recurrence of febrile seizures in children in a tertiary care hospital in Kanpur: a one year follow up study. Ann Indian Acad Neurol. 2019;22(1):31–36.

6. Cappellari AM, Brizio C, Mazzoni MB, et al. Predictive value of EEG for febrile seizure recurrence. Brain Dev. 2018;40(4):311–315.

7. Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389–394.

This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision-making at the point of care.

This series is coordinated by Mark H. Ebell, MD, MS, deputy editor for evidence-based medicine.

A collection of Point-of-Care Guides published in AFP is available at https://www.aafp.org/afp/poc.

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