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Children with first complex febrile seizure are at low risk for subsequent seizure in hospital
Clinical Question
How often do children with a first complex febrile seizure have another seizure while in the hospital?
Bottom line
Children hospitalized after their first complex febrile seizure have a low rate of subsequent seizures during the hospitalization. This study can't answer whether this is related to the delivery of anticonvulsant medication in the emergency department or to natural history. The children with multiple seizures at the time of presentation had the highest risk of subsequent seizure. 2b
Reference
Study design: Cohort (retrospective)
Funding: Self-funded or unfunded
Setting: Inpatient (any location)
Synopsis
Approximately 25% to 33% of febrile seizures are classified as complex (ie, focal, prolonged [longer than 15 minutes], or multiple [more than 1 within 24 hours]). Common practice is to hospitalize children after their first complex febrile seizure for observation and testing. These authors reviewed the charts of 183 such children, aged 6 to 60 months, hospitalized at a single urban tertiary care center over a 15-year period. The main outcome was subsequent seizure during the hospital stay. More than half the children had multiple seizures, approximately one-third had focal seizures, and one-third had prolonged seizures. Slightly less than half had more than one feature. Thirty-eight (21%) of the children received an anticonvulsant in the emergency department; none of these kids had a subsequent seizure during the hospitalization. One additional child received an anticonvulsant while hospitalized. Seven (3.8%) of the children had subsequent seizures during the hospital stay, 6 of whom had multiple seizures at the time of presentation. Of the 183 children, 104 underwent electroencephalography; the results for one child were consistent with a generalized seizure disorder and 11 others were sent home with anticonvulsants. This is a small, retrospective study with multiple confounders. Nonetheless, given the low frequency of subsequent seizures, it suggests that only children with multiple seizures benefit from hospitalization.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
This is a quote from the review. "This is a small, retrospective study with multiple confounders. Nonetheless, given the low frequency of subsequent seizures, it suggests that only children with multiple seizures benefit from hospitalization."
This is a non-sequitur. The article is no more than a curiosity and suggests nothing. Do not use this article as the basis for any clinical decisions to admit or not.
Complex seizures with multiple seizures need admission for sure.
This study is helpful also for counseling the parents about outcome management for their child with seizure.
The question that arises is do we admit these children only to ensure the prevention of an additional seizure? This answer is a no. Many times - especially if they have received anticonvulsants by either EMS, or ED, time is required to ensure that they return to their baseline. The question then can be asked - where should this watching take place?
He has grown up and has no more seizures.
Good poem
This information is interesting. In my practice, it is unlikely that I would be exposed to such children. However, it occurs to me, that preventing repeated and further seizures while the cause of the fever and the fever are not treated would be poor practice. In addition, I am not sure why the relationship to specific therapy for the fever and for the underlying cause are not commented upon in this paper.