AAP GRAND ROUNDS

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Mission: To provide pediatricians with timely synopses and critiques of important new studies relevant to
Vol. 26 No. 5 | Pages 49-60 | November 2011
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pediatric practice, reviewing methodology, significance, and practical impact, as part of ongoing CME activity.

NEUROLOGY

Febrile Seizure Duration & Association With Development

Source: Hesdorffer DC, Benn EKT, Bagiella E, et al, for the FEB- normal electroencephalogram (EEG). FSs that were prolonged, focal in type,
STAT study team. Distribution of febrile seizure duration and or associated with EEG abnormalities were classified as “epileptic seizures” in
associations with development. Ann Neurol. 2011;70(1):93-100; which fever acted as a precipitating factor. Other investigators classified FS as
doi:10.1002/ana.22368 “simple” and “atypical.”2 Criteria for the atypical FS included long duration of
the seizure, frequent recurrence, abnormal neurologic signs, and incidence

M
of spontaneous seizures or epilepsy.
embers of the FEBSTAT
(febrile status) multi- PICO A study involving 1,706 children followed to age 7 years found that the
Question: In children with first-time febrile risk of epilepsy in children who had experienced at least one FS was 2%.
center study team as-
seizures (FS), what is the distribution of the Another 10% of the children experiencing at least one FS had at least one
sessed the distribution of febrile
duration of FS, and the association between afebrile seizure but did not meet the definition of epilepsy.3 In children with
seizure (FS) duration in a cohort duration of FS and baseline characteristics
developmental delay and abnormal neurologic examination whose first FS
of 158 children, aged 6 months to of the children?
was complex (longer than 15 min, multiple or focal), epilepsy developed at a
5 years, presenting with a first FS at Question type: Descriptive
rate 18 times higher than in children with no FS (9.2% vs 0.5%; P<.001). In
Morgan Stanley Children’s Hospital Study design: Cohort
the group with normal development and simple FS, epilepsy developed in 11
in New York, and determined the
per 1,000 (1.1%), a moderate frequency, but greater than for children with no
association between FS duration
FS (0.5%; P=.027). Prior neurologic and developmental status and duration
and baseline characteristics of the children. The emergency department
of the first FS were important predictors of epilepsy after FS.
record and parent interviews were used to estimate seizure duration. The
In another study evaluating the association between FS and epilepsy in
median FS duration was 4.0 minutes. Using a two-population assumption
nearly 50,000 children, 6.9% developed epilepsy. These children were fol-
and model, a “short FS” population (mean duration 3.8 minutes) accounted
lowed for up to 23 years, suggesting that the risk of epilepsy is also dependent
for 82.3% of FSs, and a “long FS” population (mean duration 39.8 minutes)
on the length of follow-up.4
accounted for 17.7% of FSs.
The risk of afebrile seizures and epilepsy developing in children with FS
Compared to short FSs, long FSs were significantly more likely to be as-
also correlates with the EEG. Slow wave frequencies occur in approximately
sociated with developmental delay (P=.01) and with younger age (15 vs 19
50% of EEG records obtained shortly after the convulsion, but the abnor-
months) at first FS (P=.048). At baseline, children with long FSs had lower
mality is transient and rarely persists longer than 10 days.5 Persistent and
motor scores than those with short FSs, but the difference was not significant
significant EEG abnormalities are more common in FS patients older than 5
(87.5 vs 93.5; P=.1). FS duration was not associated with cognitive scores
years.6 In those who develop afebrile seizures the frequency of epileptiform
or with adaptive communication behavior. The cutpoint between the two
discharges is five times that in children with simple FS alone.6 In a recent
populations of FSs is approximately 10 minutes.
extensive analysis of the literature concerning EEG in prolonged FS, Douglas
The authors conclude that the distribution of first FS duration and associ-
Nordli, a member of the FEBSTAT study team, concludes that evidence of a
ated risk factors supports a two-popu-
relationship between focal EEG slowing and development of epilepsy is suf-
lation model, with 10 minutes as the
ficiently compelling to warrant planned prospective studies.7
upper limit duration for a simple FS.
Determination of a 10-minute cut-off point as the upper limit for a simple
INSIDE FS, by assuming a two-population model, is more meaningful than the
Breastfeeding Assistance: Hand Versus
Commentary by arbitrary 15-minute limit previously employed. The classification of FS as
Pump Expression J. Gordon Millichap, MD, FAAP, Neu- simple versus complex based on seizure duration is important for prognosis.
MYO1E Mutations in Familial Focal rology, Children’s Memorial Hospi- Children who experience a complex seizure, including those with a duration
Segmental Glomerulosclerosis tal, Northwestern University Medical greater than 10 minutes, warrant close follow-up.
Predicting Diabetes in Adolescents: A1C School, Chicago, IL
or Plasma Glucose?
Dr Millichap has disclosed no financial relationship relevant References
Evidence-based Empyema Algorithm: to this commentary. This commentary does not contain a 1. Livingston S. The Diagnosis and Treatment of Convulsive Disorders in Children.
Impact on Quality of Care discussion of an unapproved/investigative use of a com- Springfield: Thomas; 1954:76-80
Sexual Minority Students Engage in mercial product/device. 2. Pritchard JS, et al. Med Clin N Amer. 1958;42:379-387
More Risky Health Behaviors 3. Nelson KB, et al. N Engl J Med. 1976;295:1029-1033
The term “simple” FS was in-
More Sleep, Better Basketball 4. Vestergaard M, et al. Am J Epidemiol. 2007;165:911-918
Performance troduced by Livingston in 19541 to
5. Lennox MA. Amer J Dis Child. 1949;78:868-882
Complicated Patients Transitioning describe seizures with fever in chil- 6. Millichap JG, et al. Neurology. 1960;10:643-653
From Pediatric to Adult Care dren under 6 years of age with short 7. Nordli DR, et al. Brain Dev. 2010;32:37-41
Can Infant US Predict Clinical Function duration (seldom longer than a few
in Sickle Cell Anemia? Key words: febrile seizure, seizure duration, developmental delay
minutes), generalized seizures, and a
CPR-Related Rib Fractures After Change
in Infant CPR Technique
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Charles Woods, MD (Editorial Board Member) disclosed a Research Grant from Pfizer.
Joseph Geskey, DO (Editorial Board Member) disclosed a Speaker’s Bureau with GlaxoSmithKline.

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 Febrile Seizure Duration & Association With Development
AAP Grand Rounds 2011;26;49
DOI: 10.1542/gr.26-5-49

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 Febrile Seizure Duration & Association With Development
AAP Grand Rounds 2011;26;49
DOI: 10.1542/gr.26-5-49

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://aapgrandrounds.aappublications.org/content/26/5/49

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