1
|
Hesdorffer DC, Shinnar S, Lewis DV, Nordli DR, Pellock JM, Moshé SL, Shinnar RC, Litherland C, Bagiella E, Frank LM, Bello JA, Chan S, Masur D, MacFall J, Sun S. Risk factors for febrile status epilepticus: a case-control study. J Pediatr 2013; 163:1147-51.e1. [PMID: 23809042 PMCID: PMC3989363 DOI: 10.1016/j.jpeds.2013.05.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/11/2013] [Accepted: 05/15/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify risk factors for developing a first febrile status epilepticus (FSE) among children with a first febrile seizure (FS). STUDY DESIGN Cases were children with a first FS that was FSE drawn from the Consequences of Prolonged Febrile Seizures in Childhood and Columbia cohorts. Controls were children with a first simple FS and separately, children with a first complex FS that was not FSE. Identical questionnaires were administered to family members of the 3 cohorts. Magnetic resonance imaging protocol and readings were consistent across cohorts, and seizure phenomenology was assessed by the same physicians. Risk factors were analyzed using logistic regression. RESULTS Compared with children with simple FS, FSE was associated with younger age, lower temperature, longer duration (1-24 hours) of recognized temperature before FS, female sex, structural temporal lobe abnormalities, and first-degree family history of FS. Compared with children with other complex FS, FSE was associated with low temperature and longer duration (1-24 hours) of temperature recognition before FS. Risk factors for complex FS that was not FSE were similar in magnitude to those for FSE but only younger age was significant. CONCLUSIONS Among children with a first FS, FSE appears to be due to a combination of lower seizure threshold (younger age and lower temperatures) and impaired regulation of seizure duration. Clinicians evaluating FS should be aware of these factors as many episodes of FSE go unnoticed. Further work is needed to develop strategies to prevent FSE.
Collapse
Affiliation(s)
- Dale C. Hesdorffer
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, NY
| | - Shlomo Shinnar
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Darrell V. Lewis
- Department of Pediatrics and Neurology, Duke University Medical Center, Durham, NC
| | - Douglas R. Nordli
- Department of Neurology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - John M. Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, VA
| | - Solomon L. Moshé
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ruth C. Shinnar
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Claire Litherland
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, NY
| | - Emilia Bagiella
- Department of Health Evidence, Mount Sinai Medical Center, New York, NY
| | - L. Matthew Frank
- Department of Neurology, Children’s Hospital of The King’s Daughters and Eastern Virginia Medical School, Norfolk, VA
| | - Jacqueline A. Bello
- Department Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Stephen Chan
- Department of Radiology, Columbia University, New York, NY
| | - David Masur
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - James MacFall
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Shumei Sun
- Department of Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond VA
| | | |
Collapse
|