Long-Term Mortality Does Not Increase in Children With Febrile Seizures

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Title: Long-Term Mortality Does Not Increase in Children With Febrile Seizures
URL: http://www.pslgroup.com/dg/2276B2.htm
Doctor's Guide
August 7, 2008

NEW YORK -- August 7, 2008 -- Long-term mortality is not increased in children with febrile seizures, although there seems to be a doubling of mortality during the 2 years after complex febrile seizures, according to a study in the August 9 issue of The Lancet.

However, the overall risk of death associated with febrile seizures remains extremely low, and the authors say that parents should be reassured that death after febrile seizures is very rare, even in high-risk children.

Mogens Vestergaard, MD, Department of General Practice, Institute of Public Health, Aarhus University, Aarhus, Denmark, and colleagues, studied mortality after febrile seizures in a large cohort of children in Denmark with up to 28 years of follow up.

The study analysed 1,675,643 children born in Denmark between 1977 and 2004, each of whom was followed up from 3 months of age until death, emigration, or August 31, 2005.

The researchers identified 8,172 children who died, including 232 deaths in 55,215 children with a history of febrile seizures. Overall, 132 per 100,000 children died within 2 years of a febrile seizure compared with 67 per 100,000 children without a history of the condition.

Children who had simple febrile seizures had mortality similar to that of the general population. But in children who had had more complex febrile seizures, mortality was twice as high as in the general population in the 2 years following the seizure -- thereafter, mortality returned to that seen in the general population.

The authors stress that although this is a doubling of risk, the absolute risk remains small. In children followed up for 2 years, there would be 1 death in 1,500 children in the general population, compared with 2 deaths in 1,500 children who had had febrile seizures.

"Children with simple febrile seizures had a risk of death similar to the background population, whereas those with complex febrile seizures, febrile seizures triggered by temperature below 39şC, and febrile seizures occurring before 12 months of age had a 2-fold higher mortality lasting for about 2 years," said Dr. Vestergaard.

"The excess mortality was at least partly due to pre-existing neurological abnormalities and subsequent epilepsy. … Parents should be reassured that death after febrile seizures is very rare, even in high-risk children."

In an accompanying comment, Maitreyi Mazumdar, MD, Department of Neurology, Children's Hospital, Boston, Massachusetts, said: "[The] study again seems to refute, for infants and children who have simple febrile seizures, the idea of a shared cause between febrile seizures and sudden death ... [the] study suggests that there is a subset of children with febrile seizures -- notably those with complex features and underlying neurological abnormalities -- that may warrant closer attention and follow-up."

SOURCE: The Lancet

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