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July 15, 2008; 71 (3) Articles

Phenomenology of prolonged febrile seizures

Results of the FEBSTAT study

S. Shinnar, D. C. Hesdorffer, D. R. Nordli, J. M. Pellock, C. O’Dell, D. V. Lewis, L. M. Frank, S. L. Moshé, L. G. Epstein, A. Marmarou, E. Bagiella, The FEBSTAT Study Team
First published June 4, 2008, DOI: https://doi.org/10.1212/01.wnl.0000310774.01185.97
S. Shinnar
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D. C. Hesdorffer
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D. R. Nordli Jr
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J. M. Pellock
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C. O’Dell
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D. V. Lewis
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L. M. Frank
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S. L. Moshé
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L. G. Epstein
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A. Marmarou
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E. Bagiella
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Citation
Phenomenology of prolonged febrile seizures
Results of the FEBSTAT study
S. Shinnar, D. C. Hesdorffer, D. R. Nordli, J. M. Pellock, C. O’Dell, D. V. Lewis, L. M. Frank, S. L. Moshé, L. G. Epstein, A. Marmarou, E. Bagiella, The FEBSTAT Study Team
Neurology Jul 2008, 71 (3) 170-176; DOI: 10.1212/01.wnl.0000310774.01185.97

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Abstract

Background: Febrile status epilepticus (FSE) has been associated with hippocampal injury and subsequent mesial temporal sclerosis and temporal lobe epilepsy. However, little is known about the semiology of FSE.

Methods: A prospective, multicenter study of the consequences of FSE included children, aged 1 month through 5 years, presenting with a febrile seizure lasting 30 minutes or more. Procedures included neurologic history and examination and an MRI and EEG within 72 hours. All information related to seizure semiology was reviewed by three epileptologists blinded to MRI and EEG results and to subsequent outcome. Inter-rater reliability was assessed by the κ statistic.

Results: Among 119 children, the median age was 1.3 years, the mean peak temperature was 103.2°F, and seizures lasted a median of 68.0 minutes. Seizure duration followed a Weibull distribution with a shape parameter of 1.68. Seizures were continuous in 52% and behaviorally intermittent (without recovery in between) in 48%; most were partial (67%) and almost all (99%) were convulsive. In one third of cases, FSE was unrecognized in the emergency department. Of the 119 children, 86% had normal development, 24% had prior febrile seizures, and family history of febrile seizures in a first-degree relative was present in 25%.

Conclusions: Febrile status epilepticus is usually focal and often not well recognized. It occurs in very young children and is usually the first febrile seizure. Seizures are typically very prolonged and the distribution of seizure durations suggests that the longer a seizure continues, the less likely it is to spontaneously stop.

GLOSSARY: ED = emergency department; FS = febrile seizures; FSE = febrile status epilepticus; HHV = human herpesvirus; ILAE = International League Against Epilepsy; IQR = interquartile range; MTLE = mesial temporal lobe epilepsy; MTS = mesial temporal sclerosis.

Footnotes

  • ↵ sshinnar{at}aol.com

    Editorial, page 162

    e-Pub ahead of print on June 4, 2008, at www.neurology.org.

    *Members of the FEBSTAT Study Team are listed in the appendix.

    Supported by grant NS 43209 from NINDS (PI: S. Shinnar).

    Disclosure: The authors report no disclosures.

    Presented in part at the annual meeting of the American Epilepsy Society, December 1–5, 2006, San Diego, CA.

    Supplemental data at www.neurology.org

    Received June 4, 2007. Accepted in final form December 14, 2007.

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Disputes & Debates: Rapid online correspondence

  • Phenomenology of prolonged febrile seizures: Results of the FEBSTAT study
    • Rod C. Scott, UCL-Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UKrscott@ich.ucl.ac.uk
    • Brian G Neville
    Submitted September 22, 2008
  • Reply from the author
    • Shlomo Shinnar, Comprehensive Epilepsy Management Center, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467sshinnar@aol.com
    Submitted September 22, 2008
  • Phenomenology of prolonged febrile seizures. Results of the FEBSTAT study
    • Edgar Avalos Herrera, Guatemala, 5ta Calle 0-72 zona 1, Guatemalaeavalosh@yahoo.com
    • Silvia Yamanic Alvarez, Oliver Cobox, Teresa Villeda
    Submitted August 26, 2008
  • Reply from the authors
    • Shlomo Shinnar, MD, PhD, Montefiore Medical Center, Albert EInstein College of Medicine, Epilepsy Management Center, Montefiore Medical Centersshinnar@aol.com
    • 111 E 210th St, Bronx, NY 10467
    Submitted August 26, 2008
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