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Risk factors for acute encephalitis and early seizure recurrence in complex febrile seizures

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Abstract

The purpose of this study is to elucidate risk factors for central nervous system infection and early seizure recurrence in children with febrile seizures (FSs) and thus facilitate outpatient management of complex FS. This single-center, retrospective cohort study investigated 688 children (6–60 months old) with FSs in Japan during 2011–2021. We investigated the incidence and clinical manifestations of children with acute encephalitis or bacterial meningitis. Logistic regression modeling was used to examine risk factors for seizure recurrence within 24 h. Among children with recurrent FSs, the distribution of intervals between first and second FS was assessed. Among 145 children with complex FSs, 2 patients (1.4%) had acute viral encephalitis and none had bacterial meningitis. Acute encephalitis was found in 2 of 8 patients (25%) with FSs prolonged ≥30 min and 2 of 3 patients (67%) requiring ≥2 intravenous anticonvulsants to stop seizures. Seizure recurrence within 24 h was observed in 16% of participants and was independently associated with preceding use of diazepam and family history of FS. In 82% of patients with FS recurrence within 24 h, early recurrences occurred within 8 h of the first seizure.

     Conclusion: Patients with prolonged or refractory FSs are still indicated for hospital admission due to the risk of acute encephalitis. FS patients with a family history of FS may be managed safely by 8-h observation or single-dose rectal diazepam as prophylaxis against early recurrent seizure.

What is Known:

• Hospitalization has been recommended for children with complex febrile seizures due to the increased risk of central nervous infections.

• Recent studies showed low incidences of bacterial meningitis (<1%) in children with complex febrile seizures in the presence of routine immunization.

What is New:

• Acute encephalitis was identified in 1.4% of children with complex febrile seizures, characterized by prolonged seizures ≥30 min and refractory seizures.

• Early recurrent seizures may be safely managed by prophylactic diazepam or 8-h expectant observation.

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Availability of data and material

The data that support the findings of this study are available from the corresponding author, HK, on reasonable request.

Code availability

Not applicable.

Abbreviations

AAP:

American Academy of Pediatrics

CI:

Confidence interval

CNS:

Central nervous infection

CT:

Computed tomography

FS:

Febrile seizure

Hib:

Haemophilus influenzae Type b

MRI:

Magnetic resonance imaging

RR:

Risk ratio

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Author information

Authors and Affiliations

  1. Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita, 874-0011, Japan

    Kenta Kajiwara & Hiroshi Koga

Authors
  1. Kenta Kajiwara
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  2. Hiroshi Koga
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Contributions

All authors contributed to the study conception and design. Data collection and initial analyses were performed by Kenta Kajiwara. The first draft of the manuscript was written by Kenta Kajiwara and all authors critically reviewed previous version of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hiroshi Koga.

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Ethics approval

This observational study has been approved by the ethics committee of the National Hospital Organization Beppu Medical Center. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Consent to participate

Informed consent was obtained from the parents or the guardian of children.

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Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Gregorio Paolo Milani

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Kajiwara, K., Koga, H. Risk factors for acute encephalitis and early seizure recurrence in complex febrile seizures. Eur J Pediatr 181, 3103–3110 (2022). https://doi.org/10.1007/s00431-022-04529-1

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  • DOI: https://doi.org/10.1007/s00431-022-04529-1

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