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Long-Term Effects of Reccurent Febrile Seizures

Febrile seizures are seizures that occur at an increase in body temperature (rectal temperature above 38oC) caused by the extracranial process and previously had no neurological problems.

Long-term consequences in patients with recurrent febrile seizures, unfortunately, not many realize it. So often, the treatment of febrile seizures in children is not performed correctly.

Long-Term Effects of Reccurent Febrile Seizures

The incidence of febrile seizures in children aged 3 months to 5 years is 2-5%. Some children who suffer from febrile seizures, by 30-40%, have the risk of having recurrent febrile seizures. Recurrent febrile seizures generally occur within the first year after the first febrile seizure, which is 75%.

As many as 3% of children with febrile seizures will develop epilepsy later in life. The risk of epilepsy in complex febrile seizures is 5-10 times higher compared to simple febrile seizures.

Here are some of the long-term effects of recurrent febrile seizures.


a. Epilepsy

Epilepsy can occur in 3% of children with recurrent febrile seizures. Some risk factors for epilepsy after getting febrile seizures are a family history of epilepsy, neurological disorders before the onset of febrile seizures, and complex febrile seizures.

The incidence of epilepsy also increases in cases of febrile seizures in children over 6 years, known as fever plus seizures. Febrile plus seizures are believed to be related to autosomal dominant inherited genetic factors.

Sclerosis in the hippocampus and temporal brain post febrile seizures is associated with epilepsy. Several studies find that sclerosis in the brains of children who have epilepsy with a history of previous febrile seizures. There is no clear pathophysiology about this.

A cohort study involving 1.5 million children showed the consequences of becoming epileptic increased 5.43 times after the occurrence of febrile seizures. This study did not distinguish between types of febrile seizures that cause epilepsy. Risk factors found in this study were family history of epilepsy, children with cerebral palsy, and APGAR score less than 7 at 5 minutes.

b. Psychiatric Disorders

A study in Kenya stated that behavior and emotional disorders increased by 27% in children with histories of febrile seizures. One risk factor for these behavioral and emotional disorders is recurrent febrile seizures.

A cohort study in Denmark conducted from 1977-2011, involving more than 2 million children, showed an association between the incidence of recurrent febrile seizures and the risk of epilepsy, psychiatric disorders, and death. No specific mention of mental disorders such as what happened to children in the study.

The risk of epilepsy increased by 15.8%, while the incidence of psychiatric disorders increased by 29.1% after febrile seizures occurred 3 times. The mortality rate also increased from 1.4 to 2.7% in patients who had epilepsy.

This cohort study is based on secondary data from medical records. No theory can explain with certainty how recurrent febrile seizures cause behavioral and psychiatric disorders.


How to Prevent the Long-Term Effects of Recurrent Fever Seizures


It is necessary to take appropriate treatment in febrile seizures Considering the high risk of epilepsy and other problems in patients with recurrent febrile seizures.

A meta-analysis study by Cochrane in 2017, included 40 articles describing 30 randomized trials with 4256 participants, who analyzed 13 continuous or intermittent prophylactic interventions in the management of febrile seizures.

The analysis found no significant benefits for intermittent phenobarbital, phenytoin, valproate, pyridoxine, ibuprofen, or zinc sulfate, compared with placebo or without treatment.

Daily administration of valproic acid or phenobarbital is said to be effective in preventing febrile seizures, but the adverse side effects of using both drugs outweigh the benefits.

Also, long-term use of antiepileptic therapy does not reduce the risk of epilepsy. Thus, the current consensus does not recommend preventing preventive antiepileptic therapy to prevent recurrent febrile seizures.

The use of intermittent anticonvulsant therapy, such as diazepam, is not routinely indicated. Also, antipyretics have no role in preventing febrile seizures in children.


Conclusion

Recurrent febrile seizures in children have many long-term effects, including epilepsy, neurological disorders, behavioral disorders, psychiatric disorders, and increased mortality.

This type of complex febrile seizure has a risk of becoming recurrent febrile seizures compared to simple febrile seizures.

Appropriate treatment in children with febrile seizures can reduce the incidence of recurring febrile seizures and prevent long-term adverse consequences.

Prevention is an important factor in the management of febrile seizures. However, routinely administering antiepilepsy or anticonvulsants is not recommended to prevent recurrency febrile seizures. 

Give a fever-lowering when a fever aims to provide comfort to the child and not to prevent febrile seizures.

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