What is the risk of developing epilepsy in a 6-year-old child with a history of three febrile seizures (fever-induced seizures)?

From the Guidelines

The risk of developing epilepsy in a 6-year-old child with a history of three febrile seizures is approximately 1%, similar to the general population, according to the most recent and highest quality study 1. The child's history of three febrile seizures does not significantly increase the risk of developing epilepsy, as the study found that children with simple febrile seizures have approximately the same risk of developing epilepsy by the age of 7 years as the general population 1. However, certain factors such as family history of epilepsy, age younger than 12 months at the time of the first febrile seizure, and neurologic abnormalities before the first seizure may increase the risk 1. Some key points to consider:

• Children with simple febrile seizures have a high rate of recurrence, with approximately 50% of children younger than 12 months at the time of their first simple febrile seizure having a recurrent febrile seizure 1.
• There is no evidence that simple febrile seizures cause structural damage to the brain or that successful treatment of simple febrile seizures can prevent the later development of epilepsy 1.
• Genetic predisposition is likely to play a role in the increased risk of epilepsy in children with a family history of epilepsy 1.
• Regular follow-up with a pediatrician is recommended to monitor the child's development and address any concerns.

From the Research

Risk of Developing Epilepsy

The risk of developing epilepsy in a 6-year-old child with a history of three febrile seizures is a concern for many parents. According to the available evidence:

• The risk of developing epilepsy after an initial febrile seizure is relatively low, ranging from 1.5-2.4% for simple febrile seizures 2.
• However, children with complex febrile seizures are at a higher risk of developing epilepsy, with a risk of up to 27% in some studies 3.
• The risk of developing epilepsy is also influenced by factors such as family history of epilepsy, complex febrile seizures, and neurological abnormality 4.
• Recurrent febrile seizures do not necessarily increase the risk of developing epilepsy, with the risk of an unprovoked seizure after a febrile seizure being approximately 2-3% 4.

Factors Influencing the Risk of Epilepsy

Several factors can influence the risk of developing epilepsy in children with febrile seizures, including:

• Family history of epilepsy: a family history of epilepsy increases the risk of developing epilepsy 4.
• Complex febrile seizures: complex febrile seizures, defined by prolonged seizures, partial seizures, and multiple seizures, carry a higher risk of developing epilepsy 3.
• Neurological abnormality: children with neurological abnormalities are at a higher risk of developing epilepsy 4.
• Age at the time of the first febrile seizure: young age at the time of the first febrile seizure is a risk factor for recurrent febrile seizures, but not necessarily for epilepsy 4.

Management and Treatment

The management and treatment of febrile seizures focus on reducing the risk of recurrence and addressing parental anxiety:

• Oral diazepam or clobazam, given only when fever is present, can reduce the risk of recurrence 2.
• Antiepileptic medication is not recommended to prevent recurrence of febrile seizures, as the potential toxicities outweigh the relatively minor risks associated with simple febrile seizures 5.
• Parents should be informed that recurrence is common, and that these convulsions are benign with an excellent prognosis 6.