Do Febrile Seizures Cause Disability?
Simple febrile seizures do not cause long-term disability, including no decline in IQ, academic performance, behavioral abnormalities, or structural brain damage. 1
Cognitive and Developmental Outcomes
No cognitive impairment occurs from simple febrile seizures. The evidence is clear and consistent:
- Studies of 431 children with febrile seizures showed no significant difference in learning compared with sibling controls 1
- A separate study of 303 children with febrile seizures found no difference in learning, except in those who had pre-existing neurologic abnormalities before their first seizure 1
- There is no decline in IQ, academic performance, neurocognitive attention, or behavioral functioning as a consequence of recurrent simple febrile seizures 1, 2
Risk of Epilepsy
The risk of developing epilepsy is essentially the same as the general population (approximately 1% by age 7 years). 1, 2
However, certain high-risk subgroups exist:
- Children with multiple simple febrile seizures, age <12 months at first seizure, and family history of epilepsy have a slightly elevated risk of 2.4% by age 25 years 1, 2
- This increased risk is due to genetic predisposition, not brain damage caused by the febrile seizures themselves 1
- No study has demonstrated that treating simple febrile seizures can prevent later epilepsy development 1
Structural Brain Damage
There is currently no evidence that simple febrile seizures cause structural damage to the brain. 1
Mortality Risk
Death during a simple febrile seizure has never been reported to the American Academy of Pediatrics committee's knowledge. 1
While there is a theoretical risk of death from documented injury, aspiration, or cardiac arrhythmia during a seizure, this has not been documented in clinical practice 1
Important Caveat: Complex Febrile Seizures
This reassuring prognosis applies specifically to simple febrile seizures (lasting <15 minutes, generalized, occurring once in 24 hours). 1
Complex febrile seizures (prolonged >15 minutes, focal features, or multiple episodes in 24 hours) may carry different risks:
- Some cohorts have shown long-term neurodevelopmental sequelae with complex febrile seizures 3
- Complex febrile seizures may rarely herald devastating conditions like Dravet syndrome or Febrile-Infection Related Epilepsy Syndrome (FIRES) 3
Clinical Bottom Line
The only significant adverse outcome of simple febrile seizures is a high rate of recurrence (30-50% depending on age at first seizure), not disability. 1
Given the benign long-term prognosis, the American Academy of Pediatrics strongly recommends against continuous or intermittent anticonvulsant prophylaxis, as the potential toxicities outweigh the minimal risks 1, 2, 4