Which of the following statements about febrile seizures in children is correct?

Febrile Seizures and Epilepsy Risk

Statement B is correct: Complex febrile seizures are more likely to progress to epilepsy compared to simple febrile seizures. 1, 2, 3

Analysis of Each Statement

Statement A: "There is a 2% chance to develop epilepsy"

This statement is partially correct but lacks important context:

• Children with simple febrile seizures have approximately 1% risk of developing epilepsy by age 7, which is identical to the general population 1, 4
• However, children with multiple risk factors (multiple simple febrile seizures, age <12 months at first seizure, and family history of epilepsy) have a 2.4% risk of developing epilepsy by age 25 years 1
• The overall rate across all febrile seizure types is approximately 2% by age 7 3
• This statement oversimplifies the risk stratification and doesn't distinguish between simple and complex febrile seizures 1

Statement B: "If it is a complex febrile seizure, it is more likely to progress to epilepsy" ✓

This statement is CORRECT:

• Complex febrile seizures carry significantly higher epilepsy risk than simple febrile seizures 2, 3
• In children with complex febrile seizures, 22.1% developed subsequent epilepsy in a 2022 retrospective cohort study 2
• Specific risk factors in complex febrile seizures that predict epilepsy include: prolonged seizures >15 minutes (HR: 2.475), developmental delay (HR: 4.476), epileptiform discharges on EEG (HR: 1.391), and abnormal neuroimaging (HR: 1.355) 2
• Children with abnormal neurologic/developmental status before any seizure AND complex first febrile seizure developed epilepsy at a rate 18 times higher than children with no febrile seizures (92 vs. 5 per 1000) 3

Statement C: "If parents had febrile seizures, it will increase the chance to progress to epilepsy"

This statement is INCORRECT:

• Family history of febrile seizures does NOT increase the risk of developing epilepsy 2
• Family history of epilepsy (not febrile seizures) is one of the risk factors that, when combined with other factors, increases epilepsy risk to 2.4% by age 25 1
• The 2022 study specifically found that family history of febrile seizure was NOT associated with increased risk of subsequent epilepsy 2
• Febrile seizures tend to occur in families, but this genetic predisposition relates to febrile seizure recurrence, not epilepsy development 5

Statement D: "Using antipyretics will decrease the chance of febrile convulsions"

This statement is INCORRECT:

• Antipyretics (acetaminophen, ibuprofen) do NOT prevent febrile seizures or reduce recurrence risk, according to the American Academy of Pediatrics 1, 6
• Antipyretics should be used only for the child's comfort and to prevent dehydration, not for seizure prevention 1
• One exception: rectal acetaminophen reduced the risk of short-term recurrence following a febrile seizure, but this does not apply to primary prevention 6

Key Clinical Pitfalls to Avoid

• Do NOT prescribe prophylactic anticonvulsants for simple febrile seizures—the American Academy of Pediatrics explicitly recommends against this due to potential toxicities outweighing minimal risks 1
• Do NOT falsely reassure parents that antipyretics will prevent seizures—this is not evidence-based 1, 6
• Do NOT confuse family history of febrile seizures with family history of epilepsy—only the latter contributes to epilepsy risk 1, 2
• Recognize that pre-existing neurological abnormalities predict epilepsy development, not the febrile seizures themselves 1, 3