The predictive value of multiple clinical variables for febrile seizure recurrence was assessed in a follow-up study of 155 Dutch children at the Department of Paediatrics, University Hospital and Sophia Children’s Hospital, Rotterdam, The Netherlands. Children between 6 months and 5 years presenting with a first febrile seizure and a body temperature of 38.5c or higher but without intracranial infection or defined cause were included. Those with a history of nonfebrile seizures or with neurological abnormalities such as cerebral palsy and mental retardation were excluded as were those treated with continuous phenobarbitone or sodium valproate. Of these initially untreated children 37% had 1, 30% had 2, and 17% had 3 or more recurrences. The highest risk period for recurrence was during the 6 months after a seizure and the lowest risk was after 24 months freedom from seizures. The younger the child at the 2nd and 3rd seizures, the higher the likelihood of further recurrences. A first degree relative with any type of seizure predicted multiple recurrences of febrile seizures. A body temperature of 40c at initial seizure was associated with a lower risk as was an age of 30 months or older. [1]

COMMENT. The authors conclude that the predictive value of combined risk factors (age at onset, family history, height of fever) is superior to that of single variables. The association between elevated temperature and risk of recurrence is in keeping with the theory of a threshold of febrile seizures based on the height of the body temperature. [2]