The outcome of children with status epilepticus (afebrile seizure >30 min) or lengthy febrile convulsions (>30 min) is reported by a British population based cohort study group that followed 16004 neonatal survivors born in one week in 1970 and assessed them after 5 and 10 years. Febrile convulsions (FC) in 398 children were lengthy in 19 (4.8%). Children with lengthy FC had a greater risk of afebrile seizures than those with FC <30 min (4/19 [21%] v 13/379 [3.4%]), but the rate was lower than in the status group (14/17 [82%]) and none died. Of 84 children with afebrile seizures, 18 (21%) had status epilepticus, and 2 died: one of cerebellar tumor hemorrhage and the other as a result of encephalitis and pneumonia. Neither death was directly due to status epilepticus. In 10 of 33 survivors of lengthy FC or status, measures of IQ were abnormal but 8 had preceding developmental delay or neurologic abnormality. [1]

COMMENT. This population based study gives a more optimistic outcome of lengthy febrile convulsions and status epilepticus than hospital based studies. A poor outcome was determined more by the underlying cause than the seizure itself. In a prospective study of 110 patients with febrile seizures followed for up to 2 years, the incidence of afebrile seizures and of EEG seizure discharges was significantly greater in patients with ‘prolonged’ febrile seizures >20 min than in those with short seizures <20 min [2]. Both duration of the seizure and the EEG were predictive of outcome.

Pavone L, Galli V et al, Universities of Catania and Modena, Italy, report a follow-up study of 204 children who suffered febrile (FS) and afebrile seizures (AFS) within a 12 month period. EEG specific abnormalities found in 69 (33%) were associated with AFS recurrences in 94%. EEG seizure discharges were predictive of further AFS. [3]