The relation between postulated risk factors and seizure recurrence after a first febrile seizure (FS) was assessed by reanalysis of pooled data from five centers and follow-up studies and reported from the Sophia Children’s Hospital, Rotterdam, The Netherlands. Of 2496 children with 1410 episodes of recurrent seizures, 32% had one, 15% had two, and 7% had three or more recurrent seizures after a first FS; 7% had a complex FS. The risk of FS recurrence was increased at ages 12 to 24 months, after a first and second recurrence, with a family history of seizures, and following FSs with a relatively low temperature (<40°C). The risk of complex FS was increased if onset of FS was <12 months, if family history was positive for unprovoked seizures, and if the initial FS was focal or partial. [1]

COMMENT. In a previous report of a follow-up study of 155 Dutch children the principal author had concluded that the predictive value of combined risk factors (age at onset, family history, height of fever) was superior to that of single variables (see Ped Neur Briefs March 1992;6:17). Similar risk factors have been identified previously by a metaanalysis study [2] and a prospective study [3]. A threshold to febrile seizures based on the height of body temperature was first established in animals with seizures induced by microwave diathermy [4], and has been confirmed clinically (Febrile Convulsions, New York, Macmillan, 1968).

None of the patients in the pooled analysis study had received monitored prophylactic treatment, continuous or intermittent. Having established that 54% of children had one or more recurrences of febrile seizures, the authors may be encouraged to conduct trials of intermittent oral diazepam in their patient population at increased risk, especially in those between the ages of 12 and 24 months, with a positive family history, and whose first FS occurred with a temperature <40°C.