Authors :
Presenting Author: Laura Gould, MSc, MA, PT – NYU Grossman School of Medicine
Orrin Devinsky, MD – Professor of Neurology, Neurology, NYU Grossman School of Medicine; Thomas Wisniewski, MD – NYU Grossman School of Medicine; Eric Oermann, MD – NYU Grossman School of Medicine
Rationale:
Febrile seizures occur in 3% of U.S. children aged six months to five years and are considered largely benign.1 However, Sudden Unexplained Death in Childhood (SUDC) is associated with a 10 times increase in febrile seizures compared to general population rates.2 With unremarkable autopsy findings, we considered whether characteristics of febrile seizures (FS) in victims of SUDC differ from FS in the general population and would support a risk assessment tool.
Methods:
We conducted a case-controlled analysis of observer accounts of febrile seizures among children with and without sudden death through an online anonymous survey created from two validated seizure interview tools and one parasomnia scale. The study enrolled subjects from December 2021 to December 2022. Subjects were parents or legal guardians of children, living or deceased, who had experienced a febrile seizure from six months to six years. Subjects were excluded if the child’s onset of febrile seizures were before six months of age or greater than six years, if the child experienced an afebrile seizure or if the parent subject had not witnessed at least one complete febrile seizure. This study was approved by the NYU Langone Health Institutional Review Board (i21-01294).
Results:
A total of 365 valid surveys were received: 47 febrile seizures with SUDC (FS+SUDC) and 318 living controls with febrile seizures. FS+SUDC experienced their first febrile seizure younger than FS controls (p=.008). Development concerns were increased in FS+SUDC versus controls (OR= 2.18, CI95[1.025,4.651], p=.039). Thirty-five percent FS+SUDC vs 66.94% FS were restless sleepers or often awoke >2x/night (OR= .266, CI95[0.132,0.537], p=.0001).
Conclusions:
Our study reports novel associations of febrile seizures with sudden death, with cases more likely to be younger at onset of febrile seizures, have development concerns, and less likely to be restless sleepers or awaken during nighttime sleep. These findings suggest that arousal mechanisms may play a role in febrile seizure related deaths. Child death registries should include sleep quality measures to further elucidate this potential risk factor. Further research should include a large prospective cohort study of febrile seizures to assess sleep quality and direct observations of febrile seizure characteristics.
1 Graves RC, Oehler K, Tingle LE. Febrile seizures: risks, evaluation, and prognosis. American Family Physician;85(2):149-53.
2Crandall LG, Lee JH, Stainman R, Friedman D, Devinsky O. Potential Role of Febrile Seizures and Other Risk Factors Associated With Sudden Deaths in Children. JAMA Network Open.2019
Funding:
This study was funded by SUDCUK and FACES.