Abstracts

Rationale: Our goal was to assess the risk factors for recurrent febrile seizure on Jeju Island, South Korea. Methods: We reviewed retrospectively the computerized medical records of 293 patients whose 1st FS developed at between 3 months and 5 years of age among the patients who visited the outpatient clinic or were admitted to the pediatric department of the Jeju National University Hospital for a 1st FS between March 2007 and May 2013. We defined recurrent FS as FS that occurred more than twice. We excluded patients with evidence of intracranial infection or unprovoked seizure before the 1st FS. The variables included age, sex, birth history, body temperature at the 1st FS onset, presence of complex FS or epilepsy (first-degree relatives), EEG findings, the family's economic status, and parents' educational level. Results: Two hundred and ninety-three patients (178 boys and 115 girls) were enrolled in the study. The mean follow-up duration since the 1st FS onset was 41.8 months. The mean age at the time of the study was 60.7 months. The average age at the 1st FS was 18.9 months. The average total number of FS attacks was 3.6. Family histories of FS and epilepsy were found in 82 (28.0%) and 22 (7.5%) patients, respectively; 130 (44.4%) patients had complex FS; 33.8% developed FS before 1 year of age; 60.8% had a body temperature <39°C at the onset of the 1st FS; and 12.6% had neurodevelopmental delay. We studied these 293 patients in two groups: less than three and more than two attacks of FS. The results of univariate analysis were as follows: family history of FS (p = 0.001), male dominance (p = 0.014), abnormal EEG findings (p = 0.030), early onset of FS (<1 year of age; p = 0.049), complex FS (p = 0.001), neurodevelopmental delay (p = 0.037), low level of education of the father (p = 0.004), and low educational level of the mother (p = 0.001). Parameters such as maternal age at childbirth, gestational age, mode of delivery, birth weight, low family's economic status, and family history of epilepsy did not differ significantly between the groups. EEG was performed in 69.6% of the total study population and information about educational status for both parents was collected in 71.3% of the total study population. These two variables were not included in the multivariate model because these numbers were not considered representative of the whole sample. On multivariate analysis, several parameters yielded statistically significant findings: complex FS (p = 0.001; OR, 3.69; 95% CI, 2.12-6.44), family history of FS (p = 0.001; OR, 3.10; 95% CI, 1.67-5.75), male dominance (p = 0.002; OR, 2.44; 95% CI, 1.39-4.26), and early onset of the 1st FS (<1 year of age; p = 0.032; OR, 1.89; 95% CI, 1.06-3.37). Conclusions: Complex FS, family history of FS, male sex, and early onset of the 1st FS increased the risk of recurrent FS. Abnormal EEG findings and low parental educational status may be new prognostic indicators. However, further investigation using larger populations and a prospective design is needed to confirm the validity of these prognostic factors of recurrent FS.