Abstracts

Rationale: Simple febrile seizures are deemed complex if seizures are multiple (within a 24-hour period), prolonged or focal. Children with complex febrile seizures have traditionally been considered at increased risk of neuropathology and developing epilepsy, necessitating further investigative work-up. We present a prospective case series of 13 children treated by us who all had initial multiple febrile seizures within a 24-hour period. Methods: All patients underwent brain MRI imaging and EEGs. Results: The group consisted of 10 males with ages ranging from eight months to four years. The number of seizures within the 24-hour period ranged from two to seven, and patients returned to baseline inter-ictally. The neurological exams were all normal. Two patients had subsequent admissions with recurrent febrile seizure clusters. Family history was significant for seizures in nine, the majority childhood febrile seizures. All the EEGs were normal with the exception of one which was an ictal EEG recording. Brain MRI was normal in all cases except for one girl who had slightly increased size of the right hippocampus which was thought to be a sequelae of post-ictal swelling. Three children were subsequently diagnosed with generalized epilepsy with febrile seizures plus (GEFS +) based upon later development of afebrile seizures. Conclusions: We propose a new term, “simple febrile seizures plus (SFS+)” to describe those patients who have multiple febrile seizures within a 24-hr period, but are otherwise no different than the patient with simple febrile seizures. Diagnostic implications include avoiding low yield tests for this subgroup such as brain MRI (which often requires the use of general anesthesia), as well as therapeutic implications, in particular avoiding the use of scheduled antiepileptic drugs.