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Margriet van Stuijvenberg, MD; Ewout W. Steyerberg, PhD; Gerarda Derksen-Lubsen, MD, PhD; Henriëtte A. Moll, MD, PhD

Arch Pediatr Adolesc Med. 1998;152:1170-1175.

Objective  Prediction of a recurrent febrile seizure during subsequent episodes of fever.

Design  Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen syrup to prevent febrile seizure recurrences.

Setting  Two pediatric hospitals in the Netherlands.

Patients  A total of 230 children with an increased risk of febrile seizure recurrence.

Main Outcome Measure  Seizure recurrence during a subsequent fever episode.

Results  A total of 509 episodes of fever were registered with 67 recurrences; 35 (52%) recurrences within the first 2 hours after fever of onset had a lower median temperature (39.3°C) than 32 (48%) after more than 2 hours of fever (40.0°C, P<.001). Poisson regression analysis resulted in 3 univariably significant (P<.05) predictors of a recurrence of seizure during a subsequent episode of fever. In a multivariable model, they were corrected for their correlation: interval between the last previous seizure and fever of onset less than 6 months (relative risk=1.3 [95% confidence interval: 0.8-2.4]), age at fever of onset (relative risk=0.7 [95% confidence interval: 0.5-1.0] per year increase) and temperature at fever of onset (relative risk=1.7 [95% confidence interval: 1.1-2.8] per degree Celsius increase).

Conclusions  Half of the recurrent seizures occur in the first 2 hours after fever of onset of a subsequent fever episode. If seizure recurs at a later time, the temperature at seizure is higher compared with recurrences occurring in the first 2 hours of fever. Young age at fever of onset, high temperature at fever of onset, and high temperature during the episode of fever are associated with an increased risk of a recurrent febrile seizure at the moment that a child with a history of febrile seizures has fever again.

From the Departments of Pediatrics, Sophia Children's Hospital (Drs van Stuijvenberg and Moll), Rotterdam, and Juliana Children's Hospital (Dr Derksen-Lubsen), Den Haag; and the Department of Public Health, Erasmus University (Dr Steyerberg), Rotterdam, the Netherlands.

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