Febrile Seizures – Counseling of the family

1. Can the child have a repeat episode in future?

There are 30-50% chances of recurrence after simple febrile seizure, 70% of which occurs within first year. The  factors that can predict the increased risk are:

• Age of onset  less than 18 months
• If the first febrile seizure had occurred within one hour of fever
• If the initial febrile seizure occurred at a low temperature
• History of febrile seizures in a first degree relative.

2. What is the Risk of epilepsy in the child?

• Risk of any child to develop epilepsy by the age of 20 years is around 1 %
• In patients with simple febrile seizures, the risk is approximately 2.4%. 
• In patients with complex febrile seizures,  the risk of epilepsy is 6-7%. 

Other factors which increase the risk for developing epilepsy at a later age are:

• Presence of neuro-developmental delay 
• Presence of family history of epilepsy 
• Presence of complex features  – focal seizures  or  seizure duration more than 10 minutes
• Persistent EEG abnormalities in follow up

3. Should Clobazam be routinely used in fever as a prophylaxis for simple febrile seizures ?

Clobazam (Frisium) prophylaxis is given for three days with every episode of fever by many of us. The benefit is marginal and is not worth the side effect of sedation. It is recommended to counsel the parents about the benign nature of the phenomenon and how to manage a seizure at home.Clobazam prophylaxis is best reserved for over anxious parents and especially in situations when medical facilities are sparse.