Prognosis of Febrile Status Epilepticus in Children: a systematic review

Abstract

Febrile Seizures (FS) are the most common type of seizures in childhood. Febrile Status Epilepticus (FSE) is defined as a FS of prolonged duration, lasting for longer than 30 minutes, constituting a medical emergency. FSE is both a subtype of FS and an etiology of Convulsive Status Epilepticus (CSE). Although Simple Febrile Seizures are considered relatively benign this is debatable when FSE is considered. This type of prolonged seizures has been hypothesized to have worse outcomes than their briefer counterparts, but when CSE is of concern, febrile etiology appears to have the best prognosis. Therefore, we performed a systematic review on FSE prognosis in its entirety, either as part of FS or CSE, considering outcomes such has mortality and morbidity, in terms of neurological sequelae, recurrence of seizures and epilepsy. Pubmed, Scopus and Web Of Science were searched and 14 studies were considered eligible for further analysis. We found no deaths attributable to FSE and there was little risk for further morbidity. Most children with FS will not have a recurrence, but the risk of a second FSE is higher after the first. Unprovoked seizures and epilepsy need further studies with longer follow-up times. Permanent sequelae are unlikely, although memory impairment is of concern and the association with hippocampal sequelae is yet to be understood. It is of the utmost importance for physicians to understand prognosis of FSE in order to reassure parents and provide counselling on what measures to take.