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Letters to the Editor Indian Pediatrics 2001; 38: 1433-1434 |
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Reply |
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We thank Dr. Yash Pal for his interest in our article. It seems there is some confusion about risk of recurrence. The risk of subsequent recurrence of Febrile Seizure (FS) is the issue and depends upon the point in time when the child is being assessed. Recurrence risk in a child with previous episode of recurrence is higher than in a child with no history of previous recurrence. It has been found that after two febrile seizures the recurrence risk hazard was twice as high as that in otherwise similar children with only one previous episode. After three or more episodes, the recurrence risk was 2.5 times higher(1). Thus, if a pediatrician is assessing a child who has had many previous episodes of FS, this in itself forms a risk factor for subsequent (new) recurrences. Hence, previous episodes of FS has been included as a risk factor for recurrence in the Table. This is mportant to know for the further management and prognosis of the child. Regarding the study quoted(2) it deals with 18 months follow-up of children with FS in which it was found that children with "many subsequent febrile episodes" (as in those being cared in day nursery) had a higher recurrence rate of FS and this was an additional risk factor for recurrence. All the five items, i.e., young age at onset (<15 months), epilepsy in first degree relatives, febrile seizure in first degree relatives, many subsequent febrile episodes (day nursery) and a first complex FS had independant predictive values and each of the factors contributed separately to the recurrence rate. Certainly, a brief febrile episode is not always associated with a seizure. However, if a child is likely to/is shown to have repeated febrile episodes then this per se forms a risk factor. In fact three studies have found that many febrile episodes after the initial FS appears to be the most powerful risk factor for recurrent FS(3-5). It may be emphasized that the two most consistent risk factors for recurrence of FS reported in different studies include young age at onset and family history of seizures. A complex interplay between genetic and environmental factors determines the occurrence of new FS(6).
Pratibha D. Singhi, |
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