Therapeutic indicators of acute encephalopathy in patients with complex febrile seizures

Background The aim of this study was to identify predictors of neurologic damage in children with febrile seizures or altered consciousness within 6h of seizure onset. Methods The present study included 86 children (age range, 4-159 months old), who fulfilled the diagnostic criteria for complex febrile seizures on admission between October 2002 and November 2008. Using the Pediatric Cerebral Performance Category Scale (PCPC), the children were classified into two groups: poor outcome (PCPC = 2-6) and good outcome (PCPC = 1). Clinical profiles and laboratory findings were compared between the groups. Results Of the 86 children, 17 fell into the poor outcome and 69 into the good outcome group. Using univariate analysis, three early risk factors for poor outcome were identified: (i) consciousness disturbance or hemiplegia at 6h from onset; (ii) refractory status epilepticus; and (iii) elevation of aspartate aminotransferase to >90IU/L within 6h of onset. Using these criteria, children in the poor outcome group were identified with a 94% sensitivity and 67% specificity rate (odds ratio, 36.6; 95% confidence interval: 4.87-1560). During the study period, the inpatients who met the criteria for acute encephalopathy also fell into the poor outcome group. Conclusions The development of neurologic damage in children with complex febrile seizures can be predicted within 6h of onset, using the identified risk factors. The authors propose an assumption of severe febrile seizures (SFS) in children who fulfill these risk factors. Using SFS as an inclusion criterion, an interventional study for acute encephalopathy can be designed.