Predictors for the recurrent febrile seizures after the first complex febrile seizures

Main Article Content

Conny Tanjung
Irawan Mangunatmadja
Sudigdo Sastroasmoro
I. Budiman


Background Complex febrile seizures (CFS) have been shown
to be related to recurrence and epilepsy. Many studies were done
to determine the predictors of recurrence in both simple and com-
plex febrile seizures. To our knowledge until now there is no pub-
lished data that specially looks for predictors of recurrence after a
first CFS.
Objective To find out clinical and demographical characteristics
of a first CFS and to define the predictors for the recurrent febrile
Methods Prospective survival analysis study was done in chil-
dren with first CFS who visited Cipto Mangunkusumo Hospital,
Jakarta, over 14 months periods. The predictors for development
of recurrence were analyzed by SPSS for Windows 11.5 using
Kaplan-Meier test and Cox regression model with a level of signifi-
cance <0.05.
Results There were 62 subjects completed this study. Male-to-
female ratio was 1.4:1. The mean age at onset was 18.2 months.
Recurrence occurred in 9 subjects (14.5%). Body temperature
between 38-38.5°C (7 of 26 subjects, P=0.02), upper motor neu-
ron type of delayed development (3 of 7 subjects, P=0.03), and
epileptic history in the family (2 of 2 subjects, P<0.05) were asso-
ciated with recurrence in bivariate analysis. In multivariate analy-
sis only body temperature between 38-38.5°C (HR 1.6, 95% CI
1.0;23.9) and epileptic history in the family (HR 16.9, 95% CI
2.8;101.4) were identified as predictors.
Conclusion Low body temperature at the first seizures and epi-
leptic history in the family were independent predictors for the re-
currence after a first CFS

Article Details

How to Cite
Tanjung C, Mangunatmadja I, Sastroasmoro S, Budiman I. Predictors for the recurrent febrile seizures after the first complex febrile seizures. PI [Internet]. 18Oct.2016 [cited 19Jul.2019];46(5):204-. Available from:
Author Biographies

Conny Tanjung

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

Irawan Mangunatmadja

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

Sudigdo Sastroasmoro

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

I. Budiman

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Received 2016-10-16
Accepted 2016-10-16
Published 2016-10-18


1. Hirtz DG. Febrile seizure. Pediatr Rev 1997;18:5-9.
2. Rosman NP. Febrile convulsions. In: Mackowiak PA,
editor. Fever: Basic mechanism and management. 2nd
edition. Philadelphia: Lippincott; 1997. p. 267-77.
3. Commission on epidemiology and prognosis, Interna-
tional League Against Epilepsy. Guidelines for epide-
miologic studies on epilepsy. Epilepsia 1993;34:592-6.
4. American Academy of Pediatrics. Committee on qual-
ity improvement, subcommittee on febrile seizures. Prac-
tice parameter: Long term treatment of the child with
simple febrile seizures. Pediatrics 1999;103:1307-9.
5. Bessisso MS, Elsaid MF, Almula NA, Kadomi NK,
Zeidan SH, Azzam SB, et al. Recurrence risk after a
first febrile convulsion. Saudi Med J 2001;22:254-8.
6. Verity CM. Do seizures damage the brain? The epide-
miological evidence. Arch Dis Child 1998;78:78-84.
7. Shinnar S. Febrile seizures. In: Swaiman KF, Ashwal S,
editors. Pediatric neurology: Principles & practice. 3rd
edition. St. Louis: Mosby; 1999. p. 676-82.
8. Berg AT, Shinnar S. Complex febrile seizures. Epilepsia
9. Van Stuijvenberg M, Steyerberg EW, Derksen-Lubsen G,
Moll HA. Temperature, age, and recurrences of febrile
seizure. Arch Pediatr Adolesc Med 1998; 152:1170-5.
10. Berg AT, Shinnar S, Levy SR, Testa FM. Childhood-
onset epilepsy with and without preceding febrile sei-
zures. Neurology 1999;53:1742-8.
11. Madiyono B, Moeslichan S, Sastroasmoro S, Budiman
I, Purwanto SH. Perkiraan besar sampel. In:
Sastroasmoro S, Ismael S, editors. Dasar-dasar
metodologi penelitian klinis. Jakarta: CV Sagung
Seto; 2002. p. 259-87.
12. Verity CM, Greenwood R, Golding J. Long-term intel-
lectual and behavioral outcomes of children with fe-
brile convulsions. N Engl J Med 1998;338:1723-8.
13. Rosman NP, Colton T, Labazzo J. A controlled trial of
diazepam administered during febrile illnesses to pre-
vent recurrence of febrile seizures. N Engl J Med
14. Ling SG. Clinical characteristics and risk factors for a
complex first febrile convulsion. Singapore Med J
15. Van Stuijvenberg M, Beijeren E, Wils NH, Derksen-
Lubsen G, Duijn CM, Moll HA. Characteristics of
the initial seizure in familial febrile seizures. Arch Dis
Child 1999;80:178-80.
16. Evita. Berulangnya kejang demam pada penderita
kejang demam pertama [thesis]. Jakarta: University of
Indonesia; 1992.
17. Nelson KB, Ellenberg JH. Prognosis in children with
febrile seizures. Pediatrics 1978;61:720-7.
18. Habib Z, Akram S, Ibrahim S, Hasan B. Febrile sei-
zures: Factors affecting risk of recurrence in Pakistani
children presenting at the Aga Khan University Hos-
pital. J Pak Med Assoc 2003;53:11-7.
19. Rantala H, Tarkka R, Uhari M. A meta-analytic re-
view of the preventive treatment of recurrences of fe-
brile seizures. J Pediatr 1997;131:922-6.
20. Offringa M, Bossuyt PMM, Lubsen J, Ellenberg JH,
Nelson KB, Knudsen FU, et al. Risk factors for seizure
recurrence in children with febrile seizures: A pooled
analysis of individual patient data from five studies. J
Pediatr 1994;124:574-84.
21. Tarkka R, Rantala H, Uhari M, Pokka T. Risk of recur-
rence and outcome after the first febrile seizure. Pediatr
Neurol 1998;18:218-20.