Exploring the Age-Old Question: What Is the Predictive Value of EEG for Future Epilepsy in Children With Complex Febrile Seizures?

Children with complex febrile seizures (CFS) have increased risk for the development of epilepsy, but varying prognostic value has been ascribed to abnormal post-CFS electroencephalograms (EEGs). We conducted a retrospective cohort study of 621 children with post-CFS EEGs and identified an association between CFS and midline-vertex discharges, which were present in 52% of the 56 EEGs with interictal epileptiform discharges. Among patients who completed at least 1 year of follow-up, 24.7% subsequently developed epilepsy. Most patients had normal EEGs but 20% had interictal epileptiform discharges. Midline-vertex discharges were seen at a similar rate in children who did not develop epilepsy (55%) and those who developed epilepsy (45%). The development of epilepsy was not associated with any interictal epileptiform discharge localization. Logistic regression modeling identified 4 predictors of future epilepsy: >3 febrile seizures in 24 hours, interictal epileptiform discharges during post-CFS EEG, family history of afebrile seizures, and age of CFS onset ≥ 3 years.