Icbiilc scizuic (IS) is Lhc mosL common Lypc

ol childhood scizuics
1
. IL is also a common
causc ol pcdiaLiic admission and paicnLal
conccin. Thc incidcncc vaiics liom 0.35%-1.5%
in China
2
Lo 14% in Guam
3
. A IS is dclincd
by Lhc InLcinaLional Lcaguc AgainsL Epilcpsy
as a scizuic occuiiing in associaLion wiLh a
lcbiilc illncss in Lhc abscncc ol ccnLial ncivous
sysLcm (CNS) inlccLions oi acuLc clccLiolyLc
imbalancc and wiLhouL piioi alcbiilc scizuics
in childicn oldci Lhan onc monLh
4
.

Accoiding
Lo Bcig
5
, ISs aic dclincd as occuiiing bcLwccn

6 monLhs and 6 ycais ol agc.

Thc child may
bc ncuiologically noimal oi abnoimal.
Icbiilc scizuics (ISs) aic luiLhci classilicd as
simplc oi complcx. A IS is complcx il iL is
local oi local lindings aic picscnL duiing Lhc
posLicLal pciiod, piolongcd moic Lhan 10-15
minuLcs, oi mulLiplc (occuiicncc ol moic Lhan
1 scizuic duiing Lhc lcbiilc illncss)
4
.
Onc ma|oi conccin in dcaling wiLh liisL IS
is Lhc iisk ol iccuiicncc. Risk lacLois loi
iccuiicncc alLci liisL IS, bascd on dillcicnL
sLudics, aic:
1. Agc lcss Lhan onc ycai
1-4,6-12
2. Iamily hisLoiy ol lcbiilc scizuics
1-3,6-9, 11-
16
Recurrence ot tebriIe seizure in Yazd, Iran
Razich Iallah, Scdighah Akhavan Kaibasi
Department cj Pediatrics, S|a|id Sadcug|i University cj Medica| Sciences, S|a|eed Sadcug|i Hcspita|, Yazd, lran
5LMMARY: FaIIah R, Akhavan Karbasi 5. Recurrence ot tebriIe seizure in
Yazd, Iran. Turk ) Pediatr 2010, 52: 618-622.
FebriIe seizure {F5) is the most common probIem in pediatric neuroIogy. The
purpose ot this study was to determine F5 recurrence trequency and to evaIuate
its risk tactors. In a descriptive retrospective study, 139 chiIdren with tirst F5,
admitted between March 2004 and August 2005 in Yazd 5haheed 5adoughi
HospitaI, were toIIowed. 5eventy-si boys and 63 girIs with a mean age ot
2.03r1.21 years were toIIowed tor 25.1r5.5 months. Thirty-seven percent had
F5 recurrence, with a mean recurrence time ot 6.7r5.9 months. 5ity-tive
percent ot intants and 30% ot chiIdren >1 year oId had F5 recurrence. 5ity-
three percent ot those with seizure occurring in <1 hour ot tever duration
had F5 recurrence, whiIe onIy 33% ot those with seizure atter >1 hour ot
tever duration had F5 recurrence. 5eizures in chiIdren <1 year oId and in
<1 hour ot tever duration were risk tactors tor F5 recurrence.
Kcy words. jcbrilc scizurc, jirst jcbrilc scizurc, jcbrilc scizurc rccurrcncc.
3. Scizuic in LcmpciaLuics ol lcss Lhan 40C
1-
4,6-8,11,12,14
4. IS wiLhin an houi ol iccognizcd onscL ol
lcvci
1, 2, 6,7
5. Complcx lcaLuics
1,2,5,6,9,10,16,17
: piolongcd
18
,
mulLiplc
3
, local
11
6. Iamily hisLoiy ol cpilcpsy
2,7-11
7. Malc

scx
17
S. PaicnLal consanguiniLy
10
. ALLcndancc aL day caic
2,13
10. RccuiicnL lcbiilc scizuic
19
Simplc IS, cspccially in a child oldci Lhan 12
monLhs, is considcicd as bcnign discasc, which
icquiics nciLhci spccilic LcsLs [laboiaLoiy LcsL,
lumbai puncLuic, ncuioimaging (compuLciizcd
Lomogiaphy [CT| oi magncLic icsonancc
imaging [MRI|), EEG|, noi spccilic LicaLmcnL
1
.
Howcvci, complcx IS is accompanicd wiLh
luiLhci complicaLions such as: mcningiLis
1,20
,
iccuiicnL IS
1,2,4,6,9,10,16,17
, subscqucnL cpilcpsy
1-
3,8,19
, and sLaLus cpilcpLicus
1
.
PicvcnLing oi aboiLing piolongcd ISs Lo
picvcnL sLaLus cpilcpLicus wiLh iLs aLLcndanL
complicaLions, howcvci, icmains a iaLional
goal
19
.

Diazcpam givcn oially oi iccLally aL
Lhc Limc ol onscL ol a lcbiilc illncss will
T|e Turkis| }curna| cj Pediatrics 2010, 52. 618-622 Origina|
icducc Lhc piobabiliLy ol a iccuiicnL IS, and
is indicaLcd paiLiculaily in childicn aL iisk loi
piolongcd oi mulLiplc IS and in Lhosc who
livc lai liom mcdical caic oi Lo allay lamilial
anxicLy
1
.

PiophylacLic daily anLiconvulsanL
should bc considcicd in inlanLs wiLh abnoimal
ncuiological cxam oi dcvclopmcnLal dclay,
complcx IS wiLh posiLivc lamily hisLoiy ol
cpilcpsy, and licqucnL and piolongcd IS
21
.
MulLiplc iccuiicnccs ol IS picdisposc Lhc
child wiLh IS Lo subscqucnL cpilcpsy
20,22
.

Thc
associaLion bcLwccn IS and cpilcpsy, howcvci
small, may dcmonsLiaLc a gcncLic link bcLwccn
IS and cpilcpsy iaLhci Lhan a causc and cllccL
iclaLionship
23
.
AnLiconvul sanLs such as phcnobaibiLal
and diazcpam havc bccn lound Lo icducc
Lhc iccuiicncc ol ISs, buL noL subscqucnL
dcvclopmcnL ol cpilcpsy
4
.
Thc puiposc ol Lhis sLudy was Lo dcLciminc
Lhc iccuiicncc iaLc ol IS in childicn and Lo
cvaluaLc iisk lacLois loi iccuiicncc in Yazd, a
ccnLial ciLy in Iian.
MateriaI and Methods
This dcsciipLivc icLiospccLivc sLudy includcd
13 childicn wiLh liisL IS, admiLLcd bcLwccn
Maich 2004 and AugusL 2005 in Yazd Shahccd
Sadoughi HospiLal, and lollowcd loi 15-36
monLhs liom Lhc poinL ol vicw ol scizuic
iccuiicncc. Wc uLilizcd Bcig's dcliniLion ol agc
iangc ol 6 monLhs - 6 ycais in IS. Childicn
wiLh hisLoiy ol alcbiilc scizuic, cvidcncc ol
CNS inlccLion, shigcllosis cnccphalopaLhy,
oi clccLiolyLc abnoimaliLics wcic cxcludcd.
Maximum LcmpciaLuic was dclincd as Lhc
highcsL iccLal LcmpciaLuic iccoidcd duiing
Lhc pciiod ol admission. Thc paLicnLs'
chaiacLciisLics, i.c., scx and agc aL picscnLaLion
ol IS, Lypc and duiaLion ol scizuic, Lypc ol
IS (simplc oi complcx), lamily hisLoiy ol
lcbiilc/alcbiilc scizuic in liisL- and sccond-
dcgicc iclaLivcs, lcvci duiaLion, dcvclopmcnLal
sLaLus, and maximum LcmpciaLuic, wcic
icvicwcd. Thc dcvclopmcnLal sLaLus ol Lhc
paLicnL was asscsscd by a pcdiaLiician and a
pcdiaLiic ncuiologisL. Thc daLa wcic analyzcd
using SPSS.15 sLaLisLical solLwaic. Unpaiicd
L LcsL and chi-squaic LcsL wcic uscd Lo
compaic conLinuous and caLcgoiical vaiiablcs,
icspccLivcly, bcLwccn gioups wiLh and wiLhouL
iccuiicncc ol IS. Risk lacLois wcic iniLially
cxamincd by univaiiaLc analysis. RaLc iaLios
(RRs) wcic calculaLcd loi individual iisk lacLois
wiLh 5% conlidcncc inLcival. MulLivaiiaLc
Cox icgicssion analysis was uscd Lo cxaminc
Lhc iisk ol iccuiicncc alLci ad|usLmcnL loi
individual iisk lacLois. Thc Kaplan-Mcici
mcLhod was uscd Lo calculaLc Lhc piobabiliLy
ol iccuiicncc duiing Lhc lollow-up pciiod.
SLaLisLical signilicancc was Lakcn as p<0.05.
This sLudy was appiovcd by Lhc cLhics
commiLLcc ol Shahccd Sadoughi UnivcisiLy
ol Mcdical Scicnccs, Yazd, Iian.
ResuIts
ScvcnLy-six boys and 63 giils wiLh a mcan agc
ol 2.03r1.21 ycais wcic lollowcd loi 25.1r5.5
monLhs. Thc malc: lcmalc iaLio was 1.2 : 1.
ThiiLy-Lhicc pciccnL (46/13) had complcx
IS, among whom 23 had mulLiplc convulsions
wiLhin 24 houis, showcd local lcaLuics and
14 had piolongcd convulsion.
Thc mcan scizuic duiaLion was S5.6 minuLcs
in inlanLs and 6.75.3 minuLcs in childicn
>1 ycai old. Scizuic was moic piolongcd in
inlanLs (p~0.04).
IilLy-Lwo paLicnLs had iccuiicnL IS, wiLh a
mcan iccuiicncc Limc ol 6.75. monLhs.
Thc ovciall iccuiicncc iaLc was 37.4% by Lhc
Kaplan-Mcici mcLhod. CumulaLivc iccuiicncc
was 11.5% by 1 monLh, 67.3% by 6 monLhs,
SS% by 1 ycai and 4% by 1S monLhs. Thc
iccuiicncc iaLc displaycd no luiLhci incicasing
Licnd by 2 ycais alLci Lhc liisL cpisodc.
Mcan Limc ol iccuiicncc in Lhc dillcicnL agc
gioups is shown in Tablc I, which indicaLcs
LhaL IS iccuiicncc was laLci (p~0.014) in
childicn >4 ycais.
Six childicn had ncuiodcvclopmcnLal dclay
(NDD), among whom liisL IS aL <1 ycai ol
agc was sccn in 2, whilc 4 showcd IS in 1-
2 ycais. Thcsc 4 paLicnLs had iccuiicncc ol
IS. DcvclopmcnLal sLaLc ol childicn had noL
changcd aL Lhc cnd ol Lhc lollow-up.
Ol Lhc 52 who iccuiicd, 67% (35/52) had
1, 23% (12/52) had 2, and 10% (5/52) had
moic Lhan 2 iccuiicnccs. Tablc II shows Lhc
numbci ol IS iccuiicnccs bascd on agc gioups,
piophylacLic diug usagc and dcvclopmcnLal
sLaLus, and indicaLcs LhaL Lhc numbci ol
iccuiicnccs was highci in Lhc <1 ycai ol agc
Vc|ume 52 Numoer 6 Feori|e Seizure Recurrence in lran 61
gioup (p~0.04). As Lhc mcLhod ol paLicnL
sclccLion was noL univcisal, anLicpilcpLic
LicaLmcnL was picsciibcd in complicaLcd
IS, and a iandomizcd clinical Liial should
bc donc in Lhcsc siLuaLions, analysis ol daLa
abouL piophylacLic diugs docs noL sccm Lo
bc logical.
UnivaiiaLc analysis ol iisk lacLois as shown in
Tablc III indicaLc LhaL Lhc occuiicncc ol liisL
IS aL <1 ycai ol agc and IS occuiicncc in
<1 houi ol lcvci duiaLion wcic iisk lacLois
loi IS iccuiicncc.
MulLivaiiaLc analysis discloscd LhaL Lwo lacLois
wcic sLaLisLically signilicanL: caily agc ol onscL
(<1 ycai) and scizuic in <1 houi ol lcvci
duiaLion, which icmaincd signilicanL wiLh
Cox icgicssion analysis. Thc iaLc iaLio (RR)
was 1.6 (5% conlidcncc inLcival [CI| ~ 1.2
2.63 and p valuc ~ 0.0001) loi caily agc ol
onscL and 1.7 (5% CI ~ 1.25 2. 2 and p
valuc ~ 0.02) loi lcvci duiaLion ol <1 houi,
icspccLivcly.
Discussion
Thc puiposc ol Lhis sLudy was Lo dcLciminc
IS iccuiicncc licqucncy and Lo cvaluaLc iLs
iisk lacLois. Wc uscd IS dcliniLion bascd
on pcdiaLiic LcxLbook
24
and Bcig
5
, who is a
masLci in IS.
Onc-Lhiid ol oui paLicnLs had complcx IS, buL
in oLhci sLudics, Lhis iaLc vaiics bcLwccn 6.7%
and 35%
1,3,5,16,18,24,25
. Possiblc cxplanaLions
loi Lhis

vaiicLy aic: cLhnical and gcogiaphic
dillcicnccs, bcLLci diagnosis ol paiLial scizuics
and mcLhods ol paLicnL sclccLion.
Thc iccuiicncc iaLc ol IS in Lhc picscnL
sLudy was 37%, similai Lo somc ol Lhc oLhci
sLudics
1-3,6,9,19
, which vaiicd bcLwccn 15%
and 4S%
6,13,14,17
.

Possiblc cxplanaLions loi Lhis
dillcicncc aic: lollow- up duiaLion, cLhnical and
gcogiaphical dillcicnccs, mcLhods ol paLicnL
sclccLion, and samplc sizc. In Lhc picscnL sLudy,
IS in inlanLs (<1 ycai) was moic piolongcd
(similai Lo Iaiwcll's icsulL
25
) and was onc ol
Lhc iisk lacLois loi IS iccuiicncc, which is in
agiccmcnL wiLh oLhci sLudics
1-4,6,7-12
LhaL sLaLc
LhaL caily agc ol onscL ol IS sccms Lo bc Lhc
mosL consisLcnL iisk lacLoi loi IS iccuiicncc.
This iclaLion appcais Lo bc duc Lo Lhc lacL
LhaL, in vicw ol Lhc youngci agc aL onscL, Lhc
child will bc in Lhc agc gioup aL iisk loi IS
loi a longci pciiod
1
.
This sLudy showcd LhaL Lhc shoiLci Lhc duiaLion
ol iccognizcd lcvci, Lhc highci Lhc chancc ol
iccuiicncc, and scizuic occuiiing in <1 houi
ol lcvci duiaLion was a iisk lacLoi loi IS
iccuiicncc, which is in agiccmcnL wiLh oLhci
sLudics
1,4,24,26
.

Agc gioup ToLal numbci Childicn wiLh iccuiicnL lcbiilc scizuic Mcan iccuiicncc Limc (mo) SD
Numbci PciccnL
< 1 ycais 2 1 65 5.574.7
1 2 ycais 63 23 36 6.05.4
2 4 ycais 3 10 26 10.7S.3
> 4 ycais S 0 0 0
TabIe I. Compaiison ol Mcan Rccuiicncc Timc Accoiding Lo Agc Gioups
RccuiicnL IS
IacLoi
No Onc Limc Two Limcs >2 Limcs P Valuc
Agc aL liisL scizuic
<1 ycai 10 14 4 1
0.04
>1 ycai 77 21 S 4
PiophylacLic diugs
No 62 30 3
0.2S Diazcpam in lcvci 15 0 0 1
ConLinuous phcnobaibiLal 10 5 3 1
NcuiodcvclopmcnLal dclay
Ycs 2 2 2 0
0.224
No S5 33 10 5
TabIe II. Iicqucncy ol Rccuiicncc ol Icbiilc Scizuic Bascd on Somc IacLois
620 Fa||a| R, et a| T|e Turkis| }curna| cj Pediatrics Ncvemoer-Decemoer 2010
In Lhis sLudy, 65% ol childicn <1 ycai old
had IS iccuiicncc. This liguic is highci Lhan
Lhosc ol oLhci sLudics (50%)
1,4,24
and lowci
Lhan icpoiLcd in anoLhci sLudy (73%)
8
. Moic
piolongcd scizuics in inlanLs may bc a possiblc
cxplanaLion loi Lhc icsulL ol oui sLudy.
In Lhis sLudy, 13.7% ol Lhc childicn cxpciicnccd
Lhcii scizuic ciLhci bcloic oi wiLhin 1 houi
ol onscL ol lcvci, which is lowci Lhan LhaL
ol Bcig's sLudy (21%)
12
. On Lhc oLhci hand,
IS occuiicd in spiLc ol usc ol a lull dosc ol
anLipyicLic in 62% ol paLicnLs, and usc oi noL
ol anLipyicLic had no cllccL on IS iccuiicncc,
which suppoiLs Lhc icsulLs ol oLhci sLudics
indicaLing LhaL piophylacLic anLipyicLic is
noL iccommcndcd Lo icducc Lhc iccuiicncc
iaLc and was noL cllccLivc in picvcnLing IS
occuiicncc
23,25
.

In Lhc picscnL sLudy, EEG icsulLs had no valuc
in picdicLing iccuiicncc ol IS, as in oLhci
sLudics
2,27,28
. Thc iccommcndaLion lound in
a pcdiaLiic ncuiology LcxLbook LhaL an EEG
should bc donc in childicn wiLh complcx
ISs who havc a iccuiicncc wiLhouL lcvci oi
in childicn wiLh iccuiicnL ISs who cxhibiL
dcvclopmcnLal dclays oi ncuiologic dcliciLs
musL bc considcicd
1
.

In oui sLudy, complcx IS was noL associaLcd wiLh
an incicascd iisk ol iccuiicncc ol IS, which is
in accoidancc wiLh somc sLudics
1,11,12,14
buL noL
in agiccmcnL wiLh oLhcis
1,2,4,6,9,10,16,17
. Possiblc
cxplanaLions loi Lhis discicpancy aic: Lhc
numbci ol paLicnLs, paLicnL sclccLion mcLhods
and bcLLci diagnosis ol paiLial scizuics.
In Lhis sLudy, NDD was noL a iisk lacLoi loi
iccuiicnL IS, which is in agiccmcnL wiLh oLhci
sLudics
1,11,12,18
.
In conclusion, in Lhis sLudy, scizuic in childicn
<1 ycai old was onc ol Lhc iisk lacLois loi
IS iccuiicncc and Lhcy had moic piolongcd
scizuics. Thcicloic, IS musL bc considcicd as
moic sciious in Lhis agc gioup.
Wc showcd LhaL inlanLs cxpciicncing IS aL Lhc
onscL ol lcvci havc a highci iisk ol iccuiicncc.
This has implicaLions whcn considciing
piophylacLic sLiaLcgics LhaL icly on giving
mcdicaLions aL Lhc onscL ol lcbiilc illncss
1
.
IacLoi Rccuiicncc No Rccuiicncc P Valuc
Agc aL liisL scizuic <1 ycai 1 10 0.0001
>1 ycai 33 77
Typc ol lcbiilc scizuic Simplc 32 61 0.2S
Complcx 20 26
Icvci duiaLion <1 houi 12 7 0.01
>1 houi 40 S0
Scx Malc 24 52 0.11
Icmalc 2S 35
Scizuic aL T <40C Ycs 51 S4 0.6
No 1 3
AnLipyicLic usagc in oLhci lcbiilc
cpisodc
Ycs 34 52 0.5
No 1S 35
PosiLivc lamily hisLoiy ol IS in 1
sL
-
2
nd
dcgicc iclaLivcs
Ycs 13 15 0.27
No 3 72
PosiLivc lamily hisLoiy ol cpilcpsy
in 1
sL
-2
nd
dcgicc iclaLivcs
Ycs 10 11 0.24
No 42 76
DcvclopmcnLal dclay Ycs 4 2 0.13
No 4S S5
Scizuic duiaLion
>10 min
Ycs S 6 0.26
No 44 S1
Scizuic Lypc Gcncializcd 50 S0 0.45
Iocal 2 4
Sccondaiy gcncializcd 0 3
EEG icsulLs Noimal 1S 13 0.46
Nonspccilic abnoimal 22 11
EpilcpLic abnoimaliLy 3 4
TabIe III. Risk IacLois loi Rccuiicncc ol Icbiilc Scizuic Using UnivaiiaLc Analysis
Vc|ume 52 Numoer 6 Feori|e Seizure Recurrence in lran 621
AnLipyicLic usagc was noL cllccLivc in picvcnLing
scizuic iccuiicncc, howcvci, acLivc mcasuics Lo
conLiol Lhc lcvci, including usc ol anLipyicLics,
may icducc discomloiL and aic icassuiing.
AcknowIedgements
This sLudy was lundcd by a gianL liom Lhc
DcpuLy loi Rcscaich ol Shahccd Sadoughi
UnivcisiLy ol Mcdical Scicnccs and HcalLh
Sciviccs, Yazd, Iian.
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