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Distribution of febrile seizure duration and associations with development

Authors

  • Dale C. Hesdorffer PhD,

    Corresponding author
    1. Gertrude H. Sergievsky Center, Departments of Epidemiology, Biostatistics, and Neurology, Columbia University, New York, NY
    • GH Sergievsky Center, Columbia University, 630 West 168th Street, P & S Unit 16, New York, NY 10032
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  • Emma K. T. Benn MPH,

    1. Gertrude H. Sergievsky Center, Departments of Epidemiology, Biostatistics, and Neurology, Columbia University, New York, NY
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  • Emilia Bagiella PhD,

    1. Gertrude H. Sergievsky Center, Departments of Epidemiology, Biostatistics, and Neurology, Columbia University, New York, NY
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  • Douglas Nordli MD,

    1. Children's Memorial Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • John Pellock MD,

    1. Departments of Pediatrics and Neurology, Virginia Commonwealth University, Richmond, VA
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  • Veronica Hinton PhD,

    1. Gertrude H. Sergievsky Center, Departments of Epidemiology, Biostatistics, and Neurology, Columbia University, New York, NY
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  • Shlomo Shinnar MD, PhD,

    1. Departments of Neurology, Pediatrics, and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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  • for the FEBSTAT Study Team


Abstract

Objective:

In prior studies of febrile seizures (FSs), prolonged FSs were defined, absent empirical evidence, as lasting 10 or 15 minutes or more. We assessed the distribution of FS duration in a cohort with first FSs, and the association between FS duration and baseline characteristics of the children.

Methods:

We calculated the observed cumulative probability, S(t), that a FS would last at least t minutes, S(t) = exp(−t/τ). Data were also fit using a model obtained as the sum of 2 exponential distributions (S[t] = αexp[−t1] + [1 − α]exp[−t2]). After assessing the best fit, the cutoff defining long FS was determined. Logistic regression was used to examine associations between long FSs and baseline characteristics, behavior, and development.

Results:

In 158 children with a first FS, median duration was 4.0 minutes. Duration of FS was best fit by a 2-component mixture exponential model. Using this model, we identified 1 population that accounts for 82.3% of FSs and has a mean duration of 3.8 minutes (short FS) and a second population that accounts for 17.7% of FSs and has a mean duration of 39.8 minutes (long FS). Long FSs were significantly associated with developmental delay (p = 0.010) and delays and younger age at first FS (p = 0.048).

Interpretation:

Like the distribution of afebrile seizure duration in children, the distribution of first FS duration is best modeled by assuming 2 populations. Developmental delay and younger age are associated with prolonged FSs. Our data lend further support to defining 10 minutes as the upper limit for a simple FS. ANN NEUROL 2011

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