ORIGINAL RESEARCH article
Front. Neurol.
Sec. Pediatric Neurology
Early Recurrence of Febrile Seizures During Acute Illness: Risk Factors and Lack of Association With Long-Term Epilepsy in a Pediatric Cohort
Provisionally accepted
- Shanghai Children's Hospital, Shanghai, China
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Background: Febrile seizures (FSs) are a common neurological manifestation in children, affecting 2–5% of children worldwide. While acute-phase recurrences during the same febrile illness are frequent, their risk factors and implications for long-term epilepsy remain incompletely understood. This study aimed to identify independent risk factors for recurrent FSs (RFS) during the acute febrile phase and clarify their association with long-term epilepsy development. Materials and Methods: This retrospective cohort study included 611 children (aged 6 months to 3 years) diagnosed with FSs at a tertiary pediatric hospital in Shanghai between April 2021 and March 2023. Clinical data on seizure recurrence patterns, demographic characteristics, and influenza A infection status were collected. Multivariate logistic regression was used to identify independent risk factors for acute-phase RFS. Long-term outcomes, including subsequent seizure recurrence and epilepsy incidence, were compared between children with and without RFS using Kaplan–Meier survival analysis, with differences assessed by the log-rank test. Results: The median time to recurrence was 6 hours after the initial seizure, and 94.95% of recurrent events occurred within 24 hours. Independent risk factors for acute-phase RFS were a prior history of FSs (odds ratio [OR]=2.24, 95% confidence interval [CI]: 1.42–3.56) and positive influenza A infection (OR=3.34, 95% CI:1.96-5.71). Among 99 children with RFS, 22.22% experienced further seizures and 2.02% developed epilepsy during a median follow-up of 39 months (interquartile range: 37-41). In the non-recurrent FS group (n=512), 19.14% had later seizures and 0.39% developed epilepsy. Although any subsequent seizure (febrile or afebrile) was more frequent in the RFS group, the difference in long-term seizure risk was not statistically significant (log-rank χ²=0.74, P=0.391; hazard ratio [HR]=1.223, 95% CI: 0.770–1.942). Conclusion: Acute-phase FSs recurrence is common and typically occurs within 24 hours, with prior FSs history and influenza A infection as key risk factors. However, early recurrence was not associated with increased long-term epilepsy risk. These findings support close monitoring of high-risk children during febrile illnesses while alleviating unnecessary concerns regarding future neurologic outcomes.
Keywords: Acute-Phase Recurrence, febrile seizures, Influenza A, Long-TermRecurrence, Risk factors
Received: 28 Oct 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Jiang, Cheng, Wang, Wang, Zhang and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Weiqin Jiang
Yujuan Huang
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