Peds Neurology References
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Berg AT, Shinnar S, Shapiro ED, Salomon ME, Crain EF, Hauser WA
Risk factors for a first febrile seizure: a matched case-control study.
Epilepsia 1995 Apr;36(4):334-41

We conducted a matched case-control study to identify risk factors for first
febrile seizures, with special emphasis on characteristics of the acute
illness episode. Cases were identified through hospital emergency
departments; controls were identified through outpatient clinics and
emergency departments.. Sixty-nine children with first febrile seizures and
no history of previous unprovoked seizures were matched for age (+/- 6
months), site of routine pediatric care, and date of visit (+/- 2 weeks)
with 1 or 2 febrile controls who had no history of previous febrile or
unprovoked seizures. Medical records for the index visit were reviewed, and
parents were interviewed by telephone. Illness characteristics examined
included height of temperature, type of underlying illness, contact with a
physician during the illness but before the index visit, and use of
acetaminophen or decongestants. Family history of febrile and of unprovoked
seizures, sociodemographic characteristics, daycare use, and selected pre-
and perinatal variables were also studied. On multivariable analysis,
significant independent risk factors were height of temperature, history of
febrile seizures in a first- or in a higher degree relative. Gastroenteritis
as the underlying illness had a significant inverse (i.e., protective)
association with febrile seizures. Maternal smoking during pregnancy was a
marginally significant predictor of febrile seizures.

Berg AT
Are febrile seizures provoked by a rapid rise in temperature?
Am J Dis Child 1993 Oct;147(10):1101-3

Pediatricians are frequently taught that a rapid rise in temperature is
responsible for causing a febrile seizure; yet there are no clinical data to
support this hypothesis. The few experimental data are based on
hyperthermia-induced seizures in animals and are of no clear relevance to
naturally occurring fevers and accompanying seizures. Further, the
experimental findings are not consistent across studies. By contrast, there
is substantial evidence indicating that the height of temperature plays a
role in eliciting a febrile seizure. Although febrile seizures are now
recognized as benign and, in general, a disorder that should not be treated
with chronic anticonvulsant therapy, an understanding of how fevers lead to
febrile seizures may be useful for evaluating the appropriateness and
efficacy of treatments that involve intermittent therapy given at the time
of fever.