Predictors of Epilepsy Following Febrile Seizures: A Longitudinal Cohort Study

Background: Febrile seizures affect 2-5% of children and carry an increased risk of subsequent epilepsy. Identifying predictors of epilepsy development is essential for risk stratification and family counseling. This study aimed to determine the cumulative incidence of epilepsy following febrile seizures and identify independent predictors. Methods: This prospective longitudinal cohort study enrolled 523 children aged 6-60 months presenting with febrile seizures between January 2014 and December 2023. Baseline clinical characteristics, electroencephalography (EEG) findings, and neuroimaging results were recorded. Participants were followed for a median of 6.2 years. Epilepsy was defined according to the International League Against Epilepsy criteria. Multivariate logistic regression and Kaplan-Meier survival analyses were performed. Results: Of 482 children completing follow-up, 29 (6.0%) developed epilepsy. Cumulative incidence at 2, 5, and 8 years was 2.3%, 4.8%, and 6.0%, respectively. Five independent predictors were identified: complex febrile seizures (adjusted OR 3.24; 95% CI 1.38-7.62), family history of epilepsy (OR 3.87; 95% CI 1.48-10.12), neurodevelopmental abnormality (OR 2.91; 95% CI 1.14-7.44), epileptiform EEG abnormalities (OR 6.42; 95% CI 2.61-15.78), and ≥3 febrile seizure recurrences (OR 4.56; 95% CI 1.62-12.85). A risk stratification score demonstrated good discriminative ability (AUC 0.847), classifying children into low-risk (1.2%), intermediate-risk (8.4%), and high-risk (42.9%) categories. Conclusion: This study identifies five independent predictors enabling effective risk stratification for epilepsy following febrile seizures, facilitating individualized counseling and surveillance strategies.