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Vol. 91. Issue 6.
Pages 529-534 (November - December 2015)
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Vol. 91. Issue 6.
Pages 529-534 (November - December 2015)
Original article
Open Access
Febrile seizures: a population-based study
Convulsão febril: estudo de base populacional
Visits
3201
Juliane S. Dalbema,b,
Corresponding author
jsdalbem@hotmail.com

Corresponding author.
, Heloise H. Siqueirab, Mariano M. Espinosab, Regina P. Alvarengaa
a Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
b Universidade Federal de Mato Grosso (UFMT), Cuiabá, MT, Brazil
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Tables (3)
Table 1. Screening questionnaire.10
Table 2. Observed frequency distribution, percentage, and 95% CI of 18 patients with febrile seizures according to clinical and sociodemographic variables. Barra do Bugres, MT, Brazil, 2014.
Table 3. Characteristics assessed in the main studies on febrile seizures.
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Abstract
Objectives

To determine the prevalence of benign febrile seizures of childhood and describe the clinical and epidemiological profile of this population.

Methods

This was a population-based, cross-sectional study, carried out in the city of Barra do Bugres, MT, Brazil, from August 2012 to August 2013. Data were collected in two phases. In the first phase, a questionnaire that was previously validated in another Brazilian study was used to identify suspected cases of seizures. In the second phase, a neurological evaluation was performed to confirm diagnosis.

Results

The prevalence was 6.4/1000 inhabitants (95% CI: 3.8–10.1). There was no difference between genders. Simple febrile seizures were found in 88.8% of cases. A family history of febrile seizures in first-degree relatives and history of epilepsy was present in 33.3% and 11.1% of patients, respectively.

Conclusions

The prevalence of febrile seizures in Midwestern Brazil was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and differences in socioeconomic factors among the evaluated areas.

Keywords:
Prevalence
Febrile seizure
Epidemiology
Resumo
Objetivos

Estabelecer a prevalência das crises febris e descrever o perfil clínico e epidemiológico dessa população.

Métodos

Estudo transversal de base populacional realizado na cidade de Barra do Bugres (MT), no período de agosto de 2012 a agosto de 2013. Os dados foram coletados em duas etapas. Na primeira fase utilizamos um questionário validado previamente em outro estudo brasileiro, para identificação de casos suspeitos de crises epilépticas. Na segunda etapa realizamos a avaliação neuroclínica para confirmação diagnóstica.

Resultados

A prevalência de crise febril foi de 6,4/1000 habitantes (IC95% 3,8; 10,1). Não houve diferença entre os sexos. As crises febris simples foram encontradas em 88,8% dos casos. A história familiar de crise febril e epilepsia em parentes de 1° grau esteve presente em 33,3% e 11,1% dos pacientes, respectivamente.

Conclusões

A prevalência da crise febril na região centro-oeste foi menor do que a encontrada em outras regiões brasileiras, provavelmente relacionado à inclusão apenas das crises febris com manifestações motoras e as diferenças de fatores socioeconômicos entre as regiões pesquisadas.

Palavras-chave:
Prevalência
Crise febril
Epidemiologia
Full Text
Introduction

Febrile seizures are the most common seizures in children younger than 5 years, affecting 2–5% of the pediatric population1; they are considered to be benign and self-limited,2 and are classified as simple and complex.1 Upper airway viral infections are the most common triggering factors.3,4 The risk of subsequently developing epilepsy is 6.9%5; although they have an excellent prognosis, they bring anxiety to parents and family members.6

The clinical signs of febrile seizures are not different among populations, but the clinical and demographic characteristics are not identical in the different parts of the world,7 thus justifying the necessity of the present study. There is no Brazilian study that has described the clinical and epidemiological characteristics of patients with febrile seizures.

This study aimed to determine the prevalence and describe the clinical and epidemiological characteristics of patients with febrile seizures.

MethodsStudy site and assessed population

The study was conducted in the municipality of Barra do Bugres, state of Mato Grosso, Brazil, from August 2012 to August 2013. The estimated population in 2013 was 33,022 inhabitants,8 with 3445 inhabitants aged between 0 and 5 years and 11 months, of whom 1775 were males and 1670 females.8 Approximately 60% of the population is of African descent. In the municipality, 77% of the households have sewerage and 55% have water supply services. The Human Development Index of the municipality is 0.693 and the per capita income, based the Gross Domestic Product (GDP) of 2012 was US$ 6740.00.8 The municipality has six healthcare teams working for the Family Health Program (FHP) and forty-six healthcare workers attending to 75% of the population; the population that is not assisted by the FHP receives health care in a Basic Health Unit located downtown. The fact that the municipality has good FHP coverage and that the program works regularly facilitated this study.

Study phases

This was a cross-sectional, population-based study, performed in two phases. In the first phase, the healthcare workers performed an active search at the households, seeking suspected cases of seizures. A questionnaire with eight questions was used (Table 1). The questions were modified from the guidelines of the World Health Organization and are similar to the questions used in epidemiological studies conducted in Ecuador,9 and were previously validated in a Brazilian study with a sensitivity of 95.8% and specificity of 97.8%.10 This screening questionnaire was also used in a prevalence study of epilepsy in childhood in the state of São Paulo.11 The healthcare workers were previously trained and received explanations on seizures/epilepsy and how to apply the questionnaire. The cases in which there was at least one affirmative response to the eight questions were referred to the second phase of the evaluation (diagnostic confirmation), when the clinical history was obtained and the neurological examination was performed.

Table 1.

Screening questionnaire.10

Name:  Age:   
Number of children in the household up to 19 years:  Age:   
1. Have the children/adolescents up to 19 years in your home had (or still have) seizures (fits, convulsions) in which they lost consciousness and fell down suddenly?  Yes (No (
2. Have the children/adolescents up to 19 years in your home had (or still have) seizures in which they has lost touch with reality and was “disconnected”?  Yes (No (
3. Have the children/adolescents up to 19 years in your home had (or still have) seizures in which they had sudden/abrupt movements of the arms, legs, or mouth, or turned their head to the side?  Yes (No (
4. Have the children/adolescents up to 19 years in your home had (or still have) episode (s) of fainting and after they regained consciousness, you realized they had urinated or defecated on their clothes by accident?  Yes (No (
5. Have the children/adolescents up to 19 years of your home had (or still have) seizures in which they had a bad feeling such as a “hunch” or a “knot” in the stomach that rose to the throat, after which he or she fell unconscious? Can the person who witnessed it say whether they was touching the clothes, chewing, or staring at a distant point?  Yes (No (
6. Has a doctor or health care professional or even family members ever mentioned that the child in your home had febrile seizures in childhood or during any severe illness?  Yes (No (
7. Have the children/adolescents up to 19 years in your home had (or still have) sudden movements similar to a “shock” in the arms (he or she dropped things) or legs, with or without falls, especially during the morning?  Yes (No (
8. Have the children/adolescents up to 19 years in your home who have epilepsy been admitted to a hospital in Mato Grosso before?  Yes (No (
In case of any affirmative answer, refer the child/adolescent for consultation.  Yes (No (

This study was approved by the Ethics Committee of Hospital Geral Universitário (Registered under n.128 CEP/UNIC–protocol n. 2011-128).

Inclusion and exclusion criteria

Children with a history of at least one episode of febrile seizure residing in Barra do Bugres and aged 0–5 years were included in the study. Patients whose condition did not fit the definition of febrile seizures were excluded. Febrile seizures without motor symptoms were not considered, due the difficulty in ascertaining whether they were really epileptic seizures according to the description of the family members.

Definitions

Febrile seizures were defined as seizures occurring in children older than 1 month and younger than 5 years associated with febrile illness. This definition excluded seizures that occurred in the presence of central nervous system infection or cases with a history of epileptic seizures in the neonatal period, unprovoked seizures, and acute symptomatic seizures.12 Febrile seizures can be classified as simple or complex; simple seizures are primarily generalized, lasting less than 15min with no recurrence within 24h, whereas complex seizures are focal, last longer than 15min, and show recurrence within 24h.1

Data processing and statistical analysis

The data collected during the interview in pre-coded questionnaires were processed in a personal computer, typed in duplicate to reduce typos, in an electronic database using Excel (Microsoft 2003. Microsoft Excel [computer software]. Redmond, Washington, USA). When inconsistent data were found, they were verified in the original questionnaire and the necessary corrections were performed. Data were analyzed descriptively, and 95% confidence intervals were built for their respective prevalence in the inferential analysis. This technique was used because the comparison measurement scale was categorical or non-quantitative.

Results

The municipality of Barra do Bugres has a population of 3445 inhabitants at the age range of 0–5 years and 11 months; a total of 2811 inhabitants (81.6%) were screened. The losses in the first phase of the study occurred because it was not possible to find residents in the households in more than one visit by the healthcare workers. The prevalence of febrile seizures in this sample was 6.40/1000 inhabitants (95% CI: 3.8–10.10). The age at the first seizure ranged from 1 month to 60 months (mean of 19.38 months). Clinical and sociodemographic variables are shown in Table 2.

Table 2.

Observed frequency distribution, percentage, and 95% CI of 18 patients with febrile seizures according to clinical and sociodemographic variables. Barra do Bugres, MT, Brazil, 2014.

Variable  Observed frequency (nPercentage (%)  95% CI 
Gender
Male  50.00  (26.02–73.98) 
Female  50.00  (26.02–73.98) 
Ethnicity
White  38.89  (17.30–64.25) 
Non-white  11  61.11  (35.74–82.70) 
Number of seizure episodes
Single episode  16  88.89  (65.29–98.62) 
Two episodes  5.56  (0.14–27.29) 
Three episodes  5.56  (0.14–27.29) 
Antiepileptic drug used
Phenobarbital  11.11  (1.38–34.71) 
Valproate  16.67  (3.58–41.42) 
None  13  72.22  (46.52–90.30) 
Type of seizure
Generalized  16  88.89  (65.29–98.62) 
Focal  11.11  (1.38–34.71) 
Risk of miscarriage in pregnancy
Yes  11.11  (1.38–34.71) 
No  16  88.89  (65.29–98.62) 
Received prenatal care (> six consultations)
Yes  18  100  – 
Type of delivery
Vaginal  50.00  (26.02–73.98) 
Cesarian section  50.00  (26.02–73.98) 
Gestational age
Full-term  17  94.44  (72.71–99.86) 
Preterm  5.56   
Birth weight
2000gweight<250011.11  (1.38–34.71) 
2500gweight300027.78  (9.70–53.48) 
Weight>300011  61.11  (35.74–82.70) 
Apgar>7
Yes  18  100  – 
Neonatal complication (infection)
Yes  11.11  (1.38–34.71) 
No  16  88.89  (65.29–98.62) 
Neuropsychomotor development
Normal  18  100  – 
Family history of epilepsy
Yes  11.11  (1.38–34.71) 
No  16  88.89  (65.29–98.62) 
Family history of febrile seizure
Yes  33.33  (13.34–59.01) 
No  12  66.67   
Consanguinity
No  18  100  – 
Paternal level of schooling
Incomplete Elementary School  50.00  (26.02–73.98) 
Complete Elementary School  16.67  (3.58–41.42) 
Incomplete High School  5.56  (0.14–27.29) 
Complete High School  22.22  (6.41–47.64) 
College/University  5.56  (0.14–27.29) 
Maternal level of schooling
Incomplete Elementary School  44.44   
Complete Elementary School  11.11  (1.38–34.71) 
Incomplete High School  11.11  (1.38–34.71) 
Complete High School  27.78  (9.69–53.48) 
College/University  5.56  (0.14–27.29) 
Family income
1MW  38.89  (17.30–64.25) 
Between 1 and 2MWs  5.56  (0.14–27.29) 
2 MW  33.33  (13.34–59.01) 
>3MW  22.22  (6.41–47.64) 

MW, Brazilian minimum wage; 95% CI, 95% confidence interval.

Discussion

The prevalence of febrile seizures in this sample was 6.4/1000 inhabitants; in the literature, it ranges from 3.5/100013 to 17/1000.14 Two Brazilian studies assessed the prevalence of febrile seizures, showing a rate of 13.9/1000 in São Paulo, SP, Brazil and 16/1000 in Pelotas, RS, Brazil.11,15 In the assessed area, it was observed that the prevalence was lower than that found in the South and Southeast regions of Brazil. These differences in prevalence rates may be justified by different methodologies used for patient recruitment, socioeconomic factors, and particularities of the populations from each region studied. In the present study, active search in households was used for patient recruitment, with 18.4% of losses in this age group.

When comparing with the study conducted in Pelotas, RS, Brazil, which used a birth cohort, the losses consisted of 26.2% individuals that could not be assessed, thereby indicating a larger population analysis in the present study. The study conducted in São Paulo, SP, Brazil used a convenience sample to assess individuals treated at Complexo Einstein in the Paraisópolis community, thus creating a bias that could justify a higher prevalence in that study.

Socioeconomic differences may also explain the lower prevalence found in Mato Grosso; when comparing the basic sanitation in the municipality (sewerage and water supply services), per capita income, and Human Development Index of the municipality with other studied regions, better socioeconomic indicators were observed in Barra do Bugres.

Although over 60% of the population is of African descent, the region has been colonized by populations originating from different regions of Brazil. Thus, the population is very particular, reflecting the miscegenation observed in this country. This is different from other Brazilian regions, where the population is more homogeneous, indicating that Barra do Bugres bears more resemblance to the general Brazilian population profile. In this study, only febrile seizures with motor manifestations were included. This, together with the abovementioned factors, may explain the lower prevalence found in the present study.

Studies have shown a variation in simple febrile seizure prevalence ranging from 55.2% to 85.6%16,17; in the present study, this proportion was 88.8%, similar to that reported in Tunisia, Turkey, Cameroon, India, China, Iran, and England.16–23 Status epilepticus secondary to febrile seizure was not observed in the present study, unlike the one conducted in Cameroon, which identified it in 10% of cases.24

When analyzing the frequency of febrile seizures in relation to gender, no difference was observed, similar to the research by Pavlovic et al.25 differing from some studies in which the authors described a higher frequency in the male gender,7,16,19,26 whereas only Sillanpää et al. found a predominance in the female gender.27

The family history of febrile seizures and epilepsy in first-degree relatives was found respectively in 33.3% and 11.1% of cases. Studies have shown a variation from 14.7% to 39.3%16,17,19,20,22–24,28 in relation to family history of febrile seizures and from 2.7% to 12.71%16,17,20,24 regarding epilepsy.

Family income was up to two minimum wages in 77.7% of cases. Studies have shown that the prevalence of febrile seizures is not associated with social class and parental level of schooling.22,23Table 3 shows a summary of the main variables in articles published to date, demonstrating the lack of data regarding the pre- and perinatal periods and the heterogeneity of the studied variables, which hinders data comparison and the development of meta-analyses related to the subject.

Table 3.

Characteristics assessed in the main studies on febrile seizures.

Author/year  Country  Patient recruitment  Mean age at first seizure (months)  Prevalence/1000  Male gender  Family history of febrile seizure  Family history of epilepsy  Simple febrile seizure 
Sampaio, 201011  Brazil  Cross-sectional (active search)    13.9         
Nunes, 201115  Brazil  Cohort    16         
Al Rajeh, 200113  Saudi Arabia  Cross-sectional (active search)    3.55         
Sfaihi, 201216  Tunisia  Hospital files      58.7%  14.7%  5.6%  55.2% 
Nguefack, 201018  Cameroon  Hospital files  24.6      36.4%    58.7% 
Yakinci, 200017  Turkey  Cross-sectional  23.0  3.24    37.28%  12.71%  85.6% 
Banerjee, 200919  India  Cross-sectional (active search)    1.11        84.7% 
Chung, 200620  China  Hospital files  25      17.5%     
Fallah, 201021  Iran  Hospital files  24          67% 
Verity, 198522  England  Cohort  24      16.2%  7.5%  76.9% 
Sillanpää, 200827  Finland  Cohort             
Aydin, 200828  Turkey  Cross-sectional, schoolchildren        15–17.3%     

It can be concluded that the prevalence of febrile seizures in the Midwest region was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and to the socioeconomic differences among the assessed regions.

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgments

The authors would like to thank the Health Secretariat of the municipality of Barra do Bugres, the Family Health Program, and the technical-administrative team of Centro de Saúde do Maracanã who spared no efforts to conduct this research.

References
[1]
Subcommittee on Febrile Seizures; American Academy of Pediatrics.
Neurodiagnostic evaluation of the child with a simple febrile seizure.
Pediatrics, 127 (2011), pp. 389-394
[2]
J.L. Patterson, S.A. Carapetian, J.R. Hageman, K.R. Kelley.
Febrile seizures.
Pediatr Ann, 42 (2013), pp. 249-254
[3]
C. Kaputu Kalala Malu, E. Mafuta Musalu, J.M. Dubru, P. Leroy, A.M. Tomat, J.P. Misson.
Epidemiology and characteristics of febrile seizures in children.
Rev Med Liege, 68 (2013), pp. 180-185
[4]
F. Abuekteish, A.S. Daoud, M. Al-Sheyyab, M. Nou’man.
Demographic characteristics and risk factors of first febrile seizures: a Jordanian experience.
Trop Doct, 30 (2000), pp. 25-27
[5]
A.K. Leung, W.L. Robson.
Febrile seizures.
J Pediatr Health Care, 21 (2007), pp. 250-255
[6]
M. Vestergaard, C.B. Pedersen, P. Sidenius, J. Olsen, J. Christensen.
The long-term risk of epilepsy after febrile seizures in susceptible subgroups.
Am J Epidemiol, 165 (2007), pp. 911-918
[7]
A. Shimony, Z. Afawi, T. Asher, M. Mahajnah, Z. Shorer.
Epidemiological characteristics of febrile seizures – comparing between Bedouin and Jews in the southern part of Israel.
[8]
Instituto Brasileiro de Geografia e Estatística (IBGE) [cited 15 out 2013]. Available from: http://www.cidades.ibge.gov.br
[9]
M. Placencia, J.W. Sander, S.D. Shorvon, R.H. Ellison, S.M. Cascante.
Validation of a screening questionnaire for the detection of epileptic seizures in epidemiological studies.
Brain, 115 (1992), pp. 783-794
[10]
M.A. Borges, L.L. Min, C.A. Guerreiro, E.M. Yacubian, J.A. Cordeiro, W.A. Tognola, et al.
Urban prevalence of epilepsy: populational study in São José do Rio Preto, a medium-sized city in Brazil.
Arq Neuropsiquiatr, 62 (2004), pp. 199-204
[11]
L.P. Sampaio, L.O. Caboclo, K. Kuramoto, A. Reche, E.M. Yacubian, M.L. Manreza.
Prevalence of epilepsy in children from a Brazilian area of high deprivation.
Pediatr Neurol, 42 (2010), pp. 111-117
[12]
Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy.
Epilepsia, 34 (1993), pp. 592-596
[13]
S. Al Rajeh, A. Awada, O. Bademosi, A. Ogunniyi.
The prevalence of epilepsy and other seizure disorders in an Arab population: a community-based study.
Seizure, 10 (2001), pp. 410-414
[14]
R.J. Baumann, M.B. Marx, M.G. Leonidakis.
Epilepsy in rural Kentucky: prevalence in a population of school age children.
Epilepsia, 19 (1978), pp. 75-80
[15]
M.L. Nunes, L.T. Geib, Grupo Apego.
Incidence of epilepsy and seizure disorders in childhood and association with social determinants: a birth cohort study.
J Pediatr (Rio J), 87 (2011), pp. 50-56
[16]
L. Sfaihi, I. Maaloul, S. Kmiha, H. Aloulou, I. Chabchoub, T. Kamoun, et al.
Febrile seizures: an epidemiological and outcome study of 482 cases.
Childs Nerv Syst, 28 (2012), pp. 1779-1784
[17]
C. Yakinci, N.O. Kutlu, Y. Durmaz, H. Karabiber, M. Eğri.
Prevalence of febrile convulsion in 3637 children of primary school age in the province of Malatya, Turkey.
J Trop Pediatr, 46 (2000), pp. 249-250
[18]
S. Nguefack, C.A. Ngo Kana, E. Mah, C. Kuate Tegueu, A. Chiabi, F. Fru, et al.
Clinical, etiological, and therapeutic aspects of febrile convulsions. A review of 325 cases in Yaoundé.
Arch Pediatr, 17 (2010), pp. 480-485
[19]
T.K. Banerjee, A. Hazra, A. Biswas, J. Ray, T. Roy, D.K. Raut, et al.
Neurological disorders in children and adolescents.
Indian J Pediatr, 76 (2009), pp. 139-146
[20]
B. Chung, L.C. Wat, V. Wong.
Febrile seizures in southern Chinese children: incidence and recurrence.
Pediatr Neurol, 34 (2006), pp. 121-126
[21]
R. Fallah, S.A. Karbasi.
Recurrence of febrile seizure in Yazd, Iran.
Turk J Pediatr, 52 (2010), pp. 618-622
[22]
C.M. Verity, N.R. Butler, J. Golding.
Febrile convulsions in a national cohort followed up from birth. I – Prevalence and recurrence in the first five years of life.
Br Med J (Clin Res Ed), 290 (1985), pp. 1307-1310
[23]
C.M. Verity, N.R. Butler, J. Golding.
Febrile convulsions in a national cohort followed up from birth. II – Medical history and intellectual ability at 5 years of age.
Br Med J (Clin Res Ed), 290 (1985), pp. 1311-1315
[24]
A.K. Gururaj, A. Bener, E.K. Al-Suweidi, H.M. Al-Tatari, A.E. Khadir.
Predictors of febrile seizure: a matched case–control study.
J Trop Pediatr, 47 (2001), pp. 361-362
[25]
M.V. Pavlovic, M.S. Jarebinski, T.D. Pekmezovic, B.D. Marjanovic, Z.M. Levic.
Febrile convulsions in a Serbian region: a 10-year epidemiological study.
Eur J Neurol, 6 (1999), pp. 39-42
[26]
J.R. Farwell, G. Blackner, S. Sulzbacher, L. Adelman, M. Voeller.
First febrile seizures. Characteristics of the child, the seizure, and the illness.
Clin Pediatr (Phila), 33 (1994), pp. 263-267
[27]
M. Sillanpää, P. Camfield, C. Camfield, L. Haataja, M. Aromaa, H. Helenius, et al.
Incidence of febrile seizures in Finland: prospective population-based study.
Pediatr Neurol, 38 (2008), pp. 391-394
[28]
A. Aydin, A. Ergor, H. Ozkan.
Effects of sociodemographic factors on febrile convulsion prevalence.
Pediatr Int, 50 (2008), pp. 216-220

Please cite this article as: Dalbem JS, Siqueira HH, Espinosa MM, Alvarenga RP. Febrile seizures: a population-based study. J Pediatr (Rio J). 2015;91:529–34.

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