ReviewActa neurologica Belgica2026
Fever seizures beyond the typical age: clinical characteristics and subsequent epilepsy risks in children over five.
Review in Acta neurologica Belgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundFebrile seizures are classically defined as occurring between six months and five years of age; however, fever-associated seizures may also occur in older children, a group that remains relatively underrecognized. This age group may present with different clinical characteristics and a potentially increased risk of epilepsy or underlying structural abnormalities.
methodsWe retrospectively analyzed children older than five years who presented with fever-associated seizures to the pediatric emergency department between July 2019 and July 2024. Demographic characteristics, seizure semiology, family history, electroencephalography(EEG) and neuroimaging results, and long-term epilepsy outcomes were evaluated. Patients with prior epilepsy, neurodevelopmental disorders, or metabolic diseases were excluded.
resultsOne hundred ten children (mean age:7.3 years; 73.6% male) were included. Most patients (80%) experienced simple febrile seizures; however, complex seizures occurred in 20%. EEG abnormalities were present in 33.3% of those tested (45/110), and neuroimaging revealed structural abnormalities in 2/51 patients. Over a median follow-up of 18 months, 14 children (12.7%) developed epilepsy, a markedly higher risk being observed in those with complex seizures (40.9% vs. 5.7%) and in children over seven.
conclusionFebrile seizures occurring beyond the age of five may represent a clinically relevant subgroup. Although many children present with simple features and follow a favorable course, complex seizure characteristics and older age may be associated with an increased risk of subsequent epilepsy. Selected patients may therefore require careful clinical evaluation and follow-up.
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