A 2-year-old girl develops a seizure (lasting 4 minutes, generalized tonic-clonic) during a febrile illness with temperature of 39.5°C. She is neurologically normal post-ictally. EEG and neuroimaging are not performed. Which statement is MOST accurate regarding her risk of future epilepsy?

• A Lifetime risk of epilepsy is 30%, similar to population risk
• B EEG is mandatory to predict recurrence risk
• C Long-term antiepileptic prophylaxis with phenobarbitone reduces future epilepsy risk
• D Risk of future epilepsy is 2–4%, slightly higher than the general population (0.5–1%) ✓

Explanation

Simple febrile seizures (duration <15 min, generalized, single episode in 24 hours, in a neurologically normal child) carry a slightly elevated risk of future epilepsy of approximately 2–4%, compared to 0.5–1% in the general population. The risk is higher with complex febrile seizures, family history of epilepsy, or neurodevelopmental abnormalities. EEG is not recommended for simple febrile seizures and does not predict recurrence. Long-term antiepileptic prophylaxis does not prevent future epilepsy and has significant side effects; it is not recommended for simple febrile seizures. The recurrence risk for febrile seizures is 30–40%, not epilepsy risk.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.