A 3-year-old child presents with complex febrile seizures lasting 20 minutes on three occasions in the same febrile illness. MRI later shows hippocampal sclerosis. Which of the following is the most significant long-term risk associated with prolonged/complex febrile seizures?

• A Generalised tonic-clonic epilepsy
• B Mesial temporal lobe epilepsy (MTLE) ✓
• C Childhood absence epilepsy
• D West syndrome (infantile spasms)

Explanation

Prolonged febrile seizures (especially febrile status epilepticus) are the strongest risk factor for subsequent mesial temporal lobe epilepsy (MTLE), the most common focal epilepsy syndrome in adults. Hippocampal sclerosis on MRI is the pathological substrate of MTLE and is causally linked to febrile status epilepticus in genetically predisposed individuals. FEBSTAT study confirmed this association. Generalised epilepsy syndromes are not preferentially associated with febrile seizures. West syndrome occurs in infancy with infantile spasms and hypsarrhythmia, unrelated to febrile seizures. Childhood absence epilepsy has genetic basis unrelated to febrile seizures.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.