Recurrence of febrile convulsions in children treated with intermittent benzodiazepines: a retrospective study investigating predisposing factors

INTRODUCTION: Febrile seizures are the most common neurologic disorder in infants and young children, affecting 2-4% of those under six years of age. Although their overall prognosis is benign, recurrence is frequent and a major concern for families. This study aimed to identify factors associated with recurrence despite intermittent benzodiazepine prophylaxis. METHOD: We conducted a retrospective cohort study at Tehran Children's Medical Center including 76 children aged 6-60 months with febrile seizures who were discharged on intermittent benzodiazepine therapy. The primary outcome was recurrence despite treatment. Clinical and laboratory variables were compared between recurrence and non-recurrence groups using logistic regression. RESULTS: Febrile seizures recurred in 20 of 76 children (26.3%). Age at first febrile seizure was significantly lower in the recurrence group (p-value = 0.001), and a history of previous febrile seizures was associated with recurrence (p = 0.018). Hyponatremia was also more frequent among recurrent cases (p-value = 0.003). In multivariable analysis, lower serum sodium (OR 0.713; 95% CI 0.518-0.981; p = 0.038) and younger age at first febrile seizure (OR 0.902; 95% CI 0.818-0.995; p = 0.039) remained independent predictors. CONCLUSION: Younger age at first seizure and lower serum sodium were associated with recurrence despite intermittent benzodiazepine prophylaxis. These findings may help identify children at higher risk of treatment failure and guide counselling of families considering prophylaxis.