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Do seizures damage the brain? The epidemiological evidence
  1. Christopher M Verity
  1. Addenbrooke’s Hospital, Hills Road, Cambridge
  1. Dr C M Verity, Child Development Centre, Box 107, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ.

https://doi.org/10.1136/adc.78.1.78

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    Do seizures damage the brain? If they do, how often does it happen? The answers are very dependent on the type of research that is used to investigate the questions. Evidence has come from two areas of study that are of particular interest to paediatricians: the outlook for children who have febrile convulsions, and the prognosis after status epilepticus (in this paper febrile convulsions lasting longer than 30 minutes are called lengthy febrile convulsions and are considered separately from status epilepticus). When considering the outcome after seizures it is important to take account of the different types of study that have provided the evidence in children.

    Know your study—selected groups or population based?

    The advantage of studying a selected group of patients is that each individual can be carefully evaluated, perhaps using the latest imaging or neurophysiological techniques. The disadvantage is that patients who attend specialised clinics or hospitals tend to have relatively severe seizure problems and a worse outlook. By studying unselected groups of children or adults, population based studies have given a more optimistic view of outcome. This paper will refer particularly to three large population based studies:

    • The National Collaborative Perinatal Project (NCPP) which enrolled approximately 54 000 pregnant American women between 1959 and 1966 and followed up their children until 7 years of age.1-3

    • The system of medical records linkage of the Rochester Epidemiology Project which was used to identify residents of Rochester, Minnesota, USA, who had seizures.4-6

    • The Child Health and Education Study (CHES), a birth cohort study, which enrolled over 16 000 neonatal survivors born in the United Kingdom in one week in April 1970 and followed them for 10 years.7-9

    Outcome after febrile convulsions

    THE CONTROVERSY

    In 1971 Taylor and Ounsted10 wrote: “We think that the convulsive hypoxia sustained during prolonged febrile convulsions causes the death of vulnerable neurones in the cerebellum, the thalamus, …

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