Erythrocyte malondialdehyde (EMA), glutathione peroxidase (GPO), and superoxide dismutase (SDM) levels were assessed in 31 children with a febrile seizure and 30 without, in a study at Dokuz Eylul University, Izmir, Turkey. Febrile seizures were simple in 25 (80%) and complex in 6 (20%) patients. EMA and GPO levels were significantly higher and SDM significantly lower in the febrile seizure group. Levels were not different in the simple and complex seizure groups. Changes in antioxidant enzyme levels are evidence of oxidative stress that may lead to brain cell damage following febrile seizures. [1]

COMMENT. The authors conclude that the oxidant-antioxidant balance is disturbed in children with febrile seizures, and changes in lipid peroxidation and level of antioxidant enzymes may result in neuronal cell damage after febrile seizures. That febrile seizures may be less benign than generally assumed, as suggested by this study, is also apparent from a recent report of MRI abnormalities that followed both simple and complex febrile seizures [2], and an increased risk of sudden unexpected death during 2 years after a first febrile seizure (Ped Neur Briefs 2008;22:47-48 and 68-69) [3]. Recommendations for the management of febrile seizures are outlined in a report of the Italian League Against Epilepsy [4], with reference to the AAP Guidelines 1996, 1999, and to [5]. The possible benefits of prolonged antiepileptic therapy to prevent recurrence of febrile seizures must be weighed against the reported adverse cognitive effects. Currently, chronic prophylactic treatment is usually discouraged, except in some patients with recurrent complex febrile seizures. More effective antipyretic treatment, rapid viral testing and antiviral therapy should provide a more specific approach to the prevention of recurrence of febrile seizures. [6]