Nagase et al repored a clinical prediction rule for neurological sequelae in a child with complex febrile seizures who develops acute encephalopathy. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Japan.

Name given to clinical prediction rule: Neurological Sequelae due to Acute Encephalopathy (NSAE-CPR)


Patient selection:

(1) pediatric patient < 16 years old with complex febrile seizures

(2) exclusion of epilepsy by history, infection and inherited metabolic disorders


Features of complex febrile seizures - one or more of the following:

(1) partial onset or focal features during the seizure

(2) duration > 15 minutes (prolonged)

(3) recurrent febrile seizure within 24 hours


Outcome: adverse neurological sequelae (intellectual disability, vegetative state)


Predictors of a poor outcome:

(1) refractory status epilepticus (seizure lasting > 60 minutes without response to first-line medications)

(2) consciousness disturbance (GCS <= 14) and/or hemiplegia at 6 hours from onset

(3) serum AST > 90 IU/L within 6 hours of onset (reference range not stated)



Early elevation of serum AST was associated with metabolic disorder or cytokine storm.

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