Factors associated with recurrent febrile seizures and electroencephalographic findings in children: a follow-up study in Vietnam

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Background: Recurrent febrile seizures (RFS) are frequently observed in early childhood, yet factors associated with recurrence and electroencephalographic (EEG) abnormalities remain unclear. The objective of this study is to identify clinical, perinatal, and biochemical factors associated with RFS and to assess interictal EEG abnormalities in children with RFS. Methods: A hospital-based follow-up study was conducted at Can Tho Children’s Hospital, Vietnam, from March 2023 to March 2025. Eligible children aged 6–60 months with febrile seizures were consecutively recruited during the study period. Demographic, clinical, perinatal, and biochemical variables, including age, sex, family history, delivery mode, and iron and zinc status, were collected. A total of 198 eligible children were enrolled, of whom 170 were included in the final analysis after follow-up. Among these, 65 children with ≥2 episodes formed the RFS group, and 105 children with a single episode and no recurrence during 12 months of follow-up formed the non-RFS group. Results: Among 170 children, 55.3% were male, and 52.9% had their first seizure before 24 months of age. Factors associated with RFS included age at first seizure ≤24 months [adjusted odds ratio (aOR): 4.94, 95% confidence interval (CI): 1.96–12.4, P=0.001], family history of febrile seizures (aOR: 4.90, 95% CI: 1.96–12.25, P=0.001), cesarean section (aOR: 7.29, 95% CI: 2.90–18.3, P<0.001), iron deficiency (aOR: 5.92, 95% CI: 2.40–14.62, P<0.001), and zinc deficiency (aOR: 4.50, 95% CI: 1.76–11.61, P=0.002). Among children with RFS, abnormal EEG findings were identified in 8 children (12.3%), predominantly as spike-wave discharges and generalized slowing; these abnormalities were more commonly observed in children with complex features. Conclusions: Early onset of seizures, positive family history, cesarean birth and micronutrient deficiencies (iron and zinc) were factors associated with recurrence in this cohort. While EEG abnormalities were relatively infrequent, they were observed mainly in children with RFS and complex features; however, these findings should be interpreted cautiously, as EEG was performed only in the RFS group.