Prolonged febrile seizures (PFS) are the commonest cause of childhood status epilepticus and are believed to carry a risk of neuronal damage, in particular to the mesial temporal lobe. This study was designed to determine: i) the effect of prolonged febrile seizures on white matter and ii) the temporal evolution of any changes seen. 33 children were recruited 1month following PFS and underwent diffusion tensor imaging (DTI) with repeat imaging at 6 and 12months after the original episode of PFS. 18 age-matched healthy control subjects underwent similar investigations at a single time point. Tract-based spatial statistics (TBSS) was used to compare fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) between patients and controls on a voxel-wise basis within the white matter skeleton. Widespread reductions in FA along multiple white matter tracts were found at 1 and 6months post-PFS, but these had resolved at 12months. At one month post-PFS the main changes seen were reductions in AD but at 6months these had predominantly changed to increases in RD. These widespread white matter changes have not previously been noted following PFS. There are many possible explanations, but one plausible hypothesis is that this represents a temporary halting of normal white matter development caused by the seizure, that then resumes and normalises in the majority of children. Highlights ? Widespread reductions in FA occur in children after prolonged febrile seizures. ? These reductions persist up to 6months post-PFS but resolve by 1year. ? This may represent a seizure-related disruption of white matter development.
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