Febrile Seizures Associated With Minimal Differences in School Performance

Febrile seizures were associated with only small differences in later reading and mathematics performance in a nationwide Danish cohort study published in JAMA Network Open. Larger differences were observed among children with repeated seizure-related hospital contacts and those who subsequently developed epilepsy.

Investigators analyzed 672,119 children born in Denmark between 1997 and 2009 who completed national school tests from 2010 through 2019. Testing covered children aged 7 to 17 years. Among them, 26,173 (3.9%) had hospital-recorded febrile seizures between ages 3 months and 5 years. The primary outcome was performance on standardized reading and mathematics tests, expressed as national percentile scores on a 1–100 scale.

Mean combined scores were 54.7 among children with febrile seizures and 55.8 among those without. After adjustment for demographic, birth, family, and test characteristics, the mean difference was −0.4 point. A comparison with unaffected siblings also found a small difference of −0.6 point.

Differences increased with the number of seizure-related hospital contacts. The adjusted difference was −0.1 point after one contact and approximately −5.8 points after seven or more contacts, compared with children without febrile seizures. Epilepsy occurred in 3.2% of children with a febrile seizure history versus 0.9% of those without. Children with both conditions scored an adjusted 7.2 points lower than children with neither (95% CI, −8.7 to −5.7).

The study could not distinguish simple from complex febrile seizures. Recurrence was measured through hospital contacts, so the findings may not represent all children with recurrent febrile seizures. Children who did not participate in testing were excluded, limiting generalizability, particularly for those in special education. The authors concluded that school performance was generally comparable with that of peers, although children with recurrent hospital contacts or subsequent epilepsy may benefit from additional educational support.

Source: Dreier JW, Trabjerg BB, Wimberley T, Feenstra B, Christensen J. Febrile seizures and school performance. JAMA Netw Open. 2026;9(9):e2631273. doi:10.1001/jamanetworkopen.2026.31273