Neurology -- Correspondence for Chang et al., 57 (1) 37-42

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Correspondence published:

Reply to Servais: T Baram, S Shinnar (13 December 2001)

Working memory of school-aged children with a history of febrile convulsions: A population study: "appears to be first names and last initials, can't guess, suggest leave blank" (12 December 2001)

Reply to Servais 13 December 2001

T Baram
University of California, Irvine,
S Shinnar
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Re: Reply to Servais

tallie{at}uci.edu T Baram, et al.

We read the letter by Servais and Dan with interest. Our Editorial clearly indicated that the 'take-home' messages from Chang et al's paper were: First, in children older than one year, there is little evidence that febrile seizures impair hippocampal-mediated memory, Secondly, this paper, as well as others, raises concerns about infants younger than a year, And last, there are methodological issues with the paper that do not allow us to conclude that 'febrile seizures improve memory'...
Drs. Servais and Dan, perhaps not recognizing the 'tongue in cheek' element of the title of our editorial, illustrate these methodological issues well. Their letter may serve to further clarify the paper and the editorial to the broad readership of Neurology.

Working memory of school-aged children with a history of febrile convulsions: A population study 12 December 2001

"appears to be first names and last initials, can't guess, suggest leave blank"
Hopital Universitaire Des Enfants Reine Fabiola
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Re: Working memory of school-aged children with a history of febrile convulsions: A population study

bernard.dan{at}ulb.ac.be "appears to be first names and last initials, can't guess, suggest leave blank"

Chang et al.'s recent article [1] provides pediatricians with a new argument for reassuring parents of children with febrile seizures (FS). Beyond the acute, baleful fright from witnessing FS in their own child, parents often chronically apprehend disability. Uncertainty regarding the latter has been entertained by longstanding controversies on epilepsy and cognitive impairment following FS. In this context, recent epidemiologic studies [2] and the careful population-based study of Chang et al. should settle the debate with optimism. The authors' results confirm other epidemiologic evidence showing that FS is not harmful to the developing brain if occurring after one year. We question the conclusion of a possible positive effect of FS on working memory. First, as each group was compared at least 19 times with the control group, the significance of the results should be ascertained using a correction for multiple tests (e.g. Bonferroni). Secondly, the anxiety induced by witnessing FS may be so high as to modify subsequent general parental attitude. In particular, close attention and stimulation might have a positive effect on the child's performance in clinical tests. This would be consistent with the absence of correlation between the number of FS and working memory improvement. Finally, it cannot be ruled out that a proportion of the 16 parents (i.e. over 15%) who refused to participate were afraid of the results that their child could get, possibly creating a bias in favor of the FS group. In conclusion, we agree with Baram and Shinnar (3) that it is premature to tell parents that FS have positive effects on their child, and that further studies are required.
1. Chang YC, Guo NW, Wang ST, Huang CC, Tsai JJ. Working memory of school-aged children with a history of febrile convulsions: a population study. Neurology 2001;57:37-42. 2. Verity CM, Greenwood R, Golding J. Long term intellectual and behavioural outcomes of children with febrile convulsions. N Engl J Med 1998;338:1723-1728. 3. Baram TZ, Shinnar S. Do febrile seizures improve working memory ? Neurology 2001;57:7-8.