The results of 14 published reports were analyzed to evaluate the strength of association between proposed risk factors and recurrence of febrile seizures in a metaanalytic review from the Departments of Pediatrics and Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, New York; and Columbia University College of Physicians and Surgeons, New York, NY. Young age at onset (less than one year) and a family history of febrile seizures each distinguished between groups with approximately a 30% versus a 50% risk of recurrence. Family history of afebrile seizures, focal, prolonged, and multiple seizures were associated with an inconsistent or only a small increment in risk of recurrence. Only one of five indications for anticonvulsant prophylaxis as defined by the 1980 NIH Consensus Developmental Conference was consistently predictive of a recurrence of febrile seizures. 
COMMENT. The risk factors and indications for long term phenobarbital prophylaxis of febrile seizures need to be reconsidered. Therapeutic guidelines may be helpful but the decision to treat must be made on an individual basis. Greater reliance on parental education and intermittent therapy should lessen the necessity for long term therapy with potentially toxic medications.