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Febrile Seizure

What is a Febrile Seizure?

A seizure is described as an involuntary spasm of muscles. Febrile seizures occur in developmentally and neurologically normal children between ages 6 months to 5 years of age who are also experiencing a fever and who are without an infection of the central nervous system. Febrile seizures occur in 2-5% of all children under 5 years of age. While frightening, they are generally benign events.

Two classifications exist:

  1. The simple febrile seizure is a single, brief episode associated with a fever and it resolves within 15 minutes.
  2. The complex febrile seizure lasts longer than 15 minutes and/or it recurs within a 24 hour period.

Who is at Risk for Febrile Seizures?

Three risks have been identified as possible predisposing factors for febrile seizures: height and duration of the temperature, a first degree relative with a history of febrile seizures, and if it occurs in association with vomiting and diarrhea.

One third of children will have a recurrence of a febrile seizure, more commonly between 12 - 24 months of age.

Four risks have been identified for recurrence of febrile seizures:

  1. First degree relative with a history of febrile seizures,
  2. Age of onset less than 18 months of age,
  3. Temperature greater than 104 degrees Fahrenheit (40 degrees Celsius), and
  4. Rapid onset (less than one hour between the onset of the fever and occurrence of a seizure).

How are Febrile Seizures Diagnosed?

A practitioner will perform a history and physical exam and determine if any other tests would be helpful to assess the problem. No routine blood tests are necessary to diagnose a febrile seizure.

Lumbar puncture should be performed if an infection of the nervous system is suspected or if a child is under 18 months of age and your practitioner has a concern for a nervous system infection. An electroencephalogram (EEG) is not indicated unless a complex febrile seizure occurs or if a child has a neurological abnormality. An MRI is reserved for difficult cases; for example, seizures with neurological changes and/or changes on an EEG exist.

How is a Febrile Seizure Treated?

A fever is best treated with antipyretic medication (Acetaminophen and/or Ibuprofen) and administered prior to an event. If the seizure occurs, avoid danger to the child by assuring safe placement of the head and avoiding choking. Parents should activate their local emergency medical system (i.e. call 911) if the child has a loss of consciousness for greater than 1 minute. Treatment of a single febrile seizure is not indicated since only one third of children will have a second febrile seizure.

Typically an anticonvulsant medication is chosen for children with a known underlying neurological abnormality or if a recurrent febrile seizure is prolonged. The onset of a febrile seizure does not occur with every fever; therefore, treatment is specific to the case and chosen by the practitioner and parents. Intermittent therapy has been used. Most of the medications that have been studied do have side effects (including sedation, aggressiveness, euphoria, cognitive changes, weight changes, blood abnormalities etc.). The medications include diazepam, phenobarbital, and valproate. Diazepam has been the most favorable and can be administered orally or rectally, Two drugs are ineffective in preventing recurrent febrile seizures phenytoin and carbamazepine.

What are the Complications of Febrile Seizures?

Febrile seizures do not result in serious complications, including mental retardation, a decrease in IQ, cerebral palsy, neurological damage, epilepsy or learning difficulties. Thus the simple febrile seizure has no long or short term effect. No recommendation to restrict activities exists.

Can a Febrile Seizure be Prevented?

Acetaminophen and Ibuprofen are used to treat fever but have not been proven to prevent a seizure or its recurrence. Nothing has been guaranteed to prevent an initial febrile seizure.

References

Baumann RJ, Duffner PK: Treatment of Children with Simple Febrile Seizures: The AAP Practice Parameter. Pediatric Neurology 2000;23 (1):11-17.

Shinnar S, Glauser TA: Febrile Seizures. Journal of Child Neurology 2002;17:S44-S52.

Provisional committee on Quality Improvement Subcommittee on Febrile Seizures: Practice Parameter: The Neurodiagnostic Evaluation of the Child with a First Simple Febrile Seizure. Pediatrics/AAP 1996:71-74.

Hampers L: Diagnosis and Management of Febrile Seizures. Pediatric Emergency Medicine at The Children's Hospital, Denver Colorado p 1-8.

Reviewed by: Sunit Gill MD

This Article contains the comments, views and opinions of the Author at the time of its writing and may not necessarily reflect the views of Pediatric Web, Inc., its officers, directors, affiliates or agents. No claim is made by Pediatric Web, the Author, or the Author's medical practice regarding the effectiveness and reliability of the statements contained herein and such individuals and entities disclaim any and all liability for the comments and statements contained in this Article and for any use or misuse of the statements made in this article in any specific medical situations. Further, this Article is intended to be general in nature and shall not be considered medical advice. The statements made are not to be utilized to diagnose and/or treat any individual's medical symptoms. If you or someone you know has symptoms which you believe are similar to this Article, you should discuss such symptoms with your personal physician or other qualified medical practitioner.

Copyright 2012 Pediatric Web, Inc., by Dan Feiten, M.D. All Rights Reserved