Febrile Seizures
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Febrile Seizures

(Fever Seizures)

Pronounced: FEEB-ril SEE-zherz

En Español (Spanish Version)

Definition

A febrile seizure is a convulsion associated with a fever in infants or small children. A febrile seizure is diagnosed when all underlying causes are eliminated such as meningitis , encephalitis , or any other intracranial disease.

There are two types of febrile seizures:

  • Simple febrile seizures—convulsions last between a few seconds to 15 minutes and are followed by a period of confusion and sleepiness which slowly resolves
  • Complex febrile seizures—last longer than 15 minutes, occur more than once within 24 hours, or produce convulsions which affect only part the body

Causes

Elevated body temperature associated with a fever is believed to trigger the seizure. The common causes of fever include any childhood infection, especially viral infections. Fever associated with routine immunizations may also cause a febrile seizure.

Risk Factors

Age is the greatest risk factor. Two to four percent of children have a febrile seizure before age five. There is some evidence that seizures associated with a high fever can occur if there is a family history of them.

Symptoms

Signs of a febrile seizure include:

  • A fever, usually above 102°F
  • Convulsion (jerking or stiffening muscles)
  • Abnormal eye movements
  • Coarse breathing sounds during the convulsion
  • Loss of consciousness
  • Loss of bladder or bowel control
  • Vomiting
  • Brief period of drowsiness or confusion following a seizure

A typical seizure produces generalized shaking, twitching, or muscle rigidity. It is usually associated with loss of consciousness. The seizure typically lasts anywhere from a few seconds to a few minutes.

Febrile seizures occur between the ages of three months to five years, with the usual age being 6 months to 3 years. About 30% of children suffer recurrent simple febrile seizures. Of those children, 50% of the seizures usually occur in the first year, and 90% occur within 2 years.

In general, the younger the age that the first febrile seizure occurs, the more likely it is that a child will have another seizure.

The long-term risk of developing adult epilepsy is very low (less than 1% for a child with a simple febrile seizure). This risk is higher for children with:

  • A complex febrile seizure
  • Problems in development before the febrile seizure
  • A family history of a seizure disorder.

The long-term risk of developing physical or mental problems is also very low.

If you suspect your child is having a febrile seizure, act quickly:

  • Protect from physical injury—Place your child on the floor or bed away from any hard or sharp objects.
  • Protect airway—Do not place anything in the mouth during the convulsion. Turn the child’s head to the side to allow saliva or vomit to drain from the mouth.
  • Watch the time—The length of the convulsions should be less than five minutes. If convulsions last longer than five minutes, call 911.

Diagnosis

In the case of simple febrile seizures, the diagnosis revolves around determining the source of the fever. This may require blood or urine tests. Rarely, if the doctor suspects meningitis or encephalitis , a lumbar puncture may be necessary to analyze the spinal fluid.

In the case of complex febrile seizures, the source of the fever is important. Additional neurologic evaluation may be needed, including a CT scan or MRI scan of the brain, electroencephalogram , lumbar puncture, and a hospital stay.

MRI Scan

MRI of the Brain

© 2008 Nucleus Medical Art, Inc.

Treatment

In most cases, the seizure resolves within a few minutes. Treatments are targeted at determining the underlying source of fever, which may require antibiotics or antiviral medications. In the rare case of a persistent seizure, call 911 and give antiseizure medication if necessary.

Prevention

About 30% of children will suffer another febrile seizure when they have a fever. This tendency is outgrown, and very few will develop epilepsy . Giving your child acetaminophen at the first sign of a fever may help prevent recurrent febrile seizures. Unfortunately, a fever can happen suddenly, with the seizure being the first sign. Do not give oral medications during a seizure.

Daily antiseizure medications, such as phenobarbital and valproic acid , can be used to prevent seizures. These medications do have side effects, though. Simple febrile seizures, while alarming, do not harm the brain.

Given the side effects, medications are not routinely recommended. In children with recurrent febrile seizures, your doctor may prescribe rectal valium to stop the seizure if it lasts more than 4-5 minutes.

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

Epilepsy Foundation
http://www.epilepsyfoundation.org

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca

Caring for Kids
http://www.caringforkids.cps.ca

References:

Bradley WG, Daroff Rb. Neurology in Clinical Practice . Philadelphia, PA: Butterworth Heinemann; 2004.

Febrile seizure. Mayo Clinic website. Available at:
http://www.mayoclinic.com/invoke.cfm?id=DS00346 . Accessed August 9, 2005.

Febrile seizures. American Academy of Pediatrics website. Available at: http://www.aap.org/pubed/ZZZ4PU1JUSC.htm?&sub_cat=107 . Accessed September 26, 2005.

Febrile seizures. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed May 23, 2008.

Febrile seizures. Medline Plus Encyclopedia website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000980.htm . Accessed September 26, 2005.

Febrile seizures: what every parent should know. American Academy of Family Physicians website. Available at: http://familydoctor.org/066.xml . Accessed September 25, 2005.

NINDS febrile seizures information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/febrile_seizures/febrile_seizures.htm . Accessed September 26, 2005.

Shellhaas, R, Camfield, C, Camfield, P. Febrile seizures. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Medlink website. Available at: http://www.medlink.com. Accessed May 12, 2008.



Last reviewed March 2008 by J. Thomas Megerian, MD, PhD, FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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