Febrile Seizure
Definition
Febrile seizure is a convulsion triggered by fever, typically occurring in children between 6 months and 6 years of age. Unlike epileptic seizures, febrile seizures are not caused by underlying neurological disorders. They are the most common type of seizure in young children and are generally benign, meaning they do not usually lead to long-term complications or epilepsy. However, in rare cases, FS can lead to status epilepticus, which impacts the brain and causes neurological complications. On the other hand, the most common cause of status epilepticus is febrile seizure.
Epidemiology Febrile seizures occur in approximately 2-5% of children under 6 years old, with a peak incidence between 12 and 18 months of age. They are slightly more common in boys than in girls and tend to have a genetic component, as children with a family history of febrile seizures are at a higher risk.
Clinical Manifestations
Simple Febrile: Seizures are the most common type. They last less than 15 minutes and involve generalized convulsions (affecting the whole body). They do not recur within 24 hours.
Complex Febrile Seizures: These last longer than 15 minutes, may recur within 24 hours and might involve only one side of the body (focal seizures). Complex febrile seizures are less common but may indicate a slightly higher risk of developing epilepsy later.
Febrile seizures often begin with a fever and are characterized by sudden, involuntary movements, such as jerking or stiffening of the body, which may be accompanied by loss of consciousness. The fever is usually due to a viral infection, though bacterial infections can also cause it.
Diagnosis
Febrile seizures are diagnosed based on the child’s medical history and physical exam.
Physical Examination and History: The healthcare provider will look for signs of infection, including ear, throat, or urinary tract infections, that could be causing the fever.
Lumbar Puncture: In some cases (especially for infants under 1 year of age or if there are signs of meningitis), a lumbar puncture may be performed to rule out a central nervous system infection.
Electroencephalography (EEG): An EEG is not typically necessary for simple febrile seizures. EEG may be used for complex febrile seizures to check for signs of abnormal brain activity.
Imaging (MRI or CT): Brain imaging is generally not required unless there are concerns about structural abnormalities or underlying conditions.
Treatment
Most febrile seizures resolve on their own within a few minutes. Treatment typically focuses on managing the fever and ensuring the child’s safety during the seizure.
Fever Management: Antipyretics like acetaminophen or ibuprofen may help reduce fever but do not prevent febrile seizures.
Seizure First Aid: Caregivers are advised to place the child in a safe position (lying on their side), ensure the airway is clear, and avoid putting anything in the child’s mouth.
Emergency Intervention: If a seizure lasts more than 5 minutes, emergency medical help may be required. Medication like rectal diazepam or intranasal midazolam may be used to stop prolonged seizures.
Prognosis
The prognosis for febrile seizures is generally excellent, especially for simple febrile seizures.
Recurrence: Approximately 30-40% of children with febrile seizures will experience another febrile seizure, usually within one year of the first episode.
Risk of Epilepsy: The risk of developing epilepsy later in life is slightly higher in children with febrile seizures, mainly if they have complex febrile seizures, a family history of epilepsy, or abnormal neurological development. However, most children with febrile seizures will not develop epilepsy.
Long-Term Outlook: Febrile seizures usually have no long-term effects on cognitive or developmental outcomes. Most children outgrow febrile seizures by age 5 or 6.
