Febrile seizure (children)

Causes and Risks:

A febrile seizure is a generalized tonic-clonic (grand mal) seizure that occurs in some children as a response to a fever . Febrile seizures are usually associated with rapidly rising fevers and usually occur early in the fever rather than later. The seizure may last a few seconds up to a few minutes although short seizures are more typical. It most commonly occurs in children three months to 5- years-old. Approximately two percent to five percent of children will have a seizure associated with fevers.

However, the exact cause of febrile seizures is unknown.

There is a tendency for febrile seizures to run in families. This may suggest that there are genetic factors involved. Occasionally, seizures associated with fever may be a symptom of other diseases such as poisoning, meningitis or encephalitis . Roseola , or infection with Human herpesvirus-6, is also a frequent cause of febrile convulsions in children. Dysentary caused by Shigella is frequently associated with a high fever and febrile seizures in children. A child who has a febrile seizure may not have further seizures in response to a fever.

Prevention:

Seizures may occur when the child's temperature is rising or falling rapidly. In many cases, the seizure may not be predicted or prevented. In the past prophylactic anticonvulsants were given to children who had multiple febrile seizures. However, that practice is seldom used now. Occasionally, a physician will prescribe rectal diazepam for the treatment of prolonged febrile seizures.

Symptoms:
  • fever (especially a high temperature or rapid rise in body temperature)
  • tonic clonic or grand mal seizure
  • loss of consciousness that lasts 30 seconds to fiveminutes (experienced by almost all children with this condition)
  • tonic posturing (general muscle contraction and rigidity that usually lasts 15 to 20 seconds)
  • clonic movement (a violent rhythmic muscle contraction and relaxation that commonly lasts for one to two minutes)
  • biting of cheek or tongue
  • clenched teeth or jaw
  • incontinence (loss of control) of urine and/or stool
  • breathing difficulty
  • absence of breathing or difficulty breathing during a seizure
  • blue skin color
  • usually resuming deep, spontaneous breathing after the seizure

After the seizure:



Signs and Tests:

A febrile seizure may be diagnosed by the health care provider when a grand mal seizure occurs in a child with a fever and no prior history of seizure disorders ( epilepsy ). In infants and young children it is important to rule out outer causes for a first-time seizure, especially meningitis.

In a typical febrile seizure the examination usually shows no abnormalities other than the illness causing the fever. However, it remains important to rule out other causes.
An EEG may show no sign of abnormality when the child is not actively having seizures . A lumbar puncture ( spinal tap ) and analysis of the cerebrospinal fluid may be used to rule out meningitis or encephalitis . Other blood tests or examinations may be appropriate to rule out other causes for the seizures.

Treatment:

A child with febrile seizures, especially a first-time febrile seizure, should be brought to the emergency room for an examination.
First aid interventions for a seizure may include prevention of injury (by removing surrounding objects on which the child may become injured), turning the child to the side to prevent aspiration of vomit or mucus into the lungs, and watching to make sure the tongue does not obstruct breathing. DO NOT stick anything into the individual's mouth.

Treat the fever with acetaminophen - oral or ibuprofen.. Aspirin should not be used to treat fever in children with possible viral infections because this increases the risk of Reye's syndrome . The CAUSE of the fever should be treated.

Medications may be prescribed to treat the seizures . Single episodes may not be treated with anticonvulsant medications.

If the seizure(s) is not stopped by the time the child reaches the hospital, then it is probably not a "simple" febrile seizure

Prognosis:

Febrile seizures are not generally chronic or recurring. Some children will be more susceptible to future febrile seizures than other children. Two or more episodes may indicate susceptibility to febrile seizures. Most children outgrow the tendency to develop febrile seizures.

If a single seizure does not last longer than fiveminutes, the chances of brain injury or chronic seizure disorder are minimal. Prolonged or repeated seizures , or febrile seizures that are not the typical grand-mal type, or abnormalities on EEG or neurologic examination may indicate a risk for future seizures unrelated to a fever .

Complications:

  • seizures (unrelated to fever )
  • an injury that results from falling or bumping into objects
  • biting one's self
  • aspiration of fluid into the lungs, pneumonia
  • permanent brain damage
  • side effects of medications used to treat and prevent seizures (if prescribed)



Call Your Healthcare Provider:

Call your health care provider or go to the emergency room if this is the first time the child has had seizures , or if this is a new type of seizure for the child. Also call if any other symptoms occur, such as changes in mental status ( drowsiness , restlessness , confusion , sedation, or others), nausea or vomiting , rash , loss of hair , tremors or abnormal movements, or problems with coordination.

Go to the emergency room or call the local emergency number (such as 911) if a seizure lasts longer than two to three minutes. Also go if repeated seizures occur (over any amount of time). Prolonged and repeated seizures indicate emergency situations.