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Febrile Seizures

Introduction

Febrile seizures occur in 2% – 5% of children and are the most common form of childhood seizures.

  • Febrile seizures usually occur in children between the ages of 6 months and 6 years and are particularly common in toddlers.
  • Approximately one in every 25 children will have at least one febrile seizure, and more than one-third of these children will have additional febrile seizures before the age of 5 years.
  • Children rarely develop their first febrile seizure before the age of 6 months or after 3 years of age.
  • The older a child is when the first febrile seizure occurs, the less likely that child is to have recurrent febrile seizures.

Diagnosis

Febrile seizures are seizures that are brought on by a fever in normal infants or small children. A diagnosis of febrile seizures is made only after excluding causes other than the fever itself.

Signs and symptoms

  • The child often loses consciousness and has jerky movements of all limbs.
  • Sometimes the child may become stiff or have jerking of one part or more of the body, such as an arm or a leg. It can be only on one side.
  • Febrile seizures usually spontaneously stopped after 2-3 minutes or less, and rarely persist beyond 10 minutes. In cases where the seizure lasts longer than 5 minutes, the child needs to be brought to the nearest medical facility.
  • During a seizure, the child may be injured by falling or may choke from food or saliva in the mouth.
  • Most children with febrile seizures have temperatures greater than 38.5 Celcius degree.
  • Most febrile seizures occur on the first day of a child’s fever.
  • Children with febrile seizures are not considered to have epilepsy, since epilepsy is characterized by recurrent seizures that are not triggered by fever.

Risk factors for recurrent febrile seizures

  • Young age (less than 15 months) during the first seizure.
  • Seizure occurs soon after a fever has begun or when the temperature is relatively low.
  • Febrile seizures in a first degree relative.
  • Epilepsy in a first degree relative.

A prolonged (more than thirty minutes) febrile seizure does not increase the risk of recurrent febrile seizures.

Long term effects of febrile seizures

  • The vast majority of febrile seizures are harmless.
  • There is no evidence that febrile seizures cause brain damage.

Large studies have found that children with febrile seizures have normal school achievement and perform as well on intellectual tests as their siblings who don’t have seizures. Even in the rare instances of very prolonged seizures (more than 1 hour), most children recover completely. About 3% of children with febrile seizures go on to develop epilepsy.

These include children with:

  • Febrile seizures that are prolonged, affect only one part of the body, or recur within 24 hours.
  • Delayed development.
  • Other family members who have epilepsy.

Children without any of these risk factors have only a one percent chance of developing epilepsy after a febrile seizure (same risk as general population).

Treatment

First aid measures

Control of seizures (See topic ‘First Aid During Seizures’)

  • The majority of children do not need medication.
  • If seizures last longer than 5 minutes then rectal diazepam (Valium) may have to be given.

Control of fever

  • Use drugs such as paracetamol or ibuprofen to lower the fever.
  • Tepid sponging of the whole body, but do not use icy water.
  • Give your child cool liquids to drink. This will help lower the temperature as well as keep him hydrated.

Admission to hospital

Children with febrile seizures may need to be admitted to the ward, although this is not necessary in all cases. Admission will be necessary in the following situations:

  • Fear of recurrent seizures.
  • To rule out infection of the brain and other serious illnesses.
  • To find out and treat the cause of fever besides infection of the brain.
  • To allay parental anxiety.

There is no need for laboratory investigations to make a diagnosis of febrile seizures. However, the doctor may decide to perform some tests to find the source of fever. A spinal tap may be required when infection of the brain is suspected. (See the topic ‘Lumbar Puncture’).

Prevention of further seizures

There is no proven method that can effectively prevent further recurrence of febrile seizures, though doctors may prescribe rectal diazepam (valium) for children with recurrent febrile seizures. The rate of recurrence will eventually be declining as a child’s age approaching 5-6 years old.

Last reviewed : 26 April 2012
Content Writer : Dr. Irene Cheah Guat Sim
: Dr. Terrance Thomas
: Dr. Umathevi Paramasivam
Reviewer : Dr. Nor Azni b. Yahaya