FEBRILE SEIZURES IN CHILDREN

What are febrile seizures? 

Febrile seizures are seizures  accompanied by fever (temperature more than 38.4°C or 100.4°F) without any other cause of seizure in children aged 6 months to 6 years. The usual cause of fever is respiratory infection. Although the seizure is upsetting for parents to watch , it does not cause any permanent damage to the child.

How common are febrile seizures ?

Febrile seizures affect 2-5% of all children , in some places 12% of all children .They are most common cause of seizures in children without an underlying disorder.

What age group do they occur?

They usually occur in children between 6 months and 5 years of age.

 What are the causes of febrile seizures?

Both genetic and environmental factors play a role. There is usually a family history of febrile seizures , in children with febrile seizures. During some infections , the body may release cytokines substances to fight infection which may also cause a seizure 

What are the different kinds of febrile seizures ?

Febrile seizures are classified as Simple Febrile Seizure , seizure of short duration of less than 15 minutes , generalised ( full body involvement) occur once  within 24 hours 

Complex febrile seizures : Seizures which may be focal ( one part of the brain involved ) , seizures which recur multiple times within 24 hours or a seizures which last more than 15 minutes .

How will my child be evaluated ?

Your doctor will take a detailed history and also specific neurodevelopmental history , perform a detailed neurological and general examination and then decide further management . There are many guidelines to guide management and your doctor will individualize for your child .

What tests are needed for febrile seizures ?

No TESTS ARE ROUTINELY RECOMMENDED . Tests may be needed to identify the cause of fever like urine tests etc. Children less than 12 months of age may need to be evaluated for brain fever and hence may need lumbar puncture.

Will an EEG and MRI Brain need to be done?

EEG is not routinely recommended in children with simple febrile seizures. In complex febrile seizures EEG may be needed in a small percentage of patients . Your doctor will discuss the best management for your child .

MRI Brain is not needed routinely in simple febrile seizures . You doctor may consider MRI Brain if your child has not woken up completely or has altered consciousness , there is a doubt about brain fever ( partially treated meningitis) or your child has had a prolonged focal seizure (seizures which come from one part of the brain) at a younger age.

How will my child be managed?

Most of the time febrile seizures do not lead to any neurological problems long term. Antipyretic (anti-fever)  medications administered round the clock for the duration of fever may not prevent occurrence or recurrence of seizures but will make the child comfortable. Your doctor will treat the cause of the fever.

What treatment will be given ?

All parents of children with febrile seizures will be trained on emergency management and first aid for febrile seizures and taught how to administer Midazolam nasal spray if seizure duration is more than 5 minutes . Please have a look at the leaflet on first aid for seizures in a  child/young person.

With respect to anti-seizure medications it is best to discuss with your doctor the best way for your child 

Could my child have been damaged by the febrile convulsion?

Febrile convulsions do not cause epilepsy ( tendency to have unprovoked seizures).Some children who suffer repeated febrile seizures may go on to have a diagnosis of epilepsy later, but these are a very small number.

Febrile seizures  usually do not cause brain damage as they are mostly of short duration.Even though they may look frightening, children recover completely from febrile seizures and return to normal.

References 

1. Corsello A, Marangoni M, Macchi M ...
Febrile Seizures: A Systematic Review of Different Guidelines
Pediatric Neurology, 2024; 155, 141-148

2. Kaushik JS, Sondhi V, Yoganathan S, Dubey R, Sharma S, Vinayan KP, Gupta P, Mittal R; For AOCN Expert Committee. Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures. Indian Pediatr. 2022 Apr 15;59(4):300-306. Epub 2021 Dec 10. PMID: 34894120.

Dr Rashmi Adiga

MBBS, DCH, MRCPCH(U.K), CCT(U.K), FRCPCH.

Consultant Paediatric Neurologist