Febrile seizures

What are febrile seizures and why do they happen?

Febrile seizures are seen in a group of children who tend to convulse when they have fever. And I’m not talking about seizures that occur due to severe infections in the central nervous system, but about those seizures that occur in certain groups of children that tend of convulse even during a simple, viral febrile illness.
The prevalence of febrile seizures is about 2-5% in healthy children.
In terms of age, most of the cases occur starting at 6 months and up until 5 years.
It is interesting to see that the seizures do not necessarily occur when a child develops a higher temperature or beyond a certain temperature; they are more dependent on how fast the fever rises and on familial and genetic factors.
What we see visually is loss of consciousness. The child may roll his eyes, urinate or defecate and/or have repetitive, shaking movements of his limbs. The duration of most episodes is usually a few minutes, even though it could feel like forever.
One must not confuse febrile seizures with shaking chills and teeth chattering (when the fever is spiking), during which the child may be silent but conscious.

What is a simple febrile seizure?

Febrile seizures are categorized into simple febrile seizures and complicated febrile seizures.
In a simple febrile seizure, the following apply:
– Generalized – the whole body is involved and not just one side of the body.
– Tonic-clonic – it starts with the stretching of muscles and is then followed by repetitive, spastic, rhythmic movements of the muscles and limbs.
– Lasts less than 15 minutes
– Does not recur in the next 24 hours

What is a complicated febrile seizure?

A complicated seizure is any febrile seizure that doesn’t fulfill all the above criteria.

Why is it important to distinguish between a simple and complicated febrile seizure?

Since a simple febrile seizure, in contrast to a complicated seizure, is not dangerous in the short run and does not increase the prevalence of neurological issues or epilepsy in the long run.

Two other important factors:
– In the past there was an additional criterion for diagnosing simple febrile seizures and it included the patient’s neurological medical history prior to the febrile seizure. What does this mean? If a child had a significant underlying neurological illness, including a history of non-febrile seizures or a significant developmental delay, then his febrile seizure would be considered complicated. At the same time a febrile seizure can only be considered simple if it occurs in a neurologically healthy child.
– In terms of the four criteria mentioned above, the last one that discusses simple febrile seizures as such seizures that do not recur within 24 hours is the criteria that is least concerning. I’ve seen many children who have had more than one febrile seizure within 24 hours, and once it was the determined that the seizure was due to fever and not because of any other reason, then these children, for the most part, are also not at higher risk of developing epilepsy in the future.

What are the chances of a having a recurrent febrile seizure in the future for a child who experienced an episode of a simple febrile seizure?

After the first episode – in 70% of the cases the febrile seizure will not recur, 30% will have at least one more episode
After the second episode – about 50% will have additional episodes
Risk factors for recurrent febrile seizures including being under the age of one during the first episode, a seizure that occurs during (lower) temperatures, between 38 and 39 degrees Celsius and a febrile seizure during the first 24 hours of the fever.
A family history of febrile seizures is usually common in these children, and this may slightly increase the chances of recurrent seizures in the future.

What should I do if my child has a seizure?

During the seizure, despite the scare, one should act as follows:
– Lay the child on a comfortable surface so that they do not get injured as a result of the fall and are not injured by any surrounding objects
– Lay the child on their side so that if they vomit, they do not suffocate.
– If this is their first seizure or the seizure lasts for a long time, call for medical help
– Give the child an anti-pyretic suppository if they are unconscious.
– Do not open the child’s mouth by force and do not give them anything by mouth during the seizure or while they are unconscious
– Despite it being difficult or even impossible, I suggest maintaining a calm environment and not handling the situation with lots of yelling.
– Keep track of time in order to document how long the episode occurred for

If it wasn’t a first episode that required immediate medical attention, see a doctor afterwards. He will take a full history of the present illness, will carry out a physical examination in order to find out the source of the fever and will dictate the rest of the workup/treatment required. This means the physician will have two main tasks:
– Workup and treatment of the febrile illness the child has presented with. It is true that most simple febrile illnesses are due to simple viral disease. Nonetheless, it is important to see a physician so that he can determine the source of the fever and decide whether or not it is viral.
– Carry out workup and determine management, including considering the need for an EEG and the need for further neurological workup (this is usually unnecessary in simple febrile seizures).

How can febrile seizures be prevented in children?

So, they are not always preventable…
It is not rare to see a febrile illness presenting as a febrile seizure – i.e the seizure happening at a time when the parents are still unaware of the fever and had not had the opportunity to try and break it.

In children with a history of febrile seizures we tend to recommend a more aggressive and meticulous approach to the reduction of fever. Parents should make sure to take their child’s temperature and lower it every few hours, as I explain in my other posts about fever (read here).

What about treatment?

In very rare cases, where febrile seizures occur frequently, the physician might recommend a medication that can be given either by mouth (gel formulation) or as a suppository, in order to prevent or shorten these episodes.