Febrile seizure

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Febrile seizure
SynonymsFever fit, febrile convulsion
Clinical thermometer 38.7.JPG
An analog medical thermometer showing a temperature of 38.8 °C or 101.8 °F
SpecialtyEmergency medicine, neurology
SymptomsTonic-clonic seizure[1]
Usual onsetAges of 6 months to 5 years[1]
DurationTypically less than 5 minutes[1]
TypesSimple, complex[1]
CausesHigh body temperature[1]
Risk factorsFamily history[1]
Differential diagnosisMeningitis, metabolic disorders[1]
TreatmentSupportive care[1]
MedicationBenzodiazepines (rarely needed)[1]
PrognosisGood[1]
Frequency~6% of children[1][2]

A febrile seizure, also known as a fever fit or febrile convulsion, is a seizure associated with a high body temperature but without any serious underlying health issue.[1] They most commonly occur in children between the ages of 6 months and 5 years.[1] Most seizures are less than five minutes in duration and the child is completely back to normal within an hour of the event.[1][3]

Febrile seizures may run in families.[1] The diagnosis involves verifying that there is not an infection of the brain, there are no metabolic problems, and there have not been prior seizures that have occurred without a fever.[1] There are two types of febrile seizures: simple febrile seizures and complex febrile seizures.[1] Simple febrile seizures involve an otherwise healthy child who has at most one tonic-clonic seizure lasting less than 15 minutes in a 24-hour period.[1] Blood testing, imaging of the brain or an electroencephalogram (EEG) is typically not needed for the diagnosis.[1] Examination to determine the source of the fever is recommended.[1] In otherwise healthy-looking children a lumbar puncture is not necessarily required.[1]

Neither anti-seizure medication nor anti-fever medication are recommended in an effort to prevent further simple febrile seizures.[1] In the few cases that last greater than five minutes a benzodiazepine such as lorazepam or midazolam may be used.[1][4] Outcomes are generally excellent with similar academic achievements to other children and no change in the risk of death for those with simple seizures.[1] There is tentative evidence that children have a slight increased risk of epilepsy at 2%.[1] Febrile seizures affect two to five percent of children before the age of five.[1][2] They are more common in boys than girls.[5] After a single febrile seizure there is a 15 to 70% chance of another one.[1]

Signs and symptoms[edit]

During generalized febrile seizures, the body will become stiff and the arms and legs will begin twitching. The child loses consciousness, although their eyes remain open. Breathing can be irregular. They may become incontinent (wet or soil themselves); they may also vomit or have increased secretions (foam at the mouth). The seizure normally lasts for less than five minutes.[3] The child's temperature is usually greater than 38 °C (100.4 °F).[3]

Causes[edit]

Genetic associations[6]
Type OMIM Gene
FEB3A 604403 SCN1A
FEB3B 604403 SCN9A
FEB4 604352 GPR98
FEB8 611277 GABRG2

Febrile seizures are due to fevers,[5] usually those greater than 38 °C (100.4 °F).[7] The cause of the fevers is often a viral illness.[1] The likelihood of a febrile seizure is related to how high the temperature reaches.[1] Some feel that the rate of increase is not important[1] while others feel the rate of increase is a risk factor.[8] This latter position has not been proven.[8]

There is a small chance of a febrile seizure after certain vaccines.[9] Implicated vaccines include measles/mumps/rubella/varicella, diphtheria/tetanus/acellular pertussis/polio/Haemophilus influenzae type b, whole-cell pertussis, some versions of the pneumococcal vaccine, and some types of influenza vaccine when given together with the pneumococcal vaccine or diphtheria/tetanus/acellular pertussis vaccine.[9]

The seizures occur, by definition, without an intracranial infection or metabolic problems.[1] They run in families.[1] Several genetic associations have been identified.[6] An association with iron deficiency has also been reported, particularly in the developing world.[10]

Diagnosis[edit]

The diagnosis is arrived at by eliminating more serious causes of seizure and fever: in particular, meningitis and encephalitis. However, in locales in which children are immunized for pneumococcal and Haemophilus influenzae, the prevalence of bacterial meningitis is low. If a child has recovered and is acting normally, bacterial meningitis is very unlikely.

Blood test, imaging of the brain and an electroencephalogram are generally not needed.[1]

Types[edit]

There are three types of febrile seizures.

  • A simple febrile seizure is characterized by shorter duration (lasting less than 15 minutes), no focal features (meaning the shaking is general rather than restricted to a part of the body such as an arm or leg), and if they do occur in series, the total duration is less than 15 minutes (classically a generalized tonic-clonic seizure).
  • A complex febrile seizure is one in which the seizure lasts longer than 15 minutes or multiple episodes occur within 24 hours and generally does have focal features.
  • A febrile status epilepticus is a febrile seizure that lasts for longer than 30 minutes. It can occur in up to 5% of febrile seizure cases.[11]

Prevention[edit]

There is no benefit from the use of phenytoin, valproate, pyridoxine, ibuprofen, zinc sulfate, diclofenac, acetaminophen.[12]

There is a decrease of recurrent febrile seizures with intermittent diazepam and phenobarbital but there is a high rate of adverse effects.[12] They are thus not recommended as an effort to prevent further seizures.[1]

Treatment[edit]

It is important that parents and caretakers remain calm, take first aid measures, and carefully observe the child. If a child is having a febrile seizure, parents and caregivers should do the following:[13]

  • Note the start time of the seizure. If the seizure lasts longer than 5 minutes, call an ambulance. The child should be taken immediately to the nearest medical facility for diagnosis and treatment.[13]
  • Call an ambulance if the seizure is less than 5 minutes but the child does not seem to be recovering quickly.
  • Gradually place the child on a protected surface such as the floor or ground to prevent accidental injury. Do not restrain or hold a child during a convulsion.[13]
  • Position the child on his or her side or stomach to prevent choking. When possible, gently remove any objects from the child’s mouth. Nothing should ever be placed in the child's mouth during a convulsion. These objects can obstruct the child's airway and make breathing difficult.[13]
  • Seek immediate medical attention if this is the child’s first febrile seizure and take the child to the doctor once the seizure has ended to check for the cause of the fever. This is especially urgent if the child shows symptoms of stiff neck, extreme lethargy, or abundant vomiting, which may be signs of meningitis, an infection over the brain surface.[13]

In those who have prolonged seizures intravenous lorazepam is recommended.[1] The other benzodiazepines—midazolam and diazepam—are also reasonable options.

Prognosis[edit]

Long term outcomes are generally good with little risk of neurological problems or epilepsy.[1] Those who have one febrile seizure have an approximately 40% chance of having another one in the next two years, with the risk being greater in those who are younger.[1]

Simple febrile seizures do not tend to recur frequently (children tend to outgrow them) and do not make the development of adult epilepsy significantly more likely (about 3–5%) compared with the general public (1%).[14] Children with febrile convulsions are more likely to have a febrile seizure in the future if they were young at their first seizure (less than 18 months old), have a family history of a febrile convulsions in first-degree relatives (a parent or sibling), have a short time between the onset of fever and the seizure, had a low degree of fever before their seizure, or have a seizure history of abnormal neurological signs or developmental delay.[citation needed] Similarly, the prognosis after a complex febrile seizure is excellent, although an increased risk of death has been shown for complex febrile seizures, partly related to underlying conditions.[15]

Epidemiology[edit]

Febrile seizures happen between the ages of six months and five years.[1] They affect between 2-5% of children.[1] Rates between 5 and 10% have been reported in India and Japan.[2]

References[edit]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am Graves, RC; Oehler, K & Tingle, LE (15 January 2012). "Febrile seizures: risks, evaluation, and prognosis". American Family Physician. 85 (2): 149–53. PMID 22335215.
  2. ^ a b c Patterson, JL; Carapetian, SA; Hageman, JR; Kelley, KR (Dec 2013). "Febrile seizures". Pediatric annals. 42 (12): 249–54. doi:10.3928/00904481-20131122-09. PMID 24295158.
  3. ^ a b c "Symptoms of febrile seizures". www.nhs.uk. 1 October 2012. Archived from the original on 6 October 2014. Retrieved 13 October 2014.
  4. ^ Paritosh Prasad (2013). Pocket Pediatrics: The Massachusetts General Hospital for Children Handbook of Pediatrics. Lippincott Williams & Wilkins. p. 419. ISBN 9781469830094. Archived from the original on 6 September 2017.
  5. ^ a b Ronald M. Perkin, ed. (2008). Pediatric hospital medicine : textbook of inpatient management (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 266. ISBN 9780781770323. Archived from the original on 6 September 2017.
  6. ^ a b Nakayama J, Arinami T (August 2006). "Molecular genetics of febrile seizures". Epilepsy Res. 70 Suppl 1: S190–8. doi:10.1016/j.eplepsyres.2005.11.023. PMID 16887333.
  7. ^ David A. Greenberg; Michael J. Aminoff; Roger P. Simon (2012). "12". Clinical neurology (8th ed.). New York: McGraw-Hill Medical. ISBN 978-0071759052.
  8. ^ a b Engel, Jerome (2008). Epilepsy : a comprehensive textbook (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 661. ISBN 9780781757775. Archived from the original on 6 September 2017.
  9. ^ a b Monfries, N; Goldman, RD (February 2017). "Prophylactic antipyretics for prevention of febrile seizures following vaccination". Canadian family physician Medecin de famille canadien. 63 (2): 128–130. PMC 5395384. PMID 28209678.
  10. ^ King, D; King, A (October 2014). "Question 2: Should children who have a febrile seizure be screened for iron deficiency?". Archives of Disease in Childhood. 99 (10): 960–4. doi:10.1136/archdischild-2014-306689. PMID 25217390.
  11. ^ Ahmad, S; Marsh, ED (September 2010). "Febrile status epilepticus: current state of clinical and basic research". Semin Pediatr Neurol. 17 (3): 150–4. doi:10.1016/j.spen.2010.06.004. PMID 20727483.
  12. ^ a b Offringa, Martin; Newton, Richard; Cozijnsen, Martinus A.; Nevitt, Sarah J. (22 February 2017). "Prophylactic drug management for febrile seizures in children". The Cochrane Database of Systematic Reviews. 2: CD003031. doi:10.1002/14651858.CD003031.pub3. ISSN 1469-493X. PMID 28225210.
  13. ^ a b c d e "Febrile Seizures Fact Sheet | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Archived from the original on 28 July 2017. Retrieved 9 August 2017. This article incorporates text from this source, which is in the public domain.
  14. ^ Shinnar, S; Glauser, TA (January 2002). "Febrile seizures". Journal of Child Neurology. 17 Suppl 1: S44–52. doi:10.1177/08830738020170010601. PMID 11918463.
  15. ^ Vestergaard M, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J (August 2008). "Death in children with febrile seizures: a population-based cohort study". Lancet. 372 (9637): 457–63. doi:10.1016/S0140-6736(08)61198-8. PMID 18692714.

External links[edit]

Classification
External resources
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