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Febrile seizure

A febrile seizure, also known as a fever fit or febrile convulsion is a generalized convulsion caused by elevated body temperature. They most commonly occur in children below the age of three years old and should not be diagnosed in children under the age of 6 months or over the age of 6 years. In many cases, the first sign of fever is the onset of the seizure. It has been theorized that the seizure is triggered by the rapidity of the rise in temperature, rather than the actual temperature reached. more...

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Febrile seizures represent the meeting point between a low seizure threshold (genetically and age determined) - some children have a greater tendency to have a seizure under certain circumstances - and a trigger: fever. The genetic causes of febrile seizures are still being researched. Some mutations that cause a neuronal hyperexcitability and could be responsible for febrile seizures have already been discovered.

The diagnosis is one that must be arrived at by eliminating more serious causes of seizure: in particular, meningitis and encephalitis must be ruled out. Therefore a doctor's opinon should be sought and in many cases the child would be admitted to hospital overnight for observation and/or tests. As a general rule, if the child returns to a normal state of health soon after the seizure, a nervous system infection it is unlikely. Even in cases where the diagnosis is febrile seizure, doctors will try to identify and treat the source of fever. In particular, it is useful to distinguish the event as a simple febrile seizure - in which the seizure lasts less than 15 minutes, does not recur in the next 24 hours, and involves the entire body. The complex febrile seizure is characterized by long duration, recurrence, or focus on only part of the body. The simple seizure represents the majority of cases and is considered to be less of a cause for concern than the complex. It is reassuring if the cause of seizure can indeed be determined to have been fever, as simple febrile seizures generally do not cause permanent brain injury; do not tend to recur frequently, as children tend to 'out-grow' them; and do not make the development of adult epilepsy significantly more likely.

Children with febrile convulsions who are destined to suffer from afebrile epileptic attacks in the future will usually exhibit the following:

  • A family history of afebrile convulsions in first degree relatives (a parent or sibling)
  • A pre-convulsion history of abnormal neurological signs or developmental delay
  • A febrile convulsion lasting longer than 15 minutes
  • A febrile convulsion with strong indications of focal features before, during or afterward


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Optimal management strategy for recurrent febrile seizure - adapted from the Journal of Pediatrics, June 1995 - Tips from Other Journals
From American Family Physician, 11/1/95

Febrile seizure recurs in about one-fifth to one-third of children who have had one febrile seizure. Although these seizures are generally benign, long-term drug therapy has been used in an attempt to prevent recurrences. Uhari and colleagues performed a randomized, double-blind trial of acetaminophen and diazepam to determine whether these agents, alone or in combination, are effective in preventing recurrent febrile seizure.

Children with a first episode of febrile seizure who did not have any chronic disease that required continuous drug therapy were randomly assigned to receive either placebo or diazepam during all subsequent febrile infections. Febrile episodes were alternately treated with acetaminophen or placebo, with the first treatment randomly selected. At the end of two years, the authors reviewed notes recorded by parents. Four groups of patients to be included in the analysis were identified: those who received two kinds of placebo, those who received diazepam and a placebo, those who received acetaminophen and a placebo, and those who received both diazepam and acetaminophen. The main end point in the analysis was a febrile seizure reported by the parents.

A total of 157 children completed the study, with 80 in the diazepam group and 77 in the placebo group. Although 23 children did not complete the entire study, all of the 180 children who were initially enrolled were followed for at least 18 months. Children ranged in age from 0.3 years to 4.6 years. Eighty-five percent of the 180 children had at least one febrile event during the first 18 months of follow-up. Thirty-eight (21.1 percent) had a total of 55 recurrences of febrile seizure. Acetaminophen had no effect on the recurrence of febrile seizure. No difference was noted between the diazepam group and the placebo group in the number of febrile seizure episodes.

The authors conclude that both acetaminophen as an antipyretic agent and diazepam appear to be ineffective in preventing recurrences of febrile seizure. Since acetaminophen is a centrally acting antipyretic agent, it is possible that antipyretics whose mechanism of action is inhibition of prostaglandins might work better. Studies that have found diazepam to be effective in this situation have used higher doses and have evaluated patients after recurrence of febrile seizure rather than after the first episode of seizure. The authors note that if diazepam is used, as may be appropriate in patients who have risk factors for recurrences, the dose should be at least 0.33 mg per kg every eight hours.

In a related editorial, Camfield and associates suggest that because parents become very upset at what they perceive to be a near-death event for their child, physicians should focus their efforts on helping parents cope with anxiety. As the authors point out, fever control does not seem to diminish the frequency of febrile seizure recurrences, and side effects of anticonvulsants such as diazepam include somnolence and ataxia. Therefore, counseling parents and reducing anxiety about this benign disorder is probably a better strategy than offering medications that do not appear to be effective. (Journal of Pediatrics, June 1995, vol. 126, pp. 929, 991.)

COPYRIGHT 1995 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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