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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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Ibuprofen and acetaminophen in children with febrile seizure - adapted from the Archives of Pediatrics and Adolescent Medicine, June 1995 - Tips from Other
From American Family Physician, 10/1/95

Two to 5 percent of young children have febrile seizures, and 30 percent of children have a recurrent seizure. Although previous studies have proved that ibuprofen and acetaminophen reduce fever in children, these studies have excluded children with a history of febrile seizure. Van Esch and colleagues compared the antipyretic efficacy of ibuprofen and acetaminophen in children with a history of febrile seizure.

The study included 70 children with a history of febrile seizure who had a rectal temperature of 38.5[degrees]C (101.3[degrees]F) on presentation. The children ranged in age from 10 months to four years (mean age: 2.1 years). Children received either acetaminophen syrup (10 mg per kg per dose) or ibuprofen syrup (5 mg per kg per dose). Medication was given every six hours for one to three days, depending on the duration of the febrile illness.

Four hours after the initial dose, ibuprofen reduced fever 0.50[degrees]C more than did acetaminophen; this difference was statistically significant. During the overall treatment, ibuprofen lowered the mean initial temperature from 39.1[degrees]C (102.4[degrees]F) to a mean temperature of 37.7[degrees]C (99.9[degrees]F); acetaminophen lowered the temperature from 39.2[degrees]C (102.6[degrees]F) to 38.0[degrees]C (100.4[degrees]F). Adverse events, which did not differ significantly between the groups, included gastrointestinal complaints, exanthemas and insomnia.

The authors conclude that both ibuprofen and acetaminophen are effective antipyretic agents in children with a history of febrile seizure. Use of ibuprofen resulted in a greater reduction in temperature at four hours after ingestion. The authors call for further research to determine the value of these antipyretic agents in the prevention of recurrent febrile seizures. (Archives of Pediatrics and Adolescent Medicine, June 1995, vol.149, p.632.)

COPYRIGHT 1995 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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