FEBRILE SEIZURES

Febrile seizures are convulsions or seizures that happen with a sudden onset of fever (100.4F or higher). These are most commonly seen in children from 1-2 years old but can still be seen in those between 6 months to 6 years of age. Unlike other, more serious types of seizures, simple febrile seizures have no permanent or lasting neurological effects.

What causes febrile seizures?

There is no specific medical condition that causes febrile seizures. It is not due to infections in the brain or spinal cord, nor is it related to serious hereditary or congenital neurologic conditions like epilepsy. However, there are many cases of patients with a family history of febrile seizures (e.g., one parent had febrile seizures as a child).

Febrile seizures are triggered by a sudden increase in fever during certain viral and bacterial infections. These include influenza, acute otitis media, roseola infantum, some types of viral gastroenteritis, and even the common cold. Rarely a recent vaccination can cause high-grade fever, which may trigger a febrile seizure.

Around 2-5% of infants and younger children have febrile seizures, but otherwise are normal in terms of behavior, neurological and cognitive development, including school performance.

Are there any risk factors for this condition?

The risk for febrile seizures is multifactorial. This condition may be inherited, although the specific genes or pattern of inheritance is uncertain as of now. There is a 10-20% chance of developing febrile seizures if a first-degree relative has had one before. Other possible risk factors include iron deficiency, atopic conditions (such as bronchial asthma and allergies), and exposure to nicotine before birth (prenatally).

Types of Febrile Seizures

There are three main types of febrile seizures: simple febrile seizures, complex febrile seizures, and febrile status epilepticus.[1] 

The majority of seizures are simple febrile seizures. Seizures usually involve fever with stiffening and jerking (tonic-clonic) of the muscles, lasting for a few minutes, and most often happen only once within the last 24 hours. The tonic-clonic movements affect the whole body. Some kids may also have upward rolling of the eyes or a bluish discoloration of the face or lips (cyanosis). After the seizure episode, a child may feel weak, irritable, or sleepy but are otherwise conscious with normal behavior.

In complex febrile seizures, the convulsions reach 15 minutes or longer per episode, may occur again within the next 24 hours, and may involve only certain areas, like one limb or one side of the body. This type of seizure comprises 20% of all febrile seizure cases and is associated with kids with developmental delays. Most children with complex febrile seizures have had their first seizure at a younger age as compared to other types.

The third type is febrile status epilepticus, wherein seizures last for a minimum of 30 minutes. A child may be having a seizure continuously or may have brief pauses between seizure episodes without regaining consciousness.

First Aid Measures for Febrile Seizures at Home

If a febrile seizure happens outside the hospital, there are several steps that a caregiver or bystander can perform while waiting for medical personnel to arrive.

The child should be moved to a flat and firm surface, such as the floor, and placed on their side or stomach. There is no need to place any restraints, but you may firmly hold the patient in the above-mentioned position to prevent aspiration or choking.

If there is anything in the child’s mouth, carefully remove it. Do not place anything else inside the mouth. This is important in avoiding secondary problems, such as airway blockage.

The seizure usually ends before the child is seen by a healthcare professional. After seizure episodes, kids would commonly look confused, drowsy, or upset. Provide support by calming or soothing the child. However, it is important to bring the child to the doctor for evaluation even if the convulsions have already ended. This is especially true for all first febrile seizures.

Managing Febrile Seizures

All children who experience a febrile seizure for the first time MUST be brought to a doctor or the emergency department for evaluation. The child’s medical history, including the family’s medical history, will be reviewed, and a physical examination is typically done.

If the patient still has an ongoing seizure, additional medical management will be done by healthcare providers. For some children, there may be a need for laboratory tests and imaging, depending on several factors and on a case-to-case basis. Examples are blood tests, serum electrolyte levels, blood sugar levels, urine tests, and a lumbar puncture.

For complex febrile seizures, an electroencephalogram (EEG) may be done. Most cases of simple febrile seizures do not require to be seen by a pediatric neurologist or other specialized doctors.

There is no specific therapy to treat febrile seizures. Anti-seizure medications have adverse effects that are riskier for this age group and are therefore not recommended by experts.

Complications of Febrile Seizures

About 30% of cases may have recurrent febrile seizures. If the first episode occurred before 12 months of age, there is a 50% chance of having another episode before the child turns one year old. If the child has a low-grade fever during a seizure episode or developes a seizure less than 24 hours from the start of the fever, they may have a 25-50% chance of having another episode. Kids whose family members have had febrile seizures before are also at risk of having more than one episode. The more risk factors a child has, the higher the possibility of a recurring febrile seizure. This can go up by as much as 70%.

The risk for epilepsy is low in uncomplicated cases of simple febrile seizures - about 1-2%. If the child has complex febrile seizures, a neurodevelopmental condition, or a family history of epilepsy, this risk increases to 5-10%.

Studies have not shown that febrile seizures affect a child’s cognitive development, including intelligence and learning ability.

An Important Note on Febrile Seizures

Note that there are some epilepsy syndromes that may initially present with febrile seizures. This means that the child is already predisposed to develop epilepsy, and febrile seizures did not contribute to developing this condition. This is why medical evaluation is important during or immediately after a febrile seizure episode.

Examples of these epilepsy syndromes are severe myoclonic epilepsy of infancy (Dravet syndrome) and generalized epilepsy with febrile seizures plus (GEFS+).

Summary

Febrile seizures are benign seizures that occur in children aged 6 months to 6 years. There are no specific conditions that cause febrile seizures; these are simply triggered by the development of fever during viral or bacterial infections. There are three types of febrile seizures: simple febrile seizures, complex febrile seizures, and febrile status epilepticus. All children who develop febrile seizures should be seen by a doctor for proper medical evaluation, including ruling out other possible causes of the seizure.

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Sources:

• Kliegman, R.M. & St. Geme, J. (2019). Chapter 611: Seizures in Childhood. Nelson Textbook of Pediatrics, 21st edition. Elsevier.
• National Institute of Neurological Disorders and Stroke (n.d.) Febrile Seizures. National Institutes of Health. Taken from: https://www.ninds.nih.gov/health-information/disorders/febrile-seizures
• Xixis KL, Samanta D, Keenaghan M. Febrile Seizure. [Updated 2022 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448123/
• Millichap, J.J. (2022). Clinical features and evaluation of febrile seizures. UpToDate. Taken from: https://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizures

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