Febrile seizures in children

Anyone of any age, can potentially have a seizure and develop epilepsy: approximately one in 200 people have epilepsy, and more than one in 100 will have a seizure in their lifetimes.

Rachel Botma heard a hoarse cry from the upstairs bedroom and found her healthy three-year-old, Sophie, unconscious on the floor, blue in the face and unresponsive. Earlier that day the little girl had been irritable and had felt warm. A minute or so later, Sophie had come round, but was groggy and initially seemed not to recognise her mother.

At the hospital an hour later, the child remained subdued, but was more alert, and physical examination was normal except for a reddened, sore throat and a slight fever.

Children often develop uncomplicated fevers, but in a few cases, mostly in the six-month to five-year age range, these are associated with an epileptic seizure – a frightening experience for parents (the child rapidly loses consciousness and is unaware of what has just happened). These so-called febrile seizures occur in 2-4% of children, and are the most common form of paediatric seizure.

Resolve within minutesMost febrile seizures, known as "simple" febrile seizures, are generalised convulsions that resolve within a few minutes and occur only once. Even for those that do recur (about a third) with another fever in the next year or two, the outcome is very good: neurological development is quite normal, and only a small number (about one in 20 children) go on to have epilepsy as adults. On the other hand, many adult epileptics will have had febrile seizures as children.

When a child has experienced a febrile seizure, it is important to seek medical attention. Meningitis and encephalitis need to be excluded as the possible source of the fever – these infections can produce seizures in their own right. If the seizure has settled and the child seems well, further investigations (such as brain scanning and lumbar puncture) and hospitalisation will usually not be necessary. In general, measures are taken to bring the temperature down, and the source of the fever (often a simple sore throat or viral infection) may require specific treatment.

Prophylactic anti-seizure medications are generally not used, as their side-effects tend to outweigh their modest effect of preventing recurrence. Occasionally diazepam (Valium) is helpful in the case of unusually prolonged ("complex") febrile seizures.