Febrile seizures should always be investigated!

Febrile seizures are very rarely associated with epilepsy or other seizure disorder.
Febrile seizures are convulsions (fits) associated with fever.

They typically occur between the ages of six months and five years

The seizures usually last less than five minutes and seldom longer than 15 minutes.

They are the most common form of seizure in childhood.

Although febrile seizures are not a problem, the child must be carefully examined as there may be a serious disease that caused the fever.

What are febrile seizures?

Having excluded other serious causes of a fever and seizure, particularly meningitis, then a febrile seizure may be diagnosed if it is a generalised (whole body involved) convulsion associated with fever occurring in a child between the ages of six months and five years. Occasionally the seizure may be confined to just one side of the body. The accepted duration is from a few seconds up to a maximum of 15 minutes - but most last less than five minutes. After the seizure the child may be a bit drowsy, but there should not be any other abnormality such as weakness. They are usually self-limiting and do not require any anti-epileptic drugs.

Febrile seizures are very rarely associated with epilepsy or other seizure disorder. They are the most common cause of seizures during childhood and occur in 2-5% of normal children.

Factors suggesting an associated epilepsy include multiple recurrent seizures, prolonged seizures (>15 minutes), one-sided seizures and any abnormality on examination of the nervous system.
What causes febrile seizures?The cause is unknown. Any illness causing a significant fever may be associated with febrile seizures. The seizures appear to be triggered by a rapid rise in the temperature rather than by a sustained high fever. The seizure is often the first indication that the child is ill which makes prevention difficult.

Who gets febrile seizures and who is at risk?

Any child between the age of six months and five years who gets a high fever {>380C in the axilla (armpit)} is at risk. The peak is about 18 months.

There is often a history that febrile seizures occurred in a parent or other sibling.

About half of the children who have had a febrile seizure are at risk for a recurrence, but very few children will have multiple recurrent febrile seizures.

What are the symptoms and signs of a febrile seizure?

By its very nature, the seizure is often all over before the parents can even react. The child may have appeared unwell earlier in the day or the seizure may suddenly occur. Most children with a febrile seizure will have a temperature of >380C.

The seizure may present as just twitching of the arms and legs through to a full-blown generalised convulsion. Usually both sides of the body are involved, but occasionally only one side or one limb may be affected.

How is a diagnosis of febrile seizure made?

The diagnosis of febrile seizure is mainly one of exclusion. If the child has had a previous febrile seizure then it may be easier to make the diagnosis.

By the time the child reaches the health facility the seizure has stopped and quite often the temperature has fallen.

The child is examined to find the cause of the fever and to rule out a serious illness. Because of the concern regarding meningitis, many institutions will perform a lumbar puncture when a child first presents under these circumstances.

An electroencephalogram (EEG) is not a routine investigation and would only be considered if the seizure was in any way atypical e.g. longer than 15 minutes or if there were recurrent seizures.
Can febrile seizures be prevented?

Often little can be done to prevent a febrile seizure because it usually occurs at the onset of the illness and may be the first sign that the child is ill.

Generally, the temperature should be kept as close to normal as possible in any ill child. Non-specific measures are to remove excess clothes and bedding and sponging down with tepid (not cold) water. Paracetamol can be given to reduce the fever.

How are febrile seizures treated?

A true febrile seizure is self-limiting and does not require specific management.

The basic principles of handling any child having a seizure is to ensure that the child cannot be hurt i.e. fall off the bed. The child should be gently rolled over onto their side and under no circumstances should one attempt to restrain or force open the child’s mouth.

The child should be examined for the cause of the fever and the appropriate management instituted, together with e.g. paracetamol to reduce the fever.

Anti-epileptics are not routinely used and are only prescribed when a child has many recurrent seizures and after further investigation.

When to call the doctor

Any child who has a seizure and who has not been formally diagnosed as having epilepsy or other seizure disorder must be seen by a doctor or health care worker to identify the cause.

The fever and convulsion may be associated with a serious illness such as meningitis.