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Febrile seizures are the most common type of seizures observed in the pediatric
age group.
Although described by the ancient Greeks, it was not until this century that febrile
seizures were recognized as a distinct syndrome separate from epilepsy. In
1980, a consensus conference held by the National Institutes of Health described
a febrile seizure as, "An event in infancy or childhood usually occurring between
three months and five years of age, associated with fever, but without evidence
of intracranial infection or defined cause." It does not exclude children with prior
neurological impairment and neither provides specific temperature criteria nor
defines a "seizure."
Febrile seizures are usually benign but can cause considerable parental anxiety.
Recent studies have defined a group of patients at higher risk for febrile seizures
and a group likely to have recurrence of febrile seizures.
For related CME activities, see CME/CE - Neonatal Emergencies and CME/CE -
Commonly Administered Vaccines and Associated Illnesses.
Pathophysiology
Febrile seizures occur in young children at a time in their development when the
seizure threshold is low. This is a time when young children are susceptible to
frequent childhood infections such as upper respiratory infection, otitis media,
viral syndrome, and they respond with comparably higher temperatures. Animal
studies suggest a possible role of endogenous pyrogens, such as interleukin 1,
that, by increasing neuronal excitability, may link fever and seizure activity.
Preliminary studies in children appear to support the hypothesis that the cytokine
network is activated and may have a role in the pathogenesis of febrile seizures,
but the precise clinical and pathological significance of these observations is not
yet clear.
Febrile seizures are divided into 2 types: simple febrile seizures (which are
generalized, last <15 min and do not recur within 24 h) and complex febrile
seizures (which are prolonged, recur more than once in 24 h, or are focal).
Complex febrile seizures may indicate a more serious disease process, such as
meningitis, abscess, or encephalitis. Viral illnesses are the predominant cause of
febrile seizures. Recent literature documented the presence of human herpes
simplex virus 6 (HHSV-6) as the etiologic agent in roseola in about 20% of a
group of patients presenting with their first febrile seizures. Shigella
gastroenteritis also has been associated with febrile seizures. One study
suggests a relationship between recurrent febrile seizures and influenza A.
Genetics: Febrile seizures tend to occur in families. In a child with febrile seizure,
the risk of febrile seizure is 10% for the sibling and almost 50% for the sibling if a
parent has febrile seizures as well. Although clear evidence exists for a genetic
basis of febrile seizures, the mode of inheritance is unclear.
Frequency
United States
Between 2% and 5% of children have febrile seizures by their fifth birthday. About
one third of these patients have at least one recurrence.
International
Mortality/Morbidity
Race
Sex
Age
CLINICAL
Section 3 of 10
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Treatment
Medication
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History
Physical
Causes
DIFFERENTIALS
Section 4 of 10
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Treatment
Medication
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WORKUP
Section 5 of 10
Authors and Editors
Introduction
Clinical
Differentials
Workup
Treatment
Medication
Follow-up
Miscellaneous
References
Lab Studies
Routine laboratory studies usually are not indicated unless they are
performed as part of a search for the source of a fever.
Electrolytes assessments are rarely helpful in the evaluation of febrile
seizures.
Patients with febrile seizures have an incidence of bacteremia similar to
patients with fever alone.
Imaging Studies
Other Tests
An electroencephalogram (EEG) usually is not necessary in the routine
evaluation of a child with a first simple febrile seizure.
Procedures
Lumbar puncture
o Controversy exists regarding the need for a lumbar puncture in a
child presenting with a simple febrile seizure.
o Certainly, meningitis can present with a seizure, although the
seizure usually is not the only sign of meningitis. Patients who have
a first time febrile seizure and do not have a rapidly improving
mental status (short postictal period) should be evaluated for
meningitis.
o Several reviews of the medical literature report less than 5%
incidence of meningitis in children presenting with seizures and
fever.
o Risk factors for meningitis in patients presenting with seizure and
fever include the following:
o
A physician visit within 48 hours
Seizure activity at the time of arrival in the ED
Focal seizure, suspicious physical examination findings (eg,
rash, petechiae) cyanosis, hypotension, or grunting
Abnormal neurologic examination
o In 1996, the American Academy of Pediatrics (AAP) recommended
that a lumbar puncture be strongly considered in patients younger
than 12 months presenting with fever and seizure. 2 The AAP also
recommended that a lumbar puncture be considered in patients
aged 12-18 months. A lumber puncture is not routinely necessary in
patients older than 18 months. This recommendation is
conservative, but it takes into account the difficulty in recognizing
meningitis in infants and young children and the range of
experience in the evaluation of pediatric patients among healthcare
providers.
TREATMENT
Section 6 of 10
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Clinical
Differentials
Workup
Treatment
Medication
Follow-up
Miscellaneous
References
Prehospital Care
FOLLOW-UP
Section 8 of 10
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Workup
Treatment
Medication
Follow-up
Miscellaneous
References
Further Inpatient Care
Deterrence/Prevention
Given a more established role of influenza A in the etiology of febrile
seizure, both acute and recurrent, there may, perhaps, be a role of
vaccination against influenza A in the flu season, to prevent development
of both acute and recurrent febrile seizures.3
Prognosis
Patient Education
MISCELLANEOUS
Section 9 of 10
Authors and Editors
Introduction
Clinical
Differentials
Workup
Treatment
Medication
Follow-up
Miscellaneous
References
Medical/Legal Pitfalls
REFERENCES
Section 10 of 10
Authors and Editors
Introduction
Clinical
Differentials