Seizures and Fever Overview

Febrile seizures, also known as convulsions, body spasms, or shaking, occur mainly in children
and are caused by fever. (Febrile is derived from the Latin febris,meaning fever.) As with most
types of seizures, the onset is dramatic, with little or no warning. In most instances,
the seizure lasts only a few minutes and stops on its own.

Febrile seizures may occur because a child's developing brain is sensitive to the effects of
fever. These seizures are most likely to occur with high body temperatures (higher than 102°F)
but may also occur with milder fevers. The sudden rise in temperature seems to be more
important than the degree of temperature. The seizure may occur with the initial onset of fever
before a child’s caregiver is even aware the child is ill.

• Seizures generally occur in those aged 3 months to 5 years; peak incidenceis in infants
aged 8-20 months.

• About 2-5% of all children will experience a febrile seizure.

• Of those who have had a febrile seizure, 30-40% will experience more seizures.

• About 25% have a first-degree relative with a history of febrile seizure.

• The seizure itself is almost always harmless. It does not cause brain damage or lead
to epilepsy.

Febrile seizures are classified into 2 types:

• Simple febrile seizures are more common and are characterized by generalized
seizures that last less than 5 minutes.

• Complex febrile seizures are those that are either prolonged (longer than 15
minutes),focal (meaning they involve only a part of the body, such as the face), or recurring
within a 24-hour period.

Children who have experienced a complex febrile seizure may be at risk for these outcomes:

• A somewhat higher risk of having a serious infection

• More likely to have preexisting neurologic abnormalities

• A higher risk for developing epilepsy later

Most fevers associated with febrile seizures are due to the usual causes of fever in young
children—namely, common viral and mild bacterial infections such as ear infections. Although
perhaps only 1% of children with febrile seizures have a serious infection of the central nervous
system such as meningitis, this possibility should always be carefully considered in a child who
has had a febrile seizure.

By definition, febrile seizures occur when the child has a fever. Most febrile seizures are
generalized. In other words, the whole body may be involved.

• During a generalized seizure, any or all of the following may be seen:

o Stiffening of the entire body

o Jerking of the arms and legs

o Complete lack of response to any stimuli

o Eyes deviated, staring, rolling back, moving back and forth

o Tightness of the jaws and mouth

o Urinary incontinence (wet their pants)

o Noisy breathing, labored, slower than normal (unusual for a child to stop
breathing completely)

• Although it may seem like an eternity if you are witnessing a seizure, most of these
episodes last only 1-5 minutes. Afterward, the child is typically drowsy but usually starts to
become responsive within 15-30 minutes.

• Following a seizure, a child may remain somewhat “twitchy,” with intermittent small
jerks of the arms or legs. It can be difficult to distinguish these movements from seizure
activity, but the caregiver should be reassured if the child’s body tone has become relaxed,
breathing is regular, and the child begins to show some signs of responding to stimulation
(will respond if talked to, for example).

• Focal seizures are less common and, as the term implies, involve only a part of the
body. Abnormal movements may be seen only in the face (eye blinking, lip smacking, other
movements of the mouth) or one side of the body. Variable degrees of alteration in
consciousness are seen in focal seizures. Some seizures begin as focal ones and then
become generalized.
Seizures and Fever Treatment

Self-Care at Home

These aspects of home care need to be considered:

• Care of the child during the seizure: During a seizure, only a limited amount
ofintervention should be undertaken. The main objective is to protect the child’sairway so
that breathing is maintained. Protection from other injury is important.

o Remove objects, such as food and pacifiers, from the mouth.

o Place the child on his or her side orabdomen.

o Clear the mouth with a suction bulb (if available) if there is vomiting.

o Perform a jaw thrust or chin lift maneuver if there is noisy or labored breathing.

o Do not try to restrain the child or try to stop seizure movements.

o Do not force anything into the child's mouth. Don't try to hold the tongue. (It is
not necessary to try to prevent the tongue from being swallowed.)

• Control of the fever: Because the seizure is being caused by fever, measures should be
taken to lower the body temperature.

o Remove clothing.

o Apply cool washcloths to the face and neck.

o Sponge the rest of the body with cool water (do not immerse a seizing child in
the bathtub).

o Give medication to lower the fever (acetaminophen suppositories in therectum,

if available). Oral medications should not be given until the child is awake.

• Consider the cause of the fever: This is probably best left up to the doctor's medical
evaluation.

Medical Treatment
Should the child come to the hospital with persistent seizure activity (what is termedstatus
epilepticus), the following interventions will be undertaken in the emergency department:

• Emergency treatment is begun to make sure the airway is open and oxygen intake is
adequate. A monitor called a pulseoximeter will be used to measure oxygen content in the
bloodstream. If additional oxygen is needed, a mask may be used.

• If necessary, the airway may be opened by means of a jaw thrust, chin lift, or a device
known as an oral airway. In some cases, it may be necessary to breathe for the child, either
with the use of a bag and mask or by placement of a tube in the trachea(windpipe).

• Additional interventions may be needed as a physical examination is performed.

o Placement of an IV line to obtain blood for testing and to administer medication

to stop the seizure

o A rapid bedside test for blood sugar (glucose) to determine if it is low and if
glucose needs to be given through the IV (low blood sugar can cause seizures)

o Measuring vital signs (temperature, pulse, respiratory rate, and blood

pressure)

o Treatment to lower body temperature, if fever is present

Medications

Medication is given to stop the seizure.

• Delivered through the IV line, which is the fastest and most reliable, the most commonly
used medications arebenzodiazepines, such as lorazepam(Ativan) or diazepam (Valium).
Sometimes more than one dose or more than one type of medication is needed.

• The medications used often cause sedation. Combined with the natural drowsy state
after a seizure, the child may remain sleepy for quite some time afterward.

Prevention

• Although fever control is important, it is unclear how effective this is at preventing

another episode of febrile seizures. Still, it seems reasonable to try to take these measures
to control fever during an illness. Give acetaminophen (Tylenol, Tempra, and other children's
formulas as directed by your doctor or on the label) or ibuprofen(Motrin, Advil, and others).
 • Alternating doses of acetaminophen and ibuprofen such that medication is given every
3-4 hours is common, although some authorities are concerned that this practice is of
unproven safety and benefit.

• Sponge bathing with lukewarm water must be done for 15-20 minutes. The water must
not be so cool that the child shivers (shivering tends to keep body temperature up). The
lowering effect of sponge bathing on body temperature will not last unless the child has also
been given acetaminophen or ibuprofen.

A seizure occurs when the brain functions abnormally, resulting in a change in movement,
attention, or level of awareness. Different types of seizures may occur in different parts of the
brain and may be localized (affect only a part of the body) or widespread (affect the whole
body). Seizures may occur for many reasons, especially in children. Seizures in newborns may
be very different than seizures in toddlers, school-aged children, and adolescents. Seizures,
especially in a child who has never had one, can be frightening to the parent or caregiver.

• Around 3% of all children have a seizure when younger than 15 years, half of which are
febrile seizures (seizure brought on by a fever). One of every 100 childrenhas epilepsy-
recurring seizures.

• A febrile seizure occurs when a child contracts an illness such as an earinfection, cold,
or chickenpox accompanied by fever.Febrile seizuresare the most common type of seizure
seen in children. Two to five percent of children have a febrile seizure at some point during
their childhood. Why some children have seizures with fevers is notknown, but several risk
factors have been identified.

o Children with relatives, especially brothers and sisters, who have had febrile
seizures are more likely to have a similar episode.

o Children who are developmentally delayed or who have spent more than 28
days in a neonatal intensive care unit are also more likely to have a febrile seizure.

o One of 4 children who have a febrile seizure will have another, usually within a
year.

o Children who have had a febrile seizure in the past are also more likely tohave
a second episode.

• Neonatal seizures occur within 28 days of birth. Mostoccur soon after the child is born.
They may be due to a large variety of conditions. It may be difficult to determine if a newborn
is actually seizing, because they often do not have convulsions. Instead, their eyes appear to
be looking in different directions. They may have lip smacking or periods of no breathing.

• Partial seizures involve only a part of the brain and therefore only a part of the body.

o Simple partial (Jacksonian) seizures have a motor (movement) component that

is located in one portion of the body. Children with these seizures remain awake and
alert. Movement abnormalities can "march" to other parts of the body as the seizure
progresses.

o Complex partial seizures are similar, except that the child is not aware of what
is going on. Frequently, children with this type of seizurerepeat an activity, such as
clapping, throughout the seizure. Theyhave no memory of this activity. After the seizure
ends, the childis oftendisoriented in a state known as the postictal period.

• Generalized seizures involve a much larger portion of the brain. They are grouped into
2 types: convulsive (muscle jerking) and nonconvulsive with several subgroups.

o Convulsive seizures are noted by uncontrollable muscle jerking lasting for a few
minutes-usually less than 5-followed by a period of drowsiness that is called the postictal
period. The child should return to his or her normal self except for fatigue within around
15 minutes. Often the child may haveincontinence (lose urine or stool), and it is normal
for the child not to remember the seizure. Sometimes the jerking can cause injury, which
may range from a small bite on the tongue to a broken bone.

o Tonic seizures result in continuous muscle contraction and rigidity, while tonic-
clonic seizures involve alternating tonic activity with rhythmic jerking of muscle groups.

o Infantile spasms commonly occur in children younger than 18 months. They are
often associated with mental retardation and consist of sudden spasms of muscle groups,
causing the child to assume a flexed stature. They are frequent upon awakening.

o Absence seizures, also known as petit mal seizures, are short episodes during
which the child stares or eye blinks, with no apparent awareness of their surroundings.
These episodes usually do not last longer then a few seconds and start and stop abruptly;
however, the childdoes not remember the event at all. These are sometimes discovered
after the child's teacher reports daydreaming, if the child loses his or her place while
reading or misses instructions for assignments.

• Status epilepticus is either a seizure lasting longer than 30 minutes or repeated

seizures without a return to normal in between them. It is most common in children younger
than 2 years, and most of these childrenhave generalized tonic-clonic seizures. Status
epilepticus is very serious. With any suspicion of a long seizure, you should call 911.
 • Epilepsy refers to a pattern of chronic seizures of any type over a long period. Thirty
percent of children diagnosed with epilepsycontinue to have repeated seizures into
adulthood, while othersimprove over time.

Although seizures have many known causes, for 3 out of 4 children, the cause remains
unknown. In many of these cases, there is some family history of seizures. The remaining
causes include infections such as meningitis, developmental problems such as cerebral palsy,
head trauma, and many other less common causes.

About one fourth of the children who are thought to have seizures are actually found to have
some other disorder after a complete evaluation. These other disorders includefainting, breath-
holding spells, night terrors, migraines, and psychiatric disturbances.

• The most common type of seizure in children is the febrile seizure, which occurs when
an infection associated with a high fever develops.

• Other reasons for seizures are these:

o Infections

o Metabolic disorders

o Drugs

o Medications

o Poisons

o Disordered blood vessels

o Bleeding inside the brain

o Many yet undiscovered problems

Seizures in Children Symptoms

Seizures in children have many different types of symptoms. A thorough description of the type
of movements witnessed, as well as the child's level of alertness, can help the doctor determine
what type of seizure your child has had.

• The most dramatic symptom is generalized convulsions. The child may undergo
rhythmic jerking and muscle spasms, sometimes with difficulty breathing and rolling eyes.
The child is oftensleepy and confused after the seizure and does not remember the seizure
afterward. This symptom group is common with grand mal(generalized) and febrile seizures.
 • Children with absence seizures (petit mal) develop a loss of awareness with staring or
blinking, which starts and stops quickly. There are no convulsive movements. These children
return to normal as soon as the seizure stops.

• Repetitive movements such as chewing, lip smacking, or clapping, followed by

confusion are common in children suffering from a type of seizure disorder known as
complex partial seizures.

• Partial seizures usually affect only one group of muscles, which spasm and move
convulsively. Spasms may move from group to group. These are called march seizures.
Children with this type of seizure may also behave strangely during the episode and may or
may not remember the seizure itself after it ends.

Exams and Tests

For all children, a thorough interview and examination should occur. It is important for the
caregiver to tell the doctor about the child's medical history, birth history, any recent illness, and
any medications or chemicals that the child could have been exposed to. Additionally, the
doctorasks for a description of the event, specifically to include where it occurred, how long any
abnormal movements lasted, and the period of sleepiness afterward. A wide variety of tests can
be performed on a child who is thought to have seizures. This testing depends on the child's
age and suspected type of seizures.

• Febrile seizures

o Children should receive medication for the fever such as acetaminophen (for
example, Tylenol) or ibuprofen (for example, Advil).

o Depending on the age of the child, the doctor may order blood or urine tests or
both, looking for the source of the fever.

o If the child has had his or her first febrile seizure, then the doctor may want to
perform a lumbar puncture (spinal tap) to test for possible meningitis. The lumbar
puncture should be performed in children younger than 6 months, and some
doctorsperform them in children as old as 18 months.

o Most childrendo not get a CT scan of the head, unless there was something
unusual about the febrile seizures, such as the child not returning to his or her normal self
shortly afterward.

o Very few children with febrile seizures are admitted to the hospital. The
treatment for febrile seizures is keeping the temperature down, and possibly a medication
 if a specific infection is found such as an ear infection. Follow up with the child's doctor in
a few days.

• Movement seizures

o Movement seizures, which include partial seizures and generalized (grand mal)
seizures, can be very dramatic. If the child is having a seizure in the emergency
department, he or she is given medications to stop the seizure.

o If the child has returned to normal in the hospital, then the child will probably
have a few tests performed. Blood is drawn to check the child's sugar, sodium, and some
other blood chemicals.

o If the child is on antiseizure medications, then the medication'slevels in the

blood are checked (if possible).

o Most childrenundergo a CT scan or MRI (studies looking at the structure of the

brain), but this may be scheduled for several days later rather than in the emergency
department. In children, these imaging studies are usually normal but are performed to
look for unusual causes of seizure such as bleeding or tumor.

o Most childreneventually undergo an EEG, which is a study looking at the brain

waves or electrical activity of the brain. An EEG is almost never performed in
theemergency departmentbutis performed later.

o The child will probably be admitted if he or she is very young, has another
seizure, hasabnormal physical examination findings or lab test results, or if you live far
from a hospital. Children in status epilepticus are admitted to an intensive care unit.

o If the child is doing well, doesn't have recurring seizures, and has a normal
physical examination findings and blood test results, then the child will most likely be sent
home to follow up with a pediatrician in a few days to continue the evaluation and arrange
other tests, such as the EEG.

• Absence seizures (petit mal)

o These can be evaluated without going to an emergency department. Most

likely, the doctor will only order an EEG. If the EEG tells the doctor that the child is having
absence seizures, then the child will most likely be placed on medications to control them.
 • Neonatal seizures and infantile spasms

o Seizures of this type occur in young children and are often associated with
other problems such as mental retardation. Children suspected of having these seizures
may have multiple lab tests done in the emergency department. They would include blood
and urine samples, lumbar puncture, and possibly a CT scan of the head. These children
are usually admitted to the hospital and may even be referred to a pediatric specialty
hospital. In the hospital, these children undergo several days of testing to look for the
many possible causes of the seizures.

Medical Treatment

Treatment of children with seizures is different than treatment for adults. Unless a specific cause
is found, most children with first-time seizures will not be placed on medications.

• Important reasons for not starting medications

o During the first visit, many doctors cannot be sure if the event was a seizure or
something else.

o Many seizure medications have side effects including damage to your child's
liver or teeth.

o Many children will have only one, or very few, seizures.

• If medications are started

o The doctor will follow the drug levels, which require frequent blood tests, and
will watch closely for side effects. Often, it takes weeks to months to adjust the
medications, and sometimes more than one medicine is needed.

o If your child has status epilepticus, he or she will be treated very aggressively
with antiseizure medications, admitted to the intensive care unit, and possibly be placed
on a breathing machine.

Prevention

Most seizures cannot be prevented. There are some exceptions, but these are very difficult to
control, such as head trauma and infections during pregnancy.
 • Children who are known to have febrile seizures should have their fevers well controlled
when sick.

• The biggest impact caretakers can have is to prevent further injury if a seizure does
occur.

• The child can participate in most activities just as other children do. Parents and other
caretakers must be aware of added safety measures, such as having an adult around if the
child is swimming or participating in any other activities that could result in harm if a seizure
occurs.

• One common area for added caution is in the bathroom. Showers are preferred
because they reduce the risk of drowning more than baths.

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Seizures In Children
• Definition of Seizures In Children
• Description of Seizures In Children
• Questions To Ask Your Doctor About Seizures In Children
Definition of Seizures In Children Related
Article updated and reviewed by Peter B. Kang, MD, Assistant in Neurology, Children's Hospital
Boston, and Instructor in Neurology, Harvard Medical School, Boston, MA. Editorial review Encyclopedia
provided by VeriMed Healthcare Network on April 18, 2005.

Seizures are characterized by abnormal electrical activity in the brain, • Acne

usually causing changes in behavior such as rhythmic movements or
confusion. An individual with epilepsy is someone who has recurrent • Alagille Syndrome
spontaneous seizures, that is, seizures that are not associated with
triggers such as fevers or head trauma. • Angina Pectoris
Description of Seizures In Children
Please see the �Epilepsy (Seizure Disorders)� section for basic • Angiogram
information about seizure types, emergency management, and
More...
medications.

There are a number of seizure syndromes that affect children, not all of Related
which meet the criteria for epilepsy. Three common seizure syndromes Animations
are febrile seizures, Rolandic epilepsy, and absence epilepsy.
Febrile seizures are seizures that are triggered by fevers, and typically
occur in children from the age of six months to five years. Simple febrile • Dental Cavities
seizure are ones in which the seizure is brief (up to several minutes in
duration), generalized (stiffening and shaking of all limbs), limited to More...
one seizure for the duration of the illness, and occur in children who are
developmentally normal and have no known chronic neurological
disorders. Simple febrile seizures, barring injury during the seizures Related
themselves, are generally benign, with no significant long term Healthscout
consequences for neurological development known to date and only a Videos
slightly increased risk for epilepsy in the long term. Simple febrile
seizures are not generally regarded as a form of epilepsy since the
seizures are not spontaneous. If there are features that mark the Reconstructing
ACL's in Kids
seizures as being complex (or �atypical�) rather than simple, there
may be a higher risk of epilepsy and serious long term consequences for Saving Derek from
neurological development. Many children with complex febrile seizures Paralysis
still do fairly well. Simple febrile seizures often do not require specialized
testing such as electroencephalography (EEG, an electrical brainwave Vision Revision for
test like an EKG) or an MRI scan, but complex febrile seizures may ADHD Diagnosis
require such an evaluation. If a child has seizures both with and without
Hospital Survival
fever, the child meets the criteria for epilepsy. An important concern to Guide
keep in mind, especially with an infant who has a seizure with fever, is
that such a seizure may be the first sign of meningitis, so any child with More...
a first time febrile seizure should be evaluated at the nearest hospital
emergency department. Depending on the circumstances, subsequent
seizures may require evaluation also, especially if the seizure is Related Drug
prolonged or if the child does not recover afterwards in the same Information
manner as in previous events. Febrile seizures sometimes run in
families.
Rolandic epilepsy is a common form of childhood epilepsy that is • Adderal XR
characterized by partial seizures. This disorder begins between infancy
and puberty. The most common seizure type is the simple partial • Concerta
seizure, characterized by abnormal motor activity of a specific part of
• Strattera
More...
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Febrile seizure is a convulsion that is associated with a significant rise in body
temperature in children ages of six months to five years. Febrile seizure is also
known as fever fit or febrile convulsion. A fever itself is not an illness, but is
associated with respiratory illness. [7] Symptoms
During simple febrile seizures, the body will become stiff and the arms and legs will begin
twitching. Also, the eyes roll back. The patient loses consciousness, although their eyes remain
open. Breathing can be irregular. They may become incontinent (wet or soil themselves); they
may also vomit or have increased secretions (foam at the mouth). The skin may appear to be
darker than normal during an episode. The seizure normally lasts for less than one minute, but
uncommonly can last up to fifteen minutes. [5] [7] [9]

[edit]Causes

The direct cause of a febrile seizure is not known; however, it is normally precipitated by a
recent upper respiratory infection or gastroenteritis. A febrile seizure is the effect of a sudden
rise in temperature (>39°C/102°F) rather than a fever that has been present for a prolonged
length of time. [1]

Febrile seizures represent the meeting point between a low seizure threshold (genetically and
age-determined; some children have a greater tendency to have seizures under certain
circumstances) and a trigger, which is fever. Fever most of the time accompanies respiratory
illnesses such as influenza, pneumonia, ear infections, croup, sore throats, and colds. It can
occur also with various viral illnesses. [7] [10]

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. [9]

Several genetic associations have been identified. [2] These include:

Typ
OMIN Gene
e

FEB3 60440
SCN1A
A 3

FEB3 60440 SCN9A

B 3

60435
FEB4 GPR98
2

61127 GABRG
FEB8
7 2

Diagnosis
The diagnosis is one that must be arrived at by eliminating more
serious causes of seizure and fever: in
particular, meningitis and encephalitis must be considered.
However, in locales in which children are immunized for
pneumococcal and Haemophilus influenzae, the prevalence of
bacterial meningitis is low. If a child has recovered and is acting
normally, bacterial meningitis is very unlikely. The diagnosis of
a febrile seizure should not prevent evaluation of the child for
source of fever, although this is usually limited to evaluation of
the urine in the younger age groups.
Heat-related illness or heat stroke is a more serious problem
that is confused with fever. This is caused by surrounding heat
and not infection or respiratory illnesses. It occurs when
children are in very hot places, which can lead to dangerous
levels of body temperature. It is important to prevent this and if
it does occur to go to the pediatrician or emergency room
immediately. [7]
[edit]Types

There are two types of febrile seizures.

• A simple febrile seizure is one in which the seizure lasts less
than 15 minutes (usually much less than this), does not recur in
24 hours, and involves the entire body (classically a
generalized tonic-clonic seizure).
• A complex febrile seizure is characterized by longer
duration, recurrence, or focus on only part of the body.
Simple febrile seizures are more likely to be harmless that they
do not cause brain damage, nervous system problems, mental
retardation, paralysis, or death, but should be reported
immediately to the pediatrician.[7] They do not tend to recur
frequently (children tend to outgrow them); and do not make the
development of adult epilepsy significantly more likely (about 3–
5%), compared with the general public (1%) Template:Shinnar
S, Glauser TA: Febrile Seizures. J Child Neurol 17S:S44, 2002.
Children who are younger than one year old that have a simple
febrile seizure have a 50 percent chance of having another
seizure. Children older than one year old have a 30 percent
chance of a second seizure. [7]
Children with complex febrile convulsions are more likely to
suffer from a febrile epileptic attacks in the future if they have a
complex febrile seizure, a family history of a febrile convulsions
in first-degree relatives (a parent or sibling), or a preconvulsion
history of abnormal neurological signs or developmental
delay. [1] Similarly, the prognosis after a simple febrile seizure is
excellent, whereas an increased risk of death has been shown
for complex febrile seizures, partly related to underlying
conditions. [4]
[edit]Treatment

The vast majority of patients do not require treatment for either

their acute presentation with a seizure or for recurrences. The
first thing you do if you think your child has a fever is take the
temperature with athermometer. You can either use a digital
electronic thermometer or an ear thermometer. Children two
months or younger that have a rectal temperature of 100.4
degrees Fahrenheit or higher have a fever. Children between
three and six months of age with 101 degrees Fahrenheit or
higher is a fever. Children older than six months of age with a
103 degrees Fahrenheit or higher have a fever. [7] [9]
The best way to manage is to control the temperature with
acetaminophen and ibuprofen. Both should be based on a
child’s weight not his age. Using ibuprofen is approved only for
children six months or older. Ask your doctor and pharmacist for
the appropriate dosage. It is not recommended to use aspirin to
treat a simple fever. [7]
Another way to manage is to combine medication with sponging
or just use sponging alone. Place your child sitting down in a
regular bathtub with slightly warm water. Cold water can cause
shivering, which raise the child’s temperature. Then sponge
water all over the body until the temperature reached a good
level. [7]
[edit] Fever Seizures

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Topic Overview
Fever seizures (sometimes called fever convulsions) are uncontrolled muscle spasms that can
occur in children who have a rapid increase in body temperature. You may not even know your
child has a fever. The rapid increase in body temperature in a short period of time may cause the
fever seizure. Once a fever has reached a high temperature, the risk of a seizure is probably
over. Most children who have a fever seizure have temperatures above 102 F (39 C).
Fever seizures can be frightening but they are not usually harmful to the child and do not cause
long-term problems, such as brain damage, intellectual disabilities, or learning problems.
Fever seizures affect 2% to 5% of children. Children can have another seizure. The chance of
another fever seizure varies with age, but between 30% and 50% will have another within a year
of the first one. These seizures are not a form of epilepsy.
A child who is having a seizure often loses consciousness and shakes, moving his or her arms
and legs on both sides of the body. The child's eyes may roll back. The child may stop breathing
for a few seconds and might also vomit, urinate, or pass stools. It is important to protect the
child from injury during a seizure.
Fever seizures usually last 1 to 3 minutes. After the seizure, the child may be sleepy. You can let
the child sleep, but check the child frequently for changes in color or breathing, or twitching arms
or legs. The child also may seem confused after the seizure, but normal behavior and activity
level should return within 60 minutes of the seizure.
A seizure is more likely to have been caused by a fever if the seizure occurred within 24 hours of
the start of a fever. Fever seizures usually affect the whole body, not just one side. Most children
have never had a fever seizure before and they also do not have other nervous system
(neurologic) problems.
Use the Check Your Symptoms section to decide if and when your child should see a doctor.

Check Your Symptoms

 Home Treatment
Protect your child from injury during a seizure:

• Ease the child to the floor, or lay a very small child face down on your lap. Do not restrain
the child.
• Turn the child onto his or her side, which will help clear the mouth of any vomit or saliva.
This will help keep the tongue from blocking the air passage so the child can breathe. Keeping
the head and chin forward (in the same position as when you sniff a flower) also will help keep
the air passage open.
• Loosen clothing.
• Do not put anything in the child's mouth to prevent tongue-biting. This could cause injury.
• Try to stay calm, which will help calm the child. Comfort the child with quiet, soothing talk.
• Time the length of the seizure and pay close attention to the child's behavior during the
seizure so you can describe it to your health professional.

Check your child for injuries after the seizure:

• If the child is having difficulty breathing, turn his or her head to the side and, using your
finger, gently clear the mouth of any vomit or saliva to aid breathing.
 • For home treatment of a fever, see the topic Fever, Age 3 and Younger or Fever, Age 4 and
Older.
• If the child does not need to see a health professional right away, put him or her in a cool
room to sleep. Sleepiness is common following a seizure. Check on the child often. Normal
behavior and activity level should return within 60 minutes of the seizure.

If your child has had a fever seizure in the past and you have talked with your health professional
about how to care for your child after a seizure, be sure to follow your health professional's
instructions.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur
during home treatment:

• Another seizure occurs with the same fever illness.

• Other symptoms of illness develop, such as a cough.
• Symptoms become more severe or frequent.

Prevention
The best way to prevent fevers is to reduce your child's exposure to infectious diseases. Hand-
washing is the single most important prevention measure for people of all ages.

FEBRILE SEIZURE OVERVIEW

Febrile seizures are convulsions that occur in a child who is between six months and
six years of age and has a temperature greater than 100.4º F (38º C). The majority
of febrile seizures occur in children between 12 and 18 months of age.

Febrile seizures occur in 2 to 4 percent of children younger than five years old.
They can be frightening to watch, but do not cause brain damage or affect
intelligence. Having a febrile seizure does not mean that a child has epilepsy;
epilepsy is defined as having two or more seizures without fever present.

Seizures in children not related to fever are discussed in a separate topic review.
(See "Patient information: Seizures in children" and"Patient information: Treatment
of seizures in children".)

CAUSES OF FEBRILE SEIZURES

Infection — Febrile seizures can occur as a result of the fever that accompanies
bacterial or viral infections, especially human herpesvirus-6 (also called roseola or
sixth disease).

Immunizations — Fever can occur as a side effect of certain vaccines, particularly

after measles mumps rubella (MMR) vaccination. The fever typically occurs 8 to 14
days after the injection [1].
Risk factors — A family history of febrile seizures increases a child's risk of febrile
seizures.

FEBRILE SEIZURE SYMPTOMS

Febrile seizures usually occur on the first day of illness, and in some cases, the
seizure is the first clue that the child is ill. Most seizures occur when the
temperature is higher than 102.2ºF (39ºC). The Table describes how to take a
child's temperature (table 1).

Febrile seizures are classified as being simple or complex.

Simple — Simple febrile seizures are the most common. Typically, the child loses
consciousness and has a convulsion or rhythmic twitching of the arms or legs. Most
seizures do not last more than one to two minutes, although they can last up to 15
minutes. After the seizure, the child may be confused or sleepy, but does not have
arm or leg weakness.

Complex — Complex febrile seizures are less common and can last more than 15
minutes (or 30 minutes if in a series). The child may have temporary weakness of
an arm or a leg after the seizure.

FEBRILE SEIZURE EVALUATION AND TREATMENT

A child who has a febrile seizure should be seen by a healthcare provider as soon as
possible (in an emergency department or provider's office) to determine the cause
of the fever. Some children, particularly those less than 12 months of age, may
require testing to ensure that the fever is not related to meningitis, a serious
infection of the lining of the brain. (See "Patient information: Meningitis in
children".)

The best test for meningitis is a lumbar puncture (also known as a spinal tap),
which involves inserting a needle into the low back to remove a small amount of
fluid (cerebrospinal fluid or CSF) from around the spinal cord. Other tests may also
be recommended.

Treatment for prolonged seizures usually involves giving an antiseizure medication

and monitoring the child's heart rate, blood pressure, and breathing. If the seizure
stops on its own, antiseizure medication is not required. After a simple febrile
seizure, most children do not need to stay in the hospital unless the seizure was
caused by a serious infection requiring treatment in the hospital.

After the seizure has stopped, treatment for the fever is started, usually by giving
oral or rectal acetaminophen or ibuprofen and sometimes by sponging with room
temperature (not cold) water.
RECURRENT FEBRILE SEIZURE

Children who have a febrile seizure are at risk for having another febrile seizure;
this occurs in approximately 30 to 35 percent of cases. Recurrent febrile seizures do
not necessarily occur at the same temperature as the first episode, and do not
occur every time the child has a fever. Most recurrences occur within one year of
the initial seizure and almost all occur within two years.

The risk of recurrent febrile seizures is higher for children who:

• Are young (less than 15 months)

• Have frequent fevers
• Have a parent or sibling who had febrile seizures or epilepsy
• Have a short time between the onset of fever and the seizure
• Had a low degree of fever before their seizure

Home treatment — Parents who witness their child's febrile seizure should take a
number of steps to prevent the child from harming him or herself.

• Place the child on their side but do not try to stop their movement or
convulsions. Do not put anything in the child's mouth.
• Keep an eye on a clock or watch. Seizures that last for more than five
minutes require immediate treatment. One parent should stay with the child
while another parent calls for emergency medical assistance, available by
dialing 911 in most areas of the United States.

Parents of a child who is at risk of having a recurrent febrile seizure can be taught
to give treatment at home for seizures that last longer than five minutes.
Treatment usually involves giving one dose of diazepam gel (Diastat®) into the
rectum. One dose is generally all that is required to stop a seizure.

Preventive treatment — In most cases, treatment to prevent future seizures is

not recommended; the risks and potential side effects of daily antiseizure
medications outweigh their benefit. In addition, giving medication (eg,
acetaminophen or ibuprofen) to prevent fever is not recommended in a child
without fever (eg, if the child has a cold but no fever) because it does not appear to
reduce the risk of future febrile seizures.

Treatment for fever (temperature greater than 100.4ºF or 38ºC) is acceptable but
not always required; parents should speak with their healthcare provider for help in
deciding when to treat a child's fever. A detailed discussion of fever in children is
available separately. (See "Patient information: Fever in children".)

FOLLOW-UP
Intelligence and other aspects of brain development do not appear to be affected by
a febrile seizure, whether the seizure was simple, complex, or recurrent or whether
it occurred in the setting of infection or after immunization.

Epilepsy occurs more frequently in children who have had febrile seizures. However,
the risk that a child will develop epilepsy after a single, simple febrile seizure is only
slightly higher than that of a child who never has a febrile seizure. (See "Patient
information: Seizures in children".)

SUMMARY

• Febrile seizures are convulsions that occur in a child who is between six
months and six years of age and has a temperature greater than 100.4º F
(38º C). The majority of febrile seizures occur in children between 12 and 18
months of age.
• Febrile seizures can be frightening to watch. However, they do not cause
lasting harm. Intelligence and other aspects of brain development do not
appear to be affected by a febrile seizure, and having a febrile seizure does
not mean that a child has epilepsy.
• Febrile seizure can occur with infections or after immunizations that cause
fever.
• Febrile seizures usually occur on the first day of illness, and in some cases,
the seizure is the first clue that the child is ill. Most febrile seizures occur
when the temperature is greater than 102.2 ºF (39ºC).
• Most febrile seizures cause convulsions or rhythmic twitching or movement in
the face, arms, or legs that lasts less than one to two minutes. Less
commonly, the convulsion lasts 15 minutes or more.
• A child who has a febrile seizure should be seen by a healthcare provider as
soon as possible to determine the cause of the fever. Some children,
particularly those less than 12 months of age, may undergo testing to ensure
that the fever is not related to meningitis, a serious infection of the lining of
the brain.
• Children who have a febrile seizure are at risk for having another febrile
seizure; the recurrence rate is approximately 30 to 35 percent. Recurrent
febrile seizures do not necessarily occur at the same temperature as the first
episode, and do not occur every time the child has a fever. Most recurrences
occur within one year of the initial seizure and almost all occur within two
years.
• Epilepsy occurs more frequently in children who have had febrile seizures.
However, the risk that a child will develop epilepsy after a single, simple
febrile seizure is only slightly higher than that of a child who never has a
febrile seizure.
Febrile seizures

Definition

A febrile seizure is a convulsion in a child triggered by afever. These convulsions occur

without any brain or spinal cord infection or other nervous system (neurologic) cause.

Alternative Names

Seizure - fever induced

Causes

About 3 - 5% of otherwise healthy children between ages 9 months and 5 years will
have a seizure caused by a fever. Toddlers are most commonly affected. Febrile
seizures often run in families.

Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when
the fever is highest. The seizure is often the first sign of a fever or illness

Febrile seizures are usually triggered by fevers from:

• Ear infections
• Roseola infantum (a condition with fever and rash caused by several different
viruses)
• Upper respiratory infections caused by a virus
Meningitis causes less than 0.1% of febrile seizures but should always be considered,
especially in children less than 1 year old, or those who still look ill when the fever
comes down.

A child is likely to have more than one febrile seizure if:

• There is a family history of febrile seizures

• The first seizure happened before age 12 months
• The seizure occurred with a fever below 102 degrees Fahrenheit

Symptoms

A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a
fever triggers a full-blown convulsion that involves the whole body.

Febrile seizures may begin with the sudden contraction of muscles on both sides of a
child's body -- usually the muscles of the face, trunk, arms, and legs. The child may cry
or moan from the force of the muscle contraction. The contraction continues for several
seconds, or tens of seconds. The child will fall, if standing, and may pass urine.
The child may vomit or bite the tongue. Sometimes children do not breathe, and may
begin to turn blue.

Finally, the contraction is broken by brief moments of relaxation. The child's body
begins to jerk rhythmically. The child does not respond to the parent's voice.

A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is usually
followed by a brief period of drowsiness or confusion. A complex febrile seizure lasts
longer than 15 minutes, is in just one part of the body, or occurs again during the same
illness.

Febrile seizures are different than tremors or disorientation that can also occur with
fevers. The movements are the same as in a grand mal seizure.

Exams and Tests

The health care provider may diagnose febrile seizure if the child has a grand mal
seizure but does not have a history of seizure disorders (epilepsy). In infants and young
children, it is important to rule out other causes of a first-time seizure, especially
meningitis.
In a typical febrile seizure, the examination usually shows no abnormalities other than
the illness causing the fever. Typically, the child will not need a full seizure workup,
which includes an EEG, head CT, and lumbar puncture (spinal tap).

To avoid having to undergo a seizure workup:

• The child must be developmentally normal.

• The child must have had a generalized seizure, meaning that the seizure was in
more than one part of the child's body, and not confined to one part of the body.
• The seizure must not have lasted longer than 15 minutes.
• The child must not have had more than one febrile seizure in 24 hours.
• The child must have a normal neurologic exam performed by a health care
provider.

Treatment

During the seizure, leave your child on the floor.

• You may want to slide a blanket under the child if the floor is hard.
• Move him only if he is in a dangerous location.
• Remove objects that may injure him.
• Loosen any tight clothing, especially around the neck. If possible, open or remove
clothes from the waist up.
• If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or
stomach. This is also important if it looks like the tongue is getting in the way of
breathing.
Do NOT try to force anything into his mouth to prevent him from biting the tongue, as
this increases the risk of injury. Do NOT try to restrain your child or try to stop the
seizure movements.

Focus your attention on bringing the fever down:

• Insert an acetaminophen suppository (if you have some) into the child's rectum.
• Do NOT try to give anything by mouth.
• Apply cool washcloths to the forehead and neck. Sponge the rest of the body
with lukewarm (not cold) water. Cold water or alcohol may make the fever worse.
• After the seizure is over and your child is awake, give the normal dose of
ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever.

Outlook (Prognosis)

The first febrile seizure is a frightening moment for parents. Most parents are afraid that
their child will die or have brain damage. However, simple febrile seizures are harmless.
There is no evidence that they cause death, brain damage, epilepsy, mental
retardation, a decrease in IQ, or learning difficulties.

A small number of children who have had a febrile seizure do go on to develop epilepsy,
but not because of the febrile seizures. Children who would develop epilepsy anyway
will sometimes have their first seizures during fevers. These are usually prolonged,
complex seizures.

Nervous system (neurologic) problems and a family history of epilepsy make it more
likely that the child will develop epilepsy. The number of febrile seizures is not related
to future epilepsy.

About a third of children who have had a febrile seizure will have another one with a
fever. Of those who do have a second seizure, about half will have a third seizure. Few
children have more than three febrile seizures in their lifetime.

Most children outgrow febrile seizures by age 5.

Possible Complications

• Biting oneself
• Breathing fluid into the lungs
• Complications if a serious infection, such as meningitis, caused the fever
• Injury from falling down or bumping into objects
• Injury from long or complicated seizures
• Seizures not caused by fever
• Side effects of medications used to treat and prevent seizures (if prescribed)
When to Contact a Medical Professional

Children should see a doctor as soon as possible after their first febrile seizure.

If the seizure is lasting several minutes, call 911 to have an ambulance bring your child
to the hospital.

If the seizure ends quickly, drive the child to an emergency room when it is over.

Take your child to the doctor if repeated seizures occur during the same illness, or if this
looks like a new type of seizure for your child.

Call or see the health care provider if other symptoms occur before or after the seizure,
such as:

• Abnormal movements
• Agitation
• Confusion
• Drowsiness
• Nausea
• Problems with coordination
• Rash
• Sedation
• Tremors

It is normal for children to sleep or be briefly drowsy or confused right after a seizure.

Prevention

Because febrile seizures can be the first sign of illness, it is often not possible to prevent
them. A febrile seizure does not mean that your child is not getting the proper care.

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile
seizures that occur more than once. However, no medication is completely effective in
preventing febrile seizures.

References

Johnston MV. Seizures in childhood. In: Kliegman RM, Behrman RE, Jenson HB, Stanton
BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;
2007:chap 593.
Grand mal seizure

A febrile seizure is a generalized tonic-clonic (grand mal) seizure that occurs in some
children as a response to a fever. Febrile seizures are usually associated with rapidly
rising fevers, and usually occur early in the fever rather than later.
Central nervous system and peripheral nervous system

The central nervous system is comprised of the brain and spinal cord. The peripheral
nervous system includes all peripheral nerves.

Generalized tonic-clonic seizure

Definition

A generalized tonic-clonic seizure is a seizure involving the entire body. It is also called
a grand mal seizure. Such seizures usually involve muscle rigidity, violentmuscle
contractions, and loss of consciousness.

Generalized tonic-clonic seizures are the type of seizure that most people associate with
the term "seizure," convulsion, or epilepsy. They may occur in people of any age, as a
single episode, or as part of a repeated, chronic condition (epilepsy).

For more information see:

• Seizures
• Epilepsy
• Fever (febrile) convulsions
• Petit mal or absence seizures
• Partial (focal) seizures
Alternative Names

Seizure - tonic-clonic; Seizure - grand mal; Grand mal seizure; Seizure - generalized

Symptoms

Many patients have an aura (a sensory warning sign) before the seizure. This can
include vision, taste, smell, or sensory changes, hallucinations, or dizziness.

The seizure itself involves:

• Loss of consciousness or fainting, usually lasting between 30 seconds and 5

minutes
• General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20
seconds
• Violent rhythmic muscle contraction and relaxation (clonic movement), usually
lasting for 1 -2 minutes
• Biting the cheek or tongue, clenched teeth or jaw
• Incontinence (loss of urine or stool control)
• Stopped breathing or difficulty breathing during seizure
• Blue skin color

Almost all people lose consciousness, and most people have both tonic and clonic
muscle activity.

After the seizure, the person usually has:

• Normal breathing
• Sleepiness that lasts for 1 hour or longer
• Loss of memory (amnesia) regarding events surrounding the seizure episode
• Headache
• Drowsiness
• Confusion, temporary and mild
• Weakness of one side of the body for a few minutes to a few hours following
seizure (This is called Todd's paralysis.)

For more information about diagnosis and treatment, see:

• Epilepsy
• Seizures
http://adam.about.com/encyclopedia/infectiousdiseases/Ge
neralized-tonic-clonic-
seizure.htmhttp://adam.about.com/encyclopedia/infecti

Fever Seizures
ousdiseases/Febrile-seizures.htm

Causes, Symptoms and Treatment

Print E-mail

Fever seizures (sometimes called fever convulsions) are uncontrolled muscle spasms
that can occur in children who have a rapid increase in body temperature. You may not
even know your child has a fever. The rapid increase in body temperature in a short
period of time may cause the fever seizure. Once a fever has reached a high
temperature, the risk of a seizure is probably over. Most children who have a fever
seizure have temperatures above 102°F (39°C).

Fever seizures can be frightening but they are not usually harmful to the child and do
not cause long-term problems, such as brain damage, intellectual disabilities, or
learning problems.
Fever seizures affect 2% to 5% of children. Children can have another seizure. The
chance of another fever seizure varies with age, but between 30% and 50% will have
another within a year of the first one. These seizures are not a form of epilepsy.
A child who is having a seizure often loses consciousness and shakes, moving his or
her arms and legs on both sides of the body. The child's eyes may roll back. The child
may stop breathing for a few seconds and might also vomit, urinate, or pass stools. It is
important to protect the child from injury during a seizure.
Fever seizures usually last 1 to 3 minutes. After the seizure, the child may be sleepy.
You can let the child sleep, but check the child frequently for changes in color or
breathing, or twitching arms or legs. The child also may seem confused after the
seizure, but normal behavior and activity level should return within 60 minutes of the
seizure.

A seizure is more likely to have been caused by a fever if the seizure occurred within 24
hours of the start of a fever. Fever seizures usually affect the whole body, not just one
side. Most children have never had a fever seizure before and they also do not have
other nervous system (neurologic) problems.
Use the Check Your Symptoms section to decide if and when your child should see a
doctor.