Febrile Seizures

Abstract

The provocation of seizures is one of the best known consequences of fever. Fever can be associated with the provocation of seizures at all ages, in those with or without non-febrile seizures (FS) and in those with or without other neurological impairments. Previously, the term FS was used loosely to cover all these situations.

FS is the most common childhood seizure disorder. It is divided into simple FS that is defined as generalized seizure occurring in a healthy child aged between 6 months and 5 years that lasts less than 15 min (usually 5 min) without CNS infection or metabolic disorder. Complex FS is defined as either focal, prolonged (>15 min) or multiple.

FS is usually very frightening for parents to watch; many think that their child is dying. Parents need to be reassured that the seizure is not harmful and will not cause brain damage.

There are no specific laboratory tests specific for FS. It is important to focus on diagnosing the cause of FS, excluding in particular CNS infection and UTI.

The majority of FS are triggered by febrile viral infection, particularly HH-6. Second cause is vaccination: Delaying the first dose of MMR or MMRV beyond the age of 15 months may double the risk of postvaccination seizures.

LP is usually not indicated for the majority of cases. Children who are younger than 12 months may need particular attention and evaluation to exclude meningitis because symptoms and signs of this infection at this age are subtle.

As to the question: can FS be prevented? Unfortunately we do not have a mean to prevent FS from occurring. Neither long-term nor intermittent anticonvulsant therapy has been shown to prevent recurrences, and so such a prophylaxis is not indicated for children who have experienced previously FS. Antipyretics have not been shown to prevent FS.