Febrile Seizures

  • #x203A; Attacks precipitated by fever can be epileptic or non-epileptic.

  • › Children with febrile seizures (FSs) are not considered to have epilepsy since their seizure only occurs when the child is febrile (acute symptomatic seizure).

  • › FSs do not constitute a homogeneous entity.

  • › The cumulative incidence of FSs in most countries is 2–5%.

  • › FSs usually occur between 6 months and 3 years. They peak at 18 months and it is rare for their onset to be after 6 years of age.

  • › FSs are divided into simple and complex. The latter have focal features and/or are prolonged and/or are repeated in the same illness.

  • › Viral illnesses, particularly human herpes virus 6, precipitate most FSs.

  • › One third of children who have one FS will have at least one recurrence.

  • › Recurrent FSs are more likely if the child was young at the time of the first seizure, the fever provoking the first seizure was relatively low, the child suffers from a lot of illness episodes and has a family history of FS.

  • › The risk of epilepsy following FSs is 7% at 25 years.

  • › Following one or more FS, risk factors for developing epilepsy are family history of epilepsy, neurodevelopmental problems and complex FS.

  • › The risk that a child with a FS will have bacterial meningitis is 0-4%.

  • › Routine brain imaging and EEG is not indicated following a FS.

  • › Regular prophylactic medication to prevent recurrent FSs is not recommended but rectal diazepam or buccal midazolam may be useful to stop further prolonged FSs.


Status Epilepticus Kawasaki Disease Epileptic Seizure Febrile Seizure Febrile Convulsion 
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  1. 1.
    Aadenaert D, van Broeckhoven C, De jonghe P (2006) Genes and loci involved with febrile seizures and related epilepsy syndromes. Hum Mutat 27: 291–401Google Scholar
  2. 2.
    Allen JE, Ferrie CD, Livingston JH, Feltbower RG (2006) Recovery of consciousness after epileptic seizures in children. Arch Dis Child 92: 39–42PubMedCrossRefGoogle Scholar
  3. 3.
    Hamdy A, Ginby D, Feltbower R, Ferrie CD (2007) Ethnic differences in the incidence of seizure disorders in children from Bradford, United Kingdom. Epilepsia 48: 913–916PubMedCrossRefGoogle Scholar
  4. 4.
    Annegers J F, Hauser WA, Elveback LR, Kurland LT (1979) The risk of epilepsy following febrile convulsions. Neurology 29: 297–303PubMedGoogle Scholar
  5. 5.
    Annegers JF, Hauser WA, Shirts SB, Kurland LT (1987) Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med 316: 493–498PubMedGoogle Scholar
  6. 6.
    Annegers JF, Blakley SA, Hauser WA, Kurland LT (1990) Recurrence of febrile convulsions in a population-based cohort. Epilepsy Res 5: 209–216PubMedCrossRefGoogle Scholar
  7. 7.
    Barlow WE, Davis RL, Glasser J W, et al. (2001) The risk of seizures after receipt of whole-cell pertussis or measles, mumps and rubella vaccine. N Engl J Med 345: 656–661PubMedCrossRefGoogle Scholar
  8. 8.
    Barnard C, Wirrell E (1999) Does status epilepticus in children cause developmental deterio ration and exacerbation of epilepsy? J Child Neurol 14: 787–794PubMedCrossRefGoogle Scholar
  9. 9.
    Barone SR, Kaplan MH, Krilov LR (1995) Human herpesvirus-6 infection in children with first febrile seizures. J Pediatr 127: 95–97PubMedCrossRefGoogle Scholar
  10. 10.
    Berg AT (2002) Recurrent febrile seizures. In Baram TZ, Shlomo S (eds) Febrile seizures. Academic Press, San Diego, pp. 37–52CrossRefGoogle Scholar
  11. 11.
    Berg AT (1992) Febrile seizures and epilepsy: the contribution of epidemiology. Paediatr Peri nat Epidemiol 6: 145–162CrossRefGoogle Scholar
  12. 12.
    Berg AT, Shinnar S (1996) Complex febrile seizures. Epilepsia 37: 126–133PubMedCrossRefGoogle Scholar
  13. 13.
    Berg AT, Shinnar S, Darefsky AS, et al. (1997) Predictors of recurrent febrile seizures: a pro spective cohort study. Arch Pediatr Adolesc Med 151: 371–378PubMedGoogle Scholar
  14. 14.
    Berg AT, Shinnar S, Levy SR, Testa FM (1999) Childhood-onset epilepsy with and without preceding febrile seizures. Neurology 53: 1742–1748PubMedGoogle Scholar
  15. 15.
    Blume WT, Luders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr (2001) ILAE Commission Report. Glossary of descriptive terminology for ictal semionology: report of the ILAE task force on classification and terminology. Epilepsia 42: 1212–1218PubMedCrossRefGoogle Scholar
  16. 16.
    Camfield P, Camfield C, Gordon K, Dooley J (1994) What types of epilepsy are preceded by febrile seizure? A population based study of children. Dev Med Child Neurol 36: 887–892PubMedGoogle Scholar
  17. 17.
    Carroll W, Brookfield D (2002) Lumbar puncture following febrile convulsions. Arch Dis Child 87: 238–240PubMedCrossRefGoogle Scholar
  18. 18.
    Chin RFM, Neville BGR, Peckham C, et al. (2006) Incidence, causes, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 368: 222–229PubMedCrossRefGoogle Scholar
  19. 19.
    Claes L, Ceulemans B, Audenaert D, et al. (2003) De novo SCN1A mutations are a major cause of severe myoclonic epilepsy of infancy. Hum Mutat 21: 615–621PubMedCrossRefGoogle Scholar
  20. 20.
    Commission on Epidemiology and Prognosis. International League Against Epilepsy (1993). Guidelines for epidemiological studies on epilepsy. Epilepsia 34: 592–596CrossRefGoogle Scholar
  21. 21.
    Cuestas E (2004) Is routine EEG helpful in the management of complex febrile seizures? Arch Dis Child 89: 290PubMedCrossRefGoogle Scholar
  22. 22.
    Di Mario FJ Jr (2006) Children presenting with complex febrile seizures do not routinely need computed tomography scanning in the emergency department. Pediatrics 117: 528–530CrossRefGoogle Scholar
  23. 23.
    El-Radhi AS (1998) Lower degree of fever at the initial febrile convulsion is associated with increasd risk of subsequent convulsions. Eur J Paediatr Neurol 2: 91–96PubMedCrossRefGoogle Scholar
  24. 24.
    El-Radhi AS, Banajeh S (1989) Effect of fever on recurrence rate of febrile convulsion. Arch Dis Child 64: 869–870PubMedCrossRefGoogle Scholar
  25. 25.
    El-Radhi AS, Withana K, Banajeh S (1986) Recurrence rate of febrile convulsion related to the degree of pyrexia during the first attack. Clin Paediatr 25: 311–313CrossRefGoogle Scholar
  26. 26.
    El-Radhi A, Barry W (2003) Do antipyretics prevent febrile convulsions? Arch Dis Child 88: 641–642PubMedCrossRefGoogle Scholar
  27. 27.
    Engel J Jr (2001) ILAE Commission Report. Proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE task force on classification and ter minology. Epilepsia 41: 796–803CrossRefGoogle Scholar
  28. 28.
    Ferrie C, Caraballo R, Covanis A, et al. (2006) Panayiotopoulos syndrome: a consensus view. Dev Med Child Neurol 48: 236–240PubMedCrossRefGoogle Scholar
  29. 29.
    Forsgren L, Heijbel J, Nystrom L, Sidenvall R (1997) A follow-up of an incident case-referent study of febrile convulsions seven years after the onset. Seizure 6: 21–26PubMedCrossRefGoogle Scholar
  30. 30.
    Gatti S, Vezzani A, Bartfai T (2002) Mechanisms of fever and febrile seizures: putative role of the interleukin-1 system. In Baram TZ, Shlomo S (eds) Febrile seizures. Academic Press, San Diego, pp. 169–188CrossRefGoogle Scholar
  31. 31.
    Ito M, Yamakawa K, Sugawara T, et al. (2006) Phenotypes and genotypes in epilepsy with febrile seizures plus. Epilepsy Res 70S: S199–S205CrossRefGoogle Scholar
  32. 32.
    Jensen FE, Sanchez RM (2002) Why does the developing brain demonstrate heightened sus ceptibility to febrile and other provoked seizures. In Baram TZ, Shlomo S (eds) Febrile sei zures. Academic Press, San Diego, pp. 153–168CrossRefGoogle Scholar
  33. 33.
    Joshi C, Wawrykow T, Patrich J, Prasad A (2005) Do clinical variables predict an abnormal EEG in patients with complex febrile seizures. Seizure 14: 429–434PubMedGoogle Scholar
  34. 34.
    Knusden FU (1988) Frequent febrile episodes and recurrent febrile convulsions. Acta Neurol Scand 78: 414–417CrossRefGoogle Scholar
  35. 35.
    Kondo K, Nagafuji H, Hata A, et al. (1993) Association of human herpesvirus 6 infection of the central nervous system with recurrence of febrile convulsions. J Infect Dis 167: 1197– 1200PubMedGoogle Scholar
  36. 36.
    Kwong KL, Lam SY, Que TL, Wong SN (2006) Influenza A and febrile seizures in childhood. Pediatr Neurol 35: 395–399PubMedCrossRefGoogle Scholar
  37. 37.
    Lee W-L, Ong H-T (2004) Afebrile seizures associated with minor infection: comparison with febrile seizures and unprovoked seizures. Pediatr Neurol 31: 157–164PubMedCrossRefGoogle Scholar
  38. 38.
    Mantegazza M, Gambardella A, Rosconi R (2005) Identification of a Nav1.1 sodium channel (SCN1A) loss-o function mutation associated with familial simple febrile seizures. Proc Natl Acad Sci U S A 102: 18177–18182PubMedCrossRefGoogle Scholar
  39. 39.
    Masuko AH, Castro AA, Santos GR, et al. (2003) Intermittent diazepam and continuous phe nobarbitone to treat recurrencies of febrile seizures: a systematic review with meta-analysis. Arq Neuropsiquiatr 61: 897–901PubMedGoogle Scholar
  40. 40.
    Mathai K V, Dunn DP, Kurland LT, Reeder FA (1968) Convulsive disorders in the Mariana Islands. Epilepsia 9: 77–85PubMedCrossRefGoogle Scholar
  41. 41.
    McIntyre J, Robertson S, Norris E, et al. (2005) Safety and efficacy of buccal midazolam ver sus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 366: 205–210PubMedCrossRefGoogle Scholar
  42. 42.
    Millichap JG, Millichap JJ (2006) Role of viral infections in the etiology of febrile seizures. Pediatr Neurol 35: 165–172PubMedCrossRefGoogle Scholar
  43. 43.
    Minawer M, Hesdorffer D (2004) Turning on the heat: the search for febrile seizure genes. Neurology 63: 1770–1771Google Scholar
  44. 44.
    Mitchell T V, Lewis DV (2002). In Baram TZ, Shlomo S (eds) Febrile seizures. Academic Press, San Diego, pp. 103–125CrossRefGoogle Scholar
  45. 45.
    Nakayama J, Arinami T (2006) Molecular genetics of febrile seizures. Epilepsy Res 70S: S190–S198CrossRefGoogle Scholar
  46. 46.
    Narula S, Goraya JS (2005) Febrile myoclonua. Neurology 64: 169–170PubMedGoogle Scholar
  47. 47.
    National Institutes of Health (1980). Febrile seizures: consensus development conference summary. Vol 3, No. 2. National Institutes of Health. Bethseda, MDGoogle Scholar
  48. 48.
    Nelson KB, Ellenberg JH (1976) Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 295: 1029–1033PubMedGoogle Scholar
  49. 49.
    Offringa M, Hazebroek-Kampschreur AAJM, Derksen-Lubsen G (1991) Prevalence of febrile seizures in Dutch schoolchildren. Paediatr Perinat Epidemiol 5: 181–188PubMedCrossRefGoogle Scholar
  50. 50.
    Offringa M, Derksen-Lubsen G, Bossuyt PM, Lubsen J (1992) Seizure recurrence after a first febrile seizure: a multivariate approach. Dev Med Child Neurol 34: 15–24PubMedGoogle Scholar
  51. 51.
    Offringa M, Bossuyt PMM, Lubsden J, et al. (1994) Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr 124: 574–584PubMedCrossRefGoogle Scholar
  52. 52.
    Offringa M, Moyer VA (2001) Evidence based paediatrics: evidence based management of seizures associated with fever. Br Med J 323: 1111–1114CrossRefGoogle Scholar
  53. 53.
    Okumura A, Uemura N, Suzuki M, et al. (2004) Unconsciousness and delirious behaviour in children with febrile seizures. Pediatr Neurol 30: 316–319PubMedCrossRefGoogle Scholar
  54. 54.
    Okumura A, Ishiguro Y, Sofue A, et al. (2004) Treatment and outcome in patients with febrile convulsions associated with epileptiform discharges on electroencephalography. Brain Dev 26: 241–244PubMedCrossRefGoogle Scholar
  55. 55.
    Rajakumar K, Bodensteiner JB (1996) Febrile myoclonus: a survey of pediatric neurologists. Clin Pediatr 35: 331–336CrossRefGoogle Scholar
  56. 56.
    Rantala H, Uhari M, Tuokko H (1990) Viral infections and recurrences of febrile convulsions. J Pediatr 116: 195–199PubMedCrossRefGoogle Scholar
  57. 57.
    Rantala H, Tarkka R, Uhari M (1997) A meta-analytic review of the preventative treatment of recurrencies of febrile seizures. J Pediatr 131: 922–955PubMedCrossRefGoogle Scholar
  58. 58.
    Riordan FAI, Cant AJ (2002) When to do a lumbar puncture. Arch Dis Child 87: 235–237PubMedCrossRefGoogle Scholar
  59. 59.
    Scott RC, King MD, Gadian DG, et al. (2006) Prolonged febrile seizures are associated with hippocampal vasogenic edema and developmental changes. Epilepsia 47: 1493–1498PubMedCrossRefGoogle Scholar
  60. 60.
    Shinnar S, Pellock JM, Berg AT, et al. (2001) Short term outcomes of children with febrile status epilepticus. Epilepsia 42: 47–53PubMedCrossRefGoogle Scholar
  61. 61.
    Stafstrom CE (1992). The incidence and prevalence of febrile seizures. In Baram TZ, Shinnar S (eds) Febrile seizures. Academic Press, San Diego, pp. 1–25Google Scholar
  62. 62.
    Stanhope JM, Brody JA, Brink E, Morris CE (1972) Convulsions among the Chamorro peo ple of Guam, Mariana Islands. Am J Epidemiol 95: 299–304PubMedGoogle Scholar
  63. 63.
    Soman TB, Krishnamoorthy KS (2005) Paroxysmal non-epileptic events resembling seizures in children with otitis media. Clin Pediatr 44: 437–441CrossRefGoogle Scholar
  64. 64.
    Tarkka R, Rantala H, Uhari M, Pokka T (1998) Risks of recurrence and outcome after the first febrile seizure. Pediatr Neurol 18: 218–220PubMedCrossRefGoogle Scholar
  65. 65.
    Teng D, Nayan P, Tyler S, et al. (2006) Risks of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediat rics 117: 304–308Google Scholar
  66. 66.
    Tsuboi T (1984) Epidemiology of febrile and afebrile convulsions in children in Japan. Neu rology 34: 175–181Google Scholar
  67. 67.
    van Esch A, Ramla IR, van Steensel-Moll HA, et al. (1996) Outcome after febrile status epi lepticus. Dev Med Child Neurol 38: 19–24PubMedCrossRefGoogle Scholar
  68. 68.
    van Stuijvenberg M, Jansen ME, Steyerberg E W, et al. (1999) Frequency of fever episodes related to febrile seizure recurrence. Acta Paediatr 88: 52–55PubMedGoogle Scholar
  69. 69.
    van Zeijl JH, Mullaart RA, Galama JMD (2002) The pathogenesis of febrile seizures: is there a role for specific infections. Rev Med Virol 12: 93–106PubMedCrossRefGoogle Scholar
  70. 70.
    van Zejl JH, Mullaart RA, Born G F, Galama JMD (2004) Recurrence of febrile seizures in the respiratory season is associated with influenza A. J Pediatr 145: 800–805CrossRefGoogle Scholar
  71. 71.
    Verity CM, Butler NR, Goulding J (1985) Febrile convulsions in a national cohort followed up from birth. I. Prevalence and recurrence in the first five years of life. Br Med J 290: 1307–1310Google Scholar
  72. 72.
    Verity CM, Golding J (1991) Risk of epilepsy after febrile convulsions: a national cohort study. Br Med J 303: 1373–1376CrossRefGoogle Scholar
  73. 73.
    Wallace SJ (2004) Febrile seizures. In Wallace SJ, Farrell K (eds) Epilepsy in children Arnold, London, pp. 123–130Google Scholar
  74. 74.
    Yoshikawa H, Abe T (2004) Febrile convulsion during the acute phase of Kawasaki disease. Pediatr Int 46: 31–32PubMedCrossRefGoogle Scholar
  75. 75.
    Zerr DM, Blume HK, Berg AT (2005) Nonfebrile illness seizures: a unique seizure category? Epilepsia 46: 952–955PubMedCrossRefGoogle Scholar
  76. 76.
    Zhao F, Lavine L, Wang Z, Cheng X, Li S, Emoto S, Bolis CL, Schoenberg BS (1987) Preva lence and incidence of febrile seizures (FBS) in China. Neurology 37 (Suppl 1): 149Google Scholar

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