Febrile seizure

Febrile seizure
Other namesFever fit, febrile convulsion
An analog medical thermometer showing a temperature of 38.8 °C or 101.8 °F
SpecialtyEmergency medicine, neurology
SymptomsTonic-clonic seizure[1]
Usual onsetAges of 6 months to 5 years[1]
DurationTypically less than 5 minutes[1]
TypesSimple, complex[1]
CausesHigh body temperature[1]
Risk factorsFamily history[1]
Differential diagnosisMeningitis, metabolic disorders[1]
TreatmentSupportive care[1]
MedicationBenzodiazepines (rarely needed)[1]
PrognosisGood[1]
Frequency~5% of children[2]

A febrile seizure, also known as a fever fit or febrile convulsion, is a seizure associated with a high body temperature but without any serious underlying health issue.[1] They most commonly occur in children between the ages of 6 months and 5 years.[1][3] Most seizures are less than five minutes in duration, and the child is completely back to normal within an hour of the event.[1][4] There are two types: simple febrile seizures and complex febrile seizures.[1] Simple febrile seizures involve an otherwise healthy child who has at most one tonic-clonic seizure lasting less than 15 minutes in a 24-hour period.[1] Complex febrile seizures have focal symptoms, last longer than 15 minutes, or occur more than once within 24 hours.[5] About 80% are classified as simple febrile seizures.[6]

Febrile seizures are triggered by fever, typically due to a viral infection.[6] They may run in families.[1] The underlying mechanism is not fully known, but it is thought to involve genetics, environmental factors, brain immaturity, and inflammatory mediators.[7][8][6] The diagnosis involves verifying that there is not an infection of the brain, there are no metabolic problems, and there have not been prior seizures that have occurred without a fever.[1][6] Blood testing, imaging of the brain, or an electroencephalogram (EEG) is typically not needed.[1] Examination to determine the source of the fever is recommended.[1][6] In otherwise healthy-looking children a lumbar puncture is not necessarily required.[1]

Neither anti-seizure medication nor anti-fever medication are recommended in an effort to prevent further simple febrile seizures.[1][9] In the few cases that last greater than 5 minutes, a benzodiazepine such as lorazepam or midazolam may be used.[1][10] Efforts to rapidly cool during a seizure is not recommended.[11]

Febrile seizures affect 2–10% of children.[2] They are more common in boys than girls.[12] After a single febrile seizure there is an approximately 35% chance of having another one during childhood.[6] Outcomes are generally excellent with similar academic achievements to other children and no change in the risk of death for those with simple seizures.[1] There is tentative evidence that affected children have a slightly increased risk of epilepsy at 2% compared to the general population.[1]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x Graves RC, Oehler K, Tingle LE (January 2012). "Febrile seizures: risks, evaluation, and prognosis". American Family Physician. 85 (2): 149–53. PMID 22335215.
  2. ^ a b Gupta A (February 2016). "Febrile Seizures". Continuum (Minneapolis, Minn.). 22 (1 Epilepsy): 51–9. doi:10.1212/CON.0000000000000274. PMID 26844730. S2CID 33033538.
  3. ^ Cite error: The named reference Stat2019 was invoked but never defined (see the help page).
  4. ^ "Symptoms of febrile seizures". www.nhs.uk. 1 October 2012. Archived from the original on 6 October 2014. Retrieved 13 October 2014.
  5. ^ Cite error: The named reference AAP2017 was invoked but never defined (see the help page).
  6. ^ a b c d e f Cite error: The named reference Leu2018 was invoked but never defined (see the help page).
  7. ^ Cite error: The named reference BMJ2015 was invoked but never defined (see the help page).
  8. ^ Cite error: The named reference Kwon2018 was invoked but never defined (see the help page).
  9. ^ Offringa M, Newton R, Nevitt SJ, Vraka K (16 June 2021). "Prophylactic drug management for febrile seizures in children". The Cochrane Database of Systematic Reviews. 2021 (6): CD003031. doi:10.1002/14651858.CD003031.pub4. ISSN 1469-493X. PMC 8207248. PMID 34131913.
  10. ^ Prasad P (2013). Pocket Pediatrics: The Massachusetts General Hospital for Children Handbook of Pediatrics. Lippincott Williams & Wilkins. p. 419. ISBN 9781469830094. Archived from the original on 6 September 2017.
  11. ^ "Febrile Seizures". familydoctor.org. Retrieved 24 January 2020.
  12. ^ Ronald M. Perkin, ed. (2008). Pediatric hospital medicine : textbook of inpatient management (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 266. ISBN 9780781770323. Archived from the original on 6 September 2017.
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