What is a febrile seizure?
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.
Seizures generally occur in those aged 3 months to 5 years;
peak incidence is 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.
What causes febrile seizures?
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.
Is it inherited?
Simple febrile seizures are considered
a genetic disorder, but neither a specific locus nor a specific
pattern of inheritance has been described. The mode of inheritance
is likely to vary between families and may be mutifactorial.
What are the common symptoms?
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:
Stiffening of the entire body
Jerking of the arms and legs
Complete lack of response to any stimuli
Eyes deviated, staring, rolling back, moving back and
forth
Tightness of the jaws and mouth
Urinary incontinence (wet their pants)
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.
How is it diagnosed? In evaluating
a child with a febrile seizure, the physician is concerned about
stopping the current seizure activity and then finding the causes
of the seizures and the fever.
Once seizure activity has stopped and the child’s
condition is stabilized, attention turns toward determining
the cause of the seizure. The doctor will want to know this
type of information:
Previous seizures without a fever (if so, then it is
more likely the child has an underlying seizure disorder,
such as epilepsy, rather than a febrile seizure)
Family history of seizures, febrile or otherwise
Presence of any known nervous system disorders in the
child, such as delay in development or severe head injury
Any medications the child has been taking, including
the possibility of poisoning
The doctor will conduct a careful physical examination to
detect any nervous system disorders.
The physician will also try to determine the cause of the
fever. In particular, meningitis may be a possibility, especially
in a child with any of the following characteristics:
Younger than 12 months
Appears particularly ill
Stiffness of the neck (for example, difficulty flexing
chin toward the chest)
Unusually long period of drowsiness after the seizure
Experiencing complex febrile seizure (often prolonged
or repeated seizures)
Other tests, such as blood and urine tests, and x-rays,
such as a chest x-ray, may be used in diagnosing the cause
of fever. However, advanced studies such as head CT scan and
EEG
How is it treated? Should the
child come to the hospital with persistent seizure activity (what
is termed status 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 pulse
oximeter 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.
Placement of an IV line to obtain blood for testing and
to administer medication to stop the seizure
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)
Measuring vital signs (temperature, pulse, respiratory
rate, and blood pressure)
Treatment to lower body temperature, if fever is present
medication is given to stop the seizure.
Delivered through the IV line, which is the fastest and
most reliable, the most commonly used medications are benzodiazepines,
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.
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 of intervention
should be undertaken. The main objective is to protect the
child’s airway so that breathing is maintained. Protection
from other injury is important.
Remove objects, such as food and pacifiers, from the
mouth.
Place the child on his or her side or abdomen.
Clear the mouth with a suction bulb (if available) if
there is vomiting.
Perform a jaw thrust or chin lift maneuver if there
is noisy or labored breathing.
Do not try to restrain the child or try to stop seizure
movements.
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.
Remove clothing.
Apply cool washcloths to the face and neck.
Sponge the rest of the body with cool water (do not
immerse a seizing child in the bathtub).
Medications
Give medication to lower the fever (acetaminophen suppositories
in the rectum, if available). Oral medications should not
be given until the child is awake.
Diazepam suppositories during an episode of seizure
Oral anticonvulsants which may be advised by your doctor
as intermittent / continuous prophylaxis
Others
Life style: No modification
required
Activity: No restriction
of day-to-day activities. During episodes of fever all activities
including activities of daily living to be under the watchful
eyes of an alert and educated caregiver. During episodes of
fever to avoid swimming, active sports, cycling etc.
Diet: normal diet. Plenty
of fluids during episodes of fever
Returning to school: only
after recovery from the febrile illness. Inform the school
authorities also about the condition and the initial steps
to be undertaken in case there is a seizure at school.
Symptoms to report the Physician:
With any medical concern, if you determine immediate medical emergency
is not necessary, you may call your doctor for instructions on
how to handle a febrile seizure. Your doctor may advise you to
come to the office or to proceed directly to a hospital’s
emergency department.
Understandably, unprepared parents and other caregivers who have
never dealt with a seizure before will likely be compelled to
to rush to the near by hospital when their child is having a seizure.
In most cases, the seizure will have stopped by the time they
reach an emergency medical service. Even so, it is wise to have
the child seen promptly either by the regular physician or in
the hospital’s emergency department.
It is important to consider and exclude other causes of
seizures. Although serious infections such as meningitis are
infrequent, these should be ruled out with a careful medical
evaluation.
If a child should have another febrile seizure, . The home
care measures should be followed.
Rush to the emergency medical facility in these cases:
The seizure lasts more than 5 minutes.
The child has serious trouble breathing or stops breathing.
The child develops cyanosis (blueness of the skin) indicating
insufficient oxygen in the bloodstream.
Even after a brief repeated febrile seizure, it is wise
to take the child to the physician’s office or hospital
emergency department for an examination
Mission
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