A Febrile Seizure can be defined as the transient occurrence of signs and symptoms due to excessive or synchronized activity in the brain. Clinical manifestations of these seizures can be motor, non-motor manifestations, or both.
Febrile seizures are the most common seizure disorder in childhood and normally it occur during a febrile illness. It usually has a genetic predisposition and it occurs in a specific age group of children peak age is the second year of life mainly between 18-24 months.
Clinical Manifestations of Seizures
Motor Manifestations
- Automatism which includes involuntary or seemingly voluntary movements
- Jerky movements
- Bizarre movements with an increased level of activity
- An electric shock, like movements
Non motor manifestations
- Behavioral arrest as staring blankly
- Abnormal feelings such as fear in unsuitable places
- Visual aura
- Paraesthesia
- Abnormal smells.
Diagnosis
A febrile seizure can be defined as a seizure that occurs in children after the age of one month to six years associated with a febrile illness. It is important to exclude prior unprovoked seizures and the presence of acute CNS infections, electrolyte imbalances, and other acute symptomatic events.
Types of Febrile Seizures
Several types of seizures include simple febrile convulsions which are the commonest, complex febrile seizures, and febrile status epilepticcus.
- Simple febrile seizure include a single episode of seizure during the particular fever episode, which lasts for less than 10-15 minutes. The seizure does not need to occur during the first 24 hours of the onset of fever for it to be a simple febrile seizure.
- Complex febrile convulsions are prolonged for more than 15 minutes and multiple seizures occur during a single febrile episode and can result in damage to the central nervous system with neurological signs and symptoms after the fever is over.
- Febrile status epilepticcus includes seizures with longer duration and can cause epilepsy in the future. This is considered a Paediatric emergency.
Etiology
- Age – due to immaturity of the blood-brain barrier and increased excitability in childhood brain
- Genetics- familial predisposition
- Environment – exposure to peripheral infections which include bacterial infections in the middle ear and throat and viral infections such as influenza, hand foot mouth disease
Management of Febrile Seizure
Understanding pathogenesis- It is important to educate the parents and avoid fever terrorization. Must also advise the parents about how to face an episode.
Management at Home
- At the time of febrile seizures parents can do the following first aid maneuvers Turning the patient to the left lateral side
- Maintaining a clear airway
- Protecting the child from any injury
- Loosen clothing or remove excessive clothing.
- Most seizures stop spontaneously within 5 minutes. Using antipyretics during febrile illness doesn’t reduce the risk of recurrence.
- Tepid sponging is not thought to be beneficial as no clinical trial data is available.
Risk factors for Recurrence of Febrile Seizures
- Age is less than one year
- Fever between 38-39
- Minor family history of febrile seizure, epilepsy, complex febrile seizures, male gender
Long term Management
Intermittent anticonvulsant prophylaxis can be utilized as Diazepam and Clobazam. Candidates for long-term therapy of anticonvulsants are patients who have had episodes of fever with complex febrile seizures, increased risk factors for recurrence, living far away from medical care, and anxious parents.
References
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
