Febrile seizures are convulsions brought on by a fever in infants or
small children. During a febrile seizure, a child often loses
consciousness and shakes, moving limbs on both sides of the body. Less
commonly, the child becomes rigid or has twitches in only a portion of the
body, such as an arm or a leg, or on the right or the left side only. Most
febrile seizures last a minute or two, although some can be as brief as a
few seconds while others last for more than 15 minutes.
The majority of children with febrile seizures have rectal temperatures
greater than 102 degrees F. Most febrile seizures occur during the first
day of a child's fever. Children prone to febrile seizures are not
considered to have epilepsy, since epilepsy is characterized by recurrent
seizures that are not triggered by fever.
Approximately one in every 25 children will have at least one febrile
seizure, and more than one-third of these children will have additional
febrile seizures before they outgrow the tendency to have them. Febrile
seizures usually occur in children between the ages of 6 months and 5
years and are particularly common in toddlers. Children rarely develop
their first febrile seizure before the age of 6 months or after 3 years of
age. The older a child is when the first febrile seizure occurs, the less
likely that child is to have more.
A few factors appear to boost a child's risk of having recurrent
febrile seizures, including young age (less than 15 months) during the
first seizure, frequent fevers, and having immediate family members with a
history of febrile seizures. If the seizure occurs soon after a fever has
begun or when the temperature is relatively low, the risk of recurrence is
higher. A long initial febrile seizure does not substantially boost the
risk of recurrent febrile seizures, either brief or long.
Although they can be frightening to parents, the vast majority of
febrile seizures are harmless. During a seizure, there is a small chance
that the child may be injured by falling or may choke from food or saliva
in the mouth. Using proper first aid for seizures can help avoid these
hazards (see section entitled "What should be done for a child having a
febrile seizure?").
There is no evidence that febrile seizures cause brain damage. Large
studies have found that children with febrile seizures have normal school
achievement and perform as well on intellectual tests as their siblings
who don't have seizures. Even in the rare instances of very prolonged
seizures (more than 1 hour), most children recover completely.
Between 95 and 98 percent of children who have experienced febrile
seizures do not go on to develop epilepsy. However, although the absolute
risk remains very small, certain children who have febrile seizures face
an increased risk of developing epilepsy. These children include those who
have febrile seizures that are lengthy, that affect only part of the body,
or that recur within 24 hours, and children with cerebral palsy, delayed
development, or other neurological abnormalities. Among children who don't
have any of these risk factors, only one in 100 develops epilepsy after a
febrile seizure.
Parents should stay calm and carefully observe the child. To prevent
accidental injury, the child should be placed on a protected surface such
as the floor or ground. The child should not be held or restrained during
a convulsion. To prevent choking, the child should be placed on his or her
side or stomach. When possible, the parent should gently remove all
objects in the child's mouth. The parent should never place anything in
the child's mouth during a convulsion. Objects placed in the mouth can be
broken and obstruct the child's airway. If the seizure lasts longer than
10 minutes, the child should be taken immediately to the nearest medical
facility for further treatment. Once the seizure has ended, the child
should be taken to his or her doctor to check for the source of the fever.
This is especially urgent if the child shows symptoms of stiff neck,
extreme lethargy, or abundant vomiting.
Before diagnosing febrile seizures in infants and children, doctors
sometimes perform tests to be sure that seizures are not caused by
something other than simply the fever itself. For example, if a doctor
suspects the child has meningitis (an infection of the membranes
surrounding the brain), a spinal tap may be needed to check for signs of
the infection in the cerebrospinal fluid (fluid that bathes the brain and
spinal cord). If there has been severe diarrhea or vomiting, dehydration
could be responsible for seizures. Also, doctors often perform other tests
such as examining the blood and urine to pinpoint the cause of the child's
fever.
A child who has a febrile seizure usually doesn't need to be
hospitalized. If the seizure is prolonged or is accompanied by a serious
infection, or if the source of the infection cannot be determined, a
doctor may recommend that the child be hospitalized for observation.
If a child has a fever most parents will use fever-lowering drugs such
as acetominophen or ibuprofen to make the child more comfortable, although
there are no studies that prove that this will reduce the risk of a
seizure. One preventive measure would be to try to reduce the number of
febrile illnesses, although this is often not a practical possibility.
Prolonged daily use of oral anticonvulsants, such as phenobarbital or
valproate, to prevent febrile seizures is usually not recommended because
of their potential for side effects and questionable effectiveness for
preventing such seizures.
Children especially prone to febrile seizures may be treated with the
drug diazepam orally or rectally, whenever they have a fever. The majority
of children with febrile seizures do not need to be treated with
medication, but in some cases a doctor may decide that medicine given only
while the child has a fever may be the best alternative. This medication
may lower the risk of having another febrile seizure. It is usually well
tolerated, although it occasionally can cause drowsiness, a lack of
coordination, or hyperactivity. Children vary widely in their
susceptibility to such side effects.
The National Institute of Neurological Disorders and Stroke (NINDS), a
part of the National Institutes of Health (NIH), sponsors research on
febrile seizures in medical centers throughout the country.
NINDS-supported scientists are exploring what environmental and genetic
risk factors make children susceptible to febrile seizures. Some studies
suggest that women who smoke or drink alcohol during their pregnancies are
more likely to have children with febrile seizures, but more research
needs to be done before this link can be clearly established. Scientists
are also working to pinpoint factors that can help predict which children
are likely to have recurrent or long-lasting febrile seizures.
Investigators continue to monitor the long-term impact that febrile
seizures might have on intelligence, behavior, school achievement, and the
development of epilepsy. For example, scientists conducting studies in
animals are assessing the effects of seizures and anticonvulsant drugs on
brain development.
Investigators also continue to explore which drugs can effectively
treat or prevent febrile seizures and to check for side effects of these
medicines.
Keeping on Top of Your Condition
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Additional information for patients, families, and physicians is
available from:
Epilepsy Foundation
4351 Garden City Drive
Landover, Maryland
20785
(301) 459-3700
(800) EFA-1000
(332-1000)
www.epilepsyfoundation.org
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