Febrile Seizure in Children: Things We Should Know

What is Febrile Seizure?

Febrile means feverish; any seizure or convulsion which is accompanied by fever is known as febrile seizure. The look of child during seizure seems life threatening (Child’s whole body is shivering, shaking, twitching, eyes may roll up, there could be frothing from mouth and child may become unconscious) and it can be very frightening for parents.

They are scary to witness but remember that they are fairly common.  But they are usually not serious and have NO long term bad effects on brain.

Simple Febrile Seizure typically occurs in

• Age: 6 months to 5 years
• Usually happens on the first day of febrile illness
• Lasts for few minutes only
• It is generalized (i.e. not localized to one body part)
• Usually occurs once in 24 hours
• No previous neurological illnesses in child

Salient Features:

• Currently there is no evidence that simple febrile seizures cause structural damage to the brain
• With the exception of a high rate of recurrence, no long-term adverse effects of simple febrile seizures have been identified.
• Administering prophylactic acetaminophen/Paracetamol (any other fever drug) during febrile episodes was ineffective in preventing or reducing fever and in preventing febrile-seizure recurrence
• Long-term therapy with antiepileptic drugs is not recommended
• Febrile seizures are not considered epilepsy, and kids who’ve had a febrile seizure; only have a slightly increased risk for developing epilepsy compared to the general population.

Management:

Just the site of your baby during seizure can be terrifying and very distressing for parents but Do not Panic (The episode might look life threatening but febrile seizures are very benign and child’s brain development is normal)

Follow  these steps:

• Make sure your child is in a safe place.
• Put your child sideways by turning the body to one side; to prevent choking
• Watch for danger signs like breathing difficulty, child turns blue.
• Wait for Seizure to get over and then shift the child to nearest hospital/medical care facilities for proper evaluation of your child’s condition and to rule out serious illnesses like Meningitis.

Things one should NOT DO:

• Do not shake the child, or try to hold or restrain your child.
• Do not put anything in your child’s mouth.
• Do not try to give any medicine while child is in active seizure not even fever-reducing medicine.
• Do not try to put your child into cool or lukewarm water to cool off.

When the seizure is over, meet your child doctor to look for causes of Fever. The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is paracetamol or ibuprofen.

Conditions which need urgent Hospitalization are

• If the child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting; child will go through few tests to rule out other illnesses like Meningitis and determine the cause of fever.
• The seizure lasts more than several minutes
• If the child is having breathing difficulty or child turns blue
• If the child looks ill, lethargic and is not responding normally
• Persistent vomiting is there

Medications:

Midazolam nasal spray, Tablet Frisium, and various other medications might be prescribed by your child’s doctor as per need of your child and hospital protocol.

Investigations:

Neuroimaging and EEG need to be done during first episode just to rule out other illnesses with seizure. Investigations to find the cause of fever may also be done which may include few blood test and urine test.

Recurrence of Febrile Seizures is high in following cases:

• Younger children (less than 18 months)
• Shorter duration of fever before onset of seizure increases the risk of recurrence
• Family history of febrile seizure (in sibling or any other family member)
• Lower the peak of Fever at onset of seizure ,higher the chances of recurrence

Few children might develop seizure without fever later. These children have

• Complex febrile Seizure
• Family history of epilepsy
• Neurological illness or developmental delay (eg. Cerebral palsy, Hydrocephalus etc)

To Summarise

Simple febrile seizure is a benign and common event in children between the ages of 6 and 60 months. Nearly all children have an excellent prognosis. There is evidence that both continuous antiepileptic therapy with phenobarbital, primidone, or valproic acid and intermittent therapy with oral diazepam are effective in reducing the risk of recurrence, the potential toxicities associated with antiepileptic drugs outweigh the relatively minor risks associated with simple febrile seizures. As such, long-term therapy is not recommended. In situations in which parental anxiety associated with febrile seizures is severe, intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence. Although antipyretics may improve the comfort of the child, they will not prevent febrile seizures