From the Guidelines
Febrile seizures, whether simple or complex, should be managed with a focus on ensuring airway patency, placing the child in recovery position, and avoiding restraint, with no routine anticonvulsant treatment recommended for simple febrile seizures due to their excellent prognosis and minimal risk of developing epilepsy 1.
Key Considerations
- Simple febrile seizures last less than 15 minutes, are generalized, occur once in a 24-hour period, and resolve spontaneously.
- Complex febrile seizures last longer than 15 minutes, have focal features, recur within 24 hours, or are followed by neurological abnormalities.
- Antipyretics like acetaminophen or ibuprofen can be used for comfort but do not prevent seizure recurrence.
- Continuous anticonvulsant prophylaxis is generally not recommended for either type.
- Intermittent diazepam may be considered for children with recurrent complex febrile seizures or prolonged febrile seizures.
Management Approach
- Immediate management focuses on ensuring airway patency and placing the child in recovery position.
- Avoid restraint and do not put anything in the mouth during a seizure.
- Parent education is crucial, including fever management, seizure first aid, and reassurance about the generally benign nature of febrile seizures.
- Further neurological evaluation with EEG or neuroimaging is typically reserved for complex cases, atypical presentations, or developmental concerns.
Prognosis
- Simple febrile seizures have an excellent prognosis with minimal risk (1-2%) of developing epilepsy.
- Complex febrile seizures have a higher risk of epilepsy (4-15%) but it is still relatively low.
- The risk of recurrence is higher in children with simple febrile seizures, especially those younger than 12 months at the time of their first seizure 1.
From the FDA Drug Label
Valproic acid is indicated as monotherapy and adjunctive therapy in complex partial seizures in adults and pediatric patients down to the age of 10 years, and in simple and complex absence seizures. Valproic acid is indicated for use as sole and adjunctive therapy in the treatment of simple and complex absence seizures, and adjunctively in patients with multiple seizure types which include absence seizures.
The FDA drug label does not answer the question about the prognosis and management of febrile seizure simple vs complex.
From the Research
Definition and Classification of Febrile Seizures
- Febrile seizures are classified as simple or complex, with simple febrile seizures being short (<15 min) generalized seizures that do not recur within 24 hours, and complex febrile seizures lasting 15 minutes or more, being associated with focal neurologic findings, or recurring within 24 hours 2.
- Febrile seizures occur in children between 6 months and 5 years of age, accompanied by a fever (100.4°F or greater) without central nervous system infection 2.
Prognosis of Febrile Seizures
- Febrile seizures are not associated with increased long-term mortality or negative effects on future academic progress, intellect, or behavior 2.
- Children with febrile seizures are more likely to have recurrent febrile seizures, with approximately 30-40% of children experiencing a recurrence during early childhood 2, 3.
- The prognosis is generally favorable, with the condition being usually benign and self-limiting 3.
Management of Febrile Seizures
- Children who have a simple febrile seizure and are well-appearing do not require routine diagnostic testing, except as indicated to discern the cause of the fever 2.
- For children with complex seizures, the neurologic examination should guide further evaluation 2.
- For seizures lasting more than five minutes, a benzodiazepine should be administered 2.
- Antipyretics, such as acetaminophen, do not decrease the risk of febrile seizures, but may reduce the risk of short-term recurrence following a febrile seizure 2, 4.
- Continuous preventative antiepileptic therapy for the prevention of recurrent febrile seizures is not recommended, and intermittent anticonvulsant therapy is not routinely indicated 5, 6, 3.
Prevention of Febrile Seizure Recurrences
- Intermittent oral diazepam, phenobarbitone, and intermittent rectal diazepam may reduce the risk of febrile seizure recurrences, but their use is not without adverse effects 5.
- Acetaminophen may be safe and effective in preventing febrile seizure recurrences during the same fever episode 4.
- Parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and the benign nature of the phenomenon 5.