From the Guidelines
Febrile seizures in adults are a medical emergency that requires immediate attention to identify and treat the underlying cause, which can be a serious neurological or systemic problem. Unlike children, where febrile seizures are generally benign and self-limiting, adults experiencing seizures with fever should seek emergency medical care promptly 1. The diagnostic workup for an adult with a fever-associated seizure typically includes blood tests, lumbar puncture, EEG, and brain imaging to determine the underlying cause, such as meningitis, encephalitis, brain abscess, severe systemic infection, or other neurological disorders.
Key Considerations
- The management of seizures in adults, as outlined in the 2024 clinical policy by the American College of Emergency Physicians 1, emphasizes the importance of prompt treatment and identification of the underlying cause.
- First-line treatment for recurrent seizures involves the appropriate dosing of benzodiazepines, with second-line treatment including agents such as phenytoin, levetiracetam, and valproic acid 1.
- Status epilepticus, defined as a seizure lasting longer than 5 minutes or multiple seizures without a return to neurologic baseline, requires immediate and effective management to prevent further complications 1.
Clinical Approach
- Adults presenting with seizures and fever should be evaluated promptly for potential life-threatening conditions.
- The use of benzodiazepines as a first-line treatment for seizures, as recommended by the clinical policy 1, is crucial in managing the seizure activity while investigating the underlying cause.
- A thorough diagnostic workup, including imaging and laboratory tests, is essential to determine the cause of the seizure and guide appropriate treatment 1.
From the Research
Febrile Seizures in Adults
- Febrile seizures are more commonly associated with children, and there is limited information available on febrile seizures in adults 2, 3.
- The available studies primarily focus on febrile seizures in children, with no specific mention of adults 4, 5.
- However, one study discusses the prehospital care for adult and pediatric seizure patients, including those with febrile seizures, and provides recommendations for evaluation and treatment 6.
Evaluation and Treatment
- For children with febrile seizures, routine diagnostic testing is not recommended, except to determine the cause of the fever 2, 3.
- In cases of complex seizures or febrile status epilepticus, benzodiazepines such as lorazepam or midazolam may be administered 2, 6.
- Antipyretics like acetaminophen may be used to reduce the risk of short-term recurrence following a febrile seizure, but their effectiveness in preventing febrile seizures is still being studied 4, 3.
Prognosis and Recurrence
- Febrile seizures are generally considered to be benign, with no increased risk of long-term mortality or negative effects on future academic progress, intellect, or behavior 2, 3.
- However, children with febrile seizures are at a higher risk of recurrent febrile seizures, with a 15 to 70 percent risk of recurrence in the first two years after an initial febrile seizure 2.
- The risk of recurrence is increased in patients younger than 18 months, those with a lower fever, short duration of fever before seizure onset, or a family history of febrile seizures 2.