From the Guidelines
Febrile seizure recurrence risk is approximately 30-40% overall, with higher risk in children who had their first seizure before 12 months of age, have a family history of febrile seizures, or experienced their initial seizure with a relatively low fever (below 40°C). Management primarily focuses on parent education and fever control rather than anticonvulsant prophylaxis. Parents should be taught to place the child in the recovery position during a seizure, avoid putting anything in the mouth, and time the seizure. Fever can be managed with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) 1.
Key Points
- Continuous anticonvulsant prophylaxis is generally not recommended due to potential side effects outweighing benefits, though intermittent diazepam (0.3 mg/kg rectally at fever onset) may be considered in select cases with multiple recurrences or prolonged seizures 1.
- Most febrile seizures are benign and self-limiting, lasting less than 5 minutes, and do not lead to epilepsy or neurological damage 1.
- Parents should seek immediate medical attention if a seizure lasts longer than 5 minutes, the child doesn't return to normal afterward, or shows signs of serious infection 1.
Management Considerations
- Antipyretics may improve the comfort of the child but will not prevent febrile seizures 1.
- The recovery position is intended to reduce the risk of aspiration if the person vomits during the seizure or the postictal period 1.
- Seizure movements often involve erratic movements of the head, body, and extremities that can result in significant traumatic injury during a fall or from the seizure movements, and the first aid provider can prevent the person who is experiencing a seizure from unintentional injury 1.
From the Research
Risk of Febrile Seizures Recurrence
- The risk of febrile seizures recurrence is significant, with approximately 30% of children experiencing a recurrence 2.
- Various factors contribute to the risk of recurrence, including younger age at onset of first seizure, lower temperature during the seizure, brief duration between the onset of fever and the initial seizure, and family history of febrile seizures 3, 4.
- Simple febrile seizures are not associated with increased long-term mortality or negative effects on future academic progress, intellect, or behavior, but children with febrile seizures are more likely to have recurrent febrile seizures 5.
Management of Febrile Seizures Recurrence
- The routine use of antiepileptics is not indicated for febrile seizures due to adverse effects of these medications 2, 5.
- Antipyretics, such as acetaminophen, may be used to reduce the risk of febrile seizures recurrence during the same fever episode 6.
- Rectal acetaminophen has been shown to be effective in preventing febrile seizures recurrence during the same fever episode, with a significant reduction in recurrence rate compared to no antipyretics 6.
- Parents should be educated on the excellent prognosis of children with febrile seizures and provided with practical guidance on home management of seizures 5.
Risk Factors for Recurrence
- Younger age at onset of first seizure is a significant risk factor for recurrence, with children under 18 months at higher risk 3, 4.
- Family history of febrile seizures is also a significant risk factor for recurrence 3.
- Lower temperature during the seizure and brief duration between the onset of fever and the initial seizure are additional risk factors for recurrence 3.
- Male gender may also be a risk factor for recurrence, although this is not consistently reported across studies 4.