From the Research
Introduction to Febrile Seizures
Febrile seizures are a common seizure disorder in childhood, classified into simple and complex types [ 1 ]. They occur in an age-related manner and have a multifactorial inheritance, suggesting both genetic and environmental factors are causative.
Risk Factors for Febrile Seizures
Risk factors for a first febrile seizure include:
- A family history of the disorder
- Developmental delay Risk factors for recurrent febrile seizures include:
- Family history
- Age below 18 months at seizure onset
- Maximum temperature
- Duration of fever Additionally, risk factors for the subsequent development of epilepsy include neurodevelopmental abnormality and complex febrile seizures [ 1 ].
Prevention of Febrile Seizures
Antipyretics are not proven to reduce the recurrence risk for febrile seizures [ 1 ]. However, intermittent therapy with oral/rectal diazepam and continuous prophylaxis with oral phenobarbital or valproate are effective in reducing the risk of recurrence [ 1 ]. It is essential to note that these medications do not reduce the risk of subsequent epilepsy.
Signs and Symptoms of Febrile Seizures
Febrile seizures are characterized by seizures occurring in a child with a fever, typically between six months to five years of age [ 2 ]. Simple febrile seizures are generalized, last less than 15 minutes, and do not recur within 24 hours. Complex febrile seizures, on the other hand, are characterized by focal onset, prolonged duration, or recurrence within 24 hours [ 3 ].
Treatment of Febrile Seizures
Treatment for febrile seizures includes:
Acute Rescue Therapy
- Benzodiazepines, such as rectal diazepam, can be administered for prolonged febrile seizures [ 2 ].
Intermittent Prophylaxis
- Oral/rectal diazepam can be used to reduce the recurrence rate [ 4 ].
Continuous Prophylaxis
- Oral phenobarbital or valproate can be used to reduce the risk of recurrence, but their use is generally not recommended due to potential side effects [ 1 ].
Differential Diagnosis and Caveats
Meningitis should be considered in the differential diagnosis for any febrile child [ 1 ]. Simple febrile seizures do not usually require further evaluation, such as ordering electroencephalography or neuroimaging [ 1 ]. However, complex febrile seizures may require further evaluation, and the neurologic examination should guide further testing [ 2 ].
Management and Prognosis
Febrile seizures are generally a benign condition with a normal neurological, motor, intellectual, and cognitive long-term outcome [ 4 ]. The prognosis for children with febrile seizures is excellent, and parents should be educated on the benign nature of the condition and provided with practical guidance on home management of seizures [ 2 ].