From the Guidelines
Febrile seizures are generally benign and self-limiting, and the most recent guidelines from 2024 recommend that administration of antipyretics such as acetaminophen, ibuprofen, or paracetamol is not effective for stopping a seizure or preventing a subsequent febrile seizure 1. When a child experiences a febrile seizure, parents should place the child on their side in a safe area, remove any objects that could cause injury, and avoid putting anything in the child's mouth. It's essential to seek immediate medical attention for the first febrile seizure or if the seizure lasts longer than 5 minutes. Most febrile seizures don't require specific treatment beyond fever management with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) 1. Some key points to consider in managing febrile seizures include:
- The person having the seizure should not be restrained 1.
- Nothing should be put in the mouth and no food, liquids, or oral medicines should be given to a person who is experiencing a seizure or who has decreased responsiveness after a seizure 1.
- Continuous anticonvulsant therapy is generally not recommended for simple febrile seizures, as the potential toxicities associated with these agents outweigh the relatively minor risks associated with simple febrile seizures 1.
- For children with recurrent or complex febrile seizures, intermittent diazepam (0.3-0.5 mg/kg rectally) may be prescribed for use during febrile illnesses 1. Febrile seizures occur because a child's developing brain is more sensitive to rapid rises in temperature rather than the absolute temperature itself. While frightening to witness, simple febrile seizures don't cause brain damage, intellectual disability, or increase the risk of death, though they do slightly increase the risk of developing epilepsy (1-2%) 1. The most recent guidelines emphasize the importance of a thorough evaluation to determine the underlying cause of the seizure and to identify any potential risk factors for future seizures 1. Overall, the management of febrile seizures should focus on providing supportive care, managing fever, and educating parents on how to respond to a seizure, rather than relying on antipyretics or anticonvulsant therapy 1.
From the Research
Definition and Prevalence of Febrile Seizures
- Febrile seizures are seizures that occur in association with a fever, typically in children between 6 months and 5 years of age 2.
- Up to 5 percent of children in North America and western Europe experience at least one episode of febrile seizure before six years of age 2.
Risk Factors for Febrile Seizure Recurrence
- Factors increasing the risk of febrile seizure recurrence include young age at onset, family history of febrile seizures, previous recurrent febrile seizures, time lapse since previous seizure <6 months, relative low temperature at the initial seizure, multiple type initial seizure, and frequent febrile illnesses 3.
Treatment and Prevention of Febrile Seizures
- Antipyretics are effective in reducing the risk of febrile seizures if given early in the illness 2.
- Acetaminophen has been shown to be safe and potentially effective in preventing febrile seizure recurrence during the same fever episode 4.
- Intermittent diazepam has been found to reduce the recurrence of febrile seizures, with a significant reduction in recurrence rates at 6,12,18,24,36, and 48 months 5.
- Continuous phenobarbitone has also been found to reduce seizures at 6,12, and 24 months, but not at 18 or 72 month follow-up 5.
Management and Outcome
- Immediate care for the patient who has had a febrile seizure includes stopping the seizure, if prolonged, and evaluating the patient for the cause of the fever 2.
- Long-term consequences of febrile seizure are rare in children who are otherwise healthy 2.
- 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.