What is the management of a febrile seizure with hyperthermia?

From the Guidelines

Management of febrile seizure with hyperthermia involves keeping the child safe and comfortable, but not using antipyretics to prevent seizure recurrence.

Key Points

• Febrile seizures are a common and benign condition in childhood, affecting 2% to 5% of children between the ages of 6 and 60 months 1.
• The first aid provider can prevent the person who is experiencing a seizure from unintentional injury by keeping them safe and using the recovery position to reduce the risk of aspiration if the person vomits during the seizure or the postictal period 1.
• Antipyretics such as acetaminophen or ibuprofen may be used to help the child feel better, but they will not prevent subsequent seizures 1.
• Seizures lasting >5 minutes may not stop spontaneously and may need emergency medical intervention such as anticonvulsant medications 1.
• The person having the seizure should not be restrained, and nothing should be put in the mouth 1.

Treatment

• For children who have experienced a febrile seizure, administration of antipyretics such as acetaminophen, ibuprofen, or paracetamol is not effective for stopping a seizure or preventing a subsequent febrile seizure 1.
• Intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence in situations where parental anxiety associated with febrile seizures is severe 1.

From the Research

Management of Febrile Seizures with Hyperthermia

The management of febrile seizures with hyperthermia involves several key considerations:

• Determining whether the seizure is simple or complex, as this guides further evaluation and treatment 2, 3, 4
• Identifying the source of the fever and treating it when possible 2, 5
• Administering a benzodiazepine for seizures lasting more than five minutes 2
• Considering rectal acetaminophen to reduce the risk of short-term recurrence following a febrile seizure 2
• Providing parental education and counseling on the excellent prognosis and home management of seizures 2, 5

Treatment Approaches

The following treatment approaches are recommended:

• No routine diagnostic testing (laboratory tests, neuroimaging, or electroencephalography) is necessary for simple febrile seizures, except to discern the cause of the fever 2, 3, 4
• Continuous preventative anticonvulsant therapy is not recommended for children with either simple or complex febrile seizures 6, 3, 5, 4
• Intermittent anticonvulsant therapy is not routinely indicated, but may be considered for certain children at risk for recurrent febrile seizures 6
• Antipyretics do not decrease the risk of febrile seizures, although they may be used to treat the underlying fever 2, 4

Special Considerations

Certain children may require special consideration, including:

• Those with complex febrile seizures, who are at risk of subsequent epilepsy 4
• Those younger than 12 months of age, who may require a lumbar puncture to rule out meningitis 4
• Those with a family history of febrile seizures, who may be at increased risk of recurrence 3