Febrile convulsions are the most common type of seizure (convulsions or fits) during early childhood. The convulsion occurs during fever. Excluding children with pre-existing neurological or developmental abnormalities, the prevalence of febrile seizures is 2.7%. In U.S. the prevalence of febrile seizures is 2-5%, among the children aged 6 months to 6 years. An underlying neurological or developmental abnormality or a family history of epilepsy increases the risk of developing epilepsy.
What is a febrile seizure?
Febrile seizure is the seizure (fits or convulsions) in children who is suffering from fever and doesn't have any neurological illness. Seizures that occur after vaccination are also included in this category. Usually the seizure does not last for more than 10 minutes and usually not more than one episode per febrile episode. After the attack of seizure is over, the patient recovers fully without any neurological deficit. There may be a family history of febrile convulsions in the siblings. Febrile convulsions are unusual before the age of six months and after 5 years. When the febrile seizures last for more than 15 minutes or if the child suffers from more than one attack of convulsion per episode of fever, it is called complex febrile seizure.
What is the treatment for febrile seizure?
Before treating a child with febrile seizures, infective conditions of the central nervous system like meningitis and encephalitis should be ruled out. Febrile convulsions are managed by prompt reduction of temperature with antipyretics or tepid sponging. Supportive therapy, adequate hydration should be maintained. If meningitis is suspected, lumbar puncture and examination of cerebrospinal fluid will be helpful. In one study, the IQ in the group of patients with febrile seizures, who were treated with phenobarbital was 8.4 points lower than the placebo group (in which no anticonvulsant medications were given), and there remained a significant difference several months after discontinuing the drug. Furthermore, there was no significant reduction in seizures the phenobarbital treated group. And yet, no other drug really appears well to treat this entity: carbamazepine and phenytoin appear ineffective; valproate may be effective but has serious risks in the children less than two years. Given the low incidence (1%) of having afebrile seizures (epilepsy after a simple febrile seizure) and the fact that anti epileptic drugs probably do not prevent this development, there is little support for prescribing anticonvulsants in these cases. The recurrence rate of febrile seizures in children with history of one or more febrile seizures can be reduced by administering diazepam 3.3mg/kg eight hourly during a febrile episode and continuing until 24 hours after the fever subside.
What is the prognosis of febrile seizures?
About one percent of children with simple febrile convulsions and five prevent of those with recurrent complex febrile seizures are likely to develop epilepsy. The parents of the child should be reassured that chances of recurrent seizures or epilepsy after simple febrile seizures are minimal. The risk of epilepsy is higher if the seizure is atypical i.e., last more than 15 minutes, are focal in nature (fits restricted to either a leg or hand), or if the child has abnormal neuro development. Complex partial seizures may manifest in a patient after several years of prolonged febrile convulsion due to the damage to the temporal lobe of the brain. Prevention of recurrent febrile seizures may not reduce the risk of developing epilepsy but reduce the risk of partial complex seizures. Recurrence rate of febrile seizures varies form 30-40 percent.