Febrile seizures

About

Febrile seizures, also known as fever seizures, are convulsions caused by a fever in young children. They generally only last a few minutes and are rarely harmful. These seizures can occur when a child’s body temperature rises rapidly, often due to a viral or bacterial illness. Symptoms can include muscle rigidity, stiffness, loss of consciousness, and jerking of the limbs. Febrile seizures usually affect children between 6 months and 5 years of age and are more common in boys than girls. Treatment typically involves antipyretic medications, such as ibuprofen or acetaminophen, to reduce the fever and help prevent further seizures.

Symptoms

Febrile seizures are seizures that occur in children as a result of a high fever. The most common symptoms of febrile seizures include:

  • Sudden loss of consciousness, usually lasting less than one minute
  • Muscle stiffness or twitching
  • Jerking or shaking of the arms and legs
  • Loss of bladder control
  • Biting the tongue or lips
  • Eyes rolling up into the head
  • Confusion, drowsiness, or difficulty waking up following the seizure
  • Flushed face or sweaty skin
  • Vomiting or drooling
  • Rapid heart rate

It is important to note that not all children with a fever will experience a febrile seizure and that not all seizures in children are caused by fever. If your child does experience a febrile seizure, it is important to seek medical help immediately.

Causes

Febrile seizures can occur when a child experiences a rapid rise in body temperature, usually over 101°F, often as a result of a viral or bacterial infection. In some cases, the cause of the seizure is unknown. Other known causes may include vaccinations, teething, or the sudden introduction of a new medication. Additionally, a family history of febrile seizures can increase a child’s risk, as can extreme environmental temperature changes.

Risk factors

The risk factors for febrile seizures include:

  • Age: Children between 6 months and 5 years old are most at risk for febrile seizures.
  • Family history: If a child’s parent or sibling has had a febrile seizure, the child is more likely to have one.
  • High fever: A fever of 102°F (38.9°C) or higher increases the risk of a febrile seizure.
  • Quick temperature changes: Sudden increases or decreases in temperature can be more likely to lead to a seizure.
  • Certain illnesses: Febrile seizures are more likely to occur if a child is sick with a urinary tract infection, upper respiratory infection, or ear infection.
  • Vaccines: Receiving certain vaccines can increase a child’s risk of having a febrile seizure.
  • Previous febrile seizure: Having a febrile seizure increases the chance of having another.

Diagnosis

Febrile seizures are typically diagnosed based on a physical examination and the patient’s medical history. The doctor will ask about symptoms such as fever, shaking, loss of consciousness, and/or convulsions. They will also likely perform a physical examination to check the patient’s temperature and other vital signs, as well as look for any signs of neurological damage. Blood tests may be ordered to look for any underlying infections that could be causing the fever. The doctor may also order an electroencephalogram (EEG) to check for any abnormal activity in the brain. Finally, imaging tests such as an MRI or CT scan may be ordered to look for any structural abnormalities in the brain.

Sub-types

Febrile Seizures are broken down into two main subtypes: simple and complex.

Simple febrile seizures are the most common type and typically last less than 15 minutes and mainly affect one side of the body. They may involve either a few jerking movements or periods of staring without movement. These are considered harmless and generally do not require medical treatment.

Complex febrile seizures are longer in duration (more than 15 minutes) or involve more than one body part. These seizures may cause long-term epilepsy or may require treatment with medications to prevent further seizures. It is important to seek medical help if a febrile seizure is longer than 15 minutes or involves multiple parts of the body.

Treatments

The treatment options for Febrile seizures depend on the severity and duration of the seizure, as well as the age and health of the patient. In general, treatment for febrile seizures is supportive and symptomatic. Treatment may include lorazepam to stop the seizure, cooling the body to reduce fever and reduce chances of another seizure, and acetaminophen to control fever and reduce risks of future convulsions. Long-term treatment typically includes antiepileptic medications such as phenobarbital, valproic acid, carbamazepine, and topiramate to reduce the likelihood of future seizures. Other long-term treatments may include EEG monitoring, brain imaging studies, and fever reduction strategies.

Prevention

The most effective way to reduce the risk of febrile seizures is to ensure that children receive prompt and appropriate treatment for a fever. This includes giving fever-reducing medications, such as acetaminophen or ibuprofen, as soon as possible and following the recommended dosage for each medication. Additionally, providing regular lukewarm baths, dressing children in lightweight clothing, and keeping the room environment cool and comfortable can help lower body temperature. In cases where the fever is caused by a bacterial infection, antibiotics may need to be prescribed and should be taken as directed. Finally, staying up-to-date on a child’s childhood vaccinations may help reduce the risk of contracting an illness that could lead to a febrile seizure.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of febrile seizures. According to a study published in the journal Pediatrics, boys who present with a febrile seizure are more likely to experience more complex and/or recurrent seizures than girls. Boys are also more likely to have focal seizures than girls, and the associated fever is often higher in boys than girls. In terms of management, boys are more likely to have a lumbar puncture (LP) performed to detect any underlying causes of the seizure, while girls are more likely to have a chest X-ray or spinal ultrasound completed. Additionally, boys are more likely to be prescribed anti-seizure medication after having a febrile seizure than girls.

Nutrition

Nutrition plays an important role in the management and prevention of febrile seizures. Proper nutrition, including a balanced diet, can help maintain a healthy weight, strengthen the immune system, and provide the necessary nutrients to support neurological development and brain functioning. Having good nutrition habits can also reduce the number and severity of febrile seizures in children. Additionally, adequate hydration is essential to reduce the risk of a seizure, so it’s important to ensure that children with febrile seizures are getting enough fluids. Furthermore, adequate dietary intake of important minerals, such as magnesium, calcium, and sodium, can also help to reduce the number and severity of seizures.

Physical Activity

Physical activity can influence the development of febrile seizures. In studies conducted on children, physical activity has been shown to increase their susceptibility to febrile seizures. It is thought that the increased body temperature associated with physical activity can lead to a faster spike in body temperature, which can increase the likelihood of febrile seizures. Additionally, physical activity can cause increased stress and fatigue that can also trigger seizures.

The best way to prevent febrile seizures is to remain aware of the signs and symptoms of a fever, and to make sure that children do not become too physically active while they are ill. If a child is having a fever, parents should limit their physical activity, and should keep them well hydrated. Parents should also be prepared to provide medical attention if needed.

Further Reading

  1. https://www.ncbi.nlm.nih.gov/books/NBK448123/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052913/
  3. https://www.uptodate.com/contents/febrile-seizures-beyond-the-basics/print
  4. https://bestpractice.bmj.com/topics/en-us/566/references
  5. https://www.mayoclinic.org/diseases-conditions/febrile-seizure/symptoms-causes/syc-20372522

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