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Febrile Seizure: Causes, Symptoms and Treatment

A febrile seizure is a convulsion in young children triggered by a rapid rise in body temperature. It is usually harmless but should always be evaluated by a doctor.

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Things worth knowing about "Febrile Seizure"

A febrile seizure is a convulsion in young children triggered by a rapid rise in body temperature. It is usually harmless but should always be evaluated by a doctor.

What is a Febrile Seizure?

A febrile seizure is a convulsion that occurs in children between approximately 6 months and 5 years of age, triggered by a rapid increase in body temperature. It is one of the most common neurological events in childhood, affecting around 2 to 5 percent of all children. Although febrile seizures can look very frightening to parents and caregivers, they are in most cases harmless and do not cause lasting neurological damage.

Causes

Febrile seizures occur due to the heightened sensitivity of a young child´s brain to sudden temperature changes. The exact cause is not yet fully understood, but several factors are known to contribute:

Rapid rise in body temperature: A quick increase to above 38.5 °C (101.3 °F) is a common trigger.
Genetic predisposition: Children with a family history of febrile seizures (parents or siblings) are at higher risk.
Infections: Common viral infections such as colds, influenza, ear infections, or roseola infantum (sixth disease) are frequent triggers.
Immature nervous system: The not-yet-fully-developed brain of young children is more susceptible to the effects of fever.

Types of Febrile Seizures

Simple Febrile Seizure

A simple febrile seizure is the most common form. It lasts less than 15 minutes, involves the whole body (generalized), and occurs only once within a 24-hour period. The child recovers fully after the event.

Complex Febrile Seizure

A complex (or complicated) febrile seizure lasts longer than 15 minutes, recurs within 24 hours, or affects only one part of the body (focal). This form requires more thorough medical evaluation.

Symptoms

The signs of a febrile seizure can vary. Typical features include:

Sudden loss of or altered consciousness
Jerking or stiffening movements of the limbs and body
Eyes rolling back
Irregular or temporarily absent breathing during the seizure
Brief drowsiness or confusion after the seizure (the postictal phase)
Loss of bladder or bowel control (uncommon)

Diagnosis

The diagnosis of a febrile seizure is primarily based on a physical examination and a detailed account of the event from parents or caregivers. The clinician will consider the following:

Duration and nature of the seizure
Presence and cause of the fever
Age and developmental stage of the child
Family history of febrile seizures or epilepsy

In certain cases -- for example, following a complex febrile seizure or when bacterial meningitis cannot be ruled out -- further investigations may be required. These can include blood tests, a lumbar puncture (cerebrospinal fluid analysis), or an EEG (electroencephalogram to measure brain activity).

Treatment and First Aid

What to Do During a Seizure

Parents and caregivers should stay calm and follow these steps during a febrile seizure:

Place the child in the recovery position (on their side) to prevent choking.
Do not put anything in the child´s mouth (no spoon, no fingers).
Protect the child from injury by removing dangerous objects nearby and cushioning the head.
Do not try to restrain the child forcefully.
Note the time and duration of the seizure.
Call the emergency services if the seizure lasts longer than 5 minutes, if the child does not regain consciousness, or if the child does not appear to recover normally.

Medication

For prolonged febrile seizures, emergency medical personnel may administer anticonvulsant medications such as diazepam (rectal gel or suppository) or midazolam (nasal spray). Long-term anticonvulsant therapy is generally not recommended for simple febrile seizures.

Fever Management

Fever-reducing medications such as paracetamol or ibuprofen can help keep the child comfortable during illness, but evidence does not support their use as a reliable method to prevent febrile seizures.

Prognosis and Risk of Recurrence

The prognosis for simple febrile seizures is excellent. The risk of developing epilepsy later in life is only slightly increased compared to the general population. The risk of a recurrent febrile seizure during a subsequent febrile illness is approximately 30 to 40 percent and is higher if the child was younger than 18 months at the time of the first seizure or if there is a family history of febrile seizures.

References

Subcommittee on Febrile Seizures, American Academy of Pediatrics: Clinical Practice Guideline -- Febrile Seizures. Pediatrics, 2011; 127(2):389-394.
World Health Organization (WHO): Epilepsy Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/epilepsy (accessed 2024).
Leung AK, Robson WL: Febrile Seizures. Journal of Pediatric Health Care, 2007; 21(4):250-255.

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