Febrile seizures are a symptom of children from 6 months to 5 years of age. It results from the reaction of a child's immature nervous system to an increased body temperature. However, it should be remembered that febrile seizures in adults are also possible. What are the causes of febrile seizures, what to do in the event of a seizure, how is the treatment going and are their complications serious?

Febrile seizuresare usually mild and do not cause permanent neurological damage. Even so, the seizure can look dangerous and can be a traumatic experience for the child and his parents.

Febrile seizures - causes

Febrile seizures are a relatively common phenomenon, affecting approximately 3-5% of the child population. Their origins are complex and depend on both environmental and genetic factors.

Remember that fever is your body's natural response to an infection. The increase in body temperature causes the release of many cytokines - molecules designed to mobilize the body to fight the pathogen.

A child's brain becomes more prone to agitation during the developmental period, so this cytokine release may alter its normal electrical activity, leading to seizures.

Febrile seizures tend to be familial and statistically more often affect boys.

They typically appear in the course of fever above 38 ° C, sometimes also at lower temperatures or precede the fever peak.

The most common causes of such an increase in body temperature in children are infections of the upper and lower respiratory tract, infectious diseases in childhood and infections within the digestive system. In some cases, electrolyte disturbances, such as a deficiency of sodium, calcium or iron, can also cause febrile seizures.

Febrile seizures - symptoms

A typical course of febrile seizures is:

  • contraction and trembling of the body muscles
  • uncontrolled limb movements
  • pale or blue skin
  • loss of consciousness
  • drooling or foamy mouth discharge
  • turning the eyeballs back
  • breathing rhythm disturbance

The seizure may also be accompanied by vomiting, and urinary incontinence and faecal incontinence.

In the post-attack period, the child may be confused, irritable, and have orientation problems.

These symptoms usually disappear within 30 minutes.

Due to the severity of symptoms and the risk of complications, there are two types of febrile seizures: simple and complex.

  • Simple febrile seizuresmake up about 70% of attacks, usually affect the entire body and last about 3-5 minutes. Symptoms resolve on their own and do not tend to recur within 24 hours.
  • Compound febrile convulsionsis longer, lasting more than 10 minutes. Convulsions are often focal, that is, they affect only certain muscle groups - for example, on one side of the body or a selected limb.
    Post-episodic drowsiness and confusion may persist for more than 1 hour. These symptoms are sometimes associated with the occurrence of the so-called Todd's paralysis - transient paralysis of the muscles of one half of the body.
    Complex seizures tend to recur - often>2 seizures occur within 24 hours.
    Occasionally, it is necessary to stop the seizure is the use of anticonvulsants. Children who develop this type of seizure have a higher risk of neurological complications, including the development of epilepsy.

The most serious type of complex febrile convulsions is the so-called febrile status epilepticus (febrile status epilepticus) lasting more than 30 minutes. Usually, it requires medical intervention and extensive neurological diagnostics.

Febrile convulsions - diagnosis

The diagnosis of febrile seizures is to rule out other, potentially dangerous causes of the seizure.

Simple febrile convulsions are mild, self-limiting and leaving no neurological defects. The result of the physical and neurological examination of the child after such a seizure is not abnormal.

There are also no significant indications for brain imaging studies, such as computed tomography or magnetic resonance imaging.

The diagnosis of complex seizures and all "suspicious" cases looks different - if the doctor observes disturbing persistent neurological symptoms, such as strabismus - he will probably order additional tests.

Any suspected central nervous system infection (e.g., meningitis) must be verified with a lumbar puncture and a CSF test.

In-depth diagnostics must also be performed onthe youngest children, under 1 year of age. Central nervous system infections may have an atypical course or may not cause any symptoms.

Valuable information for the doctor is always provided by an interview with the child's parents - you should expect questions about both the course of the seizure and psychomotor development in the earlier stages of life as well as vaccination history.

In addition to neuroinfections, epilepsy is also considered in the differential diagnosis. If a febrile seizure has ever been preceded by a seizure not related to fever, this suggests a seizure in which the fever was only the triggering factor.

Treatment of febrile seizures

A febrile seizure can look dangerous and cause paralyzing fear in the parents.

In case of its occurrence, stay calm, put the child on a stable surface (e.g. the floor) and protect it against possible injuries.

It is very important to prevent choking - you need to make sure that the child has nothing in the mouth, or to empty the mouth of any leftover food or any objects. Do not try to force the child's convulsions or limb movements to rest.

The first episode of febrile seizures should always be consulted with a physician in order to diagnose their cause and implement appropriate treatment.

If your seizures are accompanied by disturbing symptoms, such as increased heart rate, prolonged disturbance of consciousness, or a seizure lasting longer than 5 minutes, you should call an ambulance.

A simple febrile seizure is not an indication for hospitalization - it usually lasts a short time and does not require interruption with anticonvulsants.

Treatment of such a seizure is mainly based on the administration of agents that alleviate the symptoms of the infection, such as paracetamol or ibuprofen.

If the bacterial background of the infection (e.g. angina) is diagnosed, antibiotics are included in the treatment. Patients with complex seizures usually require hospitalization and more aggressive treatment.

In the case of prolonged seizures, benzodiazepine drugs having an anticonvulsant effect are administered intravenously or rectally.

Each episode of febrile seizures carries a risk of relapse. Research-based guidelines do not recommend the chronic use of anticonvulsants to prevent seizures.

Attempts to lower a child's fever by physical cooling or the administration of antipyretic drugs do not reduce the frequency of seizures. They soothehowever, they are symptoms of the disease and may contribute to the improvement of the child's comfort and well-being.

In some cases of recurrent seizures, parents may give an anticonvulsant medication (such as Diazepam) at home after proper training by a doctor.

Febrile seizures - prognosis

The prognosis for febrile seizures is good in most cases - the condition is mild and self-limiting.

Simple febrile convulsions do not lead to long-term neurological deficits, do not affect the growth and development of a child, and their tendency to relapse decreases with age and maturation of the central nervous system structures.

They may slightly increase your risk of epilepsy later in life. Factors that indicate a higher chance of febrile seizures recurrence include:

  • an interview indicating a family history of seizures
  • the first appearance of febrile seizures before the age of 18 months
  • occurrence of febrile convulsions at body temperature<38°C
  • the appearance of seizures shortly after the onset of the fever ( <1h)

Complex febrile seizures are characterized by a greater tendency to recur and the risk of epilepsy compared to simple febrile seizures.

Adult febrile seizures

Parents of older children and adolescents, and adults, often mistakenly call febrile seizures a febrile seizure.

As mentioned above, the definition of febrile seizures is very precise and only applies to children aged 6 months - 5 years. Only at this age the immaturity of the central nervous system structures can cause febrile seizures.

In older children and adults, the causes of seizures should be looked for elsewhere - they may be a symptom of epilepsy. Fever is then only a factor that aggravates the symptoms of the underlying disease.

It also happens that patients confuse the concept of seizures with other symptoms that may accompany the fever. These are, for example, chills or febrile fainting.

In such cases, the key to a correct diagnosis is a detailed medical history, supplemented by a physical examination and possibly additional tests.

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About the authorKrzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. Especiallyinterested in gynecology and obstetrics, pediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.

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