Febrile Seizures


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Febrile Seizures: What Every Parent Should Know

1. What is a febrile seizure?

Febrile convulsions (FC) or seizures (FS) are clonic or tonic-clonic seizures that most often occur in infancy or childhood, mainly occurring between four months and six years of age, with fever but without evidence of intracranial infection, antecedent epilepsy, or other definable cause. That is why they are often referred to as "fever seizures" or "febrile seizures." Most of the time when children have a seizure, or a convulsion, it's caused by fevers with a rectal temperature greater than 102 degrees F. Most febrile seizures occur during the first day of a child's fever. They occur in 1-5% of all children, and therefore febrile convulsions have the highest incidence of any childhood neurological disease. They are very frightening, but they are not as dangerous as they may appear. Nearly 80 percent of parents think that their child undergoing a seizure is dying or already dead. The controversy that the best management is parental support and education has not been substantiated. Rather, recent findings show that the parents of an affected child continue to be anxious, even after speaking with physicians, viewing videotapes, and reading educational materials, and there is often still family disruption. Parents and many physicians are sometimes driven to try to prevent seizures because of unfounded fears. Seizures do not beget seizures, and in humans there is no solid evidence of "kindling," which is seen in an experimental model in animals. The majority of children with febrile seizures have.

There have been families identified where each had multiple members affected by febrile convulsions over two or more generations. In order to identify the gene(s) for FC/FS a study was initiated by a genome screen with a panel of micro satellite markers spaced at 20 cM. Blood samples are collecting from families in which 2 siblings have had febrile seizures. Blood samples from both siblings and the biological parents are also required. Dr. R McLachlan is conducting this work in collaboration with The University of Western Ontario.

2. How serious are febrile seizures?

Usually, a child who has had a febrile seizure does not need to be hospitalized and may not need x-rays or a brain wave test. Your child may only need to be seen by your family doctor so the cause of the fever can be found.

Although they can be frightening to parents, the vast majority of febrile seizures are harmless.

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During a seizure, there is a small chance that the child may be injured by falling or may choke from food or saliva in the mouth. Using proper first aid for seizures can help avoid these hazards
(See section entitled " What should you do if your child is having a seizure? “) There is no evidence that febrile seizures cause brain damage. Large studies have found that children with febrile seizures have normal school achievement and perform as well on intellectual tests as their siblings who don't have seizures. Febrile seizures usually last just a few minutes and go away on their own. It's very unusual for a febrile seizure to last more than 10 minutes. Even in the rare instances of very prolonged seizures (more than 1 hour), most children recover completely. Between 95 and 98 percent of children who have experienced febrile seizures do not go on to develop epilepsy. However, although the absolute risk remains very small, certain children who have febrile seizures face an increased risk of developing epilepsy. These children include those who have febrile seizures that are lengthy, that affect only part of the body, or that recur within 24 hours, and children with cerebral palsy, delayed development, or other neurological abnormalities. Among children who do not have any of these risk factors, only one in 100 develops epilepsy after a febrile seizure.
3. What should you do if your child is having a seizure?
Parents should stay calm and carefully observe the child. To prevent accidental injury, the child should be placed on a protected surface such as the floor or ground. The child should not be held or restrained during a convulsion. To prevent choking, the child should be placed on his or her side or stomach. When possible, the parent should gently remove all objects in the child's mouth. The parent should never place anything in the child’s mouth during a convulsion. Objects placed in the mouth can be broken and obstruct the child's airway. If the seizure lasts longer than 10 minutes, the child should be taken immediately to the nearest medical facility, by EMS staff, for further treatment.

Here is a quick checklist:
o     Put your child on his or her side so that he or she will not choke on saliva.
o     Do not put anything in his or her mouth.
o     Do not restrain your child's movements during the seizure. The most important (and hardest) thing for you to do is to remain as calm as possible. Most seizures stop on their own within a few minutes, so keep your eyes on a clock or watch.
o     Remove or loosen all restrictive clothing to prevent injury and help reduce temperature.
o     Call 911 if the seizure lasts more than 10 minutes and/or if the child has any signs of respiratory distress.
4. What should you do after the seizure has stopped?

Once the seizure has ended, the child should be taken to his or her doctor to check for the source of the fever. This is especially urgent if the child shows symptoms of stiff neck, extreme lethargy, or abundant vomiting. Your doctor may want to see your child to find a cause for the fever and what further steps or tests to run.

5. Will a child have more seizures?

The chance of your child having another seizure is 25% to 30%. Most children will not have another seizure. The risk of another febrile seizure is slightly higher if your child is younger than 18 months, if there's a family history of febrile seizures, or if the fever was not very high when the seizure occurred.
6. Can these seizures be prevented with and without medicine?

If a child has a fever most parents will use fever-lowering drugs such as acetaminophen or ibuprofen to make the child more comfortable, although there are no studies that prove that this will reduce the risk of a seizure. One preventive measure would be to try to reduce the number of febrile illnesses, although this is often not a practical possibility. Prolonged daily use of oral anticonvulsants, such as Phenobarbital or Valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing such seizures. Children especially prone to febrile seizures may be treated with the drug diazepam orally or rectally, whenever they have a fever. The majority of children with febrile seizures do not need to be treated with medication, but in some cases a doctor may decide that medicine given only while the child has a fever may be the best alternative. This medication may lower the risk of having another febrile seizure. It is usually well tolerated, although it occasionally can cause drowsiness, a lack of coordination, or hyperactivity. Children vary widely in their susceptibility to such side effects. Many doctors and parents believe the side effects from the medicine are worse than the child having another febrile seizure. Even if medicine is used, it may not prevent another seizure. In the June 25, 1998 issue of The New England Journal of Medicine of the Journal, there is documentation on the effectiveness and safety of a rectally administered diazepam gel, which was recently approved for prescription sales in the United States. A caregiver, such as a parent, who has received special training, administers the treatment. Diazepam is not a new drug. It’s been and is used, as a rectal solution prepared from commercial parenteral formulations is successful in many situations (for the prevention of recurring febrile seizures, the pre-hospital treatments of convulsive status epilepticus, and the treatment of clusters of seizures). Studies conducted suggest that the use of rectal diazepam gel could result in significant cost savings by reducing the number of visits to the emergency room for episodes of seizures. More then half the subjects assigned to diazepam did not need emergency room treatment, whereas 6 of the 61-receiving placebo required additional medical care.

7. If a child has a febrile seizure, does this mean that he or she has epilepsy?

No. A single seizure is never epilepsy. Even repeated febrile seizures are not considered epilepsy, because children outgrow the risk of having a seizure caused by fever. A child with epilepsy has two or more seizures that are not caused by fever.
Febrile seizures do not cause epilepsy. But the chance of epilepsy developing in a child who has had a febrile seizure is slightly higher than if he or she did not have a febrile seizure. The chance of epilepsy developing in a child who has had a febrile seizure is about 2% to 4%. There is a better than 95% chance that your child will not have epilepsy, and there is no evidence that treating your child with medicine will prevent epilepsy.

8. What research is being done on febrile seizures?
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), sponsors research on febrile seizures in medical centers throughout the country. NINDS-supported scientists are exploring what environmental and genetic risk factors make children susceptible to febrile seizures. Some studies suggest that women who smoke or drink alcohol during their pregnancies are more likely to have children with febrile seizures, but more research needs to be done before this link can be clearly established. Scientists are also working to pinpoint factors that can help predict which children are likely to have recurrent or long-lasting febrile seizures. Investigators continue to monitor the long-term impact that febrile seizures might have on intelligence, behavior, school achievement, and the development of epilepsy. For example, scientists conducting studies in animals are assessing the effects of seizures and anticonvulsant drugs on brain development.
Investigators also continue to explore which drugs can effectively treat or prevent febrile seizures and to check for side effects of these medicines.

References

&     Dennis E. Bulman B.Sc. (University of Western Ontario Scientist, Ottawa General Hospital Research Institute), M.Sc. (University of Western Ontario), and Ph.D. (University of Toronto) Assistant Professor, Departments of Medicine and Biochemistry, Microbiology, and Immunology, University of Ottawa, http://www.ogh.on.ca/research/bulman.htm (06/23/1998)

&     Rosman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. The New England Journal of Medicine 1993; 329:79-84.

&     N. Paul Rosman, Theodore Colton, Jan Labazzo, Paula L. Gilbert, Nancy B. Gardella, Edward M. Kaye, Carla Van Bennekom, Michael R. Winter Gaining a Perspective on Childhood Seizures A Controlled Trial of Diazepam Administered during Febrile Illnesses to Prevent Recurrence of Febrile Seizures. The New England Journal of Medicine 1998; 338:79-84.

&     Freeman JM. The best medicine for febrile seizures. The New England Journal of Medicine
1992; 327:1161-3.

&     Berg AT, Shinnar S, Hauser WA, et al. A prospective study of recurrent
febrile seizures. The New England Journal of Medicine 1992; 327:1122-7.

&     Michael J. Painter, Mark S. Scher, Aryeh D. Stein, Stacey Armatti, Zhiming Wang, Joseph C. Gardiner, Nigel Paneth, Beth Minnigh, John Alvin Phenobarbital Compared with Phenytoin for the Treatment of Neonatal Seizures. The New England Journal of Medicine 1999; 341:485-9.)



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