Febrile Seizures

Febrile seizures are a type of generalized seizure precipitated by a fever. (Because there is a specific reason for febrile seizures, they are not considered a form of epilepsy.) They are estimated to occur in 2 to 5 percent of children between the ages of four months and five years. The majority take place between six months and three years, with a peak incidence between 14 and 18months. They become less common after three years of age and are very unusual after age five.

The setting for a febrile seizure is most commonly an upper-respiratory infection, although other situations that induce a fever may provoke it as well. The seizures often begin early in an illness, usually during the rapid upswing of a fever (which doctors refer to as a spike). In fact, an infant or child whom you find hot and cranky with a temperature of 104°F is not likely to have a seizure in the immediate future, since he has already arrived at high temperature without incident.

Febrile convulsions normally last less than five minutes (which may seem like an eternity) although rarely they continue as long as 15 minutes. During one of these episodes a child typically will roll the eyes backward then stiffen and rhythmically shake both arms and both legs. After the seizure subsides, he will still have a fever, but other than experiencing a little sleepiness, he should feel and act relatively normal.

If your child experiences febrile convulsions, first and foremost you should try to stay calm and let the seizure run its course. Panicky efforts to stop the seizure or otherwise help your child may do more harm than good. After the seizure is over and while your child is resting, take his temperature rectally, then call your doctor and describe what happened. If this is your child’s first seizure, he should be evaluated in the office or the emergency room. Further tests may be necessary, depending upon his age, his appearance when examined, and other features of his illness. It will be very important to deter-mine whether this episode was a febrile seizure or a manifestation of a more significant problem. In infants and children under the age of two, there may be particular concern about the possibility of meningitis.

If your child has had a febrile convulsion, he has a 20 to 40 percent chance of having at least one similar episode before the age of five. But only 2 to 4 percent of children who have a febrile convulsion will continue to have seizures that are not related to fevers during late childhood or adulthood. Children who are at risk for this long-term seizure problem are those whose febrile convulsion was more complex in some way – for example, lasting more than 15 minutes, involving only one side of the body, or occurring more than once in a day – or those for whom there is a family history of seizures.

It is important to understand that febrile seizures are not actually harmful to a child, even though they can be very upsetting to the parents. Repeated episodes do not damage the brain or cause behavior or learning problems later in life, and parents need not live in terror every time their child has a fever. For this reason, children with febrile seizures are typically not given ongoing anticonvulsant medications to reduce the likelihood of recurrences. However, after the first occurrence and evaluation, it is a good idea to notify the doctor when-ever one takes place. During an illness in which fever is present (or might occur), it is reasonable to give acetaminophen, every four to six hours, or ibuprofen every six to eight hours for a child who hasn’t had a febrile seizure before, although this may or may not be successful in preventing one of these episodes from recurring.

A seizure is a complex neurological symptom, not a disease. It is also not an indication of an emotional or spiritual disturbance. If your child witnesses a seizure, he may be frightened, especially if the person is someone he knows. Explain to him what has happened and reassure him that he does not need to be afraid of that individual.

With the rare exception of an extremely prolonged (more than 30 minutes) uncontrolled seizure, these episodes do not cause brain damage or mental retardation. While it is true that some children who are mentally retarded or who have brain abnormalities may have convulsions, an underlying condition is likely to be the cause of both the retardation and the seizures.

The vast majority of children with convulsions has normal intelligence and should not be put in special-education classes merely because they have seizures. Most epileptic children will be completely normal except for a few minutes (if that much) luring a given year. Most people who have seizures during childhood will not continue to have them for the rest of their lives.