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Monday, January 29, 2007

Febrile Seizures

What are Febrile Seizures?
Febrile seizures, also known as a fever fit or febrile convulsion are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes. Less commonly, a child becomes rigid or has twitches in only a portion of the body. Most febrile seizures last a minute or two; some can be as brief as a few seconds, while others last for more than 15 minutes. They most commonly occur in children below the age of three and should not be diagnosed in children under the age of 6 months or over the age of 6 years. A few factors appear to boost a child's risk of having recurrent febrile seizures, including young age (less than 15 months) during the first seizures, frequent fevers, and having immediate family members with a history of febrile seizures.

What are common cause my toddler to have a seizure?
If your child is between 6 months and 5 years old, a high fever (usually over 102 degrees Fahrenheit) can cause a seizure. In most cases, these "febrile seizures," as they're called, are harmless, but that doesn't make them any less terrifying for you while your toddler is having one. Febrile seizures represent the meeting point between a low seizure threshold (genetically and age determined) - some children have a greater tendency to have a seizure under certain circumstances - and a trigger: fever. The genetic causes of febrile seizures are still being researched. Some mutations that cause a neuronal hyperexcitability and could be responsible for febrile seizures have already been discovered.

The diagnosis is one that must be arrived at by eliminating more serious causes of seizure: in particular, meningitis and encephalitis must be ruled out. Therefore a doctor's opinion should be sought and in many cases the child would be admitted to hospital overnight for observation and/or tests. As a general rule, if the child returns to a normal state of health soon after the seizure, a nervous system infection is unlikely.

What happens during a seizure?
If your toddler has a seizure, it will probably happen during the first few hours of his fever. He may roll his eyes, twitch or jerk his body, drool, vomit, or stiffen his limbs. His skin may appear a little darker than usual. The seizure may last only a few seconds, or three or four (seemingly very long) minutes. Afterward, your child might seem a bit sleepy, or he might seem just fine.

How serious are febrile seizures?

Generally, febrile seizures aren't harmful to a child. Even in cases where the diagnosis is febrile seizure, doctors will try to identify and treat the source of fever. In particular, it is useful to distinguish the event as a simple febrile seizure - in which the seizure lasts less than 15 minutes, does not recur in the next 24 hours, and involves the entire body (classically a generalized tonic-clonic seizure). The complex febrile seizure is characterized by long duration, recurrence, or focus on only part of the body. The simple seizure represents the majority of cases and is considered to be less of a cause for concern than the complex. It is reassuring if the cause of seizure can indeed be determined to have been fever, as simple febrile seizures generally do not cause permanent brain injury; do not tend to recur frequently, as children tend to 'out-grow' them; and do not make the development of adult epilepsy significantly more likely (less than 3-5% which is similar to that of the general public).

How common are these seizures?
Between the ages of 6 months and 5 years, 3 to 5 percent of children will have a seizure. One-third of these children will have another seizure, and about half of those will have a third. Children who have their first febrile seizure in their first year of life are more likely to have another seizure than those who have one after their first birthday. It's rare for a child older than 5 to have one.

What should I do if my toddler has a seizure?
If your child has a febrile seizure, stay calm and follow these steps to help your child during the seizure:

  • Place your child on his or her side, somewhere where he or she won't fall.
  • Stay close to watch and comfort your child.
  • Remove any hard or sharp objects near your child.
  • Loosen any tight or restrictive clothing.
  • Don't restrain your child or interfere with your child's movements.
  • Don't attempt to put anything in your child's mouth.

If your toddler's temperature suddenly soars — for example, from 102 to 105 degrees F (38.9 to 40.5 degrees C), he may have a seizure. In most cases, these febrile seizures, as doctors call them, are harmless, but that doesn't make it any less terrifying if your child is having one.

If your child's having a febrile seizure — breathing heavily, drooling, turning blue, rolling back his eyes, or shaking his arms and legs uncontrollably — quickly place him on his side, away from hard objects. Make sure he doesn't have anything in his mouth, and don't put anything in his mouth while the seizure lasts. After it's over you can carefully wipe away any vomit with a washcloth. Try to remember to note how long the seizure lasts — usually between ten seconds and three to four minutes,so you can tell the doctor.

If your child's seizure lasts longer than a few minutes, or if he has difficulty breathing, he's choking, or his skin turns blue, call the emercency intitution. Otherwise, call your doctor after your child's seizure is over — no matter how short it was. She'll probably want to examine him to make sure he doesn't have a serious infection or other problem that caused the seizure. She may also recommend that you give your toddler acetaminophen and/or lukewarm sponge baths to bring down his fever.

When the seizure subsides, try to make your toddler more comfortable — and, possibly, prevent another attack — by lowering his temperature. If your child is alert, you can give him children's acetaminophen or ibuprofen. Remove his clothing and sponge him with lukewarm water. If he's alert and able to keep liquids down, give him some water to drink as well.

Even if the seizure was mild or lasted only seconds, call the doctor right away to see if she wants you to bring your toddler in. If your child has trouble breathing after his seizure, call the emercency intitution. If he started turning blue during the seizure, had convulsions that lasted for more than a few minutes, or is still drowsy or lethargic, take him to an emergency room right away.

Can these seizures be prevented with medicine?

Maybe, but 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.

Most of the time, a febrile seizure occurs the first day of an illness. Often, a febrile seizure occurs before parents realize that their child is ill.

Giving your child acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) at the first indication of fever will help reduce the fever, but won't necessarily prevent a seizure. You can also help control fever by making sure your child drinks plenty of fluids and not bundling him or her up too tightly at night.

Don't give aspirin to a child. Aspirin may trigger a rare but potentially fatal disorder known as Reye's syndrome.

Rarely, prescription medications are used to prevent febrile seizures. Anticonvulsant medications such as phenobarbital, valproic acid (Depakene) and divalproex sodium (Depakote) can prevent febrile seizures when taken daily. Oral or rectal diazepam (Valium, Diastat) also can reduce the risk of febrile seizures if taken at the time of a fever. But these medications all have drawbacks. They carry a definite risk of serious side effects in young children. Doctors rarely prescribe these prevention medications because most febrile seizures are harmless and most children outgrow them without any problems.

If my 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 aren't considered epilepsy, because children outgrow the risk of having a seizure caused by fever. A child with epilepsy has two or more seizures that aren't caused by fever.

Febrile seizures don't 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 didn't 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.

Children with febrile convulsions who are destined to suffer from afebrile epileptic attacks in the future will usually exhibit the following:

  • A family history of afebrile convulsions in first degree relatives (a parent or sibling)
  • A pre-convulsion history of abnormal neurological signs or developmental delay
  • A febrile convulsion lasting longer than 15 minutes
  • A febrile convulsion with strong indications of focal features before, during or afterward

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