Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:

Subscribers log in here

Febrile seizures


Febrile seizures are a common cause of convulsions in young children. They occur in 2 to 4 percent of children younger than five years of age, but the incidence is as high as 15 percent in some populations. This incidence has been attributed to closer living arrangements among family members making detection more likely, but racial and geographic variations may also be important.

The generally accepted criteria for febrile seizures include:

A convulsion associated with an elevated temperature greater than 38°C

A child younger than six years of age

No central nervous system infection or inflammation


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Mar 28, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
  1. Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics 2008; 121:1281.
  2. Nakayama J. Progress in searching for the febrile seizure susceptibility genes. Brain Dev 2009; 31:359.
  3. Heida JG, Moshé SL, Pittman QJ. The role of interleukin-1beta in febrile seizures. Brain Dev 2009; 31:388.
  4. Shibasaki K, Suzuki M, Mizuno A, Tominaga M. Effects of body temperature on neural activity in the hippocampus: regulation of resting membrane potentials by transient receptor potential vanilloid 4. J Neurosci 2007; 27:1566.
  5. Thomas EA, Hawkins RJ, Richards KL, et al. Heat opens axon initial segment sodium channels: a febrile seizure mechanism? Ann Neurol 2009; 66:219.
  6. Schuchmann S, Schmitz D, Rivera C, et al. Experimental febrile seizures are precipitated by a hyperthermia-induced respiratory alkalosis. Nat Med 2006; 12:817.
  7. Chung B, Wong V. Relationship between five common viruses and febrile seizure in children. Arch Dis Child 2007; 92:589.
  8. Hall CB, Long CE, Schnabel KC, et al. Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med 1994; 331:432.
  9. Suga S, Suzuki K, Ihira M, et al. Clinical characteristics of febrile convulsions during primary HHV-6 infection. Arch Dis Child 2000; 82:62.
  10. Epstein LG, Shinnar S, Hesdorffer DC, et al. Human herpesvirus 6 and 7 in febrile status epilepticus: the FEBSTAT study. Epilepsia 2012; 53:1481.
  11. Barlow WE, Davis RL, Glasser JW, et al. The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine. N Engl J Med 2001; 345:656.
  12. von Spiczak S, Helbig I, Drechsel-Baeuerle U, et al. A retrospective population-based study on seizures related to childhood vaccination. Epilepsia 2011; 52:1506.
  13. Löscher W, Rating D, Siemes H. GABA in cerebrospinal fluid of children with febrile convulsions. Epilepsia 1981; 22:697.
  14. Knight M, Ebert J, Parish RA, et al. gamma-Aminobutyric acid in CSF of children with febrile seizures. Arch Neurol 1985; 42:474.
  15. Kawakami Y, Fukunaga Y, Kuwabara K, et al. Clinical and immunological significance of neopterin measurement in cerebrospinal fluid in patients with febrile convulsions. Brain Dev 1999; 21:458.
  16. Daoud AS, Batieha A, Abu-Ekteish F, et al. Iron status: a possible risk factor for the first febrile seizure. Epilepsia 2002; 43:740.
  17. Febrile Seizures, Nelson KB, Ellenberg JH. (Eds), Raven Press, New York 1981.
  18. Kira R, Ishizaki Y, Torisu H, et al. Genetic susceptibility to febrile seizures: case-control association studies. Brain Dev 2010; 32:57.
  19. Wallace RH, Berkovic SF, Howell RA, et al. Suggestion of a major gene for familial febrile convulsions mapping to 8q13-21. J Med Genet 1996; 33:308.
  20. Johnson EW, Dubovsky J, Rich SS, et al. Evidence for a novel gene for familial febrile convulsions, FEB2, linked to chromosome 19p in an extended family from the Midwest. Hum Mol Genet 1998; 7:63.
  21. Kugler SL, Stenroos ES, Mandelbaum DE, et al. Hereditary febrile seizures: phenotype and evidence for a chromosome 19p locus. Am J Med Genet 1998; 79:354.
  22. Peiffer A, Thompson J, Charlier C, et al. A locus for febrile seizures (FEB3) maps to chromosome 2q23-24. Ann Neurol 1999; 46:671.
  23. Nakayama J, Hamano K, Iwasaki N, et al. Significant evidence for linkage of febrile seizures to chromosome 5q14-q15. Hum Mol Genet 2000; 9:87.
  24. Nakayama J, Fu YH, Clark AM, et al. A nonsense mutation of the MASS1 gene in a family with febrile and afebrile seizures. Ann Neurol 2002; 52:654.
  25. Nabbout R, Prud'homme JF, Herman A, et al. A locus for simple pure febrile seizures maps to chromosome 6q22-q24. Brain 2002; 125:2668.
  26. Poduri A, Wang Y, Gordon D, et al. Novel susceptibility locus at chromosome 6q16.3-22.31 in a family with GEFS+. Neurology 2009; 73:1264.
  27. Hedera P, Ma S, Blair MA, et al. Identification of a novel locus for febrile seizures and epilepsy on chromosome 21q22. Epilepsia 2006; 47:1622.
  28. Nakayama J, Yamamoto N, Hamano K, et al. Linkage and association of febrile seizures to the IMPA2 gene on human chromosome 18. Neurology 2004; 63:1803.
  29. Schlachter K, Gruber-Sedlmayr U, Stogmann E, et al. A splice site variant in the sodium channel gene SCN1A confers risk of febrile seizures. Neurology 2009; 72:974.
  30. Petrovski S, Scheffer IE, Sisodiya SM, et al. Lack of replication of association between scn1a SNP and febrile seizures. Neurology 2009; 73:1928.
  31. Scheffer IE, Berkovic SF. Generalized epilepsy with febrile seizures plus. A genetic disorder with heterogeneous clinical phenotypes. Brain 1997; 120 ( Pt 3):479.
  32. Singh R, Scheffer IE, Crossland K, Berkovic SF. Generalized epilepsy with febrile seizures plus: a common childhood-onset genetic epilepsy syndrome. Ann Neurol 1999; 45:75.
  33. Thomas RH, Johnston JA, Hammond CL, et al. Genetic epilepsy with febrile seizures plus: definite and borderline phenotypes. J Neurol Neurosurg Psychiatry 2012; 83:336.
  34. Scheffer IE, Harkin LA, Grinton BE, et al. Temporal lobe epilepsy and GEFS+ phenotypes associated with SCN1B mutations. Brain 2007; 130:100.
  35. Escayg A, Goldin AL. Sodium channel SCN1A and epilepsy: mutations and mechanisms. Epilepsia 2010; 51:1650.
  36. Wallace RH, Wang DW, Singh R, et al. Febrile seizures and generalized epilepsy associated with a mutation in the Na+-channel beta1 subunit gene SCN1B. Nat Genet 1998; 19:366.
  37. Sugawara T, Mazaki-Miyazaki E, Ito M, et al. Nav1.1 mutations cause febrile seizures associated with afebrile partial seizures. Neurology 2001; 57:703.
  38. Baulac S, Gourfinkel-An I, Picard F, et al. A second locus for familial generalized epilepsy with febrile seizures plus maps to chromosome 2q21-q33. Am J Hum Genet 1999; 65:1078.
  39. Lopes-Cendes I, Scheffer IE, Berkovic SF, et al. A new locus for generalized epilepsy with febrile seizures plus maps to chromosome 2. Am J Hum Genet 2000; 66:698.
  40. Zuberi SM, Brunklaus A, Birch R, et al. Genotype-phenotype associations in SCN1A-related epilepsies. Neurology 2011; 76:594.
  41. Baulac S, Gourfinkel-An I, Couarch P, et al. A novel locus for generalized epilepsy with febrile seizures plus in French families. Arch Neurol 2008; 65:943.
  42. Escayg A, MacDonald BT, Meisler MH, et al. Mutations of SCN1A, encoding a neuronal sodium channel, in two families with GEFS+2. Nat Genet 2000; 24:343.
  43. Baulac S, Huberfeld G, Gourfinkel-An I, et al. First genetic evidence of GABA(A) receptor dysfunction in epilepsy: a mutation in the gamma2-subunit gene. Nat Genet 2001; 28:46.
  44. Audenaert D, Schwartz E, Claeys KG, et al. A novel GABRG2 mutation associated with febrile seizures. Neurology 2006; 67:687.
  45. Wallace RH, Marini C, Petrou S, et al. Mutant GABA(A) receptor gamma2-subunit in childhood absence epilepsy and febrile seizures. Nat Genet 2001; 28:49.
  46. Fernández G, Effenberger O, Vinz B, et al. Hippocampal malformation as a cause of familial febrile convulsions and subsequent hippocampal sclerosis. Neurology 1998; 50:909.
  47. Shinnar S, Bello JA, Chan S, et al. MRI abnormalities following febrile status epilepticus in children: the FEBSTAT study. Neurology 2012; 79:871.
  48. Dube C, Chen K, Eghbal-Ahmadi M, et al. Prolonged febrile seizures in the immature rat model enhance hippocampal excitability long term. Ann Neurol 2000; 47:336.
  49. Kim SH, Lee HY, Kim YH. Subsequent afebrile seizure in children who have a first seizure with fever after 6 years of age. Pediatr Neurol 2010; 43:122.
  50. Hesdorffer DC, Benn EK, Bagiella E, et al. Distribution of febrile seizure duration and associations with development. Ann Neurol 2011; 70:93.
  51. Carroll W, Brookfield D. Lumbar puncture following febrile convulsion. Arch Dis Child 2002; 87:238.
  52. Oluwabusi T, Sood SK. Update on the management of simple febrile seizures: emphasis on minimal intervention. Curr Opin Pediatr 2012; 24:259.
  53. Kimia AA, Capraro AJ, Hummel D, et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics 2009; 123:6.
  54. Kimia A, Ben-Joseph EP, Rudloe T, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics 2010; 126:62.
  55. Subcommittee on Febrile Seizures, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011; 127:389.
  56. Chin RF, Neville BG, Scott RC. Meningitis is a common cause of convulsive status epilepticus with fever. Arch Dis Child 2005; 90:66.
  57. Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 2006; 368:222.
  58. Sadleir LG, Scheffer IE. Febrile seizures. BMJ 2007; 334:307.
  59. Haeusler GM, Tebruegge M, Curtis N. Question 1. Do febrile convulsions cause CSF pleocytosis? Arch Dis Child 2012; 97:172.
  60. Thoman JE, Duffner PK, Shucard JL. Do serum sodium levels predict febrile seizure recurrence within 24 hours? Pediatr Neurol 2004; 31:342.
  61. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics 1996; 97:769.
  62. Teng D, Dayan P, Tyler S, et al. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics 2006; 117:304.
  63. Kimia AA, Ben-Joseph E, Prabhu S, et al. Yield of emergent neuroimaging among children presenting with a first complex febrile seizure. Pediatr Emerg Care 2012; 28:316.
  64. Kanemura H, Mizorogi S, Aoyagi K, et al. EEG characteristics predict subsequent epilepsy in children with febrile seizure. Brain Dev 2012; 34:302.
  65. Knudsen FU. Febrile seizures: treatment and prognosis. Epilepsia 2000; 41:2.
  66. Berg AT, Shinnar S. Complex febrile seizures. Epilepsia 1996; 37:126.
  67. Vestergaard M, Pedersen MG, Ostergaard JR, et al. Death in children with febrile seizures: a population-based cohort study. Lancet 2008; 372:457.
  68. Berg AT, Shinnar S, Darefsky AS, et al. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med 1997; 151:371.
  69. Offringa M, Bossuyt PM, Lubsen J, et al. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr 1994; 124:574.
  70. Frantzen E, Lennox-Buchthal M, Nygaard A. Longitudinal EEG and clinical study of children with febrile convulsions. Electroencephalogr Clin Neurophysiol 1968; 24:197.
  71. Berg AT, Shinnar S, Hauser WA, et al. A prospective study of recurrent febrile seizures. N Engl J Med 1992; 327:1122.
  72. Pavlidou E, Tzitiridou M, Kontopoulos E, Panteliadis CP. Which factors determine febrile seizure recurrence? A prospective study. Brain Dev 2008; 30:7.
  73. Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics 1978; 61:720.
  74. Berg AT, Darefsky AS, Holford TR, Shinnar S. Seizures with fever after unprovoked seizures: an analysis in children followed from the time of a first febrile seizure. Epilepsia 1998; 39:77.
  75. Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med 1998; 338:1723.
  76. Nørgaard M, Ehrenstein V, Mahon BE, et al. Febrile seizures and cognitive function in young adult life: a prevalence study in Danish conscripts. J Pediatr 2009; 155:404.
  77. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976; 295:1029.
  78. Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med 1987; 316:493.
  79. Vestergaard M, Pedersen CB, Sidenius P, et al. The long-term risk of epilepsy after febrile seizures in susceptible subgroups. Am J Epidemiol 2007; 165:911.
  80. Neligan A, Bell GS, Giavasi C, et al. Long-term risk of developing epilepsy after febrile seizures: a prospective cohort study. Neurology 2012; 78:1166.
  81. Berg AT, Shinnar S, Levy SR, Testa FM. Childhood-onset epilepsy with and without preceding febrile seizures. Neurology 1999; 53:1742.
  82. Barr WB, Ashtari M, Schaul N. Bilateral reductions in hippocampal volume in adults with epilepsy and a history of febrile seizures. J Neurol Neurosurg Psychiatry 1997; 63:461.
  83. Theodore WH, Bhatia S, Hatta J, et al. Hippocampal atrophy, epilepsy duration, and febrile seizures in patients with partial seizures. Neurology 1999; 52:132.
  84. Tanabe T, Hara K, Shimakawa S, et al. Hippocampal damage after prolonged febrile seizure: one case in a consecutive prospective series. Epilepsia 2011; 52:837.
  85. VanLandingham KE, Heinz ER, Cavazos JE, Lewis DV. Magnetic resonance imaging evidence of hippocampal injury after prolonged focal febrile convulsions. Ann Neurol 1998; 43:413.
  86. Scott RC, King MD, Gadian DG, et al. Hippocampal abnormalities after prolonged febrile convulsion: a longitudinal MRI study. Brain 2003; 126:2551.
  87. Scott RC, King MD, Gadian DG, et al. Prolonged febrile seizures are associated with hippocampal vasogenic edema and developmental changes. Epilepsia 2006; 47:1493.
  88. Provenzale JM, Barboriak DP, VanLandingham K, et al. Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis. AJR Am J Roentgenol 2008; 190:976.
  89. Auer T, Barsi P, Bone B, et al. History of simple febrile seizures is associated with hippocampal abnormalities in adults. Epilepsia 2008; 49:1562.
  90. Hamati-Haddad A, Abou-Khalil B. Epilepsy diagnosis and localization in patients with antecedent childhood febrile convulsions. Neurology 1998; 50:917.
  91. Shinnar S, Hesdorffer DC, Nordli DR Jr, et al. Phenomenology of prolonged febrile seizures: results of the FEBSTAT study. Neurology 2008; 71:170.
  92. Seinfeld S, Shinnar S, Sun S, et al. Emergency management of febrile status epilepticus: results of the FEBSTAT study. Epilepsia 2014; 55:388.
  93. Shinnar S, Pellock JM, Berg AT, et al. Short-term outcomes of children with febrile status epilepticus. Epilepsia 2001; 42:47.
  94. Bassan H, Barzilay M, Shinnar S, et al. Prolonged febrile seizures, clinical characteristics, and acute management. Epilepsia 2013; 54:1092.
  95. Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366:591.
  96. Lewis DV, Shinnar S, Hesdorffer DC, et al. Hippocampal sclerosis after febrile status epilepticus: the FEBSTAT study. Ann Neurol 2014; 75:178.
  97. Maytal J, Shinnar S. Febrile status epilepticus. Pediatrics 1990; 86:611.
  98. Nordli DR, Moshé SL, Shinnar S. The role of EEG in febrile status epilepticus (FSE). Brain Dev 2010; 32:37.
  99. Practice parameter: long-term treatment of the child with simple febrile seizures. American Academy of Pediatrics. Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics 1999; 103:1307.
  100. Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev 2012; 4:CD003031.
  101. Rosman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med 1993; 329:79.
  102. Hirabayashi Y, Okumura A, Kondo T, et al. Efficacy of a diazepam suppository at preventing febrile seizure recurrence during a single febrile illness. Brain Dev 2009; 31:414.
  103. Verrotti A, Latini G, di Corcia G, et al. Intermittent oral diazepam prophylaxis in febrile convulsions: its effectiveness for febrile seizure recurrence. Eur J Paediatr Neurol 2004; 8:131.
  104. Lux AL. Treatment of febrile seizures: historical perspective, current opinions, and potential future directions. Brain Dev 2010; 32:42.
  105. Meremikwu M, Oyo-Ita A. Paracetamol for treating fever in children. Cochrane Database Syst Rev 2002; :CD003676.
  106. Uhari M, Rantala H, Vainionpää L, Kurttila R. Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures. J Pediatr 1995; 126:991.
  107. Strengell T, Uhari M, Tarkka R, et al. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 2009; 163:799.