Treatment and prognosis of febrile seizures
- John J Millichap, MD, FAAP
John J Millichap, MD, FAAP
- Assistant Professor of Pediatrics and Neurology
- Northwestern University Feinberg School of Medicine
- J. Gordon Millichap, MD, FRCP
J. Gordon Millichap, MD, FRCP
- Professor Emeritus of Pediatrics and Neurology
- Northwestern University Feinberg School of Medicine
Febrile seizures are the most common neurologic disorder of infants and young children, occurring in 2 to 4 percent of children younger than five years of age. They are an age-dependent phenomenon with a strong genetic predisposition. While often frightening to parents and witnesses, febrile seizures are a mostly benign occurrence and are associated with a low risk for future epilepsy. Approximately one-third of children will have recurrent febrile seizures during early childhood, and the risk is increased in association with certain clinical features, including young age, low fever, family history of febrile seizures, and abnormal development at the time of first seizure.
Febrile seizures are described as being simple or complex. Simple febrile seizures are the most common type and are characterized by a single generalized seizure lasting less than 10 to 15 minutes. Complex febrile seizures include those that are focal, prolonged, or recurrent within a 24-hour period. (See "Clinical features and evaluation of febrile seizures".)
While simple febrile seizures have typically spontaneously resolved by the time the child is evaluated and do not need to be treated, prolonged seizures may require abortive treatment with benzodiazepines in the ambulance or in the emergency department. Prophylactic antiseizure drugs can decrease the risk of recurrent febrile seizures, but given the benign nature of most seizures, the risks of side effects generally outweigh the benefits.
This topic will review the treatment and prognosis of febrile seizures, including febrile status epilepticus. Management of afebrile seizures and epilepsy in infants and children are discussed separately. (See "Seizures and epilepsy in children: Initial treatment and monitoring".)
The initial evaluation of children with seizure in the setting of fever must distinguish febrile seizure from alternative and more serious etiologies such as central nervous system infection. This can be accomplished with a thorough history and physical examination in most cases, along with neuroimaging and lumbar puncture in selected circumstances. Children with focal or prolonged febrile seizures may require more extensive evaluation than those with simple febrile seizures, particularly at the time of the first seizure. Therapies discussed below assume that such etiologies have been ruled out and that the diagnosis of febrile seizure has been established. (See "Clinical features and evaluation of febrile seizures".)
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- INITIAL ASSESSMENT
- ACUTE MANAGEMENT
- Emergency rescue therapy
- Febrile status epilepticus
- Prehospital treatment
- DISCHARGE DISPOSITION
- RECURRENT FEBRILE SEIZURES
- Risk factors for recurrence
- Provision of home benzodiazepines
- Role of preventive therapy
- - Antiseizure therapy
- - Antipyretics
- Neurologic outcomes
- Subsequent epilepsy
- - Electroencephalogram and risk of epilepsy
- - Subsequent temporal lobe epilepsy
- Febrile status epilepticus
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS