Febrile
Seizures
The long hot summer months are over, and
with the cooler weather comes the beginning of the flu and cold
season. Pediatricians across the country are gearing up for their
busiest time of the year.
A very common complaint heard during the
early fall is "my child has a fever." Many parents are
concerned about the harmful effects of a fever. Fortunately, the
harmful effects of fever are very limited. Many children feel
uncomfortable during the fever, and so it is appropriate to take
measures directed at symptomatically reducing the fever. However,
when treating a child with fever, it is very important to determine
the cause of the fever. Once the cause is determined, treatment
is relatively straightforward.
Although fever itself is not known to produce
any harmful effects in children, a resulting condition, febrile
seizures, can be very frightening for both the child and parents.
These seizures are a direct result of the fever, and other than
being a very frightening experience for the parents of the child,
the vast majority of febrile seizures are not harmful and have
no significant lasting effects.
FEBRILE SEIZURE
Febrile seizure is a common form of seizure
in that is most often seen in children. Typically, these seizures
are generalized (shaking and convulsing) and last less than 10
minutes (some physicians say 15 to 20 minutes is more typical).
The Health Consensus Development Conference of Febrile Seizure
defined the condition as "an event in infancy or childhood
usually occurring between three months and five years of age,
associated with fever but without evidence of intracranial infection
or defined cause." There are typically no lasting effects
from the seizure after it has ended, and children generally return
to their normal mental status very quickly. When an EEG (a test
used to help diagnose conditions such as epilepsy) is conducted,
the results are usually normal.
There is some evidence that febrile seizures
run in families; however, there is no indication that a child
who has had a febrile seizure will later develop a chronic seizure
disorder. Not all children who have fever will have seizures.
The most common situation is when a child who has been well suddenly
develops fever that rises to a high temperature (usually above
102 degrees). The speed at which the temperature rises seems to
be the most common factor in those who have a febrile seizure.
Once a child has a febrile seizure, it is rare that a second seizure
will occur within a 24-hour period. The incidence of febrile seizure
in the general public is approximately 4 percent, and of those
who have experienced a febrile seizure, approximately 30 percent
will have a recurrence. If seizures continue when a child is over
five years old, the possibility of other conditions being present
should be considered (such as epilepsy).
The first febrile seizure is of the most
concern. It should be determined that there is not a more significant
cause for the seizure activity such as an intracranial infection
(meningitis, encephalitis), sepsis, or bacteremia. It is critical
to rule out these serious illnesses first before the diagnosis
of a simple febrile seizure can be established. The initial evaluation
will address the more serious causes of seizure; thus, a number
of tests need to be performed (blood work and X-rays). Lumbar
puncture (spinal tap) is warranted with the first febrile seizure
or whenever intracranial sepsis is a concern. If a cause it not
found and the child is ill, admission and further workup is needed.
Underlying diseases should be diagnosed.
When a child arrives in the emergency room
with a febrile seizure, the first concern is to stop the seizures
and bring the temperature down. Often the seizure will have stopped
by the time the family has brought the child to the hospital.
Most febrile seizures will pass without any intervention; however,
if a seizure continues, there are a number of medicines that can
be used to control the seizure activity (see below).
Steps to evaluate a febrile seizure
1. Administer benzodiazepines (Valium,
Ativan) followed by Phenobarbital if needed to control the seizure.
2. Interrupt the fever gradually with tepid
baths (do not use alcohol) and acetaminophen and/or ibuprofen.
3. Identify the source of infection and
do a lumbar puncture if meningitis or encephalitis is suspected,
or if unexplained febrile seizure occurs for the first time.
4. Arrange for follow-up studies with the
child's family physician.
5. Admit the ill child who does not have
an easily treated problem or the child in whom more than one seizure
occurs within several hours or within one day.
6. Obtain an EEG when appropriate. An abnormal
EEG may be helpful as a further indication of a convulsive disorder.
When the seizure occurs, it is very important
that parents try to stay calm and remain in control to reassure
the sick child. All first febrile seizures need to be evaluated
by a physician, but it is important to realize that incidence
of death as a result of febrile seizures is very low.
Do not hesitate to have your child evaluated
by a health care professional when your child is seriously ill.
If you have any questions regarding febrile
seizures or any other medical condition, please call the St. Elizabeth
Hospital Emergency Room (225-647-5000), or consult your primary
care doctor.
St. Elizabeth is the premiere emergent
care facility in Ascension Parish. It is open 24 hours a day with
highly trained doctors and nurses who are committed to the health
and safety of the residents of Ascension Parish.
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