Febrile seizure
Core messages
Febrile seizure (FS) is the most common form of seizure
in children, occurring in 3–4%. Criteria for diagnosis are
shown in Box 2. Although FS should be distinguished
from epilepsy, there is a slightly increased risk of epilepsy
in children with FS, particularly if children experience
repeated FS (Hauser, 1989).
FS is divided into simple (80% incidence) and complex
(20% incidence). Children with complex FS have focal
features (one side of the body convulsing, e.g. hand,
arm or leg, or both arm and leg) that can be prolonged
(>10 minutes) and can be repeated in the same illness,
usually within 24 hours of the first seizure.
Viral infections, particularly human herpes virus 6, trigger
most FS. Bacterial illnesses are infrequently implicated in
the triggering of FS, except malaria, shigella and salmonella.
Bacteraemia occurs in about 2% of cases.
About one-third of children with FS will have at least
one recurrence. Recurrent FS is more likely if the child
is younger than 1 year at the time of the first FS, the fever
provoking the first FS was relatively low, and there is a
family history of FS.
Routine brain imaging and electroencephalography (EEG)
are not indicated after FS. The risk of epilepsy following FSs is
7% at 25 years of age
Regular prophylactic medication to prevent recurrent FS
is not recommended. Antipyretics such as paracetamol are
frequently used to prevent FS, but there is no evidence that
they do (El-Radhi and Barry, 2003).
The prognosis for a child with recurrent FS is generally
good. Development is usually unaffected.