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Pediatric Febrile Seizures

Author: Robert J Baumann, MD; Chief Editor: Amy Kao, MD more...

Updated: Oct 14, 2015

Practice Essentials
Pediatric febrile seizures, which represent the most common childhood seizure
disorder, exist only in association with an elevated temperature. Evidence suggests,
however, that they have little connection with cognitive function, so the prognosis for
normal neurologic function is excellent in children with febrile seizures.[1]

Epidemiologic studies have led to the division of febrile seizures into 3 groups, as
follows:

Simple febrile seizures

Complex febrile seizures
Symptomatic febrile seizures

Essential update: Starting MMR/MMRV vaccination earlier may

reduce seizure risk

In a case-series analysis of a cohort of 323,247 US children born from 2004 to 2008,

Hambidge et al found that delaying the first dose of measles-mumps-rubella (MMR)
or measles-mumps-rubella-varicella (MMRV) vaccine beyond the age of 15 months
may more than double the risk of postvaccination seizures in the second year of
life.[2, 3]

In infants, there was no association between vaccination timing and postvaccination

seizures.[3] In the second year of life, however, the incident rate ratio (IRR) for
seizures within 7-10 days was 2.65 (95% confidence interval [CI], 1.99-3.55) after
first MMR doses at 12-15 months of age, compared with 6.53 (95% CI, 3.15-13.53)
after first MMR doses at 16-23 months. For the MMRV vaccine, the IRR for seizures
was 4.95 (95% CI, 3.68-6.66) after first doses at 12-15 months, compared with 9.80
(95% CI, 4.35-22.06) for first doses at 16-23 months.

Signs and symptoms

Simple febrile seizure

The setting is fever in a child aged 6 months to 5 years

The single seizure is generalized and lasts less than 15 minutes
The child is otherwise neurologically healthy and without neurologic
abnormality by examination or by developmental history
Fever (and seizure) is not caused by meningitis, encephalitis, or any other
illness affecting the brain
The seizure is described as either a generalized clonic or a generalized tonic-
clonic seizure

Complex febrile seizure

Age, neurologic status before the illness, and fever are the same as for
simple febrile seizure
This seizure is either focal or prolonged (ie, >15 min), or multiple seizures
occur in close succession

Symptomatic febrile seizure

Age and fever are the same as for simple febrile seizure
The child has a preexisting neurologic abnormality or acute illness

See Clinical Presentation for more detail.

Diagnosis

No specific laboratory studies are indicated for a simple febrile seizure. Physicians
should instead focus on diagnosing the cause of fever. Other laboratory tests may
be indicated by the nature of the underlying febrile illness. For example, a child with
severe diarrhea may benefit from blood studies for electrolytes.

With regard to lumbar puncture, the following should be kept in mind:

Strongly consider lumbar puncture in children younger than 12 months,

because the signs and symptoms of bacterial meningitis may be minimal or
absent in this age group
Lumbar puncture should be considered in children aged 12-18 months,
because clinical signs and symptoms of bacterial meningitis may be subtle in
this age group
In children older than 18 months, the decision to perform lumbar puncture
rests on the clinical suspicion of meningitis

See Workup for more detail.

Management

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Pediatric Febrile Seizures: Practice Essentials, Background, Pathophys... http://emedicine.medscape.com/article/1176205-overview#showall

On the basis of risk/benefit analysis, neither long-term nor intermittent

anticonvulsant therapy is indicated for children who have experienced 1 or more
simple febrile seizures.

If, however, preventing subsequent febrile seizures is essential, oral diazepam

would be the treatment of choice. It can reduce the risk of febrile seizure recurrence
and, because it is intermittent, probably has the fewest adverse effects.[4]

See Treatment and Medication for more detail.

Background
Febrile seizures are the most common seizure disorder in childhood. Since early in
the 20th century, people have debated about whether these children would benefit
from daily anticonvulsant therapy. Epidemiologic studies have led to the division of
febrile seizures into 3 groups, as follows: simple febrile seizures, complex febrile
seizures, and symptomatic febrile seizures.

Simple febrile seizure

See the list below:

The setting is fever in a child aged 6 months to 5 years.

The single seizure is generalized and lasts less than 15 minutes.
The child is otherwise neurologically healthy and without neurological
abnormality by examination or by developmental history.
Fever (and seizure) is not caused by meningitis, encephalitis, or other illness
affecting the brain.

Complex febrile seizure

See the list below:

Age, neurological status before the illness, and fever are the same as for
simple febrile seizure.
This seizure is either focal or prolonged (ie, >15 min), or multiple seizures
occur in close succession.

Symptomatic febrile seizure

See the list below:

Age and fever are the same as for simple febrile seizure.
The child has a preexisting neurological abnormality or acute illness.

Pathophysiology
This is a unique form of epilepsy that occurs in early childhood and only in
association with an elevation of temperature. The underlying pathophysiology is
unknown, but genetic predisposition clearly contributes to the occurrence of this
disorder.[5]

Frequency
United States

Febrile seizures occur in 2-5% of children aged 6 months to 5 years in industrialized

countries. Among children with febrile seizures, about 70-75% have only simple
febrile seizures, another 20-25% have complex febrile seizures, and about 5% have
symptomatic febrile seizures.

Mortality/Morbidity
See the list below:

Children with a previous simple febrile seizure are at increased risk of

recurrent febrile seizures; this occurs in approximately one third of cases.
Children younger than 12 months at the time of their first simple febrile
seizure have a 50% probability of having a second seizure. After 12 months,
the probability decreases to 30%.
Children who have simple febrile seizures are at an increased risk for
epilepsy. The rate of epilepsy by age 25 years is approximately 2.4%, which
is about twice the risk in the general population.
The literature does not support the hypothesis that simple febrile seizures
lower intelligence (ie, cause a learning disability) or are associated with
increased mortality [6] .

Sex

Males have a slightly (but definite) higher incidence of febrile seizures.

Age

Simple febrile seizures occur most commonly in children aged 6 months to 5 years.

Clinical Presentation

Contributor Information and Disclosures

Author

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Pediatric Febrile Seizures: Practice Essentials, Background, Pathophys... http://emedicine.medscape.com/article/1176205-overview#showall

Robert J Baumann, MD Professor of Neurology and Pediatrics, Department of Neurology, University of Kentucky
College of Medicine

Robert J Baumann, MD is a member of the following medical societies: American Academy of Neurology,
American Academy of Pediatrics, Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College
of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kenneth J Mack, MD, PhD Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo
Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child
Neurology Society, Phi Beta Kappa, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor
Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American
Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from
Express Scripts.

Additional Contributors
James J Riviello, Jr, MD George Peterkin Endowed Chair in Pediatrics, Professor of Pediatrics, Section of
Neurology and Developmental Neuroscience, Professor of Neurology, Peter Kellaway Section of Neurophysiology,
Baylor College of Medicine; Chief of Neurophysiology, Director of the Epilepsy and Neurophysiology Program,
Texas Children's Hospital

James J Riviello, Jr, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Partner received royalty from Up To Date for section editor.

References

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4. Rosman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses
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13. [Guideline] Riemenschneider TA, Baumann RJ, Duffner PK, et al. Practice parameter: the neurodiagnostic
evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional
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