Review on Febrile Seizures in Children

Background: Febrile seizures are a common, yet benign neurological disorder and characterized by convulsions associated with fever in childhood due to the effect of fever on the immature brain. All treating clinicians must understand the nature and evaluation of this benign condition.

Objective: To provide up-to-date knowledge on febrile seizures and their evaluation.

Methods: A search was conducted with key terms “febrile seizures” or “febrile convulsion” in various databases and writings. The literature included clinical trials, descriptive and observational studies, meta-analyses, and randomized control trials.

Results: Febrile seizures occur between the ages of 6 months to 5 years in all ethnic groups. The exact mechanism has been still unknown although several etiologies have been proposed including genetic and environmental factors. Febrile seizures can be either simple or complex. Febrile seizures generally occur within the first day of fever but rarely happen after 24 hours. Most of the time, febrile convulsions are short-lasting and self-limiting. The diagnosis is mainly based on the clinical description, and investigations have a limited role. Children less than one year of age with suspicion of bacterial infection need lumbar puncture to exclude meningitis. Management mostly depends on control of fever and the treatment of underlying conditions which precipitate fever. Some children can have prolonged convulsions which need anticonvulsants to abort an acute attack. Otherwise, long term prophylactic anticonvulsants have an insignificant role in the prevention of recurrences of febrile seizures. Physical methods also play an insignificant role. As the condition commonly carries a favorable prognosis, unnecessary interventions should be avoided. Since febrile seizures recur in a significant proportion of children, they may bring needless fears and anxieties in parents. However, proper health education for parents by health care personnel might alleviate the anxiety and improve the quality of life of children with febrile seizures.

Conclusion: Febrile convulsions are benign and self-limiting. Continuous use of anticonvulsants to prevent the recurrence of febrile seizures is not endorsed. Intermittent prophylaxis at the time of fever is also not routinely recommended. Both physical methods and antipyretics have limited value in the prevention of febrile seizures.