Seizure, Febrile

Seizure, Febrile is a topic covered in the 5-Minute Emergency Consult.

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  • Occurs between 6 mo and 5 yr of age associated with fever:
    • No evidence of intracranial infection or other defined CNS primary cause
    • Average age of onset is 18–22 mo
    • Children with previous nonfebrile seizures excluded
  • Most common pediatric convulsive disorder:
    • Affects 2–4% of young children in US
  • Occurs in normal children with a systemic viral illness
  • High-risk children:
    • History of febrile seizure in immediate family members
    • Delayed neurologic development
    • Males
  • Subgroups:
    • Simple febrile seizures:
      • Brief, self-limited lasting <10–15 min, resolve spontaneously
      • Generalized without any focal features
    • Complex febrile seizures:
      • Duration >15 min
      • Focal features
      • More than 1 seizure within a 24-hr period
  • Risk of recurrence:
    • One-third of cases
    • Early age of onset, history of febrile or afebrile seizures in 1st-degree relatives, and temperature <40°C during initial seizure increase the likelihood of recurrence
  • Risk of subsequent epilepsy:
    • Greatest for those with prior abnormal neurologic development, a complex (>15 min) 1st febrile seizure, a focal seizure, or a family history of afebrile seizures
    • Only slightly greater than the general population if 1st febrile seizure is simple and neurologic development normal
    • Not affected by the use of prophylactic medications

Because this is usually self-limited, intervention must be individualized in relation to airway, breathing, and seizure management


Common childhood infections:
  • Upper respiratory illnesses
  • Otitis media
  • Roseola
  • GI infections
  • Shigella gastroenteritis

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