Symptoms
Febrile convulsions manifest as seizures, which occur in infants and children in association with a febrile illness. The children shake involuntarily, have convulsions, roll their eyes, have difficulty breathing, and may lose consciousness. Seizures usually last less than 10 minutes, but may last more than half an hour in a minority. Most cases are seen between the ages of 6 months and 6 years. Those who have had a febrile seizure once are at increased risk for a recurrence. However, febrile convulsions are benign and only a small minority of children later develop epilepsy. The symptoms do not affect the child’s development or intelligence.
Causes
Febrile seizures result as a consequence of genetic predisposition (family history) and environmental factors. The immediate cause is usually a viral or bacterial infection that is associated with fever, for example, three-day fever. Vaccine-induced fever can also cause febrile convulsions. In this case, no infection of the central nervous system can be detected. The level of the fever does not necessarily matter, i.e., the convulsions may appear at low temperatures or on the way to recovery.
Diagnosis
When making the diagnosis, medical treatment must rule out possible other causes, such as meningitis, brain inflammation, febrile delirium, chills, and epilepsy.
Nonpharmacologic treatment
Most febrile convulsions pass on their own after a few minutes. The child should be reassured and lie comfortably in a safe place so that he or she cannot fall or hurt him or herself. Do not put anything in the mouth and let the child convulse. After the seizure, medical evaluation should be done. If the course is long and complicated, immediate medical treatment is indicated.
Drug treatment
For acute treatment of prolonged convulsions, the anticonvulsant and sedative benzodiazpines are used. Diazepam is administered orally or rectally (eg, Stesolid Microclisma, Diazepam Desitin Rectal Tubes), and midazolam is administered via the oral mucosa or nose. If seizures recur, the medications are given to parents to take home so they can administer them themselves if a seizure occurs. Intravenous injection is also possible with medical treatment. If convulsions persist despite treatment, medical help must be called. Antipyretic drugs such as acetaminophen and ibuprofen may relieve the discomfort of the febrile illness, but are unlikely to be effective in preventing the convulsions. Preventive administration of antiepileptic drugs is not recommended in the literature, or only in exceptional cases, because of the benign nature of the symptoms and the potential adverse effects of the drugs.
