Therapy | Febrile convulsion

Therapy

If a child develops a febrile spasm, it is important that the parents remain calm despite the often frightening situation, call a doctor and try to lower the fever. If the parents observe closely how the seizure manifests itself, i.e. if all limbs twitch or perhaps only one arm, if the child is unconscious, if the eyes are rolled or if he or she loses urine, it is later easier for the doctor to recognize whether it is a simple febrile seizure or a more complex seizure that needs further diagnostic clarification. The acute therapy with medication is as follows:

• To interrupt the seizure, the antispasmodic drug diazepam is administered into the buttocks (diazepam rectiole). The effect usually sets in after 2-3 minutes.
• In the case of a complicated febrile convulsion, an antiepileptic drug may be necessary (e.g. valproate).
• The fever can be lowered e.g. by paracetamol as juice or suppository.
• Since the febrile convulsion comes suddenly and is usually over faster than one could have an effect therapeutically, the preventive measures are more important than the measures in an acute attack.

Consequences

To answer the question about the consequences of febrile convulsions, one must first distinguish between simple and complicated febrile convulsions. About 70% of febrile convulsions are classified as simple.They last less than 5 minutes and the whole body is affected. In complicated cases, however, the individual attacks can last several minutes and are often only present on one side.

In addition, children have speech difficulties for a short time after the onset of a complex febrile seizure, but these usually disappear again. In general, one can say that simple febrile seizures do not have long-term consequences. The occurrence of epilepsy at a later age is also not or only slightly increased (approx.

1-1.5%) compared to the average population. In contrast, the risk of developing epilepsy in the course of a lifetime is increased by about 4-15% for complicated seizures. In such cases, however, the febrile convulsions are often not always the cause of a later epilepsy, but its first symptom.

In Dravet syndrome, for example, a febrile convulsion is often the first manifestation of the disease. In addition, febrile convulsions increase the risk of recurrence. However, this is largely dependent on the age of the child during the first febrile convulsion.

For example, the risk of a new seizure is about 30-35% in infants who had their first seizure when they were younger than 12 months. In children with already known brain damage or a family history of seizures, the risk of developing epilepsy later is significantly higher. Additional complicating factors are the occurrence of febrile convulsions before the age of 6 months or after the age of 5 years, with a duration of more than 15 minutes or with permanent focal findings in the brain, as well as considerable epileptic potentials in brain wave measurements.

In these cases, the occurrence of febrile convulsions can be a clear indication, which should be followed up and followed up by comprehensive diagnostics. In contrast to many older claims, new long-term studies have shown that febrile convulsions do not have a long-term influence on mental and physical functions. The old claim that children who have suffered from febrile convulsions in the past have a reduced intelligence quotient (IQ) is therefore not true.

This has been shown especially by large studies with twins, where one of the children had febrile convulsions and the other did not. If you measure the IQ in these children after many years, no significant differences could be found. Only the development of epilepsy can lead to permanent damage in the further course of the disease.

In principle, febrile convulsions are never fatal. Depending on the type of febrile convulsion, simple or complicated, they subside after less or more than 15 minutes. The child is then very tired and weak.

With regard to long-term mortality, the study situation is not clear in some respects. Common to all studies is that simple febrile convulsions do not result in increased infant mortality. With regard to complicated seizures, two large-scale studies differ in their statements. For example, a Danish study found that children who suffered from complicated febrile convulsions had a slightly increased risk of mortality in the first two years. However, it must be noted that a certain proportion of children with these cramps already suffered from neurological deficits that can be linked to the increased risk.