Febrile seizures affect at least 2% of children in the United States, generally presenting in toddlers near age 2, but with an overall range from 3 months to 5 years. Typical seizures cause tonic-clonic motor activity lasting 1 or 2 minutes with rapid return of consciousness. Seizures tend to occur in conjunction with a rapid rise in body temperature and usually occur only once during any given illness.
Atypical febrile seizures deviate from the norm in at least one of the following ways:
A family history of febrile seizures is identified in about 25% of cases. Since no clear pattern of inheritance has yet been elucidated, multifactorial genetic influences are postulated.
Neuroimaging and EEG are usually normal in children having typical febrile seizures and need not be routinely performed in routines cases. These studies are sometimes indicated if seizures are atypical or presence of concurrent fever is not well established. The need for additional diagnostic studies such as CBC or lumbar puncture should be dictated by the severity of the underlying illness and signs on physical examination.
Most children with typical febrile seizures do not require specific treatment except for vigorous antipyretic therapy during febrile illnesses. Children experiencing excessively frequent or prolonged febrile seizures may be treated using diazepam 0.5mg/kg rectally during high fevers or prophylactically using phenobarbital at standard doses.
Several risk factors may help identify which children with febrile seizures may be at increased risk for developing epilepsy. These include:
Children having none of these risk factors have the same 1% risk for epilepsy as the general pediatric population. Having 1 risk ractor increases the risk to 2% and having 2 or more risk factors carries a 9 to 14% risk for the subsequent development of epilepsy.
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Created: July 25, 1995