Febrile Seizures: a narrative review of the current evidence

Submitted: 28 November 2023
Accepted: 5 February 2024
Published: 21 August 2024
Abstract Views: 148
PDF: 89
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Febrile Seizures (FS) are the most common childhood seizures that cause intense anxiety and fear in parents. However, it is a benign condition that does not generally cause brain damage. It mainly affects children aged three months to five years, with peak incidence at 18 months of age. To provide a clinical update on the epidemiology, clinical manifestations, diagnosis, evaluation, and management of children with febrile seizures, major databases comprising of PubMed, ScienceDirect, and Google Scholar were searched. The search contents were 'fever' AND 'convulsion', 'febrile seizure' AND 'clinical features', 'febrile seizure' AND 'management'. Both MeSH and regular keyword search strategies were used. Any form of study on FS was included and any study that was not in English or translated into English was excluded. The overall incidence of FS was estimated to be 460/100,000 in the age group of 0-4 years, the majority of which are simple, but approximately 30% will have some complex features. Although associated with a relatively moderate rate of recurrence, only a small minority of patients with FS will subsequently develop epilepsy. Many risk factors have been attributed to either the initial development or recurrence of FS, with some factors identified as risk for developing epilepsy, and these include positive family history, premature birth, developmental delay, brain disorders, and genetic mutations. Conventionally, FS are classified into simple and complex types, and they typically present with fever, body jerking, or twitching. The management basically involves abortion of the seizure event, control of the fever, airway management, and respiratory and circulatory support.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Capovilla G, Mastrangelo M, Romeo A, Vigevano F. Recommendations for the management of “febrile seizures”: ad hoc Task Force of LICE Guidelines Commission. Epilepsia. 2009;50:2-6.
Fetveit A. Assessment of febrile seizures in children. Eur J Pediatr. 2008;167:17-27.
Fayyazi A, Khajeh A, Baghbani A. Comparison of effectiveness of topiramate and diazepam in preventing risk of recurrent febrile seizure in children under age of 2 years. Iran J Child Neurol. 2018;12:69-77.
Aguirre-Velázquez C, Huerta Hurtado AM, Ceja-Moreno H, et al. Clinical guidelines: febrile seizures, diagnosis, and treatment. Rev Mex Neurocienc. 2019;20:97-103.
Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia. 1993;34:592-6.
Addy DP, Hopkins AP, Bacon CJ, et al. Guidelines for the management of convulsions with fever. Br Med J. 1991;303:634-6.
Freeman JM. Febrile seizures: a consensus of their significance, evaluation, and treatment. Pediatrics. 1980;66:1009.
Laino D, Mencaroni E, Esposito S. Management of pediatric febrile seizures. Int J Environ Res Public Health. 2018;15:2232.
Waruiru C, Appleton R. Febrile seizures: an update. Archives of Disease in Childhood. 2004;89:751-6.
Berg AT, Shinnar S, Shapiro ED, et al. Risk factors for a first febrile seizure: a matched case‐control study. Epilepsia. 1995;36:334-41.
Van Esch A, Steyerberg EW, Van Duijn CM, et al. Prediction of febrile seizures in siblings: a practical approach . Eur J Pediatr. 1998;157:340-4.
Chung S: Febrile seizures. Korean J Pediatr. 2014;57:384-95.
Seinfeld DS, Pellock JM. Recent research on febrile seizures: a review. J Neurol Neurophysiol. 2012;23:1-7.
Lee EH, Chung S. A comparative study of febrile and afebrile seizures associated with mild gastroenteritis. Brain Dev. 2013;35:636-40.
Patel N, Ram D, Swiderska N, et al. Febrile seizures. BMJ. 2015;351:1-7.
Camfield P, Camfield C, Cordon K, et al. What types of epilepsy are preceded by febrile seizures? A population‐based study of children. Dev Med Child Neurol. 1994;36:887-92.
Trinka E, Unterrainer J, Haberlandt E, et al. Childhood febrile convulsions - which factors determine the subsequent epilepsy syndrome? A retrospective study. Epilepsy Res. 2002;50:283-92.
Duffner PK, Berman PH, Baumann RJ, et al. Clinical practice guidelines - Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127:389-94.
Mewasingh LD. Febrile seizures. BMJ Clin Evid. 2014;2014:0324.
Leung AKC, Hon KL, Leung TNH. Febrile seizures: an overview. Drugs Context. 2018;7:1-12.
Eseigbe E, Eseigbe P, Adama S. Febrile seizures in Kaduna, north western Nigeria. Niger Med J. 2012;53:140.
Khair AM, Elmagrabi D. Febrile seizures and febrile seizure syndromes: an updated overview of old and current knowledge. Neurol Res Int. 2015;2015:849341.
Shlomo Shinnar TAG. Febrile seizures. J Child Neurol. 2002;17:44-52.
Chungath M, Shorvon S. The mortality and morbidity of febrile seizures. Nature Clinical Practice Neurology. 2008;4:610-21.
Vestergaard M, Basso O, Henriksen TB, et al. Febrile convulsions and sudden infant death syndrome. Arch Dis Child. 2002;86:125-6.
Mittal R. Recent advances in febrile seizures. Indian J Pediatr. 2014;81:909-16.
Dubé CM, Brewster AL, Baram TZ. Febrile seizures: mechanisms and relationship to epilepsy. Brain Dev. 2009;31:366-71.
Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of risk factors associated with first episode febrile seizure. J Clin Diagnostic Res. 2016;10:10-3.
Veisani Y, Delpisheh MA, Sayehmiri K. Familial history and recurrence of febrile seizures; a systematic review and meta-analysis. Iran J Pediatr. 2013;23:389-95.
Schuchmann S, Hauck S, Henning S, et al. Respiratory alkalosis in children with febrile seizures. Epilepsia. 2011;52:1949-55.
Virta M, Hurme M, Helminen M. Increased plasma levels of pro- and anti-inflammatory cytokines in patients with febrile seizures. Epilepsia. 2002;43:920-3.
Gokcil Z, Ipekdal HI, Ulas UH, Odabasi Z. Hot water epilepsy: seizure type, water temperature, EEG findings and treatment. The Neurologist. 2010;16:109-12.
Panda PK, Sharawat IK. Bathing and hot water epilepsy. Pediatr Neurol. 2020;104:72.
Knudsen FU. Febrile seizures: treatment and prognosis . Epilepsia. 2000;41:2-9.
Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics. 1996;97:769-71.
Berg AT, Shinnar S. Complex febrile seizures. Epilepsia. 1996;37:126-33.
Leung AKC, Robson WLM. Febrile Seizures. J Pediatr Heal Care. 2007;21:250-5.
Miller PM, Srouk Y, Watemberg N. Febrile myoclonus: an underreported, benign condition in infancy often misinterpreted as febrile seizures. Pediatr Emerg Care. 2008;24:618-20.
Paul SP, Chinthapalli R. Rational approach to management of febrile seizures. Indian J Pediatr. 2013;80:149-50.
Warden CR, Zibulewsky J, Mace S, et al. Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. Ann Emerg Med. 2003;41:215-22.
Kriel RL, Cloyd C, Hadsall RS, et al. Home use of rectal diazepam for clyster and prolonged seizures: efficacy, adverse reactions, quality of life, and cost analysis. Pediatr Neurol. 1990;7:13-7.
Camfield CS, Camfield PR, Smith E, Dooley JM. Home use of rectal diazepam to prevent status epilepticus in children with convulsive disorders. J Child Neurol. 2015;4:125-6.
McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children (Review). Cochrane Database Syst Rev. 2018;1:CD001905.
Holsti M, Dudley N, Schunk J, et al. Is intranasal midazolam better than rectal diazepam for home management of acute seizures? Arch Pediatr Adolesc Med. 2015;68:120-1.
Shinnar S, Glauser TA. Febrile seizures. J Child Neurol. 2001;17:44-52.
Joint Working Group of the Research Unit of The Royal College of Physicians and the British Paediatric Association. Guidelines for the management of convulsions with fever. BMJ. 1991;303:634-6.
Wragg E, Francis J, Amblum J. Managing Paediatric Patients with Pyrexia. Air Sci. 2014;22:20-3.
Wears RL, Luten RC, Lyons RG. Which laboratory tests should be performed on children with apparent febrile convulsions? An analysis and review of the literature. Pediatr Emerg Care. 1986;2:191-6.
Rutter N, Smales RC. Calcium, magnesium, and glucose levels in blood and CSF of children with febrile convulsions. Arch Dis Child. 1976;51:141-3.
Gerber MA, Berliner BC. The child with a simple febrile seizure: appropriate diagnostic evaluation. Am J Dis Child. 2015;135:431-3.
Subcommittee on Febrile Seizures. Febrile seizures: guidelines for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127:389-94.
Maytal J, Steele R, Eviatar L, Novak G. The value of early postictal EEG in children with complex febrile seizures. Epilepsia. 2000;41:219-21.
Byul S, Hwa J, Ju Y, et al. Risk for developing epilepsy and epileptiform discharges on EEG in patients with febrile seizures. Brain Dev. 2013;35:307-11.
Cappellari AM, Brizio C, Mazzoni MB, et al. Predictive value of EEG for febrile seizure recurrence. Brain Dev. 2018;40:311-5.
Shah PB, James S, Elayaraja S. EEG for children with complex febrile seizures. Cochrane Database Syst Rev. 2017;2017:CD009196.
Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures. Febrile seizures: clinical practice guidelines for the long-term management of the child with simple febrile seizures. Pediatrics. 2015;121:1281-6.
Roman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. New Engl J. 1993;329:79-84.
Pavlidou E, Tzitiridou M, Panteliadis C. Effectiveness of intermittent diazepam prophylaxis in febrile seizures: long-term prospective controlled study. J Child Neurol. 2006;21:1036-40.
Khosroshahi N, Faramarzi F, Salamati P, et al. Diazepam versus clobazam for intermittent prophylaxis of febrile seizures. Indian J Pediatr. 2010;78:38-40.
Knudsen FU, Paerregaard A, Andersen R, Andresen J. Long term outcome of prophylaxis for febrile convulsions. Arch Dis Child. 1996;74:13-8.
Rantala H, Tarkka R, Uhari M. A meta-analytic review of the preventive treatment of recurrences of febrile seizures. J Pediatr. 1997;131:922-5.
Offringa M, Newton R, Vraka KNevitt SJ. Prophylactic drug management for febrile seizures in children (Review). Cochrane Database Syst Rev. 2021;16:CD003031.
Paul SP, Kirkham EN, Shirt B. Recognition and management of febrile convulsion in children. Pediatr Nurs. 2015;29:36-43.
Leung AKC, Leung AAM, Wong AHC, Hon KL. Breath-holding spells in pediatrics: a narrative review of the current evidence. Curr Pediatr Rev. 2019;15:22-9.
Pappano D, Osborne M. Febrile Myoclonus. Pediatr Emerg Care. 2007;23:649-50.
Hon KL, Leung AKC, Torres AR. Febrile Infection-Related Epilepsy Syndrome (FIRES): an overview of treatment and recent patents. Recent Pat Inflamm Allergy Drug Discov. 2018;12:128-35.

How to Cite

Abdullahi, Abba Musa, and Abdulrahim Abdulrashid Onimisi. 2024. “Febrile Seizures: A Narrative Review of the Current Evidence”. Pyramid Journal of Medicine 7 (1). https://doi.org/10.4081/pjm.2024.385.