Summary
Definition
History and exam
Key diagnostic factors
- febrile illness
- seizure
Other diagnostic factors
- normal postictal exam
Risk factors
- temperature elevation
- young age
- male sex
- family history of febrile seizures
- viral or bacterial infection outside the central nervous system
- vaccinations
- prenatal exposure to nicotine
- iron deficiency
- complications of pregnancy, labor, and delivery
Diagnostic tests
1st tests to order
- diagnosis is clinical
Tests to avoid
- head CT
Tests to consider
- lumbar puncture
- viral studies
- blood culture
- EEG
- brain MRI
- serum sodium
- CBC
- capillary blood glucose
- serum glucose
- iron studies
Treatment algorithm
febrile status epilepticus
first simple febrile seizure
first complex seizure
febrile illness with prior history of simple seizure or 1 complex seizure
history of 2 or more complex febrile seizures with ineffective diazepam treatment
Contributors
Authors
Damian Roland, BMedSci, MBBS, FRCPCH, PhD
Honorary Professor and Consultant in Paediatric Emergency Medicine
Paediatric Emergency Medicine Leicester Academic (PEMLA) Group
Children’s Emergency Department
Leicester Royal Infirmary
Leicester
UK
Disclosures
DR declares that he is a previous member of the National Institute for Health and Care Excellence Feverish Illness in Children Guideline Group.
Acknowledgements
Prof Damian Roland would like to gratefully acknowledge Dr Leena Mewasingh, Dr Frances Morrison, Dr John J. Millichap and Dr J. Gordon Millichap, previous contributors to this topic. LM has received funding from drug companies (e.g., Eisai) to attend medical conferences and been invited to an educational symposium (Novartis, LivaNova). FM declares that she has no competing interests. JJM serves as an Associate Editor of Neurology and serves on the editorial board of Pediatric Neurology Briefs; volunteers on the medical advisory board of The Jack Pribaz Foundation (KCNQ2.org); received speaker honoraria from Invitae; received royalties for online monographs from Up-To-Date; served on the scientific advisory board for Mallinckrodt; is principal investigator for a clinical trial funded by UCB Pharma; and is the principal investigator for research grants from Citizens United for Research in Epilepsy and the Thrasher Research Fund. JJM is an author of a number of references cited in this topic. JGM is an author of a number of references cited in this topic.
Peer reviewers
Robert S. Rust, Jr., MA, MD
Professor
Department of Neurology
University of Virginia Health System
Charlottesville
VA
Disclosures
RSR declares that he has no competing interests.
References
Key articles
American Academy of Pediatrics: Subcommittee on Febrile Seizures. Clinical practice guideline: neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011 Feb;127(2):389-94.Full text Abstract
American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008 Jun;121(6):1281-6.Full text Abstract
Millichap JG, Millichap JJ. Role of viral infections in the etiology of febrile seizures. Pediatr Neurol. 2006 Sep;35(3):165-72. Abstract
Fetveit A. Assessment of febrile seizures in children. Eur J Pediatr. 2008 Jan;167(1):17-27. Abstract
Graves RC, Oehler K, Tingle LE. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician. 2012 Jan 15;85(2):149-53.Full text Abstract
Capovilla G, Mastrangelo M, Romeo A, et al. Recommendations for the management of "febrile seizures": Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia. 2009 Jan; 50(1 suppl):S2-6.Full text Abstract
Natsume J, Hamano SI, Iyoda K, et al. New guidelines for management of febrile seizures in Japan. Brain Dev. 2017 Jan;39(1):2-9. Abstract
Nordli DR Jr. Idiopathic generalized epilepsies recognized by the International League Against Epilepsy. Epilepsia. 2005 Nov 18;46(9 suppl):48-56.Full text Abstract
Wilmshurst JM, Gaillard WD, Vinayan KP, et al. Summary of recommendations for the management of infantile seizures: task force report for the ILAE Commission of Pediatrics. Epilepsia. 2015 Aug;56(8):1185-97.Full text Abstract
Dunlop S, Taitz J. Retrospective review of the management of simple febrile convulsions at a tertiary paediatric institution. J Paediatr Child Health. 2005 Dec;41(12):647-51. Abstract
Kimia AA, Bachur RG, Torres A, et al. Febrile seizures: emergency medicine perspective. Curr Opin Pediatr. 2015 Jun;27(3):292-7. Abstract
Rosenbloom E, Finkelstein Y, Adams-Webber T, et al. Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol. 2013 Nov;17(6):585-8. Abstract
Offringa M, Newton R, Nevitt SJ, et al. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev. 2021 Jun 16;(6):CD003031.Full text Abstract
Baumann RJ, Duffner PK; American Academy of Pediatrics. Treatment of children with simple febrile seizures: the AAP practice parameter. Pediatr Neurol. 2000 Jul;23(1):11-7. Abstract
Whelan H, Harmelink M, Chou E, et al. Complex febrile seizures: a systematic review. Dis Mon. 2017 Jan;63(1):5-23.Full text Abstract
Shinnar S, Glauser TA. Febrile seizures. J Child Neurol. 2002 Jan;17(1 suppl):S44-52. Abstract
Camfield P, Camfield C. Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+). Epileptic Disord. 2015 Jun;17(2):124-33. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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