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Febrile seizure

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 4 Apr 2025
Last updated: 19 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • febrile illness
  • seizure
Full details

Other diagnostic factors

  • normal postictal exam
Full details

Risk factors

  • temperature elevation
  • young age
  • male sex
  • family history of febrile seizures
  • viral or bacterial infection outside the central nervous system
  • vaccinations
  • antenatal exposure to nicotine
  • iron deficiency
  • complications of pregnancy, labour, and delivery
Full details

Diagnostic investigations

1st investigations to order

  • diagnosis is clinical
Full details

Investigations to consider

  • lumbar puncture
  • viral studies
  • blood culture
  • EEG
  • brain MRI
  • serum sodium
  • FBC
  • capillary blood gluscose
  • serum glucose
  • iron studies
Full details

Treatment algorithm

INITIAL

febrile status epilepticus

ACUTE

first simple febrile seizure

first complex seizure

ONGOING

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 Associate 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

Dr 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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

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

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

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

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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