Febrile seizures are usually self-limiting; increased risk of developing epilepsy is low except in a small number of cases.
Most febrile seizures resolve spontaneously and quickly, and do not require acute or long-term anticonvulsant treatment.
The American Academy of Pediatrics defines a febrile seizure as a seizure occurring in a febrile child (temperature ≥100.4°F or 38°C) between the ages of 6 and 60 months who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. The first occurrence is usually before 3 years of age but is infrequent in children under 6 months. Febrile seizures may be classified as simple or complex depending on clinical features, duration, and recurrence.
The 2006 report by the International League Against Epilepsy Task Force on Classification and Terminology of Epilepsy and Epileptic Syndromes proposed a change in terminology and the omission of the words "convulsion" and "convulsive." They suggested that the term "febrile convulsions" be replaced by "febrile seizures." Further changes in 2017 included replacing the term "benign" with "self-limiting."
History and exam
Key diagnostic factors
- febrile illness
Other diagnostic factors
- normal postictal exam
- temperature elevation
- young age
- male sex
- family history of febrile seizures
- viral or bacterial infection outside the central nervous system
- prenatal exposure to nicotine
- iron deficiency
- complications of pregnancy, labor, and delivery
1st investigations to order
- diagnosis is clinical
Investigations to consider
- lumbar puncture
- viral studies
- blood culture
- brain MRI
- serum sodium
- capillary blood glucose
- serum glucose
- iron studies
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
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
DR declares that he is a previous member of the National Institute for Health and Care Excellence Feverish Illness in Children Guideline Group.
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.
Robert S. Rust, Jr., MA, MD
Department of Neurology
University of Virginia Health System
RSR declares that he has no competing interests.
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