Febrile seizure/Febrile convulsions

As per www.nhs.uk please make sure to call 999 and go to A&E if:​

• It is your child’s first seizure

• It lasts more than 5 minutes

• Your child is having difficulty breathing

• They are twitching on only one side of the body

• They are more sleepy than usual 1 hour after the seizure stops

• They have more than 1 seizure in 24 hours.

 

Febrile seizures come in two types: 

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1. Simple

   1. 4 limb jerking (tonic clonic)

   2. Lasts less than 15 minutes – yes, it is long but we still call that simple

   3. Doesn’t occur again within 24 hours or the period of the same illness

2. Complex

   1. Longer than 15 minutes

   2. Only affects one side of the body

   3. Affects one side of the body (or starts on one side of the body)

   4. Reoccurs again within 24 hours or the same illness

   5. The child is not back to themselves within an hour of the seizure stopping

 

 

Now we have the emergency advice out of the way we can answer the big question most parents have!

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Will my child have epilepsy?

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There is a slightly increased risk but the big question is really how much does this risk increase? I would suggest that it is likely not a huge amount, but there are some factors to consider. 

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In the general population, approximately 1% of people who haven’t had a febrile seizure will have epilepsy. In the population who have a simple febrile seizure, this increases to approximately 2% who will have epilepsy and in those who have a complex febrile seizure it will be about 5% who will go on to have a diagnosis of epilepsy.

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Quite simply, this means that most patients who have febrile seizures won’t have epilepsy.

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Why did this happen?

Most of the time we don’t know. We know in some cases there are certain genes that put you at greater risk and we often hear of family histories in about 25% of cases. Many times in A&E, I have found that families are accompanied by an eyerolling grandmother nodding sagely, having been a parent in the exact same position many years earlier.

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Could this be anything serious?

• It is always important to follow the safety advice above.

• It is important to remember that serious and life-threatening illnesses (meningitis and encephalitis) can also present with temperatures and seizures.

• Most of the time your doctor will find a source for infection (chicken pox, tonsillitis, a middle ear infection etc) and can confidently diagnose febrile seizures. Sometimes they may not, and this may lead to more investigations.

• If the seizure affects one side of the body rather than all 4 limbs, your child might need to have a scan to rule out something happening in the head.

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Will giving paracetamol (Calpol) and ibuprofen (Nurofen) stop the febrile convulsion happening again?

• If I didn’t give them and my child has another febrile convulsion, is it my fault?​

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NO! Please be aware whilst paracetamol and ibuprofen reduce temperature they don’t reduce the risk of febrile seizure. If it is going to happen there is nothing you can do as a parent to have stopped it. Please don’t blame yourself.

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My paediatricians won’t start my child on anti-seizure medications for febrile seizures!

This would be appropriate and responsible practice.

We do not tend to give anti-seizure medication for febrile seizures (unless part of a larger diagnosis with ‘afebrile seizures’ – meaning those that happen without a temperature).

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Sometimes, a child may be sent home from the hospital with ‘rescue medication’ (emergency medication to stop a seizure) and training for home if there is a history of long febrile seizures, but this varies from paediatrician to paediatrician and most importantly child to child.

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Do we need to see a Paediatric Neurologist?

It is very rare for a febrile seizure to need a Paediatric Neurologist review, as most General Paediatricians (and A&E Doctors) are very experienced with them.

 

Reasons to see a Paediatric Neurologist may include:

• Febrile seizures in the very young (under 9 months and certainly under 6 months)

• Febrile seizures that last more than 30 minutes, and especially those longer lasting seizures which involve just one side of the body.

• If your child does not recover fully after febrile seizures.

• Febrile seizures continuing despite powerful anti-seizure medications – normally given in an emergency setting

Dr Taylor is always happy to see children in his private practice after febrile seizures, and knows that many parents find this to be reassuring.

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To recap the most important information here –​​

Please make sure to call 999 and go to A&E if:

• It is your child’s first seizure

• It lasts more than 5 minutes

• Your child is having difficulty breathing

• They are twitching on only one side of the body

• They are more sleepy than usual 1 hour after the seizure stops

• They have more than 1 seizure in 24 hours.

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