Febrile Seizure

Here are the typical symptoms of a febrile seizure:

• Loss of consciousness or unresponsiveness (blackout)
• Sudden onset without warning
• Twitching or jerking of arms and legs
• Muscle stiffness
• High fever (above 100.4°F / 38°C)
• Breathing difficulty
• Foaming at the mouth
• Bluish skin due to temporary oxygen deprivation
• Eye rolling or deviation during the seizure
• Post-seizure irritability and delayed response (10-15 minutes to fully awaken)

While febrile seizures are closely linked to fevers, the exact cause remains unclear. The connection between fever and seizures is intricate, with multiple factors playing a role.

• Cytokine Release: During infections, the immune system releases cytokines, which can affect the brain's temperature regulation, leading to fever.
• Temperature-induced Changes: A rapid increase in body temperature may disrupt brain activity, potentially triggering seizures in vulnerable individuals.
• Immature Brain: Young children are more prone to febrile seizures due to their developing brains being more sensitive to the effects of fever.
• Ion Channel Dysfunction: Genetic mutations or variations in brain ion channels can heighten neuron excitability, making the brain more susceptible to fever-induced seizures.

If you’re concerned about febrile seizures, consult with a paediatrician for personalized guidance and care. Book an appointment today.

Risk Factors For Febrile Seizure

Several factors can increase the risk of a child experiencing a febrile seizure:

• Age: Most common in children aged 6 months to 5 years; rare in infants under 6 months and older children.
• Family history: Higher risk if there is a family history of febrile seizures or epilepsy (e.g., parent or sibling).
• Fever: Rapid rise in body temperature due to infections is a key trigger; not all children with fever will have a febrile seizure.
• Viral Infections: Certain viral infections, such as chickenpox, flu, roseola, and human herpesvirus 6 (HHV-6), have been linked to an increased risk of febrile seizures.
• Bacterial Infections: High fever from bacterial infections like ear infections, tonsillitis, urinary tract infections, and gastroenteritis can trigger seizures.
• Developmental delays: Children with developmental delays or neurological disorders may have a higher risk of febrile seizures.
• Low birth weight: Some research suggests that children with low birth weight might be at an increased risk of febrile seizures.
• Vaccination: While most vaccines do not significantly increase the risk of febrile seizures, some studies have suggested a slight increase in risk following certain vaccinations. However, the overall benefits of vaccines in preventing serious diseases far outweigh this small risk.
• Environmental factors: Rapid changes in environmental temperature, such as overheating, can contribute to triggering a febrile seizure.
• Gender: Febrile seizures are slightly more common in boys than girls.

Diagnosing febrile seizures requires a comprehensive approach, combining medical history, physical examination, and diagnostic tests. The process involves the following steps:

I. Clinical History

The physician collects detailed information about the child’s medical background, focusing on the seizure event, overall health, and any past instances of fever-related seizures. Information on the seizure’s duration, any unusual symptoms, and changes in behavior before and after the event is also gathered.

II. Physical Examination

A thorough physical examination will be conducted to assess the child's overall health and neurological status. The doctor will look for any signs of fever, infection, or other underlying conditions that could contribute to the seizure.

III. Temperature Measurements

The presence of fever is a key factor in diagnosing febrile seizures. The doctor will measure the child's body temperature to confirm the presence of a fever at the time of the seizure.

IV. Diagnostic Tests

1. Simple Febrile Seizures

• Blood test: A complete blood cell count (CBC) and tests for glucose, electrolytes, etc.
• Urine test
• A spinal tap (lumbar puncture): This test is important for children with meningitis symptoms, febrile status epilepticus, or specific conditions. It is considered for children under 12 months old with febrile seizures, especially if immunization status is uncertain or deficient.

2. Complex Febrile Seizures

• Electroencephalogram (EEG): An EEG is a diagnostic test that assesses brain activity to identify any unusual patterns that might increase the likelihood of seizures. It is recommended for children who experience prolonged or complex febrile seizures, non-fever-associated recurrences, or have developmental delays. However, for neurologically healthy children with simple febrile seizures, a routine EEG is generally not necessary.
• Computed tomography (CT) scan (head): A CT scan employs X-rays to generate cross-sectional images of the brain, allowing the identification of abnormalities such as tumors, lesions, and bleeding that could be causing seizures.
• Magnetic resonance imaging (MRI) brain: MRI produces very detailed images of the brain by using powerful magnetic and radio waves. It assists doctors in determining the root causes of seizures.

These imaging tests may be considered for children displaying:

• Signs of increased intracranial pressure
• Focal neurological problems
• Suspected structural defects in the brain
• Unusually large head size
• Severe head injuries

While complete prevention of febrile seizures may not be possible, these strategies can help reduce the risk:

• Manage fever: Use fever-reducing medications like acetaminophen or ibuprofen as directed by your doctor. Follow the recommended dosage based on your child's age and weight.
• Hydration: Ensure your child stays well-hydrated when they have a fever. Dehydration can exacerbate fever and potentially increase the risk of seizures.
• Dress comfortably: Dress your child in light and breathable clothing to help regulate their body temperature.
• Infection prevention: Practice good hygiene and keep up with recommended vaccinations to prevent infections that can lead to fever.
• Seizure triggers: Avoid known triggers that can cause fever spikes, such as overheating.
• Educate yourself: Learn about febrile seizures, their benign nature, and how to manage them effectively.
• Regular checkups: Schedule regular checkups with a pediatrician to monitor your child's overall health and development.
• Observation: Keep a watchful eye on the child during fever episodes to detect any seizure activity early.

Tips for measuring a child’s temperature: Various methods exist for taking your child's temperature, each yielding different results based on the thermometer type. These methods encompass:

• Infrared forehead thermometer
• Digital, mercury, or alcohol thermometer under the arm or tongue
• Ear (tympanic) thermometer
• Plastic tape thermometers for the forehead (not recommended due to unreliability)

Note: Certain thermometers suit specific age ranges; hence, follow the manufacturer's guidelines for accurate readings.

From infrared forehead thermometers to digital options, find the best fit for your child's needs and ensure quick, precise readings.

First-aid tips for Febrile Seizure

If your child experiences a febrile seizure, follow these steps to ensure their safety:

• Stay calm: Most febrile seizures are brief and generally harmless. Staying calm will help you manage the situation effectively.
• Ensure safety: Gently place your child on the floor or a safe surface, away from hard or sharp objects, to prevent injury.
• Avoid mouth obstruction: Do not put anything in your child’s mouth, as this could cause choking or dental injury.
• No physical restraint: Do not hold your child down or try to stop the seizure physically. Allow the seizure to run its course.

Post-seizure care:

• Roll your child onto their side (recovery position) to keep their airway clear.
• If your child has food or vomit in their mouth, gently turn their head to the side to prevent choking; do not attempt to remove it forcefully.
• Observe the duration of the seizure. If it lasts longer than 5 minutes, seek immediate medical help.

Treatment of Febrile Seizures

The treatment of febrile seizures focuses on managing the fever, ensuring the child’s safety, and preventing future seizures:

1. Antipyretic therapy: Administer antipyretic medications (such as acetaminophen or ibuprofen) to reduce fever and discomfort. Lowering the fever may help prevent the recurrence of seizures.
2. Supportive care (Seizures < 5 Minutes): For febrile seizures lasting less than 5 minutes, the primary approach is supportive care. This may involve ensuring the child's safety during the seizure, providing comfort, and monitoring their condition. Note: Typically, medical intervention such as antiseizure medications is not immediately necessary for seizures of this duration.
3. Antiseizure medications (Seizures ≥ 5 minutes): Benzodiazepines (like lorazepam, diazepam, midazolam) are commonly used. They can be given intravenously (IV), rectally, or intranasally. Fosphenytoin can be administered intravenously if the seizure persists. Phenobarbital, valproate, or levetiracetam may be used for persistent seizures.

Febrile seizures, if not managed properly, can have several potential complications affecting a child's well-being. Some common issues include:

• Todd's paralysis: After a febrile seizure, some children may experience temporary focal weakness known as Todd's paralysis, which affects muscle control in specific areas.
• Mesial temporal sclerosis: Prolonged febrile seizures may increase the risk of mesial temporal sclerosis, a condition that can lead to focal epilepsy later in life.
• Increased epilepsy risk: While most children with febrile seizures do not develop epilepsy, those with additional risk factors might face a higher likelihood of developing the condition.
• Emotional distress: Witnessing a febrile seizure can be distressing for caregivers, leading to emotional and psychological impact.

While standard medical care remains crucial for managing febrile seizures, some complementary and alternative approaches may be considered to support overall health:

• Fever management: While lowering fever may not accelerate recovery from the underlying illness, it can provide comfort. If your child is otherwise well, there may be no need to treat the fever. For irritability:
• Offer small drinks to keep them hydrated, even if they won't eat.
• Babies under six months can have extra breastfeeds, formula, or cooled boiled water.
• Gently wipe their forehead with a warm, water-soaked sponge for cooling. Avoid over-chilling.
• Dress them appropriately, not too hot or cold. Add layers if shivering.
• No cold baths or showers.
• Herbal remedies: Some herbal remedies, such as chamomile, elderflower, or yarrow, are believed by some to have fever-reducing properties. However, their effectiveness and safety for children should be discussed with a healthcare professional.
• Nutrition and balanced diet: Maintaining proper hydration and providing a balanced, nutrient-rich diet can help support the body's immune system during infections that may trigger febrile seizures.
• Dietary supplements: Some supplements, including vitamin C, zinc, and probiotics, are thought to bolster the immune system. However, supplements should be used cautiously in children and only under the guidance of a pediatrician.

Living with febrile seizures can significantly impact the quality of life for both the child and their caregivers:

• Caregiver strain: Parents and caregivers often face emotional stress and the constant need for vigilance, which can take a toll on their overall well-being.
• Educational impact: Children with febrile seizures may experience school disruptions, leading to missed learning opportunities and potential setbacks in their education.
• Emotional toll: Witnessing seizures can be distressing, causing anxiety and fear for both the child and their loved ones.
• Anxiety: The fear of seizures occurring, especially in public or during inconvenient times, can heighten anxiety for the child and caregivers.
• Social limitations: Activities or situations may be avoided due to fear of triggering seizures, leading to social isolation.
• Impact on daily activities: Febrile seizures can disrupt daily routines, such as school attendance, extracurricular activities, and family outings.
• Sleep disruption: Seizures, along with the stress and worry they bring, can disrupt sleep patterns for both the child and their caregivers. Poor sleep can have a cascading effect on mood, behaviour, and overall health.
• Stigma and misunderstanding: A lack of understanding about febrile seizures among peers, teachers, and the community can lead to stigma, further isolating the child and family.
• Financial impact: Medical expenses, including doctor visits, tests, and medications, can place financial strain on families. Additionally, missed work due to caregiving responsibilities can impact parents' income and job stability.

Coping strategies

• Consult pediatric epilepsy specialists and join support groups to reduce feelings of isolation and gain valuable insights.
• Gradually reintroduce the child to social situations and educate others to foster understanding and reduce fear.
• Create stable routines while remaining flexible to accommodate potential seizure triggers.
• Focus on maintaining good sleep hygiene for both the child and caregivers to mitigate the impact of disrupted sleep.
• Explore financial resources and discuss work flexibility options to manage the economic impact of caregiving responsibilities.