Febrile convulsion or fever fits is the most common childhood disorder occurring in children below 5 years of age. It is always associated with high fever and occurs due to the over stimulation of electrical activity of the brain. It occurs in 2 % to 5% of children below 5 years of age and has a tendency to run in the family. It can be frightening and distressing to parents of children suffering from the febrile convulsion. However, there is no reason to be frightened as these are harmless and is not associated with long term effects. It can occur in any developmentally normal children suffering from fever due to extracranial infections, such as middle ear infection, upper respiratory tract infection, urinary tract infection, dysentery, pneumonia, pharyngitis, tonsillitis, etc. It can occur in both male and female child however the incidence of febrile convulsion is higher in male child than the female child.
Characteristic features of febrile convulsion
The following six characteristics help in diagnosing febrile convulsion
1. It occurs in children between six months to five years of age. Among these children, children’s of age 14 to 18 months are more affected.
2. It is associated with fever and occurs around a temperature of 101.8°F or 38. 8°C
3. Seizures are most often generalized and occurs once in 24 hrs lasting for a few seconds to 15 minutes.
4. The absence of signs of meningeal irritation such as neck rigidity, bulging fontanelle, stupor and irritability.
5. Absence of neurological deficit
6. Family history of febrile convulsion may be present.
Causes of febrile convulsion
Febrile convulsion occurs mostly due to bacterial and viral infections causing fever such as pneumonia, otitis media, urinary tract infection, dysentery, flu and Rosella infection. It may also occur after immunization with vaccines such as a measles mumps, rubella vaccine, diphtheria, pertussis tetanus vaccine, convulsion post immunization occurs within 8 to 14 days. It is the fever, which causes febrile convulsion not the vaccination.
Types of febrile convulsion
1. Simple febrile convulsion
It is the most common type of febrile convulsion. It may last from a few seconds under 15 minutes. The type of seizure in simple febrile convulsion is generalized tonic colonic seizure. The seizure occurs only once in 24 hours.
2. Complex or atypical febrile convulsion
It is a less common form and last for more than 15 minutes. Usually the seizure is focal. The seizure occurs more than once in 24 hours.
Pathophysiology of febrile convulsion
Exact Pathophysiology of febrile convulsion is still unknown. It is unique in nature and occurs only in children below 5 years of age. The occurrence of febrile convulsion is linked with the genetic predisposition by many health researches.
Symptoms of febrile convulsion
Symptoms may vary from staring to abnormal movement of the body parts such as shaking of legs and arms. The child may be unconscious. They have a fever higher than 38.8°C or 101°C. After the episode of febrile convulsion children usually become lethargic.
Diagnosis of febrile convulsion
Diagnosis of febrile convulsion is made by clinical evaluation and some investigations.
Your doctor will ask you questions about the type of seizure and the duration it lasted for. If any member of the family has had a febrile convulsion or any other seizure disorder, when did the fever start and the type of the fever. If the developmental milestones are achieved on time or not etc.
Physical examination includes examination to find out the source of fever such as tonsillitis, pharyngitis, otitis media, etc. Evaluation of the patients neurological status, checking signs of meningeal irritation etc.
Investigations for febrile convulsion
Investigations include cerebro-spinal fluid study, complete blood count, blood culture and sensitivity, throat swab culture and sensitivity, chest x-ray, urine analysis, etc.
The most important step in diagnosing febrile convulsion is to rule out the meningitis which can be done by cerebro-spinal fluid study. Cerebro-spinal fluid study is indicated when there is suspicion of meningitis and encephalitis as a cause of seizure, if the child is below 12 months of age or if the patient is 12 to 18 months of age and is associated with complex seizure and when the recovery is slow or there is undue prolongation of post-ictal sleep.
Treatment of febrile convulsion
Treatment of febrile convulsion should include the following
- Maintenance of airway, breathing and circulation.
- Control of seizure
It can be achieved by use of anticonvulsants such as diazepam and midazolam
- Reduction of body temperature by drugs such as paracetamol, ibuprofen or acetaminophen.
- Treatment of the infection behind fever with appropriate antibiotics.
Prognosis of febrile convulsion
Febrile condition has a good prognosis. It does not cause neurological deficit. It is a benign condition and does not result in death or disability. It can recur in about one third of cases by the age of 2years. Chance of epilepsy in children suffering from febrile convulsion is about2-5%.
Recurrent febrile convulsion
Children who have suffered from a febrile convulsion once are at a higher risk of suffering from another episode of the febrile seizure. Recurrent febrile convulsion occurs in 30 to 35 percent of cases who have suffered from febrile convulsion in the past. Recurrent febrile seizures may or may not occur at the same temperature as the first episode and does not occur every time the child suffers from fever. Recurrent convulsion occurs mostly within one year of the initial seizure and occur within two years in almost all cases
The risks of recurrent febrile convulsions are higher in some group of children. Children with higher risks for recurrent febrile convulsions are
● Children aged less than 15 months
● Child suffering from frequent episodes of fever
● Child having a family history of febrile seizures or epilepsy, especially his or her parents and siblings
● Child who had very little time gap between the onset of fever and the convulsion
● Child who had convulsion at a lower temperature in a previous episode of febrile convulsion.
Care of child during episode of convulsion
When you notice your child is on an episode of convulsion you can follow some of the following ways to prevent your child from external harm.
- Always place your child on the low lying surface. This helps in preventing your child from falling.
2. Always Stay close to your child. This may help you in comforting your child.
3. Remove hard or sharp objects from the surrounding as soon as possible.
4. Remove or loosen tight clothings. Try to keep the chest and neck region free from restraining dress.
5. Do not interfere with your child’s movements or tie them to restrict movement.
6. Note the duration of seizures.
- Do not feed your child.
Prevention of febrile convulsion
It is aimed at prevention of seizure in the child during the next episode of fever. It can be achieved by lowering down the temperature with the paracetamol and tepid Sponging and use of prophylactic anticonvulsants like diazepam and clobazam.