Febrile seizure
Synonyms in a broader sense
Medical: occasional cramp, occasional seizure
English: febrile seizures
definition
The febrile seizure is an occasional seizure that lasts a few minutes in the brain (cerebral seizure), which usually occurs in small children and is triggered by the increased temperature with a fever. It occurs in connection with febrile illnesses (infections), e.g. Three-day fever, measles or otitis media (otitis media), and manifests itself as drowsiness and rhythmic twitching of the entire body.
Summary
A febrile seizure is a relatively common occurrence in infancy:
Between the ages of 6 months and 5 years around every 25th child suffers one Febrile seizure. Such a Occasional cramp appears to the parents as a life-threatening event because the affected child rolls his eyes (Gaze deviation), twitching all over (clonic seizure) or becomes stiff (tonic seizure), is light-headed or passed out and can pass stool or urine. However, since this condition disappears by itself after an average of 5 minutes and the child does not suffer any permanent damage, the febrile seizure can be classified as harmless.
Forms of febrile convulsions
The most common form (about 75%) febrile seizure is the simple or uncomplicated febrile seizure. He runs with Muscle spasmsaffecting the entire body (generalized seizure) and usually lasts no more than 5-10 minutes. In about a quarter of the cases it can become one complicated febrile seizure come. Characteristics of this are a seizure duration of 15 minutes, two or more seizures within 24 hours, four or more febrile seizures in the past or Muscle twitchingthat are limited to one part of the body or that start from one point and spread to other parts of the body (partial seizure).
One speaks of a complicated febrile seizure if the affected child is younger than 6 months or older than 5 years. If a complicated febrile seizure occurs, the child must be hospitalized and it becomes a brain wave (EEG) to clarify whether an underlying disease of the Nervous system (e.g. epilepsy) is the cause of the seizure.
Epidemiology
A febrile seizure usually occurs 2-5% of children between the ages of 6 months and 5 years, but especially in the second year of life. Older children can also be affected: 15% of febrile seizures occur between the ages of 4 and 8.
A family history is observed in up to 40% of the affected children, i.e. that close family members also had febrile seizures in childhood. Therefore, genetic predisposition in the child is considered to be a contributing factor in the body's response to fever with a seizure. However, this does not mean that a sibling will necessarily have a febrile seizure.
At what age do febrile seizures occur?
In Europe and North America approx. 2-5% of all children affected by the occurrence of a febrile seizure. A febrile seizure is a sudden cerebral attack, combined with muscle twitching and loss of consciousness, that can manifest in early childhood in connection with a febrile infection. The febrile seizure is triggered by a violent and particularly rapid rise in body temperature.
It usually only occurs in old age children between 6 months and 5 years because during this period the child's brain is particularly prone to seizures in its development. The mean peak age for the occurrence of a febrile seizure is 14–18 months.
Febrile seizures occur less often before the age of 6 months and after they have reached the age of 5. From a statistical point of view, a febrile seizure is a one-off event that is not considered to be pathological between 6 months and 5 years of age. However, in rare cases it can also occur more frequently. If there is an additional familial accumulation, one suspects a genetic cause in these rare cases.
causes
Febrile illnesses act as the triggering factor for the febrile seizure (Infections), which are usually caused by a virus. The most common diseases are otitis media (Otitis Media), the three-day fever (Exanthema subitum), a urinary tract infection in the baby, gastrointestinal flu (gastroenteritis) or a simple infection of the upper airways (e.g. bronchitis).
Vaccinations against whooping cough (Pertussis) or measles can trigger a febrile seizure.
Read more on the topic: Fever in baby after vaccinations
Since the central nervous system (CNS) is not yet fully developed in young children, excessive electrical discharges can generally occur more easily in the brain than in adults, which are expressed in body spasms.
The increased body temperature over 38 ° C with a fever causes the nerve cells in the brain to become even more sensitive to unplanned discharges, which means that the threshold for triggering a seizure (convulsion threshold) is reached faster than normal.
This can be imagined in such a way that the impulses that an active nerve cell otherwise only transmits in a certain direction are suddenly picked up by all neighboring cells and then the entire brain is activated by a chain reaction. Figuratively speaking, this resembles a "Fireworks“In the brain, which causes all body muscles to twitch at the same time and you become unconscious. The affected person then has a "seizure" or "epileptic fit".
In order to trigger a febrile seizure, it is not essential that the child has a particularly high fever, e.g. above 40 ° C, but rather the rate at which the temperature rises; febrile convulsions can occur even with moderate fever (38.5 ° C). In summary, febrile seizures occur due to a sudden increase in fever in children with a genetic predisposition during a phase with an age-related reduced seizure threshold.
Febrile convulsions after a vaccination
Body temperature may occasionally rise slightly, especially after combination vaccinations. This is the case with the MMR vaccination (mumps-measles-rubella) and the five-fold vaccination against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP-IPV-Hib). As a result, a slightly increased risk of fever attacks has now been demonstrated in a Danish study. However, this is principally due to the slight fever and not to the actual vaccination. The risk of the first and second five-fold vaccination is up to six times higher. But this percentage is deceptive, as this only affects about 5 children out of 100,000, because the basic risk of fever attacks is generally very low with a mild fever. It is thus by definition a very rare side effect of vaccinations that often has no further consequences. It is therefore not advisable to omit the vaccination due to the fear of a fever attack.
Read more about the topic here: Fever after vaccination
While sleeping
If the child has already had a febrile seizure, there is a 30-40% risk that it can recur. This worries many parents because they do not now know whether you can still let your child sleep alone. Basically, Febrile seizures are more likely to occur in the afternoon and evening. In addition, febrile seizures usually go on always with a pre-existing fever hand in hand. If you look at the few days of the year on which the child has a fever and the percentage of fever attacks that occur at night, you come to the conclusion that parents basically don't have to worry about not noticing their child's attack during the night . Nevertheless, there is nothing wrong with parents taking their child into the bedroom with them when they have a fever, To play it safe. However, there is no great risk for the child.
Symptoms
A sick child with fever have a febrile seizure if they suddenly become lightheaded or passed out and their entire body twitches or becomes stiff. In addition, the child may have the eyes twisted (Gaze deviation), turns blue (cyanosis) or empty bladder or bowel contents. In some children, a febrile seizure does not manifest itself as a stiffness of the body, but as a sudden laxity. The symptoms can vary widely, but usually go away on their own after a maximum of 10 minutes.
After a febrile seizure, the child is usually sleepy and exhausted. Many parents have fearthat your child has a febrile seizure while sleeping at night, which then goes undetected. However, this is rather unlikely, as experience has shown that the attack occurs in the afternoon or evening.
If the symptoms persist for more than 15 minutes, recur within 24 hours, or only relate to one part or half of the body, the child must be taken to a clinic immediately, as this could be a complex febrile convulsion and if the convulsions persist, the Risk of damage, e.g. a paralysis (Paresis), consists.
Can you have a febrile seizure without a fever?
A febrile seizure occurs as a result of a rapid and sudden increase in body temperature. In young children, the network of nerve cells in the brain is not yet fully developed, so that increased electrical discharges can very easily occur. When the temperature rises, the nerve cells in the brain become particularly sensitive to unplanned, spontaneous discharges, which means that the seizure threshold is quickly reached and exceeded. Then the children's muscles all over their bodies begin to twitch and they pass out. To trigger the febrile seizure, however, it is not crucial that the body temperature exceeds a certain number of degrees, but rather at what rate the temperature rises.
One speaks of a fever from a body temperature of 38 ° C. Elevated temperatures are already at 37.5 ° C. If a toddler has a very low body temperature and then the temperature rises quickly, it can sometimes happen that a convulsive event occurs at a temperature of 37.5 ° C without a fever by definition.
Often you only notice that the child has a fever when they are already cramping. For this reason, for example, with hypothermic toddlers, care should be taken not to warm up too quickly.
Febrile-like events that occur without a rapid increase in body temperature are usually a sign of epilepsy or other neurological disorders.
diagnosis
If a child has had a febrile seizure, a doctor should always be seen as they will need to investigate what caused the attack. If the child has a real febrile seizure, the child has a fever that does not affect the nervous system (e.g. Airway infection, Otitis media, Three-day fever). If this is not the case, there are many different things that can be considered that can cause a child to have a seizure.
Read more on the topic: Three days of fever - How contagious is it?
The pediatrician must rule out that there is no inflammation of the meninges (meningitis) or the brain (Encephalitis) is present. For this it may be necessary to give the child nerve fluid (Liquor) to withdraw from the nerve canal of the spine (CSF puncture). A recording of the brain waves (EEG), an examination of the back wall of the eye (fundus examination), a blood test or an image of the brain using an MRI of the brain (MRI) may also be necessary in order to suspect inflammation of the nervous system, epilepsy or an increase in pressure in the brain or hypoglycaemia (Hypoglycemia) to be clarified. Hospitalization may therefore be necessary, especially if you have a complicated febrile seizure.
Read more on the topic: When should I see a doctor with a fever?
therapy
When it comes to a child in one Febrile seizure it is important that, despite the often frightening situation, the parents keep calm, call a doctor and try to lower the fever. If the parents observe closely how the seizure is manifesting, i.e. whether all limbs are twitching or maybe just one arm, whether the child is unconscious, rolled their eyes or Leaks urine, it is easier for the doctor to recognize later whether there is a simple febrile seizure or a more complex attack that needs to be further diagnosed.
The acute therapy with medication is as follows:
- The anticonvulsant drug is used to stop the seizure Diazepam administered in the buttocks (Diazepam rectiole). The effect usually occurs after 2-3 minutes.
- A complicated febrile seizure may require an anti-epileptic drug (e.g. valproate).
- The fever can e.g. by Paracetamol as juice or Suppositories be lowered.
- Since the febrile seizure comes suddenly and is usually over faster than one could act therapeutically, the preventive measures are more important than the measures in the acute attack.
You might also be interested in: Fever suppositories for babies and children
consequences
In order to be able to answer the question about the consequences of a febrile seizure, one must first distinguish between simple and complicated febrile seizures.
Circa 70% of febrile seizures are classified as simple. They last less than 5 minutes and the whole body is affected. In the case of complicated ones, however, the individual attacks can last several minutes and are often only present on one side. They also have children after the occurrence of a complex febrile seizure for a short time Difficulty speakingwhich, however, usually disappear again.
In general it can be said that simple febrile seizures have no long-term consequences go out.
Is a febrile seizure an indication of later epilepsy?
The incidence of epilepsy in later years is also not or only slightly increased compared to the average population (approx. 1-1.5%). With complicated seizures, however, there is an increased risk of around 4-15% of developing epilepsy in the course of life.
However, the febrile seizures are often not always the cause of later epilepsy, but rather its first symptom. In Dravet's syndrome, for example, a febrile seizure is often the first manifestation, i.e. the first manifestation, of this disease. In addition, there is an increased risk of recurrence with febrile convulsions. However, this is largely dependent on the age of the child during the first febrile seizure. The risk of a new attack is around 30-35% in small children who had their first attack when they were younger than 12 months.
In children with known brain damage or a family history of convulsive disorders, the risk of developing epilepsy later is significantly higher. Complicating factors are additionally the occurrence of febrile seizures before the 6th month of life or after the 5th year of life, lasting longer than 15 minutes or with permanent focal findings in the brain, as well as considerable potentials typical of epilepsy in the brain current measurement. In these cases the occurrence of febrile convulsions can be a clear indication that one should investigate and follow up with a comprehensive diagnosis.
Does febrile seizures cause permanent damage?
Contrary to many older claims, new long-term studies have shown that Febrile seizures do not have long-term effects on mental and physical functions Has. The old claim that children who used to have febrile seizures become unified have a reduced intelligence quotient (IQ) is therefore incorrect. This has been shown primarily by large studies with twins where one of the children had febrile seizures and the other did not. If you measure the IQ of these children after many years, you could not find any significant differences. Only through the development of epilepsy it may in the further course too permanent damage come.
You might also be interested in this topic: Intelligence test
Can a febrile seizure be fatal?
Febrile seizures run in principle never fatal. Depending on the type of febrile seizure, simple or complicated, they subside after less or more than 15 minutes. The child is very then tired and weak. With regard to long-term mortality, the study situation is not clear in some respects. What all studies have in common is that simple febrile seizures do not result in increased child mortality to have. Regarding complicated seizures, two large-scale studies differ in their statements. So one resulted Danish studythat kids that having complicated febrile seizures suffered in the first two years a slightly increased risk of death had. It must be noted, however, that a certain proportion of the children with these cramps had previously suffered from neurological deficitswhich can certainly be associated with the increased risk.
forecast
Of the Febrile seizure is a common occurrence in small children, stops by itself after a few minutes and does not cause any permanent damage to the child. Hence the forecast very good, because even if the child turns blue for a short time, the brain is adequately supplied with oxygen and is not damaged. The mental-motoric The child's development proceeds normally even after repeated simple febrile seizures. In about 30% of the cases there can be one or more additional ones Febrile seizures come, which is why early fever reduction is recommended from a body temperature of 38.5 ° C.
It is important for parents to know that a child is not at increased risk from febrile seizures, and later in life epilepsy to develop. The overall risk is 2-4%, which is no different from the likelihood of epilepsy in the general population. However, children who have a complicated febrile seizure or family members with epilepsy are much more likely to develop epilepsy (about 10%).
Prevention / prophylaxis
Many parents wonder what prophylactic measures can be taken against the occurrence of a febrile seizure. Since a rapid rise in body temperature can often trigger a febrile seizure, many parents assume that the use of antipyretic drugs (Antipyretics, e.g. Paracetamol) can have a preventive influence. International clinical studies cannot show any evidence for this and prove that a effective prevention is not possible is. Medicines to lower fever should therefore not be used to prevent new attacks, but only to relieve the symptoms caused by the fever. Classic home remedies such as calf or abdominal wraps are also helpful to reduce the increased body temperature. As always with a fever, it is important to take care of the child enough liquid takes.
To counteract a new febrile seizure, one can use an anti-seizure remedy called Diazepam deploy. This can be given to the child once again Febrile seizure should occur and the Muscle spasms do not pass by yourself after a few minutes of observation. The real one Use is still controversial, but it is believed to have a preventive effect. When using these drugs, however, one must also consider the numerous side effects such as confusion, nausea and easy excitability. Therefore should a routine prophylaxis does not apply to all young childrenwho have had a febrile seizure. If the child has already had the 3rd febrile seizure or there are other aggravating factors (complex febrile seizures), it may still be necessary for the pediatrician to prescribe the anticonvulsant medication at regular intervals over a longer period of time.
Notice
Overall, however, one can say that a febrile seizure is usually a harmless event that, although it looks frightening, has no consequences and usually does not recur.
