About 1 in 20 children will have at least one febrile
seizure at some point.
Mostly occurs between the ages of six months and
six years. The average is 18 months.
The cause is unknown, although it appears to run in
some (but not all) families. Around 1 in 4 children
who are affected by febrile seizures will have a family
history of the condition. In half of all cases, there
are no obvious causes or risk factors.
Having a seizure when the child’s body temperature
is high i.e. 38°C or above.
Usually caused by infection, but exclude intracranial
infection (bacterial meningitis/viral encephalitis)
Occur between 6 months and 6 years
Viral infections e.g. chickenpox and influenza
LRTI e.g. pneumonia, bronchitis
Types of febrile seizures
Simple febrile seizure
The most common type of febrile seizure (~90% of
Tonic clonic seizure
Does not last >15 minutes
Does not reoccur within 24 hours or during the period
in which the child has an illness.
Complex febrile seizure
Less common than simple febrile seizures (~10% of
Has one or more of the following features:
Seizure lasts >15 minutes
Partial or focal seizure
Seizure reoccurs within 24 hours of the first seizure or
during the period in which they have an illness
The child does not fully recover from the seizure within
Febrile seizures and epilepsy
Epilepsy: repeated seizures without fever
Children who have a history of febrile seizures have
an increased risk of developing epilepsy. However, it
should be stressed to the parents that the risk
increase is still quite small.
Simple febrile seizures: 1 in 50 chance of developing
epilepsy in later life.
Complex febrile seizures: 1 in 20 chance of
developing epilepsy in later life.
Almost all children make a complete recovery.
Studies on febrile seizures showed that children with
a history of febrile seizures has no evidence of an
increased risk of death in later childhood or
Simple seizures no brain damage. Subsequent
intellectual performance similar as other children
Febrile seizures often occur during the first day of a
Temperature: 38°C or above.
Seizures may also develop:
After a mild temperature. It may not develop at all
with an extremely high temperature.
Rapid rise in temperature
Rapid drop in temperature
Lose of conciousness
Urine incontinence ± soiling
Foam at the mouth
Lasting <5 minutes
Sleepiness/drowsiness after seizure ~1 hour
Signs of dehydration Other alarming signs
•Lack of tears when crying
•Seizure >5 minutes, no
sign of stopping
•Focal CNS lesion/CNS
•Previous h/o epilepsy
•>1 attack in 24h
we need to be aware of
Source of infections! Do not forget ear and throat examinations!!
Lumbar puncture (particularly if the child is <12 months old)
Contraindications for LP
Coagulopathy Thrombocytopenia Local infection at
If seizure >5 min, rescue therapy diazepam PR/
Antipyretics? Not been shown to prevent febrile
seizures. But, important to reduce temperature:-
Remove unnecessary clothes or bedding
Remember, NO ASPIRIN for <16 YO (REYE’S
10 first aid steps when your child has a seizure:
1. Stay calm
2. Look around, assess the environment
3. Note the time
4. Stay with them.
5. Cushion their head.
6. Don’t hold them down
7. Don’t put anything in their mouth
8. Check time again. If > 5mins, call 999
9. Recovery position if seizure stops. Check airway & breathing
10. Stay with them until full recovery
Risk of developing epilepsy ~1.5%
Risk rises to 2.5% if the child was under 12 months old when
they had their first seizures (in those who had multiple simple
Risk also increases with:
Neurological abnormalities, or a developmental delay before
the onset of febrile seizures.
A family history of epilepsy.
A brief fever (<1 h) before the seizure.
Short case History:
a clinical context
GH, 2 years old girl admitted due to fever with fits.
This is her 1st episode of fever with fits.
Seizure lasted for 1-2 minutes.
Seizure came from a rapid increase of temperature on
the 1st day of fever after visiting her grandfather who is
warded in HSI (due to chronic illnesses e.g. DM, HPT).
Generalised tonic-clonic seizure. Eyes rolling upwards.
No tongue biting, no mouth frothing.
Just once within 24 hours. No subsequent episode.
Source of infection?
Fever was NOT associated with:
Shortness of breath
Changes in urinary/bowel habit
Ear discomfort, discharge, hearing loss
On examination, otitis media was found to be the cause.
Family history of epilepsy. Uncle is epileptic with
Mum thinks that it may be due to the hot weather.
Mum is worried if she’ll get another febrile seizures.
Worried if she will develop epilepsy in the future.
Getting another seizure?
Risk of getting another febrile fit?
30-40% will have further febrile fits.
More likely if:
The younger the child
The shorter the duration of illness before
The lower the temperature at time of seizure
Positive family history
Risk of developing epilepsy later?
Increased risk of 1.5%
Family history of epilepsy
Brief fever (<1h) before the seizure
Simple versus complex? Simple: 1 in 50,
Complex: 1 in 20.
Risk increase by 2.5% if under 12month old
when had 1st seizure.
1. The followings are features of complex febrile
a) Duration of seizures > 15 minutes (T , F)
b) Presence of focal convulsion (T ,F)
c) Recurrence of seizure within the same day (T , F)
d) Children with preexisting neurological disease (T ,F)
e) Age of onset before 12 months (T , F)
2. The risk of recurrent febrile seizures is higher for these children
a) young (less than 15 months)
b) Have frequent fevers
c) Have a parent or sibling who had febrile seizures or epilepsy
d) Have a short time between the onset of fever and the seizure
e) Had a high degree of fever before the seizure
3. Answer true or false
a) Prophylactic antiepileptic drug treatment is recommended
b) Patients with early age of onset have higher risk of recurrent
c) Lumbar puncture is indicated in patients with even subtle clinical
features suggestive of CNS infection
d) Rescue therapy using PR Diazepam during seizure attack is
recommended provided parents are adequately counseled
4. A 2-year-old boy presents to the emergency department
for evaluation following a witnessed seizure. The
seizure was described as generalized, lasting less than 5
minutes with a short post-ictal period. The child has no
history of seizures, no family history of seizures, and
no history of head injury. His exam currently is
normal, except for a red, bulging right tympanic
membrane and a temperature of 39 C. What is the
most appropriate management for this patient?
a)Urgent CT scan of the head
b) Antibiotics and antipyretics and monitored at home
c) Admitted to hospital and EEG is performed
d) Start on phenobarbital and sent home
e)LP and Blood culture performed and start anticonvulsant in hospital