About 3 percent of all children experience a febrile seizure by the age of 7. These seizures typically affect normally developing children between the ages of six months and five years. As long as these seizures occur only during a fever or as part of an infection, they are not considered epilepsy.
Below you will find additional information as well as a list of selected febrile seizure specialists.
A child’s first febrile seizure is often an unexpected and dramatic event for parents. Many fear for their child’s life.
However, the prognosis for recurrent febrile seizures is very good.
The child’s future development is not affected. Only in rare cases can these seizures be an early sign of developing epilepsy.
Since a febrile seizure can sometimes be the first symptom of meningoencephalitis, you should see a doctor immediately.
In infants and toddlers, a lumbar puncture (examination of the cerebrospinal fluid) may be performed.
What is a febrile seizure?
A febrile seizure is a seizure that occurs during a high fever in children between 3 months and 5 years of age.
It is important to note that this is not epilepsy. Nor is it an intracranial infection or any other specific cerebral cause.
In general, febrile seizures occur in children who, due to their genetic predisposition, already have a lower seizure threshold. This threshold is lowered even further by the fever, resulting in a tonic-clonic seizure.
Febrile seizures are therefore classified as occasional seizures and, at about 50 percent, account for the largest proportion of such seizures.
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Symptoms of a febrile seizure
A febrile seizure usually occurs at the onset of an infection, during the initial rise in fever. The most common clinical form of the seizure is a generalized tonic-clonic seizure.
This involves stiffness throughout the entire body and twitching of the arms and legs. During this phase, children are unresponsive, even though their eyes are open.
Depending on the duration of the seizure, children may also develop a bluish discoloration of the face (cyanosis).
The seizures are usually brief (< 3 min), stop on their own, and occur only once within a 24-hour period. After the seizure, children are often tearful, tired, and fall asleep quickly.
Diagnosis of a febrile seizure
It is important for diagnosis and the resulting therapeutic measures to distinguish between:
- simple febrile seizure
- complicated febrile seizure
Simple febrile seizure:
- The seizure is a tonic-clonic seizure
- Duration of the seizure < 15 min
- Only one seizure occurs within 24 hours
- Although the child is tired after the seizure, there are no motor abnormalities
Complicated febrile seizure (with at least 1 symptom):
- The seizure is a focal seizure
- Duration of the seizure > 15 min
- More than one seizure within 24 hours
- The child is < 6 months or > 5 years old
- After the seizure, the child temporarily exhibits symptoms such as paralysis
Prognosis for febrile seizures
The general risk of recurrence for febrile seizures is approximately 30 percent; for a febrile seizure occurring in the first year of life, it is 50 percent.
95 percent of children with febrile seizures have a good prognosis and develop completely normally. This also applies in cases of recurrent simple febrile seizures.
The long-term risk of epilepsy in children increases only slightly after simple febrile seizures:
- Risk of epilepsy (prevalence in the general population: 1 percent)
- 1 to 2 percent of children after an uncomplicated febrile seizure
- 10 to 15 percent of children after a complicated febrile seizure
Treatment of febrile seizures
General measures:
- Stay calm; lay the child down so that they cannot injure themselves (especially the head).
- Check the time to estimate the duration of the seizure.
- In the event of a first febrile seizure, call an emergency doctor.
Most febrile seizures end spontaneously within 2 to 3 minutes. If the seizure lasts 5 minutes or longer, fast-acting emergency medications administered orally or rectally should be used to stop the seizure.
Children are given this medication after their first febrile seizure. Long-term medication therapy is generally not necessary.
Since febrile seizures occur during the initial rapid rise in fever associated with an infection, they cannot be prevented by consistently lowering the fever.
Parents should be informed accordingly, as fever-reducing medications are often still recommended once the body temperature reaches 38.5°C.
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