Febrile seizures. Recognition and management
1Section of Clinical Neurophysiology, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois.
Insights
Most febrile seizures in children are benign and do not need long-term medication. Careful evaluation helps distinguish these from serious seizures, reassuring parents and guiding treatment for fever and seizure emergencies.
Area of Science:
- Pediatrics
- Neurology
Background:
- Febrile seizures are common in infants and children.
- Most febrile seizures are benign and self-limiting.
Purpose of the Study:
- To differentiate benign febrile seizures from those requiring further evaluation.
- To guide management and parental education for febrile seizures.
Main Methods:
- Review of clinical history, including seizure details, family history, and developmental history.
- Physical examination.
- Assessment for risk factors of epilepsy and neurological sequelae.
Main Results:
- A benign febrile seizure syndrome can be identified through careful history and physical exam.
- One-third of children may have recurrent febrile seizures, but epilepsy risk is not significantly increased.
- Non-benign seizures require further evaluation, potentially including neuroimaging and EEG.
Conclusions:
- Most febrile seizures are benign, requiring reassurance and education on fever management and emergency seizure treatment.
- Physicians must accurately identify children with non-benign seizures for appropriate further investigation and potential antiepileptic drug treatment.
Abstract:
The majority of all febrile seizures represent a benign syndrome that does not require extensive testing or long term medication. A careful history of the febrile seizure, family history, developmental history and physical examination can identify those infants and children with this syndrome. While one-third of this group will experience additional febrile seizures, there is no significant increase in the incidence of later epilepsy or neurological sequelae. The parents of these children need to be reassured and educated about this syndrome. They should understand the emergency treatment of seizures and aggressively treat fever. The more difficult task for the physician is to correctly identify those children who experience nonbenign seizures. Careful history and physical examination can accurately identify this group. Further evaluation including neuroimaging, electroencephalogram and developmental assessment may be necessary. In those children with a high risk of later epilepsy, treatment with an antiepileptic drug should be considered.
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