FEBRILE CONVULSION

By

Shabrina Herdiana Putri

030.08.222

Jakarta, 8th June 2011

Abstract

Febrile seizures are the most common form of seizures observed in the pediatric age

group. In 1980, a consensus conference held by the National Institutes of Health described a

febrile seizure as, "An event in infancy or childhood usually occurring between three months and

five years of age, associated with fever, but without evidence of intracranial infection or defined

cause." Most febrile seizures are considered simple, although those with focal onset, prolonged

duration, or that occur more than once within the same febrile illness are considered complex.

Risk factors for a first febrile seizure, recurrence of febrile seizures, and development of future

epilepsy are identifiable and varied. Children with febrile seizures encounter little risk of

mortality and morbidity and have no association with any detectable brain damage. Recurrence is

possible, but only a small minority will go on to develop epilepsy. Although antiepileptic drugs

can prevent recurrent febrile seizures, they do not alter the risk of subsequent epilepsy. This has

led to a changing view of how we approach the treatment of these common and largely benign

seizures.

Introduction

Febrile seizures are full-body convulsions that can happen during a fever. The seizures

usually last for a few minutes and are accompanied by a fever above 38° C. During a febrile

seizure, a child's whole body may convulse, shake, and twitch, and he or she may moan or

become unconscious. This type of seizure is usually over in a few minutes, but in rare cases can

last up to 15 minutes. Febrile seizures are not considered epilepsy, but kids who've had a seizure

are at a slightly increased risk for developing epilepsy, especially if there is a family history.

The fever associated with a febrile seizure is usually defined by a temperature of at least

38°C.3 No evidence exists that febrile seizures are more likely to occur with the maximal rate of

temperature rise, although this is often quoted.6 Febrile seizures may occur before the fever is

apparent and early or late in the course of a febrile illness.w5

An entity of afebrile convulsions in young children with mild gastroenteritis is increasingly

recognized. This disorder was initially observed in Asian countries, but white children from the

United Kingdom have recently been reported with the condition.w6 Whether the racial differences

are caused by underlying genetic or environmental factors or relate to under-recognition is

unclear. A large case series found that these children present with clusters of generalized or focal

seizures with and without fever over several days in the setting of viral

gastroenteritis.7 w6 Children do well without recurrence of seizures and have normal

development. Compared with children with febrile seizures, these children have less of a family

history of seizures, a lower recurrence rate, and more clustering of attacks.7 w6

Conclusion

Febrile seizures are a common benign disorder with an excellent outcome. Exclusion of

central nervous system infection such as meningitis and encephalitis is important, particularly in

a child with febrile status epilepticus. Education and reassurance remains the mainstay of

management for families faced with these frightening attacks.