Febrile Seizures | National Institute of Neurological Disorders and Stroke

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What are febrile seizures?

Febrile seizures are seizures or convulsions that occur in young children. They are triggered by fever typically above 101 degrees Fahrenheit (38.3 degrees Celsius). Seizures may happen during illnesses such as a cold, the flu, or an ear infection. In some cases, a child may not have a fever at the time of the seizure but will develop one a few hours later.

Having a febrile seizure does not mean a child has epilepsy. Epilepsy involves repeat seizures that are not triggered by fever.  

Symptoms may include:

• Loss of consciousness or passing out
• Uncontrollable shaking
• Eye rolling
• Rigid (stiff) limbs

Less commonly, a child can become rigid or have twitches in only part of the body.

Most febrile seizures last a minute or two. Yet some may only last a few seconds and others may last for more than 15 minutes.

Febrile seizures that last less than 15 minutes do not cause any long-term health problems. However, if another one happens, it is more likely to be prolonged or longer than 15 minutes. A first febrile seizure that is prolonged does not boost the risk of having more. Even prolonged seizures are generally harmless on their own, but they do carry an increased risk of developing epilepsy.

Who is more likely to get febrile seizures?

About 40 percent of children who have one febrile seizure will have another. Certain things increase the risk for more febrile seizures, including:

• Young age—Children who have their first febrile seizure when they are younger than 18 months are at an increased risk of having another one. 
• Family history—Children whose family members had febrile seizures are more likely to have more than one seizure.   
• First sign of illness—Children who have febrile seizures before exhibiting other symptoms of an illness are at greater risk of having multiple seizures.
• Low temperature—Children are more likely to have another febrile seizure if the first one was accompanied by a relatively low temperature.

How are febrile seizures diagnosed and treated?

Diagnosing febrile seizures

To diagnose febrile seizures in infants and children, healthcare providers will review a child’s medical history and perform a physical exam. They often test blood and urine to help pinpoint the cause of the fever. Keep in mind that dehydration from severe diarrhea or vomiting can cause seizures. 

Meningitis, an infection of the membranes surrounding the brain, can cause both fever and seizures that can look like febrile seizures but are much more serious. If meningitis is suspected, health care providers may remove and test a small amount of the fluid that surrounds the brain and spinal cord.  

Most of the time, children who have febrile seizures will not need to be in the hospital. Healthcare providers may recommend hospitalization if:

• The seizure is prolonged
• The child has a serious infection
• The child is younger than 6 months of age

Treating febrile seizures

Parents and caregivers should remain calm, take first aid measures, and carefully watch the child. During a febrile seizure, parents and caregivers should:

• Note the start time of the seizure. If it lasts longer than five minutes, call an ambulance. The child should be taken right away to the nearest medical facility.
• Call an ambulance if the seizure is less than five minutes but the child does not seem to be recovering quickly.
• Gradually place the child on a protected surface such as the floor to prevent injury. Do not restrain or hold a child during a convulsion.
• Put the child on his or her side or stomach to prevent choking. When possible, gently remove any objects from the child’s mouth. Nothing should ever be placed in the child’s mouth during a seizure. These objects can block airway and make it hard to breathe.
• Seek immediate medical attention if this is the child’s first febrile seizure. Once it is over, take the child to the doctor to check for the cause of the fever. This is especially urgent if the child shows these symptoms of meningitis, an infection over the brain surface, which can include stiff neck, extreme lethargy, or a lot of vomiting.

Drugs that lower fevers such as acetaminophen or ibuprofen may provide comfort yet studies show that treating a fever does not lower the risk of febrile seizure. Healthcare providers may recommend other medications to control seizures if needed.

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Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

How can I or my loved one help improve care for people with febrile seizures?

Consider participating in a clinical trial so clinicians and scientists can learn more about febrile seizures and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with febrile seizures at Clinicaltrials.gov.

Where can I find more information about febrile seizures?

Information may be available from the following resources:

Centers for Disease Control and Prevention (CDC)
Phone: 800-232-4636

Citizens United for Research in Epilepsy (CURE)
Phone: 312-225-1801 or 844-231-2873

Epilepsy Foundation
Phone: 301-459-3700 or 800-332-1000

Learn about related topics

• Epilepsy and Seizures

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Seizures and hot summers | Epilepsy Society

Thank you to everyone who took part in our recent surveys looking at the impact of excessively high temperatures on seizures. These have provided us with some invaluable insight into the link between the two and will help to influence our work as we experience increasingly hot summers.

A survey carried out by the Epilepsy Society has shown that 62 per cent of people with uncontrolled seizures experience an increase in their seizure activity during unusually hot weather.

More than 1,000 people responded to our survey, including 969 people whose epilepsy does not respond to current treatments. A total of 598 of this group said that they experienced a change in their seizure activity during very hot weather. This included an increase in frequency, severity or a ‘breakthrough’ seizure even when they considered their epilepsy to be generally well controlled. 

The charity conducted its survey following the week of 21-27 June 2020, when temperatures soared above 30 degrees Celsius.  

Researchers at the charity are keen to understand more about how hot weather affects people with epilepsy and the impact that climate change might have in the future.

“Cannot sleep due to high temperatures, therefore as well as the high heat affecting my seizures ,also have to deal with sleep deprivation seizures” – respondee

Anecdotal evidence has already suggested an increase in seizure activity for children with Dravet syndrome, a severe childhood epilepsy. Dravet Syndrome UK, has shown that the unusually high temperatures of summer 2018 resulted in children with this rare condition, caused by a mutation in the SCN1A gene, experiencing more seizures and greater lethargy. 

One girl with Dravet syndrome in Australia died after being out in temperatures of 40 degrees C. Temperature changes are known to affect some genes and proteins.

But the Epilepsy Society’s survey is the first time that data has shown a direct link between excessively hot weather and seizures in a large group of people with epilepsy in the UK.  

“More extreme heat will make my seizures more frequent but also the impact of the seizures worse. And the recovery from the seizures longer” – respondee

Significantly, 40 per cent of respondees expressed concern that climate change would affect their epilepsy or the epilepsy of the person they cared for. And 75 per cent said they would like to see more research into the impact of climate change on the condition and what could be done to address it.

Taking action

Professor Sanjay Sisodiya, Director of Genomics at the Epilepsy Society said that not only did the survey capture important data about the link between temperature and seizures, but it also highlighted a growing concern among people with epilepsy that unless we take measures now to control global warming, their own health could be adversely affected.

“If the hot summers that we are experiencing now are contributing to worsening control of some people’s seizures, then we, as their doctors, need to understand that connection and take appropriate action to reduce risk by helping to tackle climate change or to mitigate its effects,” he said.

“High heat always causes my son to have breakthrough seizures” – respondee

According to research, climate change directly related to human causes such as carbon emissions make the likelihood of extreme temperatures a near certainty. Scientists warn that human influence is increasing the risk of UK summer temperatures regularly exceeding 35 degrees C.

With current emission rates, UK temperatures are likely to hit 40 degrees C every 100-350 years. Under the worst-case scenario, without mitigating greenhouse emissions, these excessive temperatures could occur every 3.5 years by 2100 (https://www.nature.com/articles/s41467-020-16834-0).

EpiCC

Prof Sisodiya has formed an international consortium – Epilepsy Climate Change (EpiCC) – specifically to address the issue.

Earlier this year, EpiCC carried out a small, preliminary study to help them begin to understand more about people’s perceptions of climate change and how it is affecting their epilepsy.

46% of people responding said that the frequency of their seizures changed during the hot summer of 2018, while 37% said their severity altered. During the hot summer of 2019, 50 per cent reported a change in both frequency and severity. 

Over 90% said they are concerned about climate change with almost half (46%) worrying that climate change will affect their epilepsy. Almost 40% said that thinking about climate change affects their mental well being, with 86% saying it causes them anxiety and 20% depression.

The majority of respondees (87%) believe that it is the responsibility of everyone, rather than just governments, to tackle climate change. And 80% have already taken action to try to reduce their own impact on the environment. This includes recycling domestic waste, using energy efficient light bulbs, avoiding single use plastics, and turning off lights.

87% said they would consider having a remote consultation with their healthcare professional, at least some of the time, if it helped to reduce carbon emissions. And almost one in three (31%) said they felt doctors should find alternative ways to network and share research, rather than flying to international conferences which carry a heavy carbon footprint.

Prof Sisodiya and EpiCC are planning to share and generate more scientific discussion around epilepsy and climate change through a series of webinars at the end of the year. This will also provide an opportunity for people affected by epilepsy to take part in a workshop about the impact of global warming on seizures.

We will bring you further updates nearer the time.

Our longer survey

If you are concerned about the impact that climate change might have on seizures, you might like to take part in our longer survey Epilepsy and Climate Change. This will help us to understand more about the link between rising temperatures and seizure activity. It will also help us to address global warming in the most appropriate ways.

Thank you.

Convulsions at high temperature in children.

What Parents Need to Know

Hyperthermia or febrile seizures in children are seizures at high temperatures. The most common so-called convulsive syndrome of childhood. It has been established that this type of seizures are more often observed in winter and spring. It is assumed that this is due to a higher frequency of infectious diseases in the winter-spring period.

When children have febrile convulsions (high temperature)

Febrile seizures can develop in children with various infections, pneumonia, otitis, which are accompanied by fever.

Hyperthermic convulsions are an age-dependent pathology and debut mainly at the age of 18-24 months.

At what age do convulsions appear in children with a high temperature? Studies have shown that in the presence of a family burden, febrile convulsions can occur at a lower temperature in children.

Parents who first encounter a seizure in a child with a high temperature, as a rule, are psychologically unprepared, confused and do not know what to do first.

What to do if a child has seizures with a high temperature

Recommendations of a pediatric neurologist to parents on providing first aid to a child with febrile seizures:
• behave calmly, do not panic;
• unfasten the collar of clothing, free the chest from tight clothing;
• lay the child down with their head turned to one side;
• do not try to open the jaws with any object;
• measure temperature;
• do not give drugs by mouth;
• closely monitor the course of the attack.

Although febrile convulsions are triggered by high fever, excessive exposure of the child to cold should be avoided.

Clinical experience shows that cold wraps, rubbing with alcohol or a solution of vinegar, the use of fans do not give a significant beneficial effect and sometimes cause discomfort that negatively affects the course of an attack.

It is important to know and remember that in most cases the course of febrile seizures is benign, the probability of their transformation into severe forms of epilepsy is generally low (2-5%).

With the development of hyperthermic seizures, it is necessary to call an ambulance.

This is especially important in the following cases:

• the duration of the seizure is more than 10 minutes;
• repeated convulsions, with impaired consciousness;
• manifestation of the first episode before the age of 6 months;
• the presence of neurological symptoms (prolonged impairment of consciousness, post-attack paralysis, etc.).

Children who have had a febrile seizure should be observed by a pediatric neurologist:

• 1 month after the seizure,
• then 2 times a year.
• In terms of examination, a pediatric neurologist prescribes electroencephalography (EEG) after an attack, then once a year.

Prevention in children to avoid recurrence of convulsions at high temperature

The likelihood of recurrence of febrile seizures is quite high. Therefore, preventive measures are of particular importance. The question of the advisability of prescribing anticonvulsant drugs is decided by a specialist – a pediatric neurologist.

Parents, on the other hand, can prevent convulsions with fever by keeping the temperature from rising. It should be remembered that a child who may have febrile convulsions should use antipyretics when the temperature rises to 37.5 ° C.

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Febrile seizures in children aged 3 months. – 5 y. – 5 years,
associated with fever.

At this age, the child’s brain is not yet mature enough and more
sensitive to internal and external factors. To a greater extent
predisposed to febrile seizures are children with similar manifestations in
parents, as well as in the presence of a pathology of pregnancy and childbirth in the mother.

Febrile convulsions appear in diseases that occur with high
temperature (above 38 ° C) – acute viral infection, influenza, tonsillitis, Tite,
bronchitis, pneumonia, etc. An increase in temperature, causing metabolic changes and
violations of the blood supply to the brain, increases the readiness for convulsions.

Not included in this group convulsions due to infectious diseases
nervous system (meningitis, encephalitis), as well as when the occurrence of febrile
seizures are preceded by afebrile paroxysms.

Convulsions usually occur on the first day of the rise in temperature and are manifested in
in the form of loss of consciousness with general tension of the body and twitching of the limbs.
Sometimes convulsions can be erased or predominate on one side.
body. Some children may foam at the mouth and involuntarily
urination.

Convulsions usually last 3-5 minutes. Repeated cramps throughout the day
are rare. Sometimes hours or minutes before seizures occur
the child becomes restless, clings to the mother, screams. And then general
excitation is replaced by convulsions.

Febrile convulsions are subdivided into simple and complex.

Simple febrile seizures account for 80-90% of all febrile seizures. Characteristic features of simple febrile seizures
are:

• single episodes,
• short duration (max. 15 min.),
• generalized tonic-clonic, clonic or tonic
  attacks.
• As a rule, simple febrile seizures occur in normal
  developing children without focal neurological disorders.
• Simple febrile seizures are usually not complicated by transient and
  permanent neurological disorders.

Complex febrile convulsions are characterized by the following
signs:

• duration more than 15 min.,
• 24 hour repeatability,
• focal character (convulsions predominate on one side of the body).
• Complicated febrile seizures are often followed by transient
  neurological disorders.

It is also possible to develop febrile status epilepticus – arising on
background of fever, recurrent generalized tonic-clonic seizures
lasting more than 30 min. Death from febrile status epilepticus
observed extremely rarely.

Neuropsychic development of children with febrile convulsions, as a rule,
age appropriate.

Prevention and treatment of febrile seizures. Significant
difficulties arise when deciding on the treatment of children with febrile
convulsions. In the absence of risk factors, even with repeated simple febrile
convulsions, there is no reason to prescribe antiepileptic therapy, since
the likelihood of developing epilepsy in such children is negligible.

If there are risk factors or complex febrile seizures, ask about
the appointment of antiepileptic therapy is decided individually. In this case
there is a risk of transition of febrile convulsions into epilepsy.

To prevent febrile seizures in a child with a high fever,
apply paracetamol (daily dose of 20-30 mg per kg) every 4-5 hours and
wet rubdowns with cold water or vodka. No increase allowed
body temperature above 38°C! It is necessary to measure the child’s body temperature
every hour, and if its increase is noted despite all the measures, it is necessary
call an ambulance.

If febrile convulsions develop, they usually last 2-3 minutes and
bought on their own. If they last more than 10 minutes or are repeated, then
it is necessary to enter diazepam (seduxen). This therapy is carried out by emergency physicians
care or hospital.

Parents of children with febrile seizures should:

1. Seizure prevention: measure body temperature every hour
   with illness; give drugs that reduce the temperature; conduct a physical
   cooling the child (rubbing, enemas with boiled water at room
   temperature).
2. Be able to properly provide first aid to a child in the event of
   fit:

• open the collar and remove tight clothing;
• remove foreign objects (prostheses) from the oral cavity;
• put the child on his back and turn his head to the side;
• do not try to open the jaws with any object;
• do not give any drugs or liquids by mouth;
• measure temperature;
• carefully observe the course of the attack;
• to be near the child until the attack stops completely.