Seizures | Boston Children’s Hospital

What are the symptoms of a seizure?

A child may have a wide variety of symptoms depending on their type of seizures. Some seizures are easy to recognize through signs like shaking or temporarily losing consciousness. Other seizures are so mild that you might not even recognize them as seizures: They might involve only a visual hallucination, for example, or a moment of very strong emotions. In some cases, seizures have no outward signs at all.

Some signs that your child may be experiencing seizures include:

• staring
• tremors, convulsions, or jerking movements in the arms and legs
• stiffening of the body
• loss of consciousness
• breathing problems
• loss of bowel or bladder control
• falling suddenly for no apparent reason
• not responding to noise or words for short periods of time
• appearing confused or in a haze
• extreme sleepiness and irritability when waking up in the morning
• head nodding
• periods of rapid eye blinking and staring
• vomiting
• changes in vision, speech, or both

Sometimes these symptoms can have a cause other than seizures. Further testing will help doctors confirm suspected seizures or find another condition that is causing the symptoms.

Seizures don’t necessarily harm the brain, but some seizures do cause damage. The side effects of seizures, such as dramatic changes in behavior and personality, may remain even when your child isn’t actually having a seizure. In some cases, seizures are associated with long-term neurological conditions and problems with learning and behavior.

During the seizure itself, children may fall or get injured. It’s important to stay with your child during a seizure. Gently ease the child to the floor if sitting or standing, turn them on their side in case of vomiting and remove any surrounding hard objects. Seizures may leave your child exhausted. Unfortunately, just as troubling as the physical complications, seizures can also cause embarrassment and social isolation.

What are the different types of seizures?

Focal seizures

Focal seizures, formerly called partial seizures, happen when abnormal electrical activity has its onset in a particular area of the brain, known as the “seizure focus. ” They can occur in any lobe of the brain. Before a focal seizure, your child may experience an aura — a strange feeling that involves changes in hearing, vision, or sense of smell.

Focal seizures may last less than a minute and have different symptoms depending on which area of the brain is involved. They usually affect the muscles, causing a variety of abnormal movements that are limited to one muscle group, such as the fingers or the larger muscles in the arms and legs. If the abnormal activity is in the brain’s occipital lobe, your child may experience changes in vision. Your child may experience sweating or nausea or become pale but will not lose consciousness.

Focal seizures may be associated with altered consciousness. Your child can experience a variety of behaviors, such as gagging, lip smacking, running, screaming, crying, or laughing. After the seizure, during what’s called the postictal period, your child may feel tired.

Generalized seizures

Generalized seizures involve both sides of the brain. Children lose consciousness and have a postictal period (a recovery phase) after the seizure. The types of generalized seizures include:

• Absence seizures (also called petit mal seizures) involve episodes of staring and an altered state of consciousness. They usually last no longer than 30 seconds but can happen several times a day. Your child’s mouth or face may move, or eyes may blink. Afterward, your child may not recall the seizure and may act as if nothing happened. Absence seizures almost always start between ages 4 and 12 and are sometimes mistaken for a learning or behavioral problem.
• Atonic seizures involve a sudden loss of muscle tone and may cause drop attacks: Your child may fall from a standing position or suddenly drop their head. During the seizure, your child is limp and unresponsive.
• Tonic seizures involve a sudden stiffening of parts of the body or the entire body. Brief tonic seizures may also cause drop attacks.
• Generalized tonic-clonic seizures (also called GTC or grand mal seizures) are characterized by five distinct phases:
  1. flexing of your child’s body, arms, and legs
  2. straightening out of their body
  3. tremors (shakes)
  4. contraction and relaxing of the muscles (the clonic period)
  5. a postictal period in which your child may be tired and sleepy, have problems with vision or speech, or have a bad headache or body aches

Myoclonic seizures

Myoclonic seizures involve sudden jerking in a group of muscles. These seizures tend to occur in clusters, happening several times a day or for several days in a row.

Infantile spasms

Infantile spasms are a rare type of seizure disorder that occurs in the first year of life. They usually involve brief periods of movement in the neck, trunk, or legs, often when a child is waking up or trying to go to sleep. They usually last only a few seconds, but infants may have hundreds of these seizures a day. This can be a serious problem and can be associated with long-term complications. Spasms may also occur throughout life and can also cause drop attacks.

Status epilepticus

Status epilepticus is a situation in which seizures develop into a prolonged seizure of 30 minutes or longer duration. This condition is a medical emergency and may require hospitalization.

Febrile seizures

Febrile seizures are triggered by fever and usually happen in children between 6 months and 5 years of age. They involve muscle contractions — either mild (such as stiffening of the limbs) or severe (convulsions). Febrile seizures are fairly common, affect about 2 to 5 percent of children in the U.S., and often run in families. Febrile seizures that last less than 15 minutes are called “simple”; those lasting longer are called “complex.”

What causes seizures in children?

Seizures can take a wide variety of forms, depending in part on what part of the brain has the abnormal electrical activity. Many different diseases and injuries can cause children to have seizures. These include:

• head injuries
• birth trauma
• congenital conditions (conditions that your child is born with)
• poisoning
• fever or infection
• brain tumors
• maternal illness during pregnancy
• heredity
• degenerative brain disorders
• stroke
• metabolic problems and chemical imbalances in the body
• alcohol or drugs
• medications

Often, however, the exact cause of seizures cannot be determined.

Seizures in Children | Causes, Types, Symptoms & Treatment

A seizure is a sudden, abnormal wave of electrical activity in the brain. Seizures begin suddenly. Most often stop on their own within a few minutes.

Seizures are common. About one in 10 people will have a single seizure in their lifetime.

People often associate seizures with dramatic symptoms, such as loss of consciousness or convulsions (uncontrolled shaking). Signs and symptoms vary depending on the type of seizure a person has and what part of the brain is involved. Some seizures are not obvious to others. Rather than physical symptoms, the child has an “odd feeling,” such as déjà vu (a sense of having experienced the present situation before). These odd feelings come “out of the blue.” They usually get worse as the person continues to have seizures.

Seizures are treatable. Many children outgrow their tendency to have them. An accurate diagnosis can help doctors find the most effective treatment.

When a child has shown a tendency to have seizures, it is called epilepsy. About one in 26 people who have seizures will develop epilepsy.

What Causes Seizures in Children?

Seizures can be divided into two general categories, provoked and unprovoked. Provoked seizures can be caused by many different conditions, such as high or low blood sugar, a head injury, infection or very high blood pressure. A stroke, kidney or liver failure, and high fever may also provoke a seizure. These types of seizures are extremely rare.

Unprovoked seizures do not have an immediate, clear cause. After further evaluation, doctors may find a cause, such as a genetic condition or lesion in the brain.

Finding the cause of seizures can be challenging for doctors and frustrating for families. Sometimes even after extensive evaluation, the cause of a child’s seizure is unknown. Even if the doctor doesn’t discover the cause of a child’s seizures, treatment may help bring the seizures under control.

Types of Seizures in Children

There are many different types of seizures in children. They fall into a few categories:

• Focal, meaning the seizure activity begins in one part of the brain and may spread from there.
• Generalized, meaning the seizure affects all parts of the brain at once.
• Infantile spasms, a type of seizure that begins during the first year of life.
• Status epilepticus, which involve convulsions of more than five minutes.
• Febrile seizures, which occur within 24 hours of a fever for children between six months and five years of age.

Focal Seizures

Focal seizures are a common type of seizure in children. Symptoms include:

• A feeling of falling or spinning
• A feeling of “pins and needles”
• A sense that familiar things are suddenly unfamiliar, or vice versa
• A sudden feeling of anger or fear
• “Automatisms” (involuntary gestures), such as removing or fiddling with clothing, grunting, lip-smacking and clumsy movements
• Buzzing noises
• Garbled speech or problems with memory
• Repeating words or phrases, laughing or crying
• Rhythmic twitching of a limb or part of a limb (twitching may spread to other parts of the body)
• The appearance of daydreaming, including blank stares
• Smelling or tasting things that aren’t there
• Vivid hallucinations
• Wandering

Children can experience two types of focal seizures:

• “Focal aware seizures” (previously called “simple partial seizures”)—The child remains fully alert and awake. They remember having the seizure. But they may not be able to interact with others while the seizure is happening.
• “Focal impaired awareness seizures” (previously called “complex partial seizures”)—The child is unaware of their surroundings. They may not remember the seizure.

Generalized Seizures

There are two categories of generalized seizures. They include non-motor such as absence (pronounced “ab-SONCE”) seizures and motor seizures.

Non-motor, Absence Seizures

Sometimes called “petit mal seizures,” absence seizures are one of the most common seizures in children. A child having this type of seizure may look like they are daydreaming or zoning out. The seizures last 15 seconds or less. They may occur many times a day. They may begin at age four through adolescence. Some children outgrow them.

Motor Seizures

The four types of generalized motor seizures include:

• Atonic seizures
• Myoclonic seizures
• Tonic seizures
• Tonic-clonic seizures

Atonic seizures
Atonic seizures involve a sudden loss of muscle tone. Sometimes called a “drop attack,” these can cause symptoms such as:

• Brief loss of consciousness
• Falling to the ground
• Head dropping down

Myoclonic seizures
Myoclonic seizures involve sudden, shock-like muscle contractions affecting one or more limbs. These seizures may happen once or in clusters, with more than one occurring in a short period of time.

Tonic seizures
These seizures involve stiffening of the body and/or arms and legs. They may occur when the person is awake or asleep. If they happen while standing or sitting, the person may fall to the ground.

Tonic-Clonic seizures
When a person has a tonic-clonic seizure (sometimes called a “grand mal seizure”), they lose consciousness, their muscles stiffen, and their arms and legs jerk uncontrollably. A tonic-clonic seizure usually begins on both sides of the brain. It can also start on one side and spread to the whole brain. There are two phases:

• Tonic phase: The person’s muscles stiffen. They may fall to the floor. Breathing is affected. The person may turn a bit blue in the face and cry out. The person may bite their tongue or cheek, causing bleeding from the mouth.
• Clonic phase: This follows the tonic phase. It involves convulsions—the person’s arms and usually legs begin to jerk. Sometimes the person loses control of their bladder or bowel.

These seizures usually last a few minutes. A tonic-clonic seizure of five minutes or more is a medical emergency.

Infantile Spasms (West Syndrome)

Sometimes called “epileptic spasms,” these seizures are diagnosed in a baby’s first year of life. They may start with a quick spasm involving a downward head jerk. Over time, these may develop into clusters of spasms in which the child’s arms or legs arms rise and/or straighten suddenly.

Seizures most often occur when the child is waking up or falling asleep. At first, these symptoms may be subtle. Over time, they become more noticeable.

Infantile spasms are a medical emergency. They do not pose an immediate danger, but children with infantile spasms are at high risk for developmental delays. The child may lose skills, such as crawling and walking, if left untreated. They need immediate treatment for the seizures to minimize their risk for long-term problems.

Cincinnati Children’s offers a specialized neurometabolic program to help infants or children experiencing infantile spasms. It is available through our Infant Seizure Program.

Status Epilepticus

Status epilepticus is a medical emergency. It involves convulsive seizures lasting more than five minutes. If the seizures last longer than 30 minutes, serious problems could occur, including permanent brain damage. Children diagnosed with status epilepticus need to have “rescue medication” nearby at all times. An adult can give this medication to stop the convulsions quickly.

Febrile Seizures (seizures in toddlers)

These seizures occur in children ages six months to five years old. They happen within 24 hours before or after the child has a fever. These motor seizures involve convulsions. Children typically outgrow these seizures.

Febrile seizures can be simple or complex. To be considered complex, febrile seizures must last longer than 15 minutes or occur more than once in 24 hours or affect one part of the body. The shaking may affect one or both sides of the body. A small percentage of children who have complex febrile seizures develop epilepsy.

Signs and Symptoms of Seizures

When you hear the word seizure, you may picture someone lying on the ground and shaking violently. This is how seizures are shown on television and in the movies. However, many types of seizures are subtle. They can be hard to recognize, especially in infants.

The most common symptoms include:

Non-motor Symptoms

• A color change of the lips or face
• A funny feeling the child can’t describe
• Lack of awareness and/or decreased responsiveness, plus staring
• Eyes or head turned into one direction
• Staring with eye fluttering
• Seeing stars or shapes
• Excessive drooling
• Loss of bowel or bladder control

Motor Symptoms

• “Automatisms,” or repetitive activities, such as fiddling with clothing, grunting, lip-smacking and clumsy movements
• Convulsions (uncontrolled shaking of the body)
• Drooping facial features
• Jerking movements or stiffening of one or more arms and legs
• Sudden loss of muscle control
• Twitching or jerking of the face, arm or leg

When the seizure is over, the child may be tired and need to rest.

Auras

Some people experience an “aura” (warning). This is part of the seizure. Auras usually last seconds to minutes. They occur before the person has visible signs of a seizure. Some common auras can include:

• A physical sensation (numbness or tingling, racing heartbeat, dizziness, headache)
• An emotion (suddenly feeling sad or anxious)
• A change in senses (unusual smells or taste)

People who experience an aura can take safety precautions, such as sitting down, telling someone they are about to have a seizure, or taking medication as prescribed.

What Do You Do if a Child is Having a Seizure?

• Stay calm and stay with your child.
• Protect your child from getting hurt. Move objects away that may harm them.
• Place a soft object under your child’s head.
• Roll your child onto their side.
• Loosen tight clothes.
• Time the seizure when it starts.
• Be prepared to give seizure rescue medication based on your child’s individual seizure plan.
• Call 911 if seizure lasts five minutes or longer and you do not have a seizure rescue medication.
• Do not put anything in the child’s mouth. Your child cannot swallow their tongue.
• Do not try to keep your child from moving. This may cause you or your child to get hurt.
• Do not give liquids or medicine by mouth until your child is fully awake and alert.

Most seizures will stop within minutes on their own. If your doctor has prescribed “rescue medication” for seizures lasting five minutes or longer, be prepared. Know where the medication is and how to give it to your child. Store the medications securely at room temperature. Avoid storing it in places such as a car’s glove compartment or a tote bag that will be out in the sun.

After a seizure:

• Your child may be confused and sleepy. It is OK to let them sleep.
• Your child may have pee or poop in their pants.
• Any bleeding from the mouth may mean that your child bit their tongue or the inside of their cheek. Check the mouth only after the seizure is over. Put a clean cloth on the area and use gentle pressure to stop the bleeding.

Most seizures are not emergencies. But you should call 911 if your child:

• Has a seizure that lasts longer than usual
• Has a cluster of seizures (more than one seizure in a short period of time)
• Does not return to “normal” after the seizure within their usual timeframe (being sleepy is OK)
• Is not breathing normally after the seizure ends
• Has a seizure while in the water
• Is injured during a seizure

Diagnosing Seizures in Children

If your child experiences a seizure, they should be seen by a pediatric neurologist or pediatric epileptologist (a pediatric neurologist specializing in epilepsy).

During your child’s first appointment, the doctor will ask questions about your child’s seizure history and health history and whether other people in your family have had seizures. The doctor will also do a thorough exam and may order tests, such as:

• Electroencephalogram (EEG)
• Magnetic resonance imaging (MRI) of the brain
• Genetic testing

The goal is to discover the underlying cause of the seizure(s) and provide treatment. Sometimes it is not possible to find the underlying cause.

Treatment for Seizures

If your child is diagnosed with epilepsy, the doctor may prescribe anti-seizure medication. This medicine helps control seizures. The doctor will choose the medicine based on your child’s age, weight, seizure type and physical condition.

The goal of treatment is to achieve the best quality of life with no seizures and no side effects from the medicine. Sometimes the medicine will need to be changed if there are side effects that are too much to handle or if it doesn’t control the seizures. If a child is seizure-free after two years of being on medicine, the doctor may try to take them off their seizure medicine.

If a child still has seizures after taking two different epilepsy medications, their epilepsy is called intractable. This is the case for about 30% of children with epilepsy.

Learn about intractable epilepsy and how it’s treated.

Preventing Seizures

Your child’s provider may prescribe anti-seizure medication. It is also important for you to be aware of situations that seem to lead to your child’s seizures. These are called seizure triggers. Some common seizure triggers include:

• Fatigue – it is important to keep a good sleep schedule.
• Excessive stress – mental health professionals can help children and families learn to manage stress in healthy ways.
• Fever or other symptoms of illness – it is important to have good hand washing. Stay up to date on immunizations.
• Visual stimuli, such as flashing bright lights or computer games (please note that this type of seizure trigger is rare.)
• Using certain medications or not taking anti-seizure medication as prescribed.
• Hormonal changes, such as those with the menstrual cycle

Knowing your child’s seizure triggers can help your child avoid situations that could lead to a seizure. This will help you be more aware during “high risk” times (such as when your child is sick).

To identify seizure triggers, keep a seizure log. For each seizure, write down what time it is, what was happening and how your child felt before the seizure started. Look for patterns and connections. Talk to your child’s provider about what you learn.

What Is the Outlook for Children with Seizures?

Seizures are not necessarily a lifelong condition. Many children outgrow their tendency to have seizures. And for those who do not, treatment is often effective.

In recent years, science has come a long way to develop new treatments for people with seizures, especially those who have intractable epilepsy. Most children who have seizures can go to school, play sports and live full lives.

full description, symptoms and causes

“Febrile seizures” is a term that refers to the occurrence of seizures in children against the background of an increase in body temperature to 38 ° C and above. It can occur in the age group from six months to 5 years, most often from one to one and a half years. In most cases, infections are responsible for the development of such a symptom, less often it is observed as a post-vaccination reaction (after the introduction of vaccines). In general, febrile seizures are not dangerous. But it is important to show the child to the doctor to make sure that the symptom is caused precisely by fever, and not by other diseases.

Febrile seizures in a child are not a sign that he has any concomitant undiagnosed diseases. They also occur in quite healthy children without pathologies of the nervous system, normally developing. Although an attack looks scary, most often it is not dangerous.

Causes

Most often, infections caused by viruses are responsible for the development of this condition, in more rare cases, bacteria. Here are some of the infections most commonly associated with high fever seizures:

• influenza and COVID-19
• windmill
• encephalitis and meningitis due to various pathogens
• otitis – inflammation of the outer and middle ear
• gastroenteritis – infections of the gastrointestinal tract, often referred to as “intestinal flu”
• SARS
• tonsillitis
• streptococcal infections of the throat

Sometimes an attack occurs some time after the introduction of live vaccines, especially against measles, mumps and rubella (MMPII) – as a post-vaccination reaction. Also, an attack can be caused by an increase in body temperature that is not associated with an infection – for example, with heat stroke.

It is important to understand that vaccines do not directly cause febrile seizures on their own. As with infections, this is a consequence of high body temperature. In fact, vaccinations often help prevent this condition, because it often develops during the infections targeted by the immunization.

Some children are more likely to develop febrile seizures due to the influence of heredity and genetics. Scientists have been able to link certain genes with an increased susceptibility to this condition.

Pathogenesis: why does a child’s brain react this way to fever?

Let’s start with some numbers. Febrile seizures are the most common type of seizures in young children. In Europe and America, they occur at least once in 2-5% of children, in Japan – in 7-10%. Most often, this condition occurs in winter, which is predictable, because it is during the cold season that the peak incidence of influenza and other acute respiratory viral infections occurs.

Pathophysiology, that is, the mechanisms of development of febrile seizures in children at the cellular and biochemical level, has not yet been studied well enough. If we explain the process in simple words in accordance with modern ideas, then everything happens like this:

• In response to the introduction of an infection into the body, the immune system is activated, inflammation develops.
• As a result, various substances are produced, which are called pyrogens. Some of them are the remains of destroyed bacteria and viruses, and some are produced by the body itself.
• Pyrogens affect the center of thermoregulation – it is located in the brain, in the hypothalamus. The result is an increase in body temperature, fever.
• Against the background of high temperature, the balance between the mechanisms that provide excitation and inhibition of brain neurons is disturbed. Uncontrolled excitation occurs in entire clusters of neurons. Because of this, convulsions occur.
• The state of lethargy and drowsiness after an attack can be simply explained by the fact that the nerve cells that were overexcited earlier now need a “rest”.

Symptoms

Febrile seizures in children are generalized (joint twitches of different muscles) and local – for example, only in the muscles of the limbs or face. In most cases, they last no more than five minutes, and after they are completed, the child may become lethargic or fall asleep.

A typical picture in a generalized seizure includes loss of consciousness and convulsions throughout the body. There may be nausea and vomiting, foam at the mouth, involuntary urination or defecation, and the child may roll their eyes. With a local attack, there is muscle tension or twitching in only a certain part of the body, such as one arm or leg.

Febrile seizures usually occur within 24 hours of a rise in body temperature. In some cases, they become the first symptom of the disease, which parents pay attention to.

Depending on the duration of the course, there are two main types of febrile seizures and another rare one:

• Simple (occur in 65–80% of cases) manifest as described above and do not recur during the current episode of the disease. Most often they last up to 5 minutes, always no more than 15 minutes.
• Complicated (occurs in 20-35% of cases) is a febrile seizure that lasts more than 15 minutes, recurs within 24 hours, or involves one side of the body. This picture suggests that the child has an increased risk of developing seizure disorders at an older age.
• Febrile status is convulsions lasting more than 30 minutes. They are rare, accounting for 25–52% of all cases of status epilepticus in children. After such attacks, relapses occur in 41% of cases and negative consequences are more common. Approximately 20% of children who have undergone febrile status suffer from concomitant diseases of the nervous system.

Possible complications

As statistics show, every third child (and every second child under the age of one year) who has had such an attack will have convulsions in the future – often after a long time, with another infectious disease. In 10% of children who have had one episode of seizures, they are repeated during childhood three more times or more. Approximately 75% of relapses occur within 1 year of the first episode, and 90% – within 2 years.


Several factors increase the risk of relapse:

• The first episode occurred against the background of subfebrile condition – body temperature below 38° C
• Before the child had a febrile seizure, the illness was not manifested by other symptoms (that is, they became the first clear sign)
• Convulsions occurred less than an hour after the temperature increase
• One of the next of kin had episodes of febrile convulsions in childhood.
• The child was less than 18 months old at the time of the first seizure
• Complex convulsions during the first episode
• Neurodevelopmental retardation
• The child often carries infections with fever

The effects of these factors are cumulative. That is, the more items from this list are present, the higher the likelihood of relapse. So, on average, if there is not a single risk factor, then the probability of a recurrence of an attack in the future is 4%, and if all are present – 80%.

Usually, there are no health consequences of febrile convulsions after an attack. This condition does not lead to damage to the brain and other parts of the nervous system, mental retardation, problems with development and learning, and other pathologies. Studies have been conducted that have studied the relationship between febrile convulsions and impaired psychomotor, mental development, ADHD and other pathologies of the nervous system. These studies showed only a slight correlation, and the results of some of them were inconsistent. For parents, this means that in general there is nothing to fear.

Is there an increased risk of epilepsy?

Febrile seizures do not mean that a child has epilepsy. Usually the child with whom this happens is otherwise perfectly healthy, it’s just that his nervous system and body reacted to the fever in such a way. Some studies show that children who have had febrile seizures have an increased risk of developing epilepsy compared to others, but not by much – 1% versus 0.5%. But after complex seizures, according to some reports, the probability is 4-6%, depending on the clinical picture during seizures. Additional risk factors for epilepsy in these children include:

• onset of attack less than an hour after fever rise
• first attack before one year or after three years
• many episodes of febrile seizures
• concomitant developmental anomalies of the nervous system
• cases of epilepsy in the family
• epileptiform activity in the brain detected during EEG

A separate question is whether there is a direct causal relationship between an episode of convulsions with fever and epilepsy at an older age. It is likely that children who initially have an increased tendency to develop epilepsy are more likely to respond with convulsive activity to high temperatures.

Febrile seizures in early childhood are not the same as epilepsy later in life. Don’t worry about it

When should I visit a doctor?

In any case, you need to consult a doctor in order to, if necessary, undergo an examination and make sure that what happened was caused precisely by fever, and not by another more serious reason.

You need to call an ambulance if the attack, as noted above, lasts longer than five minutes, and also if some manifestations are added to the symptoms of febrile convulsions:

• Vomiting
• Rigidity of the muscles of the neck – a condition when they are very tense, and it is not possible to bend the head. This may indicate an infection of the meninges of the brain
• Respiratory failure
• Very severe, prolonged lethargy and drowsiness

First aid

What is first aid for febrile seizures?

• lay the child on its side
• unbutton the collar and chest to make breathing easier
• if after five minutes the attack has not stopped, you need to call an ambulance
• record the time when the attack began: this will help you react in time if it drags on for more than 5 minutes, and subsequently provide the necessary information to the doctor

There is no specific medical care for febrile seizures. It is necessary to eliminate their cause – to bring down the temperature. In children, ibuprofen and acetaminophen (paracetamol) are used for this.

What can’t be done?

During an attack, do not give your child food, water, or medicines. Anything in the mouth can be inhaled and cause suffocation. For the same reason, no antipyretic tablets or syrups should be given directly during an attack. You need to bring down the temperature – but only after the convulsions have ended.

Many have heard that during convulsions, you need to open your jaws and insert some object between your teeth, for example, a spoon. In reality, it is highly not recommended to do this – you can easily injure your tongue and teeth, especially in a small child.

Diagnostic methods

If the child has had an episode of simple febrile seizures, does not suffer from disorders of the immune system and receives vaccinations according to the schedule, then no examinations are usually required. The doctor ascertains this condition on the basis of the anamnesis (according to the parents), advises not to worry and continue to treat the infection. To make sure that nothing terrible has happened, the doctor examines the child and evaluates his neurological status.

If the child has a weakened immune system, missed some vaccinations, the doctor found alarming symptoms during the examination, and there are suspicions of a severe infection, the following may be prescribed:

• General urine and blood tests
• Biochemical blood test
• Infection tests
• A lumbar puncture is a procedure in which a needle is inserted into the spinal canal at the lower back, a small amount of cerebrospinal fluid is obtained and sent to a laboratory for analysis. This helps in diagnosing infections of the nervous system, such as meningitis.

Electroencephalography (EEG) – a study of the electrical activity of the brain – is usually prescribed after complex seizures. This helps to better understand the causes of seizures. In some cases, magnetic resonance imaging (MRI) is indicated:

• if the child’s head is large beyond the normal range
• if the doctor found abnormalities during the neurological examination
• if the child has symptoms of increased intracranial pressure: poor sleep and appetite, excessive irritability and tearfulness, headache and dizziness, nausea and vomiting, trembling of the hands and chin, bulging fontanel in infants
• if the convulsions continued for a long time, there was a febrile status

Differential diagnosis

Against the background of fever, not only febrile, but also other types of seizures caused by other reasons can occur:

• Epileptic . The child could be initially predisposed to this disease, and the high temperature only provoked the first attack. If convulsions occur without fever, epilepsy is always suspected – although there are other causes, for example, poisoning, affective-respiratory attacks.
• Infections of the central nervous system : meningitis, encephalitis. In this case, convulsions are no longer a “pure” consequence of fever, they are due to damage to the nervous system by an infectious agent.
• Metabolic disorders in the body : when the level of glucose in the blood falls, the level of sodium, calcium decreases. These conditions can also be triggered by infection.

Febrile seizures are called convulsions caused by elevated body temperature – this is their only cause. When other factors intervene, this is already a separate condition that requires appropriate examination and treatment. An accurate diagnosis can only be established by a doctor.

Treatment

Most often, no treatment is required, as febrile seizures go away on their own. At the time the child is examined by a doctor, there are no signs that there was an attack, and the doctor can only find out about it from the words of the parents. If the episode lasts longer, then treatment will be carried out in the clinic. Doctors will administer an anticonvulsant drug to the child and, of course, will carry out other types of treatment indicated for this infectious disease.

Febrile status rarely resolves on its own and is more difficult to manage with medical therapy. Typically, more than one anticonvulsant drug is required.

Forecast

As we have already noted, the prognosis in most cases is favorable. Febrile seizures are usually self-limiting (meaning they go away on their own without treatment) and do not damage the brain or other parts of the nervous system. The child “outgrows” this condition after 5 years. There are cases when episodes were noted up to 7 years, but they are very rare.

Is it possible to prevent recurrent attacks?

“Can anything be done to prevent future febrile seizures?” This is a question many parents ask doctors.

There is no reliable way that would help to do this with a 100% guarantee.

As you now know, febrile seizures are caused by a body temperature of 38°C or more. The next time the child gets sick, do not give him antipyretic “for prevention” to bring down a lower temperature. These drugs should be used as directed. They help improve the condition, but do not prevent seizures.

Anticonvulsant medications help with seizures. But they can cause serious side effects, so they should not be used alone for either prevention or treatment. The risks of prophylactic use of these drugs far outweigh the benefits.

An effective measure to prevent febrile seizures is to prevent the infections that cause them. There are vaccines against many of them, and they are included in the Russian National Calendar of Preventive Immunizations.

This is how the psychology of anxious parents works: the worse the symptoms look, the more you want to do at least something, use more all kinds of medicines, including “modern”, advertised ones, in order to quickly cure the child of the current disease and prevent a similar condition in the future. Moms and dads are asking the pediatrician and neurologist to prescribe something “to strengthen the immune system”, “protect and improve the functioning of the nervous system.” Often the doctor, fearing dissatisfaction and negative reviews, goes on about and issues a large list of prescriptions. Often they include drugs with unproven efficacy. As a result, the parents are satisfied that they “do not sit idly by”, and the doctor breathes a sigh of relief and receives well-deserved thanks. Pediatricians at the Nashe Vremya clinic follow the principles of evidence-based medicine and take a different approach. They tell parents in detail why the child has certain symptoms, provide reliable scientific data in an accessible form. Ultimately, this benefits our little patients and at the same time helps to avoid pointless spending on unnecessary “treatment”.


Summing up, it can be noted that:

• Convulsions caused by elevated body temperature are the prerogative of young children. In children older than 5 years, they practically do not happen
• Most often this is a self-limiting condition that resolves without any treatment within 5 minutes
• After an attack, give the child an antipyretic and consult a doctor
• If the seizure lasts longer than 5 minutes, you need to call an ambulance
• Febrile seizures are not the same as epilepsy. They usually do not lead to complications
• There are no methods to prevent this condition and its recurrence

Sources:

1. Ismailova N.B. Outcomes of febrile seizures in children // Bulletin of the Kazakh National Medical University, 2013
2. Dolinina A.F., Gromova L.L., Mukhin K.Yu. Risk factors for the transformation of febrile convulsions into epilepsy // Neurology, neuropsychiatry, psychosomatics, 2015
3. Musabekova T. O., Khamzina A. I., Andrianova E. V. Febrile convulsions in children, clinical and vegetative features // Bulletin of the Kazakh National Medical University, 2014
4. Dadali E. L., Sharkov A.A., Sharkova I.V., Kanivets I.V., Konovalov F.A., Akimova I.A. Hereditary diseases and syndromes accompanied by febrile convulsions: clinical and genetic characteristics and diagnostic methods // Russian Journal of Child Neurology, 2016
5. Karlov B.A., Gekht A.B., Avakyan G.N., Guzeva V.I., Belousova E.D., Kholin A.A. Status epilepticus in children // Federal Guide to Child Neurology, 2016
6. Natsume J., Hamano S.I., Iyoda K., Kanemura H., Kubota M., Mimaki M. New guidelines for management of febrile seizures in Japan // Brain Dev, 2017

Febrile convulsions in children | Rassvet Clinic

Febrile convulsions (attacks) are episodes of convulsions in children accompanied by high fever.

Seizure may occur up to 4%:

• in a child aged 6 months to 5 years with no prior neurological problems;
• when the temperature rises above 38 ⁰C.

What can cause an attack?

Infections that cause fever. Infection can be caused by bacteria, but febrile seizures are more common in viral illnesses (eg, roseola and influenza).

Vaccinations followed by fever. There is a small chance of febrile seizures after measles, mumps, rubella, and diphtheria, tetanus, and whooping cough vaccinations. But the risks from incomplete vaccination are higher than the risk from a febrile seizure after vaccination.

Heredity. If either parent has had a febrile seizure, the child is more likely to have a fever seizure.

A febrile seizure, especially when it occurs for the first time in life, is very frightening for parents. In fact, most of these attacks are not dangerous, do not lead to complications and damage to the brain. A child with a simple febrile seizure is only marginally more likely to develop epilepsy than a child who has never experienced a febrile seizure.

What does a simple febrile seizure look like?

• The child loses consciousness, does not respond, may roll his eyes up.
• The arms and legs twitch rhythmically, this happens symmetrically on both sides.
• The attack usually lasts less than a minute, but in some cases – up to 5 minutes.
• After an attack, the child may be drowsy for an hour, but does not feel weakness in the arm or leg and gradually returns to normal.

What are complex febrile seizures? How are they different from normal ones?

In this type of febrile seizure, the seizure may begin with a twitch of one arm (leg) or with a turn of the head to one side (asymmetry).

• An attack may last longer than 15 minutes, or attacks may recur several times a day.
• An attack can occur at a relatively low temperature, below 38 ⁰C.
• After an attack, there may be prolonged drowsiness, weakness in one arm or leg.

How to help a child during an attack?

1. Lay the baby on its side, on a flat surface, and make sure that the child does not fall or hit anything during a cramp (eg, crib bars).
2. Time yourself and tell your doctor when the attack started and how long it lasted.

Attention! Do not try to open the jaw, do not put anything in the child’s mouth during an attack, this can lead to injuries (broken teeth of the child and injured fingers of the caregiver).
Do not try to restrict the movement of the child during convulsions, do not restrain him.

The child may be even more afraid of an attack than the parents. Try to calm him down, support him.

If a seizure occurs for the first time in life, lasts longer than 5 minutes, the child is unusually sleepy and lethargic before or after the seizure, call an ambulance.

In other cases, take the child to the pediatrician without delay. The doctor should examine the child after the attack and make sure that he does not have signs of a central nervous system infection (meningitis or encephalitis).

What tests are done after a febrile seizure?

In most cases, a doctor’s examination is sufficient to make this diagnosis. If meningitis is suspected, a lumbar puncture is performed. Sometimes the doctor may order urine and blood tests if the cause of the high fever is not clear.

For complex seizures, electroencephalography and MRI are scheduled. These studies are necessary because this type of febrile seizure may be a manifestation of rare epileptic syndromes that require anticonvulsant treatment.

How to treat a fever in a child who has previously had a febrile seizure?

If the child does not have a fever during illness or after vaccination, it is not recommended to give antipyretics! It does not reduce the risk of an attack.

If the fever is high, drugs to reduce it make you feel better, but do not help the attacks.

The harm of anticonvulsants for the prevention of febrile seizures outweighs the benefits, they are almost never prescribed.

If the child has a prolonged febrile seizure, it is recommended to administer a benzodiazepine enema, nasal spray, or cheek gel at the onset of the seizure. Such forms have only recently been registered in Russia, but, unfortunately, they have not yet entered the market. Therefore, if the attack lasts longer than 5 minutes, the emergency doctor can give an injection of such a medicine.

For antipyretics, children can be given ibuprofen 10 mg/kg every 8 hours or paracetamol 15 mg/kg every 6 hours. Do not give children aspirin!

Probability of recurrence of febrile seizures

After the first simple febrile seizure in life, recurrent seizures occur in ⅓ of children. A second attack usually occurs within 2 years after the first.

The likelihood of a recurrence of a febrile seizure is higher if:

• the first seizure was before the age of 15 months;
• the attack occurred at a temperature of less than 38 ⁰C;
• parents, brother or sister also had febrile convulsions;
• the child goes to kindergarten.

Important to know

Parents often mistake febrile seizures for normal fever-related chills.