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   About febrile seizures
   
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   Symptoms of febrile seizures
   
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   Causes of febrile seizures
   
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   Diagnosing febrile seizures
   
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   Treating febrile seizures
   

About febrile seizures

A febrile seizure is a fit that can happen when a child has a fever.

Febrile seizures are also sometimes called febrile convulsions. They are relatively common and, in most cases, aren’t serious.

Around one in 20 children will have at least one febrile seizure at some point. They most often occur between the ages of six months and three years.

During a febrile seizure, the child’s body usually becomes stiff, they lose consciousness and their arms and legs twitch. Some children may wet themselves. This is known as a tonic clonic seizure.

Read more about the symptoms of febrile seizures

What to do during a seizure

If your child is having a febrile seizure, place them in the recovery position. Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit, keep their airway open and help prevent injury.

Stay with your child and try to make a note of how long the seizure lasts.

If it’s your child’s first seizure, or it lasts longer than five minutes, take them to the nearest hospital as soon as possible, or dial 999 for an ambulance. While it’s unlikely that there’s anything seriously wrong, it’s best to be sure.

If your child has had febrile seizures before and the seizure lasts for less than five minutes, phone your GP or the NHS 24 111 service for advice.

Don’t put anything, including medication, in your child’s mouth during a seizure because there’s a slight chance that they might bite their tongue.

Almost all children make a complete recovery after having a febrile seizure.

Read more about diagnosing febrile seizures and treating febrile seizures

Types of febrile seizure

There are two main types of febrile seizure.

Simple febrile seizure

A simple febrile seizure is the most common type of febrile seizure, accounting for about eight out of 10 cases. It’s a fit that:

• is a tonic clonic seizure (see above)
• lasts less than 15 minutes
• doesn’t reoccur within 24 hours or the period in which your child has an illness

Complex febrile seizure

Complex febrile seizures are less common, accounting for two out of 10 cases. A complex febrile seizure is any seizure that has one or more of the following features:

• the seizure lasts longer than 15 minutes
• your child only has symptoms in one part of their body (this is known as a partial or focal seizure)
• your child has another seizure within 24 hours of the first seizure, or during the same period of illness
• your child doesn’t fully recover from the seizure within one hour

Why febrile seizures occur

The cause of febrile seizures is unknown, although they’re linked to the start of a fever (a high temperature of 38C (100. 4F) or above).

In most cases, a high temperature is caused by an infection such as:

• chickenpox
• flu (influenza)
• middle ear infections (otitis media)
• tonsillitis

There may also be a genetic link to febrile seizures because the chances of having a seizure are increased if a close family member has a history of them. Around one in four children affected by febrile seizures has a family history of the condition.

Read more about the causes of febrile seizures

Complications

Febrile seizures have been linked to an increased risk of epilepsy, as well as other problems.

Recent research findings may indicate a link between febrile seizures and sudden unexplained death in childhood (SUDC), possibly due to the connection between febrile seizures and epilepsy.

However, this link hasn’t been proven and SUDC is incredibly rare, affecting around one in 100,000 children which is equivalent to a 0.001% chance.

In addition, one of the biggest studies of its kind looked at more than 1. 5 million children with a history of febrile seizures and found no evidence of an increased risk of death in later childhood or adulthood.

Febrile seizures and epilepsy

Many parents worry that if their child has one or more febrile seizures, they’ll develop epilepsy when they get older. Epilepsy is a condition where a person has repeated seizures without fever.

While it’s true that children who have a history of febrile seizures have an increased risk of developing epilepsy, it should be stressed that the risk is still small.

It’s estimated that children with a history of simple febrile seizures have a one in 50 chance of developing epilepsy in later life. Children with a history of complex febrile seizures have a one in 20 chance of developing epilepsy in later life.

This is compared to around a one in 100 chance for people who haven’t had febrile seizures.

Symptoms of febrile seizures

The main symptom of a febrile seizure is a fit that occurs while a child has a fever.

Febrile seizures often occur during the first day of a fever, which is defined as a high temperature of 38C (100.4F) or above. 

However, there appears to be no connection between the extent of your child’s fever and the start of a seizure. Seizures can occur even if your child has a mild fever.

Simple febrile seizures can happen when there’s a rapid rise in temperature and you may only realise your child is ill when they have a fit. Alternatively, they can occur as your child’s temperature drops from a high level.

During simple febrile seizures:

• your child’s body will become stiff and their arms and legs will begin to twitch
• they’ll lose consciousness and they may wet or soil themselves
• they may also vomit and foam at the mouth and their eyes may roll back
• the seizure usually lasts for less than five minutes
• following the seizure, your child may be sleepy for up to an hour afterwards

Complex febrile seizures tend to last longer than 15 minutes, and the symptoms may only affect one area of your child’s body. The seizure sometimes recurs within 24 hours or during the period in which your child is ill.

Seeking medical advice

You should take your child to hospital or dial 999 for an ambulance if:

• your child is having a fit for the first time
• the seizure lasts longer than five minutes and shows no signs of stopping
• you suspect the seizure is being caused by another serious illness, for example meningitis
• your child is having breathing difficulties

If your child has previously had febrile seizures, it’s recommended that you telephone your GP or call the NHS 24 111 service for advice.

You should also contact your GP or the NHS 24 111 service if your child shows signs and symptoms of dehydration (a lack of fluid in the body). This includes:

• a dry mouth
• sunken eyes
• a lack of tears when crying
• a sunken fontanelle – the soft spot usually found at the top of a young child’s head

Causes of febrile seizures

Febrile seizures are linked to fevers, but the exact cause is unknown.

Some researchers think that the biological processes associated with a high temperature may be responsible.

A high temperature is thought to be caused by a bacterial or viral infection that stimulates the release of cytokines. Cytokines are proteins that affect the parts of the brain and nervous system responsible for regulating the body’s temperature. Their release causes a rise in the body’s temperature.

One theory is that in certain people, high levels of cytokines may temporarily ‘scramble’ the workings of the brain and nervous system, triggering a seizure.

Family history

Although febrile seizures are poorly understood, a family history of the conditions is thought to increase the risk. 

If a child has a first-degree relative (mother, father, sister or brother) with a history of febrile seizures, their risk of having seizures increases. The more relatives affected, the higher the risk.

This is probably the result of one or more genetic mutations that a child inherits from their parents, which makes them more susceptible to seizures. A genetic mutation means the instructions carried in certain genes become ‘scrambled’, resulting in some of the body’s processes not working in the normal way.

Associated infections

Most febrile seizures occur when a child has a high temperature caused by an infection. The three most common infections associated with febrile convulsions are:

• viral infections, such as chickenpox and flu
• middle ear infections (otitis media)
• tonsillitis

Other infections associated with febrile seizures are:

• urinary tract infections (UTIs)
• upper respiratory tract infection – an infection of the mouth, nose and throat, and associated tissues and structures
• gastroenteritis – an infection of the digestive system
• lower respiratory tract infections, such as pneumonia (a lung infection) and bronchitis (an infection of the airways that supply the lungs)

Vaccinations

In rare cases, febrile seizures can occur after a child has a vaccination. Research has shown that your child has a one in 3,000 to 4,000 chance of having a febrile seizure after having the MMR vaccine.

The risks are even lower with the DTaP/IPV/Hib vaccine – a one in 11,000 to 16,000.

Diagnosing febrile seizures

Febrile seizures can often be diagnosed from a description of what happened.

Further tests may be needed if the cause of the associated infection isn’t clear.

It’s unlikely that your doctor will see the seizure, so an account of what happened is useful.

It’s useful to know:

• how long the seizure lasted
• what happened – body stiffening, twitching of the face, arms and legs, staring and loss of consciousness
• whether your child recovered within one hour
• whether they’ve had a seizure before

Tests to identify the source of the infection will only usually be necessary to rule out rarer conditions which can cause similar symptoms, such as meningitis.

A blood or urine sample may be needed to test for signs of infection. It can sometimes be difficult to obtain a urine sample from young children, so it may have to be done in hospital.

Read more about blood tests

Further tests

Further tests may be carried out in hospital if your child’s symptoms are unusual – for example, if they don’t have a high temperature or their seizures don’t follow the normal pattern.

Further testing and observation in hospital is also usually recommended if your child is having complex febrile seizures.

Your child may have other tests including an electroencephalogram and lumbar puncture, particularly if they’re less than 12 months old.

These two tests are explained below.

Electroencephalogram

An electroencephalogram (EEG) measures your child’s electrical brain activity through electrodes that are placed on their scalp. Unusual patterns of brain activity can sometimes indicate epilepsy.

However, some studies have suggested that an EEG may not be useful in many cases of febrile seizures.

Lumbar puncture

During a lumbar puncture, a small sample of cerebrospinal fluid (CSF) is removed for testing. CSF is a clear fluid that surrounds and protects the brain and spinal cord.

A hollow needle is inserted into the base of the spine to obtain the CSF sample. During the procedure, local anaesthetic will be used to numb your child’s back so that they don’t feel any pain.

A lumbar puncture can be used to determine whether your child has an infection of the brain or nervous system.

Treating febrile seizures

In many cases, febrile seizures do not need to be treated, although care should be taken to deal with a seizure as it happens.

What to do during a seizure

If your child is having a febrile seizure, place them in the recovery position. Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit, and will keep their airway open and help prevent injury.

Stay with your child while they’re having a seizure, and make a note of when the seizure started to keep track of how long it lasts. If the seizure lasts for less than five minutes, phone your GP or call the NHS 24 111 service.

If it’s your child’s first seizure, or if it lasts longer than five minutes, take your child to the nearest hospital as soon as possible.

While there’s probably nothing seriously wrong with your child, it’s best to be sure.

Don’t put anything, including medication, in your child’s mouth while they’re having a seizure. There’s a slight chance that they might bite their tongue, although any damage isn’t usually serious and will heal within a few days.

Trying to stop someone biting their tongue by placing your hand or an object in their mouth could be dangerous both for you and for them.

High temperature (fever)

Reducing a high temperature can help make your child feel more comfortable. Paracetamol and ibuprofen have been shown to be effective in reducing a high temperature. However, they won’t reduce the chances of your child actually having a seizure.

Removing any unnecessary clothes and bedding will also help to lower your child’s temperature.

Aspirin should never be given to children under 16 years of age because there’s a small risk that the medication could trigger a condition called Reye’s syndrome, which can cause brain and liver damage.

The use of cold sponges or fans isn’t recommended for treating a high temperature. There’s little evidence that they’re effective, and they may cause your child discomfort. Your GP will be able to give you additional advice about treating the underlying cause of your child’s high temperature.

It’s also important to prevent dehydration during a fever by making sure your child drinks plenty of fluids.

Recurring febrile seizures

About one third of children will have a febrile seizure again during a subsequent infection. This often occurs within a year of the first febrile seizure.

Recurrence is more likely if:

• the first febrile seizure occurred before your child was 18 months old
• there’s a history of seizures or epilepsy in your family
• before having the first seizure your child had a fever that lasted less than one hour or their temperature was less than 40C (104F) 
• your child has multiple seizures during the same febrile episode (complex febrile seizure)
• your child attends a day care nursery (this increases their chances of developing common childhood infections, such as the flu or chickenpox)

It’s not recommended that your child is given a prescription of regular medicines to prevent further febrile seizures. This is because the adverse side effects associated with many medicines outweigh any risks of the seizures themselves.

Research has shown that the use of medication to control fever isn’t likely to prevent recurrence of further febrile seizures.

However, there may be exceptional circumstances where medication to prevent recurrent febrile seizures is recommended. For example, children may need medication if they have a low threshold for having seizures during illness, particularly if the seizures are prolonged.

In this case, your child may be prescribed medications such as diazepam or lorazepam to take at the start of a fever.

Children who’ve had a febrile seizure following a routine vaccination (which is very rare), are no more at risk of having another seizure compared to children who’ve had a seizure due to another cause for fever.

Febrile Seizures in Children – HealthyChildren.org

By: Marissa Di Giovine, MD, FAAP & Eva Catenaccio, MD

Febrile seizures are a type of seizure that can affect otherwise healthy children around the time they have a fever. Seizures can involve stiffening or shaking part of the body or the whole body.

When do febrile seizures occur?

Febrile seizures happen in in 3 or 4 out of every 100 children. They can occur between 6 months and 5 years of age, but most often around 12 to 18 months old.

A febrile seizure usually occurs during the first few hours of a fever. While they are most common with fevers of 102°F (38.9°C) or above, they can also happen with milder fevers.

What happens during a febrile seizure?

Your child may look strange for a few moments, then stiffen, twitch and roll their eyes. They may be unresponsive for a short time, or have changes in their breathing or skin color. After the seizure, the child usually returns to normal quickly.

Seizures usually last less than one or two minutes but, although uncommon, can last longer. A seizure longer than 5 minutes is usually a medical emergency and requires urgent treatment to stop the seizure.

Other kinds of seizures (ones that are not caused by fever) last longer, can affect only one part of the body, and may occur repeatedly.

If your child has a febrile seizure, act immediately to prevent injury.

• Place them on the floor or bed away from any hard or sharp objects.

• Turn their head to the side so that any saliva or vomit can drain from their mouth.

• Do not put anything into their mouth; they will not swallow her tongue.

• Call your child’s doctor.

• If the seizure does not stop after 5 minutes,
  call 911 or your local emergency number.
  

Are febrile seizures dangerous?

While febrile seizures may be very scary, they usually are harmless to the child. Most febrile seizures are short and do not cause brain damage,
nervous system problems, paralysis, intellectual disability or death. Long seizures need to be treated either with a rescue medication or by emergency medical services.

Will my child have more seizures?

Febrile seizures tend to run in families. The risk of having seizures with other episodes of fever depends on the age and development of your child. Children younger than 1 year of age at the time of their first seizure have about a 50% chance of having another febrile seizure. Otherwise healthy children older than 1 year of age at the time of their first seizure have only a 30% chance of having a second febrile seizure.

Most children out-grow febrile seizures by the time they get to school age. Only a very small number of children who have febrile seizures will go on to develop
epilepsy.

Are there certain illnesses that cause febrile seizures?

Febrile seizures can happen with any condition that causes a fever, such as common colds, the flu, ear infection or
roseola. They can also happen if your child experiences heat-related illness such as heat stroke when there is a rise in core body temperature. Febrile seizures usually happen only once during any given illness, often with the first fever spike. However, they can occur just before or just after your child gets a fever.

Can febrile seizures happen after getting a vaccine?

Vaccines can cause your child to have a fever, but febrile seizures are generally rare after vaccination. Recommended vaccines can actually help prevent some febrile seizures, since getting sick with measles, mumps, rubella, chickenpox, influenza (the flu), pneumococcal infections and other diseases can cause fevers and febrile seizures.

Febrile seizure treatments

If your child has a febrile seizure, call your child’s doctor right away. They will want to examine your child to identify the cause of their fever. It is more important to determine and treat the cause of the fever rather than the seizure. A spinal tap may be done to be sure your child does not have a serious infection like
meningitis, especially if they are younger than 1 year of age.

In general, doctors do not recommend treatment of a simple febrile seizure with preventive medicines. However, this should be discussed with your child’s doctor. In cases of prolonged or repeated seizures, the recommendation may be different.

Medicines like
acetaminophen and ibuprofen can help lower a fever, but they do not prevent febrile seizures. Your child’s doctor will talk with you about the best ways to take care of your child’s fever.

Remember

If your child has had a febrile seizure, do not fear the worst. These types of seizures are not dangerous to your child and do not cause long-term health problems. If you have concerns about this issue or anything related to your child’s health, talk with your child’s pediatrician.

More information

• Fever and Your Baby
• Treating Your Child’s Fever
• How to Take Your Child’s Temperature
• Seizure First Aid for Children

About the authors

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Vaccination in children, febrile convulsions and epilepsy

Vaccination of children is undoubtedly an effective method of preventing many diseases. But as soon as diseases prevented by vaccination became rare, the question of its side effects immediately arose. Along with acute allergic reactions, parents are concerned about the possibility of neurological complications, such as febrile seizures (FS) and epilepsy [1]. Not only many parents, but also doctors are afraid of exacerbation of neurological problems as a result of vaccination, and the development of epilepsy, coinciding with it in time, only increases these fears. As a result, parents either delay or refuse to vaccinate their children, leading to outbreaks of serious diseases such as measles.

Of course, a neurologist should not decide whether or not to vaccinate a child, what exactly to vaccinate a child with. According to the Order of the Ministry of Health of Russia No. 125n dated March 21, 2014 (as amended on April 13, 2017) “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications”, “vaccination is carried out by medical workers who have been trained in the use of immunobiological drugs for immunoprophylaxis infectious diseases, the organization of vaccination, the technique of vaccination, as well as on the provision of medical care in an emergency or urgent form” ^​1​᠎ .

However, none of the neurologists has received such training, and the solution to the problem of vaccination falls entirely on the shoulders of the pediatrician. The task of a neurologist is to accurately formulate a neurological diagnosis. But in the current clinical practice, pediatricians very often ask for a neurologist’s opinion on the possibility of vaccination. In addition, parents of patients (in particular, those suffering from epilepsy) ask many questions about this, they need more or less detailed explanations.

In this paper, literature sources on this issue are grouped into three thematic areas: vaccine-induced seizures, vaccination of a child with FS, vaccination of a child with epilepsy.

Vaccine-induced seizures. Many vaccines have instructions for side effects such as seizures: e.g. measles, mumps and rubella (MMR), hepatitis A, polio, meningococcal, influenza type B, adsorbed diphtheria-pertussis-tetanus (DPT) vaccine , vaccine against typhoid and Lyme disease [2]. As a rule, seizures are associated with fever, i.e., they are febrile.

Vaccine-induced FS usually develops within 72 hours after vaccination. Moreover, some vaccines are more associated with FS than others: DTP (especially non-inactivated) and MMR (especially in combination with the varicella vaccine) [3]. The varicella vaccine is produced only abroad, but is often used in the Russian Federation. In the DTP vaccine, the pertussis component is considered the most reactogenic [4]. After the introduction of the combined MMR vaccine, FS develop not within 3 days, but between 7 and 14 days [3]. It is less commonly mentioned that influenza and pneumococcal vaccines may also be associated with an increased risk of FS [4, 5].

Precise epidemiological data on the incidence of FS following vaccinations are not known. WHO experts give a value of 0.08 per 1000 DPT ^​2​᠎ vaccinations, which is 70 times lower than the frequency of FS caused by complications of the infections against which the vaccine is directed, and 500 times less than the frequency of conventional FS. S. David et al. [6] conducted a survey of parents of 15,069 children in the first year of life who received a non-inactivated DPT vaccine and 13,069 children who received an inactivated DPT vaccine. At the same time, FS were observed rarely and only after the 4th immunization (0.06% with a non-inactivated vaccine and 0.02% with an inactivated one). The incidence of FS was the same in children with and without a history of FS [3]. Estimating the frequency and risk of developing FS during influenza vaccination is difficult due to the presence of a large number of types and batches of influenza vaccines, apparently with different reactogenicity [4].

It should be remembered that with the development of complications, the presence of a temporal relationship does not necessarily indicate a causal relationship, which, in particular, is confirmed by the results of a double-blind study [7], in which the frequency of FS during the administration of a combined MMR vaccine was compared with placebo. According to the study, 6% of children developed a fever while receiving a placebo, and 88% of children with a fever in the vaccinated group were not associated with vaccination. Thus, the risk of vaccine-induced FS may be greatly exaggerated.

The exact mechanisms for the development of FS during vaccination are not yet known [4]. However, it has been established that FS of any etiology is largely due to genetic factors. Thus, the results of the study by B. Feenstra et al. [8] showed that children with vaccine-induced FS have a genetic propensity for immunological disorders and fever, rather than seizures. In 929 patients with FS after vaccination, frequent chromosomal variants in the genes IFI 44 L 9 were described0018 (interferon-induced gene) and in the measles virus CD46 receptor genes. At the same time, in groups of 1070 children with FS not associated with vaccination, other frequent chromosomal variants with loci associated with seizures were found ( SCN ​​ 1 A , SCN ​​017A , TMEM 16) , and a locus associated with magnesium levels.

The study by S. Auvin et al. is also interesting. [9], which demonstrated a clear pro-inflammatory profile of monocytes with an increase in IL-1β, IL-6, TNF-α in patients with Dravet syndrome after vaccination compared with the control group.

It is believed that the simultaneous administration of several vaccines may increase the risk of developing FS. In international practice, the MMR vaccine is sometimes combined with varicella vaccination. This combination doubles the incidence of vaccine-induced PS [4]. Early childhood (up to 2 years) was previously considered a risk factor for the development of F.S. But an attempt to delay vaccination until an older age to reduce the risk has not been successful. Moreover, the results of the study by M. Daley et al. [10] found that delaying measles, mumps, and rubella vaccination until a child is older than 15 months increases the risk of developing FS. Thus, postponing the vaccination period until an older age of the child does not reduce the risk of developing FS, i. e., it is not advisable [10, 11].

Vaccination and epilepsy . It is believed that vaccination increases the risk of FS, but does not increase the risk of developing afebrile epileptic seizures [3, 4, 11]. So, M. Griffin et al. [12] analyzed 38,171 DTP vaccinations and statistically showed an increase in the number of FS, but did not find an association with afebrile seizures. According to S. Shorvon and A. Berg [13], the risk of developing an afebrile seizure after vaccination is 1 in 76 133. The results of the study by S. Håberg et al. [14] found that the influenza vaccine does not increase the risk of developing epilepsy: more than 500 thousand children were examined in whom vaccination did not lead to an increase in the number of new cases of epilepsy. According to WHO, the likelihood of developing afebrile epileptic seizures that complicate DPT vaccination is 0.06 per 1000 children, which is 333 times less than the likelihood of developing afebrile seizures as a result of complications of these infections. Thus, a causal relationship of vaccination with the development of epilepsy has not been proven [4].

No correlation was found between vaccination and the development of a specific epileptic syndrome, in addition, it is believed that the risk of developing epileptic encephalopathies does not increase [3]. There is a temporal coincidence in the timing of active revaccination of a child of the first year of life and the peak of the onset of West syndrome (about 5–7 months of life), but a causal relationship has not been confirmed. In some countries, the timing of vaccination was deliberately shifted, but this did not change the incidence of West syndrome [3].

However, Dravet’s syndrome (synonymous with severe myoclonic epilepsy of infancy) and the association with vaccination deserve separate discussion. Dravet’s syndrome is an early epileptic encephalopathy in which the most common clinical manifestations are febrile status and/or prolonged FS. For the first time, the relationship between the introduction of DTP and seizures was reported by S. Bercovic et al. [15] in 2006, 11 out of 14 patients with allergic vaccine encephalopathy were found to have a mutation in the SCN ​​9 gene.0018 1 A . Of the examined patients, only 8 had a clearly defined clinical and genetic Dravet syndrome, the rest were diagnosed with “borderline” (borderline) Dravet syndrome and Lennox-Gastaut syndrome. The post sparked a heated discussion. There are reports of a close temporal relationship between vaccination and epilepsy ranging from 1 to 14 days, although epidemiological studies have not yet confirmed this relationship. It is possible that vaccination causes a fever that provokes clinical manifestations, but in this case the vaccine itself cannot be the cause [3].

N. Zamponi et al. [16] compared the frequency of vaccine-associated seizures (including those after DTP) in 72 patients with mutations in the gene SCN 1 A (with the Dravet syndrome phenotype and generalized epilepsy/FS plus) and in 11 patients with similar phenotypes, but no mutations. Vaccine-induced seizures were observed in 25% of patients with the mutation and in 18% of patients without it (a statistical difference was not obtained). In the presence of mutations, convulsions were by no means always febrile (only in 1/3 of cases). Patients who had seizures within the first 48 hours after vaccination were shown to have an earlier onset of afebrile seizures and a higher incidence of status epilepticus (compared to seizures after 48 hours). There was no other difference between the groups, including, very importantly, cognitive functions. The authors [16] concluded that vaccination does not have a significant effect on the course of Dravet syndrome and generalized epilepsy/FS plus caused by mutations in gene SCN ​​ 1 A .

Vaccination of a child with FS. According to the Federal Law and Guidelines of 2002 ^​3​᠎ , as well as a newer document (Letter of the Ministry of Health of Russia dated 08.23.17 No. 15−2/10/2−5896 ^​4​᠎ ), an absolute contraindication to vaccination is a strong reaction or post-vaccination complication to its previous administration. Strong reactions to vaccination from the side of the central nervous system include the development of vaccine-associated encephalitis and poliomyelitis; lesions of the central nervous system with generalized or focal residual manifestations leading to disability (encephalopathy, serous meningitis, neuritis, polyneuritis), as well as “also afebrile convulsions” (quoted from the Letter of the Ministry of Health of Russia, 2017), i.e., proven cases of development vaccine-induced epilepsy, the likelihood of which is extremely low. All researchers agree that it is necessary to vaccinate a child with FS. Unfortunately, this recommendation has moderate rather than high grade (III) evidence, i.e. the data were obtained from well-designed non-randomized trials), but it is likely that future studies will not change anything in it (recommendation level is high – A ) [3]. Parents of a child with FS should be aware that some vaccines are associated with temperature reactions, especially in early childhood. Japanese neurologists believe that it is better to vaccinate after a certain time interval after FS (after 3 months), but this tactic is empirical in nature [17]. According to the Order of the Ministry of Health of Russia No. 125n dated March 21, 2014, the presence of FS that developed during the previous DTP vaccination is not a contraindication to the next dose of DPT. However, after its use, it is advisable to prescribe paracetamol (10-15 mg / kg 3-4 times a day) for 1-2 days (paragraph 7.3).

Vaccination of a child with epilepsy. A patient with epilepsy should also be vaccinated. Italian pediatric neurologists [3] believe that there is no increased risk of side effects after vaccination in children with idiopathic or symptomatic epilepsy. However, this recommendation also has a moderate level of evidence against the background of its high grade (Evidence level III, recommendation grade A). The same authors write that vaccination is not contraindicated in children with epileptic encephalopathies, Dravet and West syndromes (Evidence level III, recommendation grade A), and the likely risk of epileptic encephalopathy should not lead parents to refuse vaccination (evidence level III, recommendation grade A). At the same time, parents of patients with Dravet syndrome should be informed about the risks of vaccination and their possible prevention with antiepileptic drugs. Patients with a mutation in gene SCN ​​ 1 A early and more aggressive therapy (antipyretics and/or benzodiazepines for a short period before and after vaccination) is indicated in combination with early anticonvulsant therapy, which can prevent subsequent vaccine-induced seizures (level of evidence III, class D recommendations, i.e. weak recommendation) [3].

In domestic medicine, it is traditionally considered that the pertussis component is contraindicated in patients with epilepsy (ie, DTP vaccine). Vaccines ADS, ADS-m and AD-m do not have permanent contraindications; if epidemiologically necessary, they can be used even against the background of an exacerbation of the disease. In case of a strong reaction to the previous dose of these vaccines, it is recommended to revaccinate against the background of the use of steroids (prednisone orally 1-1. 5 mg/kg per day the day before and immediately after vaccination). American recommendations for the use of DPT (2018) [18] are less stringent. They classify progressive and unstable neurological disorders, including infantile spasms, uncontrolled seizures, or progressive encephalopathy, under the category of conditions in which DTP vaccination is necessary, i.e. the benefit to the patient from vaccination must exceed the possible risks, and this benefit-risk ratio is assessed. individually in each specific case. The solution could be the introduction of an inactivated pertussis vaccine, but so far there are no domestic recommendations on the possibility of its use in patients with epilepsy.

There are controversies regarding the vaccination of children and its possible complications between physicians and parents of patients. There is a so-called “anti-vaccine” lobby that sows fear and doubt in the minds of parents, arguing that vaccination is the cause of the development of severe neurological diseases, including epilepsy. Often, parents who have a child with severe epilepsy are convinced that it was the vaccine that caused the seizures. The presence of myths about vaccination leads to an increase in the layer of unvaccinated children and to outbreaks of infections (for example, measles) even in developed countries [19].

However, as can be seen from the above review, the risk of developing vaccine-induced FS is low, and their prognosis is absolutely favorable, and the fears of parents, and sometimes doctors, regarding the neurological complications of vaccination are greatly exaggerated. The risk of developing FS and the possibility of developing epilepsy are much higher with infectious diseases themselves than with vaccinations against them. In addition, one should be aware of the progress in improving vaccination and the emergence of a large number of inactivated vaccines, which also reduces the risk of neurological complications after vaccination. In order to prevent the potential development of encephalopathy in patients with certain gene mutations, a clearer understanding of the interaction between a vaccine and a gene mutation is needed. This does not mean that this group of patients should not be vaccinated – vaccinations are indicated for them, but doctors should approach vaccination individually and choose vaccines that are associated with the lowest risk of seizures.

1. Some vaccines (DTP and associated MMR) have a risk of developing FS. They probably can provoke FS, but they are not their cause. Postponing the vaccination period until an older child does not reduce the risk of developing FS, i.e., it is not advisable.

2. Vaccines do not increase the risk of epilepsy and West syndrome. DPT vaccination may probably contribute to the earlier development of seizures in Dravet syndrome, but does not have a significant effect on its course.

3. Presence of F.S. history is not a contraindication for vaccination. Parents of a child with FS should be aware that some vaccines are associated with temperature reactions.

4. The presence of epilepsy is not a contraindication to vaccination in general. According to domestic legislation, the pertussis component should be excluded from vaccination.

5. For patients with epileptic encephalopathies, there are international recommendations on the need for vaccinations (according to domestic legislation, the pertussis component should also be excluded from vaccination). Parents of patients with Dravet’s syndrome should be informed about the risks of vaccination and their possible prevention with antiepileptic drugs.

The authors declare no conflict of interest.

e-mail: [email protected]

WHO Global Vaccine Safety Essential Medicines & Health Products 20, Avenue Appia, CH -1211, Geneva 27, Switzerland. INFORMATION SHEET OBSERVED RATE OF VACCINE REACTIONS DIPHTHERIA, PERTUSSIS, TETANUS, 2014 VACCINES http://www.who.int/vaccine_safety/initiative/tools/DTP_vaccine_rates_information_sheet.pdf

³ Medical contraindications for prophylactic vaccinations with preparations of the national vaccination schedule. Guidelines MU 3.3.1.1095-02 Ministry of Health of Russia, 2002.

⁴ Letter of the Ministry of Health of Russia dated 23.08.17 No. 15-2 / 10 / 2-5896 Guidelines “Contraindications to vaccination”. http://www.consultant.ru/document/cons_doc_LAW_222956/

Is it necessary to treat fever and in what cases

Rinza®

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Colds and flu

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Treatment for adults

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How to treat fever in colds

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How to treat fever in colds

9 0158

Co-author, editor and medical expert

Maksimov Alexander Alekseevich.

Editor

Harutyunyan Mariam Harutyunovna

Contents:

• Febrile convulsions in children
• Why does the temperature rise
• When can the temperature be brought down?
• How to deal with a fever
• Other things to help with a high temperature

Contents of the article Febrile seizures in children0003

An increase in body temperature is a protective reaction of the body, but often it turns into a problem, causing a strong deterioration in well-being ^{1. 4} .

• Adults do not always have the opportunity to spend several days in bed and refuse to reduce the temperature with medication, because there are urgent projects, family and other important matters.
• In children, fever can be a warning sign associated with a risk of febrile seizures ^1,2,3 .

Febrile seizures in children

Febrile seizures are a specific complication of fever in children that usually occurs between the ages of 6 months and 5 years ^1,2,3 . There are simple and complex febrile seizures.

Simple febrile convulsions are generalized paroxysms with loss of consciousness. At the same time, clonic-tonic convulsions ^* involve the whole body ^1.2 . The duration of the seizure is usually no more than 5 minutes, and the recurrence of convulsions within 24 hours does not occur.

Complex febrile seizures may last 15 minutes or more. This form of seizures includes focal, i. e., involving one part of the body. In this case, loss of consciousness usually does not occur, provided that focal convulsions do not turn into secondarily generalized ^** .

Febrile convulsions are considered benign, but require medical supervision and additional diagnostics to exclude other serious diseases ² .

Why the temperature rises

When an infection enters the body, immunity is activated ¹ . Biologically active substances are released that stimulate the immune defense and contribute to the development of an inflammatory response. Some of them stimulate the temperature centers of the brain, triggering the mechanisms of temperature increase ^1,2,4 .

Children are characterized by rapid (within several tens of minutes) temperature increase. It is believed that this fact provokes the development of febrile convulsions, since the child’s cerebral cortex does not have time to adapt to a sharp rise in temperature ^{1. 2} .

Paracetamol is contained in the RINZA line of drugs

^®5,6,7 :

When can the temperature be brought down?

No universal recommendation for temperature reduction ^1.4 . Adults first of all need to focus on their well-being. Some people easily tolerate temperatures up to 38.5°C, while others feel weakness and reduced performance already at 37.1°C. Temperatures above 39° are always recommended to be lowered. For the elderly and debilitated persons, as well as in the presence of chronic diseases, a decrease in temperature can be started from 38.5 °, even if you feel relatively well ¹ .

For children who have previously experienced febrile convulsions, it makes sense to lower the temperature from 37.5°, regardless of how you feel.

High temperature is harmful to patients with heart failure, hypertension, heart rhythm disorders, diseases of the nervous system, etc. ¹

Variants of elevated temperature:

• Subfebrile – up to 37. 5 °. With this temperature, SARS and exacerbations of chronic ENT infections in adults often occur. In children, low-grade fever can last for several weeks after the main symptoms of a cold have subsided.
• Febrile – 37.5° to 39°. This temperature often occurs in the first 2-3 days of SARS and other infectious diseases. If the temperature does not decrease within a week, this is a reason to see a doctor and be examined for complications.
• Hyperpyretic above 39°. Such a temperature is always dangerous and can cause serious complications in the cardiovascular and nervous systems. Hyperpyretic temperature requires urgent reduction ⁴ .

It makes sense to reduce the temperature from 38-38.5° almost always, because at these figures the state of health usually worsens and the symptoms of intoxication increase, the work of the nervous system is inhibited ¹ .

How to deal with fever

Non-steroidal anti-inflammatory drugs are used to reduce fever in infectious diseases ^{3. 4} .

Paracetamol is one of the most popular non-steroidal anti-inflammatory drugs for fever ⁴ . It has not only antipyretic, but also analgesic and anti-inflammatory effects. It can be used in children, and also, strictly prescribed by a doctor, in nursing mothers (unlike aspirin, which can cause dangerous side effects).

Paracetamol is contained in the RINZA line of drugs

^®5,6,7 :

• RINZA tablets ^® . This remedy, which helps relieve the symptoms of a cold, has a convenient format. Tablets can be taken with you to work or school. RINZA® contains a combination of paracetamol and caffeine, which allows you to quickly cope with the symptoms of weakness, drowsiness, “fog” in the head. Phenylephrine and pheniramine help clear nasal congestion and discharge ⁵ .
• Powders RINZAsip ^® with vitamin C . Blackcurrant or citrus flavored powder can be dissolved in hot water with a little honey added to create a pleasantly flavored warming drink to help combat cold symptoms. The powders contain paracetamol, caffeine, phenylephrine, pheniramine and ascorbic acid (vitamin C), which helps support immunity during illness ⁶ .
• RINZASip ^® for children . The drug contains suitable dosages of paracetamol and other active ingredients to relieve symptoms of colds in babies. RINZAsip ^® for children is a way to take care of a child during illness and help him cope with fever, nasal congestion, weakness ⁷ .

RINZA ^® products contain not only paracetamol, but also other active ingredients that allow you to fight the symptoms of a cold:

• nasal congestion,
• rhinorrhea (profuse nasal discharge),
• decreased performance,
• muscle pain,
• headache,
• weakness, etc. 9 0005 5,6,7

The duration of the course of treatment with RINZA® preparations averages 5 days and is determined by the duration of fever and other cold symptoms ^5,6,7 .

More help with high fever

• Leisure . Full sleep (at least 8 hours a day), avoiding negative experiences and excessive physical exertion will help the body recover faster. Rest is necessary for the nervous system, it allows you to fight weakness, absent-mindedness and drowsiness.
• Drinking plenty of fluids . During an illness, it is recommended to drink as much as possible, for example, fruit drinks, mineral water without gas, tea with honey, etc. The liquid activates the kidneys and helps to quickly remove toxic substances formed by bacteria and viruses during a cold ³ .
• Balanced nutrition . During illness, it is advisable to give up heavy food (fried, pastries, fatty meat) in favor of easily digestible foods. These are vegetables and fruits, lean meat, cereals, soups, dairy products. Children often refuse to eat during the first days of illness ³ : Do not insist that the child eat as before. It is enough to offer the baby a glass of nutrient fluid once an hour (juice, milk, compote) – this will help maintain strength and avoid dehydration.

Temperature, being a defensive reaction, often becomes a serious problem ^1.4 . Its reduction allows you to improve your well-being. Cold preparations RINZA ^® help reduce fever and eliminate other unpleasant symptoms of a cold ^5,6,7 . You can choose the best remedy from the RINZA® line: tablets or powders for adults, RINZAsip ^® with a dosage of components suitable for children ^5,6,7 .

The information in this article is for reference only and does not replace professional medical advice. For diagnosis and treatment, contact a qualified specialist.

* Clonic-tonic convulsions are rhythmic contractions of the muscles of the body, during which there are phase changes of clonic (fast, sweeping muscle contractions following one after another after a short period of time) and tonic (long-term muscle contractions arising from slow and lasting for a long time) contractions.