Why do children experience seizures. What are the common symptoms of seizures in kids. How can parents recognize different types of seizures. What are the potential risks and complications of childhood seizures. How are seizures diagnosed and treated in children.

The Nature of Childhood Seizures: A Comprehensive Overview

Childhood seizures are neurological events that can be both alarming and confusing for parents and caregivers. These episodes of abnormal electrical activity in the brain can manifest in various ways, ranging from subtle behavioral changes to dramatic physical symptoms. Understanding the nature of seizures in children is crucial for early detection, proper management, and ensuring the best possible outcomes for affected young ones.

What Exactly is a Seizure?

A seizure occurs when there’s a sudden, uncontrolled electrical disturbance in the brain. This can affect a child’s behavior, movements, feelings, and consciousness. Seizures can be brief or prolonged, and their intensity can vary significantly from one episode to another.

Recognizing the Symptoms: Key Indicators of Childhood Seizures

Identifying seizures in children can be challenging, as symptoms can vary widely depending on the type of seizure and the area of the brain affected. Some seizures are easily recognizable, while others may be so subtle that they go unnoticed.

Common Signs of Seizures in Children

• Staring spells
• Sudden falls or loss of balance
• Jerking movements of arms and legs
• Loss of consciousness
• Confusion or disorientation
• Sudden mood changes or emotional outbursts
• Visual disturbances or hallucinations

It’s important to note that not all seizures involve convulsions or loss of consciousness. Some may present as brief moments of altered awareness or unusual sensations.

Can seizures be mistaken for other conditions?

Yes, seizures can sometimes be confused with other medical or behavioral issues. For instance, absence seizures, characterized by brief staring spells, might be mistaken for daydreaming or inattention. Similarly, certain sleep disorders or syncope (fainting) episodes can mimic seizure activity. This is why professional medical evaluation is crucial for accurate diagnosis.

Types of Seizures: Understanding the Different Categories

Seizures in children are broadly classified into two main categories: focal seizures and generalized seizures. Each type has its own characteristics and potential impacts on a child’s health and well-being.

Focal Seizures: When Electrical Activity is Localized

Focal seizures, previously known as partial seizures, originate in a specific area of the brain. These can be further divided into two subcategories:

1. Simple focal seizures: These affect a small part of the body, such as one limb or one side of the face. The child remains conscious but may experience unusual sensations or movements.
2. Complex focal seizures: These involve a change in or loss of consciousness. The child may appear confused, perform repetitive movements, or be unresponsive to their environment.

Generalized Seizures: When the Entire Brain is Affected

Generalized seizures involve both sides of the brain from the onset and typically cause a loss of consciousness. There are several types of generalized seizures:

• Absence seizures: Brief episodes of staring and altered consciousness, often mistaken for daydreaming.
• Tonic seizures: Sudden stiffening of muscles, which can cause falls.
• Atonic seizures: Sudden loss of muscle tone, leading to “drop attacks.”
• Myoclonic seizures: Brief, shock-like jerks of muscles.
• Tonic-clonic seizures: The most dramatic type, involving loss of consciousness, muscle rigidity, and convulsions.

The Impact of Seizures on Children’s Health and Development

While not all seizures cause lasting damage, they can have significant implications for a child’s overall health, development, and quality of life. Understanding these potential impacts is crucial for parents and healthcare providers alike.

Physical and Neurological Effects

Seizures can sometimes lead to physical injuries from falls or convulsions. More importantly, frequent or prolonged seizures may potentially cause neurological damage, affecting cognitive functions, learning abilities, and behavior.

Psychological and Social Implications

Children with seizure disorders may face psychological challenges, including anxiety, depression, and social isolation. The unpredictable nature of seizures can affect a child’s confidence and ability to participate in various activities.

Diagnosing Seizures in Children: The Path to Accurate Identification

Diagnosing seizures in children often requires a comprehensive approach, combining medical history, physical examination, and various diagnostic tests. This process helps differentiate seizures from other conditions and determines the specific type of seizure disorder.

Key Diagnostic Tools

• Electroencephalogram (EEG): Measures electrical activity in the brain
• Magnetic Resonance Imaging (MRI): Provides detailed images of brain structure
• Blood tests: Can help rule out other conditions or identify underlying causes
• Video EEG monitoring: Combines EEG with video recording to capture seizure events

How do doctors distinguish between different types of seizures?

Doctors use a combination of clinical observations, patient and family descriptions of seizure events, and diagnostic test results to classify seizures. The pattern of brain activity on an EEG, along with the specific symptoms experienced during a seizure, helps determine whether it’s a focal or generalized seizure and identifies the subtype.

Treatment Approaches: Managing Childhood Seizures Effectively

The treatment of childhood seizures aims to control seizure activity, minimize side effects, and improve the child’s quality of life. The approach is often individualized, taking into account the type and frequency of seizures, the child’s age, and overall health status.

Medication Options

Anti-epileptic drugs (AEDs) are the primary treatment for most children with seizure disorders. These medications work by altering brain chemistry to reduce the likelihood of seizures. Common AEDs include:

• Valproic acid
• Carbamazepine
• Levetiracetam
• Oxcarbazepine
• Lamotrigine

Alternative Treatments

In cases where medications are not effective or cause significant side effects, alternative treatments may be considered:

1. Ketogenic Diet: A high-fat, low-carbohydrate diet that can reduce seizure frequency in some children.
2. Vagus Nerve Stimulation: A device implanted under the skin that sends electrical signals to the brain to reduce seizure activity.
3. Surgery: In some cases, removing the part of the brain causing seizures can be an effective treatment option.

Living with Seizures: Strategies for Families and Caregivers

Managing a child’s seizure disorder extends beyond medical treatment. It involves creating a supportive environment and developing strategies to ensure the child’s safety and well-being.

Safety Measures at Home and School

Implementing safety measures can help prevent injuries during seizures:

• Padding sharp corners on furniture
• Using protective headgear during physical activities
• Supervising bath time and swimming
• Educating teachers and classmates about seizure first aid

How can parents support a child with seizures emotionally?

Supporting a child with seizures emotionally is crucial for their overall well-being. Parents can:

• Maintain open communication about the condition
• Encourage participation in normal activities when possible
• Help the child build a support network of understanding friends and family
• Work with mental health professionals if needed to address anxiety or depression

Research and Future Directions in Childhood Seizure Management

The field of childhood seizure research is dynamic, with ongoing studies aimed at improving diagnosis, treatment, and quality of life for affected children. Understanding these advancements can provide hope and insight for families navigating this challenging condition.

Emerging Treatment Options

Researchers are exploring several promising avenues for seizure treatment:

• Gene therapy: Targeting specific genetic mutations associated with certain types of epilepsy
• Responsive neurostimulation: Devices that can detect and respond to seizure activity in real-time
• Precision medicine: Tailoring treatments based on an individual’s genetic profile and specific seizure characteristics

What role does technology play in seizure management?

Technology is increasingly important in seizure management. Wearable devices can track seizure activity and alert caregivers, while smartphone apps help patients and families monitor medication schedules and record seizure events. These technological advancements contribute to better seizure control and improved quality of life for children with epilepsy.

In conclusion, childhood seizures present unique challenges, but with proper understanding, diagnosis, and management, affected children can lead fulfilling lives. Ongoing research and advancements in treatment options continue to improve outcomes for these young patients. By staying informed and working closely with healthcare providers, families can navigate the complexities of childhood seizures and provide the best possible care for their children.

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.

Causes of Epilepsy in Childhood

Seizures in children have many causes. Common causes of childhood seizures or epilepsy include

• fever (these are called febrile seizures)
• genetic causes
• head injury
• infections of the brain and its coverings
• lack of oxygen to the brain
• hydrocephalus (excess water in the brain cavities)
• disorders of brain development

Most seizures in childhood are not associated with a definite cause, however.

Less common causes of childhood epilepsy include brain tumors or cysts and degenerative disorders (progressive and deteriorating conditions, often associated with loss of brain cells). There is an important difference between something that causes seizures, such as a high fever in a young child, and something that causes epilepsy, such as a severe head injury.

Extensive and careful studies have not found any evidence that immunizations cause epilepsy. However, a seizure may occur within 1 or 2 days of an immunization, especially if it is followed by a fever. In such cases, the child probably had an innocent febrile seizure. When the child receives immunizations, the parents should give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) before a fever develops. Children who have a single seizure following an immunization can usually receive further immunizations.

Many childhood seizures are benign, meaning that they are brief events that will not continue into adulthood, and the child’s development and intellect are usually normal. Other seizures are serious and often are associated with developmental delay or intellectual disability and persistent seizures.

The outlook for seizures only partially depends on their cause. For example, two children may be infected with the same bacteria and both have meningitis, an infection of the membranes covering the brain and spinal cord. One child is left with severe epilepsy, but the other child never has a seizure. How can the different outcomes be explained? The bacterial infection in one child may have been more widespread, involving sensitive areas of the brain. Or the bacteria could have infected a vein in one child and caused a small stroke, which then caused the epilepsy. Or perhaps one child had a genetic (hereditary) tendency to have seizures, and the infection brought this trait to the surface.

All people are capable of having a seizure. It remains uncertain why some children have seizures after incidents such as head injury while most others do not. “Seizure threshold” refers to the conditions necessary for the production of a seizure. In animals, the seizure threshold can be precisely defined by observing their response to certain chemicals or electrical stimulation. In human beings, the term “seizure threshold” is used in a more abstract sense. In persons who have a tendency to have seizures, the threshold is lower than in people who have a greater resistance, or higher threshold, against seizures. Genetic, hormonal, sleep deprivation, and other factors can influence an individual’s seizure threshold.

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 who had 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 with viral illnesses (eg, roseola and influenza).

Vaccinations followed by fever. There is a small chance of febrile seizures after vaccination against measles, rubella and mumps, as well as diphtheria, tetanus and whooping cough. 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.
• 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 the cramp (eg the 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 the seizure occurs for the first time in life, lasts longer than 5 minutes, the child is unusually drowsy 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.

In case of 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, anti-fever medications make you feel better overall, 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’s febrile seizures are prolonged, 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 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. With such a chill, the child’s hands and feet may tremble rhythmically. It is similar to convulsions, but the child is conscious and responds if spoken to. So that the doctor can better understand whether the incident was convulsions, and if so, which ones, try to clearly fix the duration of the attack, describe it as specifically as possible, and ideally, record what is happening on video (one person helps the child, the second shoots on the phone).

Author:

Dmitrieva Olga Borisovna
pediatric neurologist

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 in 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) refers to febrile seizures that last more than 15 minutes, recur within 24 hours, or involve 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 did not show other symptoms (that is, they became the first clear sign)
• Seizures occurred less than an hour after the temperature rise
• 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.

Does the risk of epilepsy increase?

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 one hour after fever rise
• first attack before one year or after three years
• many episodes of febrile seizures
• concomitant anomalies of the development 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 react 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
• unfasten clothing at 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
• Lumbar puncture is a procedure during 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, out of 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 (that is, they go away on their own without treatment), they do not damage the brain and 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 convulsions 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.