Febrile Seizure

Excerpt

Febrile seizures are generalized seizures, typically in children between the ages of 6 months and 5 years, that occur with a fever greater than 100.4 °F (38 °C) not associated with a central nervous system (CNS) infection, a known seizure-provoking etiology (eg, electrolyte imbalance, hypoglycemia, or substance abuse), or history of an afebrile seizure. No defined fever threshold is required to precipitate febrile seizures, as each patient's convulsive temperature threshold varies. The primary febrile seizure risk factors appear to include existing neurologic impairment, the presence of a viral infection, a family history of seizure, developmental delay, decreased serum zinc and iron levels, and maternal smoking and stress. Most febrile seizures resolve spontaneously without associated complications. However, some studies have evidence that some patients may be at higher risk of developing epilepsy or another seizure disorder following a febrile seizure. Some experts believe that either an underlying neurologic abnormality or the effect of a febrile seizure on a developing nervous system predisposes patients toward a seizure disorder. Febrile seizures are categorized as simple febrile seizures, consisting of a single seizure lasting 15 minutes or less, or complex febrile seizures, characterized by multiple seizures occurring within 24 hours with focal neurologic features or a seizure lasting 15 minutes or more. Simple febrile seizures comprise the majority of febrile seizures. Febrile status epilepticus refers to seizures lasting longer than 30 minutes and is a rare subset of febrile seizures associated with more adverse outcomes than simple febrile seizures.

The evaluation of febrile seizures primarily consists of characterizing a patient's type of febrile seizure and determining the fever's underlying cause through clinical assessment and diagnostic studies. Most febrile seizures spontaneously resolve and, therefore, may be expectantly managed. However, complex or longer-lasting febrile seizures may require pharmacologic therapy to stop the seizure activity. This activity for healthcare professionals is designed to enhance the learner's competence when managing febrile seizures, equipping them with updated knowledge, skills, and strategies for effective evaluation, timely treatment, and improved care coordination, leading to better patient outcomes.