Febrile Seizures

Learn to distinguish simple febrile seizures from complex seizures


This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail editor@EMSWorld.com.?

OBJECTIVES

  • Discuss frequency of febrile seizures
  • Review assessment of the febrile seizure patient
  • Outline prehospital care of the febrile seizure patient

      While responding to a call for an infant who was "blue and not breathing," I began to think of all the causes of respiratory arrest, which was the likely problem, and what assessments would confirm those causes.

   The first things that came to mind were:

  • Foreign body airway obstruction
  • Toxin exposure
  • Emesis with aspiration
  • Seizure
  • SIDS.

   Walking through the door expecting the worst, I was quickly reassured by the cooing 8-month-old being held by his mom. "He was blue, twitching all over and not breathing when I found him," she said. "Now he is fine."

   As my partner and I began our assessment, we learned that the boy had been sick for several days with a productive cough and a possible ear infection. Our problem list was quickly narrowing toward a febrile (fever-caused) seizure.

PEDIATRIC SEIZURES

   There are many causes of seizure in pediatric patients. Although fever is the most common, other causes include:

  • Hypoxia
  • Brain injury
  • Hypoglycemia
  • Septic infection
  • Intoxication
  • Congenital neurological problems
  • Hypovolemia.

   A febrile seizure happens when a child age 5 months to 5 years has a temperature greater than 102°F.1 There may be generalized or focal seizure activity.

   Febrile seizures are classified as simple or complex. Features of a simple febrile seizure are:2-4

  • Tonic-clonic movement
  • Stops without intervention
  • Less than 15 minutes' duration
  • Does not recur within 24 hours
  • No previous neurological problems.

   Complex febrile seizure characteristics include:2-4

  • Longer than 15 minutes' duration
  • Includes focal features
  • Recurs within 24 hours
  • Known patient history of neurological problems.

   Complex febrile seizures are more worrisome, have increased likelihood of significant consequences, and are more likely to need ALS interventions and transport. In this article, we explore febrile seizure assessment, treatment and transport considerations.

FREQUENCY OF FEBRILE SEIZURES

   Febrile seizures are a relatively common occurrence in children ages 5 months to 5 years and are most frequently caused by viral illness.4 Thirty percent of seizures in this age group are caused by fever; the next highest cause is failure to take prescribed medications. Febrile seizures may occur in as many as 5% of all children. There may be a genetic connection for febrile seizures, but the exact pathway is not well understood.4,5

   About 30% of children who have a febrile seizure are likely to have more in the future. Factors associated with having an additional febrile seizure include:1

  • Younger than 15 months at time of first seizure
  • Experiences frequent fevers
  • Family (parent and/or sibling) history of seizures
  • Seizure occurs soon after fever began
  • Seizure happened at a relatively low body temperature.

FEBRILE SEIZURE SIGNIFICANCE

   In most cases, febrile seizures have no lasting impact on the child. Basic life support skills may be needed to clear the child's airway or treat wounds from a fall or injury that occurs during the seizure, but most children who have a febrile seizure develop normally with no lasting consequence.1

   A small percentage of children--2% to 5%--who have a febrile seizure will develop epilepsy. The risk increases if the febrile seizure was complex, meaning it was prolonged, had focal features, recurred within 24 hours of the first seizure, and/or the child has underlying medical problems like cerebral palsy or other types of physical or cognitive developmental delays.1

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