INFORMATION ON FEBRILE SEIZURES
Febrile seizures are the most usual type of convulsions in infants or small children and are caused by fever. It is not in the strict sense an epilepsy syndrome but rather a symptom of a febrile illness and it normally affects children between three months and five years of age, mainly toddlers. During a febrile seizure, a child may lose consciousness and move or tremble on the limbs. The seizure itself is normally harmless and does not cause brain damage. A child who experiences a seizure in the setting of a fever should be taken to the hospital so that any serious causes of the fever can be assessed.
CAUSES OF FEBRILE SEIZURES
The exact role of the fever in the enlargement of seizures is not clear. However, it is known that viral infections are the most common cause of fever in children with a first febrile seizure who are admitted to hospitals, chiefly caused by viruses like herpes and influenza. Meningitis causes less than 1% of febrile seizures, but should be examined to rule out this serious infection, particularly in children less than one year old or those who continue to appear ill after the fever subsides. Seizures that happen after immunizations are likely to be the febrile type due to temperature elevation, particularly those after the dtp (diphtheria, pertussis, tetanus) and measles immunizations. Upper respiratory tract infections accompanied by high fever, in combination with a low seizure threshold, can often affect infants and young children and, thus, account for the most common cause of these seizures.
SYMPTOMS OF FEBRILE SEIZURES
Febrile seizures usually begin with a sudden contraction of muscles on both sides of the body, generally facial muscles, trunk, arms, and legs. The force of muscle contraction can cause the child to emit an involuntary cry or moan. The child falls, if standing, and may bite the tongue. Urinary incontinence and vomiting can occur. The child will not breathe, and may turn blue. Children cannot take action to any stimuli, and loss of consciousness, hallucinations, confusion, and feelings of fear or other emotions may take place. Focal seizures (those without loss of consciousness) involving only a part of the body is less common, and might become generalized, affecting the entire body.
TREATMENT OF FEBRILE SEIZURES
During the severe phase of the seizure, the main objective is to keep the child in a position on his or her side or stomach to avoid aspiration of saliva or vomit and avoid injuries. The child should be placed on the floor or in a safe area, and all risky objects must be removed. A child having a seizure should not be restrained. If the child vomits, or if saliva and mucus build up in the mouth, a side posture should be used. It is also important that parents do not force the child to eat anything, as this could result in breaking teeth. Also, tongue swallowing will not occur. If the child accidentally bites the tongue, it will heal. Any tight clothing should be removed, especially around the neck. Because the seizure occurs in the setting of a fever, the main aim of therapy is to bring the fever down. Removing the clothes and applying cool washcloths to the child's neck and face may help, and acetaminophen or ibuprofen suppositories, if available, may control the high temperature.
Rarely, a child may experience a constant seizure, which could evolve into what is called status epilepticus. Airway management and anticonvulsivants are the first line of treatment during this medical emergency.
The most generally used medication includes benzodiazepines such as lorazepan (ativan) and diazepam (valium).
