Febrile convulsions

Febrile convulsions are the commonest form of seizure under the age of 2, occurring in 2–4% of children in the UK. The majority occur between 12–18 months and are more common in those with a family history. The aetiology is multi-factorial, although most episodes occur in children with viral infections. In most children the seizure will have self-resolved prior to coming to hospital and the child may be back to normal. No investigation or treatment is necessary. However, it is important to appreciate that for parents who have witnessed the episode, it will have been extremely distressing and frightening. In addition, there are many myths and misconceptions held by parents particularly in relation to the association with fever and further episodes, as well as the concerns surrounding longer term outcomes. Reassurance and clear advice given by clinicians is therefore one of the most important aspects to management. This review gives a practical approach to management for clinicians and enables them to give informed and up to date guidance to parents, thus allowing them to feel confident about how to manage their child at home if they were to have further episodes, as well as providing reassurance about the harmless nature of febrile convulsions.     

Febrile convulsions and sudden infant death syndrome

It has been suggested that sudden infant death syndrome (SIDS) and febrile convulsions are related aetiologically. We compared the risk of SIDS in 9877 siblings of children who had had febrile convulsions with that of 20 177 siblings of children who had never had febrile convulsions. We found no support for the shared susceptibility hypothesis.     

Febrile convulsions and sudden infant death syndrome.

It has been suggested that sudden infant death syndrome (SIDS) and febrile convulsions are related aetiologically. We compared the risk of SIDS in 9877 siblings of children who had had febrile convulsions with that of 20 177 siblings of children who had never had febrile convulsions. We found no support for the shared susceptibility hypothesis.     

Duration of recognized fever in febrile seizure predicts later development of epilepsy

Background: The current report examines the risk of and predictors for developing epilepsy in children with febrile seizure (FS). The present study addresses two factors that were previously identified as predictors of recurrent FS in previous reports: maximum temperature and duration of fever prior to the initial FS. Methods: Children aged 6 months–6 years with an initial simple FS were eligible for the study. The interview included questions about the child's illness, family history of seizures, and other exposure information. In particular, they were asked about the duration of recognized fever prior to the seizure. After the initial interview, parents were called every 3–4 months to ascertain whether any further seizures had occurred and the circumstances under which such seizures occurred. Follow up ≥3 years was attempted for all children. Statistical analysis was done with χ² test, Fisher's exact test, Mann–Whitney U‐tests and logistic regression analysis. Results: Five of 92 children (5.4%) experienced unprovoked seizures and were considered part of an epilepsy group. In four of these five patients, the duration of recognized fever prior to FS fell more than ±2.5 SD outside the distribution for the non‐epilepsy group. Either an unusually short or long recognized fever prior to the initial FS was associated with an increased risk of unprovoked seizures. Conclusions: The duration of recognized fever appears to provide useful information about the risk for the later development of epilepsy.     

Febrile convulsions: electroencephalographic changes related to rectal temperature.

Nine children had simultaneous continuous electroencephalographic monitoring and temperature recording immediately after febrile convulsions. Background electroencephalographic rhythms did not alter with temperature and with one exception, seizure discharges occurred only during sustained high pyrexia.