Febrile Seizures Clinical Presentation

  • Author: Robert J Baumann, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Mar 27, 2012
 

History

  • Children with simple febrile seizures are neurologically and developmentally healthy before and after the seizure.
  • They do not experience a seizure in the absence of fever.
  • The seizure is described as either a generalized clonic or a generalized tonic-clonic seizure.
    • Signs of a focal seizure during the onset or in the postictal period (eg, initial clonic movements of 1 limb or of the limbs on 1 side, a weak limb postictally) would rule out a simple febrile seizure.
    • Similarly, simple febrile seizure activity does not continue for more than 15 minutes, although a postictal period of sleepiness or confusion can extend beyond the 15-minute maximum.
  • Simple febrile seizures often occur with the initial temperature elevation at the onset of illness. The seizure may be the first indication that the child is ill. While no clear cutoff is known, a rectal temperature under 38°C should raise concern that the event was not a simple febrile seizure.
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Physical

Physical examination findings reveal a neurologically and developmentally healthy child. It is especially important that the child have no signs of meningitis or encephalitis (eg, stiff neck or persistent mental status changes).

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Causes

Simple febrile seizures are considered a genetic disorder, but neither a specific locus nor a specific pattern of inheritance has been described. The mode of inheritance is likely to vary between families and may be multifactorial.

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Contributor Information and Disclosures
Author

Robert J Baumann, MD  Professor of Neurology and Pediatrics, Department of Neurology, University of Kentucky College of Medicine

Robert J Baumann, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Riviello Jr, MD  George Peterkin Endowed Chair in Pediatrics, Professor of Pediatrics, Section of Neurology and Developmental Neuroscience, Professor of Neurology, Peter Kellaway Section of Neurophysiology, Baylor College of Medicine; Chief of Neurophysiology, Director of the Epilepsy and Neurophysiology Program, Texas Children's Hospital

James J Riviello Jr, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Up To Date Royalty Section Editor

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kenneth J Mack, MD, PhD  Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

References

  1. Winawer M, Hesdorffer D. Turning on the heat: the search for febrile seizure genes. Neurology. Nov 23 2004;63(10):1770-1. [Medline].

  2. Vestergaard M, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J. Death in children with febrile seizures: a population-based cohort study. Lancet. Aug 9 2008;372(9637):457-63. [Medline].

  3. Rosman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med. Jul 8 1993;329(2):79-84. [Medline].

  4. Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. BMJ. Nov 30 1991;303(6814):1373-6. [Medline].

  5. [Best Evidence] Nørgaard M, Ehrenstein V, Mahon BE, Nielsen GL, Rothman KJ, Sørensen HT. Febrile seizures and cognitive function in young adult life: a prevalence study in Danish conscripts. J Pediatr. Sep 2009;155(3):404-9. [Medline].

  6. Baumann RJ. Technical report: treatment of the child with simple febrile seizures. Pediatrics. Jun 1999;103(6):e86. [Medline].

  7. [Guideline] Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. Jun 2008;121(6):1281-6. [Medline].

  8. [Guideline] Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics. May 1996;97(5):769-72; discussion 773-5. [Medline].

  9. [Guideline] Riemenschneider TA, Baumann RJ, Duffner PK, et al. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics. May 1996;97(5):769-72; discussion 773-5. [Medline].

  10. Thoman JE, Duffner PK, Shucard JL. Do serum sodium levels predict febrile seizure recurrence within 24 hours?. Pediatr Neurol. Nov 2004;31(5):342-4. [Medline].

 
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