Febrile Seizures in Emergency Medicine Follow-up

  • Author: Nooruddin R Tejani, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Aug 31, 2011
 

Further Inpatient Care

  • The decision to admit should be individualized, but admission usually is not necessary for patients with febrile seizure.
  • Most patients should be observed in the ED until awake and alert.
  • Conditions requiring admission of the patient include the following:
    • More than 1 seizure within 24 hours
    • Unstable clinical status
    • Lethargy beyond the postictal period
    • Uncertain home situation
    • Unclear follow-up care
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Further Outpatient Care

  • Arrange for medical reevaluation of discharged patients and parental education in a follow-up appointment within 24-48 hours.
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Inpatient & Outpatient Medications

  • Discharge medications include antipyretics and, if indicated, antibiotics (eg, otitis media, pneumonia).
  • Prophylactic use of antipyretics and sedatives/anticonvulsants for possible recurrence of febrile seizure has not shown to be effective.
    • Regular or sporadic administration of antipyretics during febrile illness is generally safe, but no study has shown them to be effective in reducing recurrence of febrile seizures.[32, 33] Acetaminophen and ibuprofen are no better than placebo for preventing recurrences of febrile seizures .[34]
    • Phenobarbital and valproic acid can be given daily and are effective, but they are associated with multiple adverse effects. Carbamazepine and phenytoin are not effective in preventing recurrent febrile seizures. Citing a preponderance of harm over benefit, the 2008 Clinical Practice Guideline for the Long-Term Management of the Child with Simple Febrile Seizures recommends neither continuous nor intermittent use of anticonvulsants for children with one or more simple febrile seizures.[33]
    • Some studies report that diazepam, given orally or rectally every 8 hours during febrile illnesses, is effective in preventing recurrence of febrile seizures.[35, 36] . However, these benzodiazepines can cause lethargy, drowsiness, and ataxia, and sedation could mask an evolving central nervous system infection. The AAP guideline released in 2008 does not recommend prophylactic use of diazepam as the risk outweighs the benefits.[33]
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Deterrence/Prevention

  • Given a more established role of influenza A in the etiology of febrile seizure, both acute and recurrent, vaccination against influenza A in the flu season may have a role in preventing development of both acute and recurrent febrile seizures.[8]
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Prognosis

  • Simple febrile seizures may slightly increase the risk of developing epilepsy,[37] but they have no adverse effects on behavior, scholastic performance, or neurocognition. The risk of developing epilepsy is increased further in children with a history of complex febrile seizures.[13, 38, 39, 40]
  • A strong association exists between febrile status epilepticus or febrile seizures characterized by focal symptoms and later development of temporal lobe epilepsy.[37, 41]
    • Children with febrile seizures have a slightly higher incidence of epilepsy compared with the general population (2% vs 1%).
    • Risk factors for epilepsy later in life include complex febrile seizure, family history of epilepsy or neurologic abnormality, and developmental delay. Patients with 2 risk factors have up to a 10% chance of developing afebrile seizures.[42]
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Patient Education

  • Parents should be taught what to do if their child has another seizure.
  • The parent should be advised to call for assistance if the seizure lasts longer than 10 minutes or if the postictal period lasts longer than 30 minutes.
  • Parents should be counseled on the benign nature of febrile seizures.
  • Parents should be reassured that simple febrile seizures do not lead to neurologic problems or developmental delay.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education articles Seizures and Fever and Seizures in Children.
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Contributor Information and Disclosures
Author

Nooruddin R Tejani, MD  Assistant Professor, Department of Emergency Medicine, SUNY Health Sciences Center Brooklyn; Director, Pediatric Emergency Medicine, Downstate Medical Center

Nooruddin R Tejani, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, William T Zempsky, MD, to the development and writing of this article.

References

  1. Consensus statement. Febrile seizures: long-term management of children with fever-associated seizures. Pediatrics. Dec 1980;66(6):1009-12. [Medline].

  2. [Guideline] Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia. Jul-Aug 1993;34(4):592-6. [Medline].

  3. Matsuo M, Sasaki K, Ichimaru T, Nakazato S, Hamasaki Y. Increased IL-1beta production from dsRNA-stimulated leukocytes in febrile seizures. Pediatr Neurol. Aug 2006;35(2):102-6. [Medline].

  4. Gatti S, Vezzani A, Bartfai T. Mechanisms of fever and febrile seizures: putative role of the interleukin-1 system. In: Baram TZ, Shinnar S. Febrile Seizures. San Diego, Ca: Academic Press; 2002:169-88.

  5. Haspolat S, Mihci E, Coskun M, Gumuslu S, Ozben T, Yegin O. Interleukin-1beta, tumor necrosis factor-alpha, and nitrite levels in febrile seizures. J Child Neurol. Oct 2002;17(10):749-51. [Medline].

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

  7. Millichap JG, Millichap JJ. Role of viral infections in the etiology of febrile seizures. Pediatr Neurol. Sep 2006;35(3):165-72. [Medline].

  8. Kwong KL, Lam SY, Que TL, Wong SN. Influenza A and febrile seizures in childhood. Pediatr Neurol. Dec 2006;35(6):395-9. [Medline].

  9. Audenaert D, Van Broeckhoven C, De Jonghe P. Genes and loci involved in febrile seizures and related epilepsy syndromes. Hum Mutat. May 2006;27(5):391-401. [Medline].

  10. Iwasaki N, Nakayama J, Hamano K, Matsui A, Arinami T. Molecular genetics of febrile seizures. Epilepsia. 2002;43 Suppl 9:32-5. [Medline].

  11. Hirose S, Mohney RP, Okada M, Kaneko S, Mitsudome A. The genetics of febrile seizures and related epilepsy syndromes. Brain Dev. Aug 2003;25(5):304-12. [Medline].

  12. Nakayama J, Arinami T. Molecular genetics of febrile seizures. Epilepsy Res. Aug 2006;70 Suppl 1:S190-8. [Medline].

  13. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life. Br Med J (Clin Res Ed). May 4 1985;290(6478):1307-10. [Medline].

  14. Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994;35 Suppl 2:S1-6. [Medline].

  15. Chung B, Wat LC, Wong V. Febrile seizures in southern Chinese children: incidence and recurrence. Pediatr Neurol. Feb 2006;34(2):121-6. [Medline].

  16. 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].

  17. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med. Nov 4 1976;295(19):1029-33. [Medline].

  18. Berg AT, Shinnar S. Unprovoked seizures in children with febrile seizures: short-term outcome. Neurology. Aug 1996;47(2):562-8. [Medline].

  19. van Esch A, Steyerberg EW, van Duijn CM, Offringa M, Derksen-Lubsen G, van Steensel-Moll HA. Prediction of febrile seizures in siblings: a practical approach. Eur J Pediatr. Apr 1998;157(4):340-4. [Medline].

  20. Bethune P, Gordon K, Dooley J, Camfield C, Camfield P. Which child will have a febrile seizure?. Am J Dis Child. Jan 1993;147(1):35-9. [Medline].

  21. Vestergaard M, Basso O, Henriksen TB, Ostergaard JR, Olsen J. Risk factors for febrile convulsions. Epidemiology. May 2002;13(3):282-7. [Medline].

  22. Offringa M, Bossuyt PM, Lubsen J, Ellenberg JH, Nelson KB, Knudsen FU. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr. Apr 1994;124(4):574-84. [Medline].

  23. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child. Aug 2004;89(8):751-6. [Medline].

  24. Berg AT, Shinnar S, Darefsky AS, Holford TR, Shapiro ED, Salomon ME. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med. Apr 1997;151(4):371-8. [Medline].

  25. Sales JW, Bulloch B, Hostetler MA. Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows. CJEM. May 2011;13(3):145-9. [Medline].

  26. Chamberlain JM, Gorman RL. Occult bacteremia in children with simple febrile seizures. Am J Dis Child. Oct 1988;142(10):1073-6. [Medline].

  27. Teng D, Dayan P, Tyler S, Hauser WA, Chan S, Leary L. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics. Feb 2006;117(2):304-8. [Medline].

  28. Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics. Jan 2009;123(1):6-12. [Medline].

  29. McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. Jul 16-22 2005;366(9481):205-10. [Medline].

  30. Bhattacharyya M, Kalra V, Gulati S. Intranasal midazolam vs rectal diazepam in acute childhood seizures. Pediatr Neurol. May 2006;34(5):355-9. [Medline].

  31. Sadleir LG, Scheffer IE. Febrile seizures. BMJ. Feb 10 2007;334(7588):307-11. [Medline].

  32. van Stuijvenberg M, Derksen-Lubsen G, Steyerberg EW, Habbema JD, Moll HA. Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. Pediatrics. Nov 1998;102(5):E51. [Medline].

  33. [Guideline] Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. 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].

  34. Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med. Sep 2009;163(9):799-804. [Medline].

  35. Autret E, Billard C, Bertrand P, Motte J, Pouplard F, Jonville AP. Double-blind, randomized trial of diazepam versus placebo for prevention of recurrence of febrile seizures. J Pediatr. Sep 1990;117(3):490-4. [Medline].

  36. Rosman NP, Colton T, Labazzo J, Gilbert PL, Gardella NB, Kaye EM. 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].

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

  38. Berg AT. Febrile seizures and epilepsy: the contributions of epidemiology. Paediatr Perinat Epidemiol. Apr 1992;6(2):145-52. [Medline].

  39. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. II--Medical history and intellectual ability at 5 years of age. Br Med J (Clin Res Ed). May 4 1985;290(6478):1311-5. [Medline].

  40. Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med. Jun 11 1998;338(24):1723-8. [Medline].

  41. Tarkka R, Paakko E, Pyhtinen J, Uhari M, Rantala H. Febrile seizures and mesial temporal sclerosis: No association in a long-term follow-up study. Neurology. Jan 28 2003;60(2):215-8. [Medline].

  42. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med. Nov 4 1976;295(19):1029-33. [Medline].

 
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