Anamnestic data are of major importance to identify FC and to avoid confusion with more severe disorders and any type of epilepsy. Although FC often occur repeatedly, a history of seizures that have not been related to a febrile illness is untypical for this disease. In most cases, fever and possibly additional symptoms associated with the underlying disease are the only pathological findings in FC patients. Of note, cerebral trauma may in certain circumstances cause manifestations similar to FC [10]. These may or may not be related to pathological findings obtainable by physical examination.

First FC are often registered within the first day after fever sets in.

Simple febrile seizures are more common than complex febrile seizures. The former last up to five minutes and the patient fully recovers within an hour after symptom onset. The affected child does not show more than one episode of FC per day. Generalized clonic seizures are most typical, but tonic and even atonic fits have also been observed. Apart from the above-described conditions, these children are healthy.

Status epilepticus, focal seizures, more frequent convulsions and a considerably prolonged post-ictal period are characteristic for complex febrile seizures. They may affect otherwise healthy children, but they are also more likely to be triggered by intracranial pathologies than simple FC. Meningitis, for instance, is rarely associated with simple seizures, but incidence rates among patients showing complex FC rise to almost 5% [11].

• Fever

  […] seizures, fever convulsion, seizure fever, fever convulsions, fever seizures, febrile seizures, seizure febrile, convulsion fever, [D]Convulsions, febrile (situation), Febrile seizure (from fever), Febrile convulsions (finding), Febrile convulsion, Fever [fpnotebook.com]

  The antipyretic shuts down prostaglandin production, resulting in a rapid fall of the fever. [thenursepath.blog]

  Also, ask your pediatrician for tips on keeping your child’s fever down during an illness. This may decrease the chances of fever-related seizures. [health.clevelandclinic.org]

  Febrile seizures are triggered by a fever. The fever is often caused by a mild infection, like a cold or an ear infection. No one knows why a fever sometimes causes seizures in a child. There are two types of febrile seizures—simple and complex. [msdmanuals.com]

• High Fever

  A 32-year-old man had generalized tonic-clonic epileptic seizures associated with episodes of recurrent high fever for 6 years. Repeated physical examinations including neurological status, EEG and nuclear brain scan were negative. [ncbi.nlm.nih.gov]

  Convulsions (fits) that occur at the time of high fever are known as febrile convulsions or febrile seizures. These febrile seizures are commonly seen in children between 6 months to 6 years and are generally harmless. [pediatriconcall.com]

  Febrile seizures often occur when a child becomes ill, usually on the first day, and are caused by a high fever (>102°F). Febrile seizures can occur in any child, but they have a slight tendency to be hereditary. [chp.edu]

  They should be avoided, if possible, by controlling high fever in children. feb·rile con·vul·sion ( feb'ril kŏn-vŭl'shŭn ) Brief seizure, lasting less than 15 minutes, seen in a neurologically normal infant or young child, associated with fever. [medical-dictionary.thefreedictionary.com]

• Falling

  Rather, move your child to an area in which he or she will be safe from falling or hitting their heads on anything hard or sharp-edged. If on a hard surface, place a blanket or item of clothing beneath your child's body. [medbroadcast.com]

  Malnutrition (literally, “bad nutrition”) is defined as “inadequate nutrition,” and while most people interpret this as undernutrition, falling short of daily nutritional requirements. [nurseslabs.com]

  Becomes stiff or floppy Eyes roll backwards Child falls to the ground Becomes unconscious and is unresponsive Have arching of the head and back Sharp jerky, twitching like movements of the arms and legs May have noisy, laboured breathing Mucus and blood [fad.net.au]

  The child will fall, if standing, and may pass urine. He may vomit. He may bite his tongue. The child will not be breathing, and may begin to turn blue. [drgreene.com]

• Crying

  She was rigid and staring straight ahead, crying as if something terrifying was happening. Then the crying stopped. Her fists clenched and she started shaking – she was having a fit. We pulled over and dialled 999. [theguardian.com]

  The child may cry out at the onset of the seizure, followed by staring and muscle stiffness, muscle limpness, rhythmic jerking on both sides, or jerking, stiffening or limpness on one side. [chp.edu]

  […] or crying when moved or touched Lethargy, drowsiness, or confusion Painful urination Rash Stiff neck Types of Febrile Seizures There are two types of febrile seizures. [healthcommunities.com]

  […] out in anguish .(9) But if something had happened to me while I was there, I wouldn't have wanted the world to gnash its teeth in anguish and despair over me.(10) Philip gave a cry of anguish(11) And when I woke up today, I found a lot of the despair [maltese.english-dictionary.help]

• Common Cold

  In most cases, febrile seizures are associated with an illness, such as an upper respiratory infection (e.g. common cold, ear infection, roseola). They often occur during the first day of the fever or illness. [healthcommunities.com]

  Examples of viral infections are the flu, common cold, and roseola. If my child has a febrile seizure, does this mean that he or she has epilepsy? No. A single seizure does not mean your child has epilepsy. [familydoctor.org]

• Labored Breathing

  labored, slower than normal (unusual for a child to stop breathing completely) Although it may seem like an eternity if you are witnessing a seizure, most of these episodes last only 1-5 minutes. [emedicinehealth.com]

• Choking

  Gently turn his head to one side so he won't choke if he vomits. Loosen his clothing if it's constricting him. Make sure he doesn't have anything in his mouth, and don't put anything in his mouth while the seizure lasts. [babycenter.com]

  During a seizure, there is a small chance that the child may be injured by falling or may choke on food or saliva in the mouth. Using proper first aid for seizures can help avoid these hazards. [ninds.nih.gov]

  Once you find that your child is convulsing, the mouth should be cleared with a finger to prevent choking. The child should be placed on his side or abdomen to drain secretions. Do not try to restrain your child or stop seizure movements. [pediatriconcall.com]

  Turn your child over onto his or her side or stomach to prevent choking. Loosen any constrictive clothing. [medbroadcast.com]

  However, if the seizure lasts longer than 15 minutes, the child is seriously injured during the seizure (e.g., from a fall), or complications (e.g., difficulty breathing, choking) develop, the parent or caregiver should dial 911 or contact the child's [healthcommunities.com]

• Diarrhea

  However, in an inconsistent study, diarrhea was the leading cause of febrile convulsion (2) this difference may be because of different geographical zones and the effect of warm climate on diarrhea. [intjinfection.com]

  For example, a child with severe diarrhea may benefit from blood studies for electrolytes. [emedicine.medscape.com]

  The doctor might order tests if your child is under 1 year old and had other symptoms, like vomiting or diarrhea. The doctor may recommend the standard treatment for fevers, which is acetaminophen or ibuprofen. [kidshealth.org]

• Failure to Thrive

  The possibility of a metabolic disorder may be suggested from the history and examination (for example, developmental regression, family history of sudden death in infancy/childhood, failure to thrive, hepatosplenomegaly, micro- and macrocephaly) and, [adc.bmj.com]

• Hypertension

  […] glycemia, - calcemia, -magnesemia Hyponatremia/hypernatremia Hyperphosphatemia Drug withdrawal Congenital anomalies Hypocalcemia Infection Hyponatremia/hypernatremia Drug withdrawal Inborn errors of metabolism Hyperphosphatemia Congenital anomalies Hypertension [emed.ie]

• Visual Impairment

  One child subsequently had visual impairment due to corneal opacification. Two (3.3%) children had incisions inflicted on their skin while 3(5%) were subjected to burning of their buttocks and feet, one of them needed plastic surgery afterwards. [ncbi.nlm.nih.gov]

• Fear

  Fear of brain damage, fear of recurrence and dyspepsia were voiced by the fathers alone (n= 20, cumulative incidence 14.3%). 109 (77.9%) parents did not know the fact that the convulsion can occur due to fever. [jpgmonline.com]

  In 41 (33%) mothers, there were other causes of concerns, including fear of visual defect, hearing loss, memory loss, brain defect, delay in walking, drug adverse effects, coma and death. [ncbi.nlm.nih.gov]

  It is important that health care providers understand potential parental misconceptions, anxieties and fears about fever and febrile seizures so that they may allay those fears effectively. [medsci.org]

  Watching your child having a seizure is a very distressing experience but the fear factor was greatly reduced simply by knowing what to do. [britmums.com]

• Withdrawn

  If any vaccine is found to cause health problems, the vaccine may be withdrawn and no longer given to the public. For more information, see Questions and Answers on Febrile Seizures Following Childhood Vaccinations, Including Influenza Vaccination. [cdc.gov]

• Convulsions

  Seizures, Seizure, Febrile Convulsion, Seizures, Febrile Convulsion, Convulsion, Fever, Convulsions, Fever, Fever Convulsion, Fever Convulsions, Convulsion, Pyrexial, Convulsions, Pyrexial, Pyrexial Convulsion, Pyrexial Convulsions, Febrile Fit, Febrile [fpnotebook.com]

  R56.00 Seizure (s) R56.9 - see also Convulsions ICD-10-CM Diagnosis Code R56.9 Unspecified convulsions 2016 2017 2018 2019 Billable/Specific Code Applicable To Convulsion disorder Fit NOS Recurrent convulsions Seizure(s) (convulsive) NOS febrile (simple [icd10data.com]

  Myth 2 Febrile convulsion is dangerous. [thenursepath.blog]

  The age of children with febrile convulsion ranged from nine months to six years. Of these, 88 had a single convulsion (62.8%) and 52 had recurrent convulsions. The mean age of onset of first febrile convulsion was 27.6 months. [jpgmonline.com]

• Seizure

  Fits, Fit, Febrile, Fits, Febrile, Fever Seizure, Fever Seizures, Seizure, Fever, Seizures, Fever, Pyrexial Seizure, Pyrexial Seizures, Seizure, Pyrexial, Seizures, Pyrexial, Febrile convulsions NOS, Febrile seizure NOS, Febrile convulsion NOS, Seizures [fpnotebook.com]

  ( F44.5 ) epileptic convulsions and seizures ( G40.- ) newborn convulsions and seizures ( P90 ) Convulsions, not elsewhere classified Approximate Synonyms Febrile convulsion Febrile seizure (from fever) Febrile seizure, simple Simple febrile seizure [icd10data.com]

  The list of criteria for the diagnosis of simple febrile convulsions: Fever >38.0° No history of neonatal seizures No previous unprovoked seizures No focal neurological features (i.e. generalised seizure) Tonic-clonic seizure Occurs after 6 months of [derangedphysiology.com]

  Affected children may show focal seizures rather than generalized ones, enter status epilepticus (i.e., experience uninterrupted seizures for more than 20 minutes), or sustain more than one febrile seizure per day. [symptoma.com]

• Febrile Seizures

  Fits, Fit, Febrile, Fits, Febrile, Fever Seizure, Fever Seizures, Seizure, Fever, Seizures, Fever, Pyrexial Seizure, Pyrexial Seizures, Seizure, Pyrexial, Seizures, Pyrexial, Febrile convulsions NOS, Febrile seizure NOS, Febrile convulsion NOS, Seizures [fpnotebook.com]

  As the name implies, febrile seizures are triggered by increases in body temperature. [symptoma.com]

  ( F44.5 ) epileptic convulsions and seizures ( G40.- ) newborn convulsions and seizures ( P90 ) Convulsions, not elsewhere classified Approximate Synonyms Febrile convulsion Febrile seizure (from fever) Febrile seizure, simple Simple febrile seizure [icd10data.com]

• Generalized Seizure

  Seizures in general might have no influence on this distinctive inflammatory process or even might have suppressive impact. Copyright © 2012 Elsevier B.V. All rights reserved. [ncbi.nlm.nih.gov]

  Febrile seizures may be simple or complex: Simple: The entire body shakes (called a generalized seizure) for less than 15 minutes and children usually lose consciousness. Over 90% of febrile seizures are simple. [msdmanuals.com]

  Febrile seizures are classified into 2 types: Simple febrile seizures are more common and are characterized by generalized seizures that last less than 5 minutes. [emedicinehealth.com]

• Excitement

  Recent studies provided evidence that KCNQ2 and KCNQ3 contribute to the M-current, which regulates the subthreshold electrical excitability in the CNS. [ncbi.nlm.nih.gov]

  Infancy, childhood and adolescence are exciting and sometimes challenging years for parents. At CPMC, children of all ages receive heartfelt, expert pediatric care. [cpmc.org]

  This was assumed to cause mild brain alkalosis, resulting in increased neuronal excitability and the subsequent development of clinical seizures [16]. [hindawi.com]

There is no consensus about an optimal approach to FC diagnosis. The vast majority of patients present with simple febrile seizures that are merely triggered by common infectious diseases. However, there is a small percentage of FC patients actually suffering from a more severe primary disease. When there is such suspicion, physicians all over the world do extensive workups.

It has to be noted that a thorough anamnesis is the mainstay of FC diagnosis. All diagnostic measures presented hereafter are only indicated if anamnesis and clinical presentation prompt the suspicion of severe illness or intracranial pathologies. This is the case especially for those children that experience complex seizures; possibly also for patients who suffer from repeated simple FC. A first simple febrile seizure in an otherwise healthy patient does not warrant extensive diagnostics [12].

• Magnetic resonance imaging and computed tomography scans may be applied to visualize inflammation, intracerebral hematoma, cerebral edema or hydrocephalus, among other pathologies.
• Electroencephalography may reveal alterations characteristic for certain forms of epilepsy, but epileptic seizures don't generally coincide with the onset of fever due to bacterial or viral infection.
• Lumbar puncture and analysis of cerebrospinal fluid is recommended to rule out infection of the central nervous system if clinical presentation prompts such a diagnosis.
• Laboratory analyses of blood samples are rarely helpful in FC diagnosis but may be required to identify the source of fever.

In general, simple febrile seizures don't require specific treatment. Patients may, however, benefit from antipyretics and possibly additional compounds that relieve symptoms associated with the underlying disease. Long-lasting episodes, i.e., seizures that extend for more than ten minutes, merit anticonvulsants. Distinct benzodiazepines have been successfully applied to pediatric patients suffering from FC. In detail, lorazepam, midazolam, and diazepam are recommended. Fosphenytoin and phenobarbital may also be administered, whereby the latter has a significantly longer half-life.

Long-term therapy is not required. In some cases, prophylactic treatment at the onset of another febrile disease is indicated, since recurrence is likely. Patients aged less than a year upon the first diagnosis of FC, those children that present febrile convulsion within a few hours after onset of low-grade fever, as well as those that already experienced a relapse are most likely to suffer FC again. Nevertheless, FC are rarely observed in pediatric patients aged more than five years.

According to retrospective studies, FC do not interfere with mental or physical development. Retardation has been described in FC patients but has usually been recognized before the first febrile seizure was noted.

However, childhood febrile seizures slightly increase the risk of developing epilepsy later in life. This particularly applies to patients who experience complex FC, i.e., who enter status epilepticus, who show focal seizures rather than generalized ones, or who sustain more than one episode of FC per day.

FC are not associated with mortality unless an adequate treatment is not provided during status epilepticus.

As the name implies, febrile seizures are triggered by increases in body temperature. Young children are particularly susceptible to a wide variety of infectious diseases that provoke fever, e.g., upper respiratory infections, otitis media, and gastroenteritis. In fact, the former has been reported to cause three out of four cases of FC [2]. However, most individuals suffer from such infections during their infancy, but only a minority presents febrile seizures. Thus, additional factors - either predisposing conditions or further triggers - are of major importance in FC etiology. The following have been identified so far [3]:

• Family history of FC
• Alcohol and/or tobacco consumption during pregnancy
• Premature birth
• Low birth weight
• Neonatal disorders that required hospitalization
• Attendance of a daycare center and thus enhanced exposure to infectious agents
• Developmental retardation

It is not yet clear how these factors contribute to FC onset. Several genes have been associated with an increased risk of FC, and they are mainly those encoding for cytokines or their receptors. Presumably, disturbances in the development of the immune system and an overall increased risk of infection augment the likelihood of a febrile seizure principally by enhancing the incidence of febrile illness. Risk factors may add up.

Febrile seizures may also be induced by immunization, as has been described for the application of pertussis vaccines (single and combined formulations), measles, mumps and rubella (MMR) vaccines, as well as influenza A (H1N1) vaccines [4].

The vast majority of FC patients are children aged over one month and less than five years, with highest incidence rates in pediatric patients aged six to twelve months. FC are also the most common type of childhood seizures and it has been estimated that an average of 2 to 5% of all children sustain at least one episode of FC before reaching the age of five. Interestingly, the overall incidence varies largely among distinct geographical regions. In Finland, for instance, 7% of all children presented febrile seizures through the age of four [5]. In Saudi Arabia, in contrast, less than 0.5% of all children are affected [6]. Of note, febrile seizures may rarely be experienced by patients pertaining to other age groups. In adults, FC have been reported as a symptom of an intracranial disease [7].

Some studies describe a male predominance among FC patients, but other publications refute the hypothesis of gender predilection. Both boys and girls can be affected by febrile seizures. Moreover, no racial predilections have been reported.

The pathophysiologic link between fever and seizures is not yet known. The underlying infection induces an immune response and triggers the release of cytokines, mediators, and other products. These may directly or indirectly (via glial cells) modulate neuronal excitability. Endogenous pyrogens like interleukin-1β and tumor necrosis factor-α are most likely to assume this role. This hypothesis is in agreement with the observation that certain single nucleotide polymorphisms affecting genes encoding for these cytokines are overrepresented in FC patients [8]. To date, it has not been possible though to identify cytokines that may be used as diagnostic markers for febrile seizures.

In few cases, FC may indicate a serious underlying disease like meningitis or encephalitis. An incidence of meningitis in FC patients has been reported to be below 2%, encephalitis is an even less frequent cause of febrile seizures [9]. Streptococcus pneumoniae and herpes simplex virus, respectively, are their most common etiologic agents. Due to the severity of these diseases, the inherent risk should not be underestimated. Similar recommendations shall be given for FC that lead into status epilepticus. Intracranial infections, as well as status epilepticus, are potentially life-threatening conditions.

Because infectious diseases are the direct trigger of fever and febrile seizures, any measure to avoid infection and increases in body temperature may be considered preventive against FC.

Febrile convulsions (FC) are the most common type of seizures in pediatric patients. Although their direct trigger is a pathophysiological increase in body temperature, the precise causes of FC are not yet completely understood. A genetic predisposition has been suggested. The temperature threshold for a pediatric patient to develop FC is presumably lower in some children than in others. In agreement with these hypotheses, FC are frequently observed in children with a family history of FC who contract a febrile infectious disease.

As per definition, FC are not a type of epilepsy, but the likelihood of a child to develop epilepsy later in life after presenting FC is slightly increased when compared to their peers. In general, FC last less than ten minutes and don't imply a disturbance of consciousness or other symptoms that persist for more than an hour. Such seizures are usually generalized and clonic, although tonic spasms have been described. They correspond to what is commonly designated a simple febrile seizure. In contrast, presentation of focal seizures has been proposed as an unfavorable prognostic factor for subsequent epilepsy and is a feature of complex febrile seizures [1]. This also applies to long-lasting convulsions and development of status epilepticus during FC.

Diagnosis mainly aims at ruling out differential diagnoses like Rolandic epilepsy or intracranial lesions, and besides anamnestic data, neuroimaging and electroencephalography are the most helpful tools in achieving this aim. Most children presenting with FC suffer from a viral infectious disease, but other microorganisms may cause fever and trigger the onset of seizures, too. However, it has to be clarified if the child suffers from encephalitis or meningitis. This may require lumbar puncture and analysis of cerebrospinal fluid.

Simple FC may not require specific therapy; standard anticonvulsants like benzodiazepines should be administered in case of prolonged seizures. The outcome is usually excellent and apart from the aforementioned slightly increased risk of epilepsy, sequelae are not to be expected. However, recurrence is likely. This situation normalizes as the child becomes older.

Febrile convulsions (FC) are the most common type of seizures in pediatric patients; they are not considered a form of epilepsy.

Children aged six months to five years are most frequently affected. They are very susceptible to a wide variety of infectious diseases that provoke fever, e.g., upper respiratory infection, otitis media and gastroenteritis. Furthermore, their temperature threshold to sustain FC is significantly lower than in older children.

Upon contracting a febrile infectious disease, pediatric patients may present generalized clonic or tonic seizures that typically don't last any longer than ten minutes. Most patients recover full awareness and freedom of additional symptoms within an hour of FC onset. Simple FC don't imply more than one such episode per day.

In contrast, complex FC present slightly differently. Affected children may show focal seizures rather than generalized ones, enter status epilepticus (i.e., experience uninterrupted seizures for more than 20 minutes), or sustain more than one febrile seizure per day. In rare cases, complex FC may be indicative of severe underlying diseases like meningitis, encephalitis, intracerebral hematoma, cerebral edema or hydrocephalus. Thus, a more extensive workup is required and neuroimaging, as well as electroencephalography, may become necessary.

Of note, children who suffer from complex FC have a slightly increased risk of developing epilepsy at a later point in time.

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