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Fever and a fit (Febrile convulsion)

by Dr. Mandar V. Bichu
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A febrile child throwing a fit is a common occurrence. ‘Fever going to the head (brain)’- that’s often the colloquial description of the condition known as ‘Febrile convulsion’. But is it really so? 

The typical scene of such an event always begins dramatically and ends rather tamely. A child who was perfectly all right a few moments ago suddenly rolls up his eyes or stares blankly, begins jerking violently or becomes limp and is found to have high-grade fever. By the time the terrified parents rush to the nearest medical facility, the baby has almost always stopped convulsing and has either gone off to sleep or regained normalcy without any treatment.

Febrile convulsion is a peculiar entity which has mystified parents and pediatricians alike from the days of Hippocrates. The medical thinking about this entity has undergone a sea-change over the recent years and still even some of the medical practitioners are not clear about the new concepts.  Let’s try and demystify this needlessly dreaded thing.

What’s a febrile convulsion?

Febrile convulsion (also known as a febrile seizure or a febrile fit) is a convulsion associated with sudden rise of temperature. It is typically observed in infancy and pre-school years.

It is not caused by any intra-cranial infection such as meningitis or encephalitis and is different from epilepsy.

Is it a common occurrence?

Yes, it is pretty common; occurring in almost 4 per cent of the children in the typical age group of six months to six years. Around half of those cases occur between 1 to 2 years of age.

Why does it occur?

The exact mechanism of this phenomenon is still a mystery. In the early years, the brain is relatively immature and has a low seizure threshold. The sudden rise of body temperature somehow seems to trigger simultaneous, excessive electrical discharges from the brain- cells leading to the seizure. We can compare this event to a sudden overload on an electrical circuit, leading to a brief shut-down.

What are the common causes for this?

Fevers associated with colds, throat infections, ear infections or dysentery and fevers with rashes (like roseola or measles) are some of the commonest triggers for febrile seizures.

What are the types of febrile seizures?

Febrile seizures can be either simple or complex. A simple febrile seizure occurs within few hours of the onset of fever, lasts less than 15 minutes, is generalised (affecting the whole body) and doesn’t recur within 24 hours. 

When the seizures are multiple, prolonged or focal (affecting only a part of the body), they are called complex seizures.

Are they hereditary?

Though the exact genetic mode of inheritance isn’t defined, these seizures tend to occur in families. If one child in the family suffers from febrile seizures, then there is a 10-20% chance of its occurrence in another sibling. The chances of occurrence are even higher if the parents also suffered from them in their childhood.

Do they recur?

Yes, often they do recur. One-third of the patients are likely to get another febrile seizure after the first one and almost 10 per cent get three or more in the specified age-group. 

The recurrences are more likely when the first seizure happens at an early age and when there is a strong family history of febrile seizures.

Do they frequently progress to epilepsy?

This is the biggest worry for the parents and luckily the outlook is positive. Epilepsy is an illness characterised by recurrent, non-febrile seizures. 

Most of the children outgrow febrile seizures and less than five per cent actually progress to epilepsy in later life

Frequent recurrences of febrile fits don’t indicate any increased risk for epilepsy.

Cerebral palsy, delayed development, mental retardation, complex febrile seizures and a strong family history of epilepsy are the risk factors for the development of epilepsy in future.

Do they cause any brain damage or growth problems?

The answer is a big ‘No’! Even with frequently recurring febrile convulsions, there is no increased risk for neurological, intellectual or growth handicaps.

Should vaccinations be avoided in such patients?

No, not at all! They should receive all the vaccines as in the normal children. 

What investigations are needed in such cases?

According to latest medical thinking, routine blood tests, lumbar punctures (for checking spinal fluid), X-rays and scans are unnecessary if clinical judgment is heavily in favour of simple febrile seizures. 

Complex febrile seizures, very young patients and suspicion of other possible serious causes warrant investigations.

Does an abnormal EEG mean something serious in these cases?

Actually EEG (Electroencephalogram) has no value in predicting a recurrence of the febrile fit or future development of epilepsy. So an EEG abnormality has no serious significance. In fact the recent trends are for avoiding EEG altogether in most such cases.

How do I manage such a convulsion at home?

  • Don’t panic. 
  • Don’t try to restrain or hold down the convulsing child.
  • Place him/her on a flat surface or ground.
  • Turn him/her on the side or on his/her tummy. 
  • Loosen or remove the tight clothes. 
  • Take care that he/she doesn’t hurt himself/herself. 
  • If it is possible, then try to gently remove any object (such as a food-blus) from the mouth.
  • Don’t try to put any object into mouth to keep it forcibly open. It is dangerous. The object can break and obstruct the airway.
  • Sponge the body with tepid water after the convulsion is over. 
  • If the convulsion doesn’t stop within 10 minutes, take the child to the nearest medical facility.

Aren’t some medicines necessary to prevent these fits?

  • In most cases of febrile seizures, no long term preventive medicines are needed. 
  • Prolonged anti-epileptic drugs Phenobarbitone or Sodium Valproate are found to have much more risk of serious side effects than advantage and are no longer used. 
  • If such seizures are frequent or have a tendency to be prolonged, then sometimes doctors may prescribe medicines such as diazepam to be used orally or rectally.
  • One important point of note: No medicine has any role in preventing progression to epilepsy.

Then what are the precautions for the likely recurrence?

Just the routine measures to bring down fever like giving the correct dose of fever-medicine (like Paracetamol) and tepid sponging are more than sufficient. Too much vigorous fever control has not been shown to have any additional benefit.

Some important things to know:

Febrile seizure is a harmless, age-specific, self-limiting phenomenon.

Though it has high chances for recurrence, it doesn’t usually progress to epilepsy.

It doesn’t cause brain damage, mental retardation or growth problems.

In most cases, the clinical diagnosis is sufficient and the investigations are unnecessary.

Except for simple anti-fever measures, special medicines are hardly ever needed.

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