Febrile seizures are brought about by an elevation in body temperature above 38°C [100.4 °F]. Febrile seizures occur due to abnormal electrical activity in the brain cells, resulting from the increase in body temperature. The exact cause of febrile seizures, however, remains to be concretely established. The risk of febrile seizures occurring increases with higher fevers. Most experts hold that seizures occur when a child’s temperature rises rapidly, while some dispute the claim that the rate of temperature increase is relevant in any way.
Many potential causes have been postulated. A link has been established between certain vaccinations and a higher risk of febrile seizures. The vaccines that are implicated include MMR, DPT, Haemophilus influenzae etc, to name a few. However, it is the post-vaccination temperature spike that causes seizures and not the vaccines themselves.
Several genetic predisposing factors have been identified, along with studies that suggest that iron and zinc deficiency may also play a part in developing the seizures.
There are three basic types of febrile seizures - Simple, complex and febrile status epilepticus. Simple febrile seizures last no longer than 15 minutes and can be distinguished by the lack of “focal” (specific to one part of the body) symptoms - i.e the convulsion is generalised. Complex febrile seizures, on the other hand, are characterised by multiple episodes within a 24 hour period and the presence of focal features. Febrile status epilepticus is when the convulsions last longer than 30 minutes. This represents a significant emergency and occurs only in about 5% of children with febrile fits.
The first and foremost thing to remember, as a parent, is to remain calm. As mentioned before, febrile seizures, scary though they might seem, are no reason to panic and in most cases, have few repercussions for your child’s health and safety.
Gently place the child on a flat surface, to avoid risk of injury. It is recommended that the child be placed on their stomach or side, to facilitate easy breathing. It is important to not restrain or hold the child during the convulsions.
If an episode lasts longer than 15 minutes or recurs within 24 hours, immediate medical attention is required and an ambulance must be called for. The doctor will look to rule out any signs of meningeal disease or metabolic disturbances and assess your child’s consciousness and alertness. In most cases, the child is completely back to a normal state by the time the examination is conducted. Although electroencephalograms, spinal taps and brain scans were indicated in the past, they are no longer recommended. The doctor might also look to ascertain the cause of your child’s fever, as viral infections are more likely to cause febrile seizures.
The doctor will look to establish a family history of febrile seizures and prescribe anti-fever medication such as paracetamol (acetaminophen) or Ibuprofen. Anti-epileptic medication such as lorazepam or midazolam, is only prescribed if a cause for recurrence is strongly suspected. However, long term use of such medication has been shown to be unnecessary in most cases, since the side effects far outweigh the potential benefits.
The highest chances of recurrence is before 18 months of age. About 40% of children with a history of febrile seizures, tend to have repeat episodes. While it is never a pleasant experience to see your child go through a seizure, it is important to bear in mind, that in all likelihood, this is a one-off event and even if it recurs, there is a very low probability that it is a sign of serious underlying illness.
So, in conclusion, if you are a worried parent fretting over your child’s first seizure, just remember that it is quite common and absolutely no reason to suspect anything sinister. A thorough discussion with your pediatrician might further reassure you about the do’s and don'ts of handling future instances.