Febrile Seizures: Risks, Evaluation, and Prognosis

DUSTIN K. SMITH, DO, Naval Hospital Yokosuka, Branch Health Dispensary Diego Garcia, Diego Garcia, British Indian Ocean Territory

MOLLY BENEDUM, Doctor, University of Southward Carolina Greenville School of Medicine, Greenville, South Carolina

Am Fam Physician. 2019 Apr ane;99(seven):445-450.

Patient information: A handout on this topic is available at https://familydoctor.org/condition/febrile-seizures/.

This clinical content conforms to AAFP criteria for continuing medical education (CME). Run across the CME Quiz Questions.

Writer disclosure: No relevant financial affiliations.

Article Sections

  • Abstract
  • Risk Factors
  • Evaluation
  • Astute Management
  • Prognosis and Long-Term Direction
  • Prevention
  • Anticipatory Guidance
  • References

A febrile seizure is a seizure occurring in a kid vi months to five years of age that is accompanied by a fever (100.iv°F or greater) without central nervous organisation infection. Febrile seizures are classified equally unproblematic or complex. A complex seizure lasts 15 minutes or more than, is associated with focal neurologic findings, or recurs within 24 hours. The crusade of delirious seizures is probable multifactorial. Viral illnesses, certain vaccinations, and genetic predisposition are common risk factors that may affect a vulnerable, developing nervous system nether the stress of a fever. Children who have a simple febrile seizure and are well-actualization do non require routine diagnostic testing (laboratory tests, neuroimaging, or electroencephalography), except as indicated to discern the cause of the fever. For children with complex seizures, the neurologic test should guide further evaluation. For seizures lasting more than five minutes, a benzodiazepine should be administered. Febrile seizures are not associated with increased long-term mortality or negative effects on future bookish progress, intellect, or beliefs. Children with delirious seizures are more likely to accept recurrent febrile seizures. Notwithstanding, given the benign nature of febrile seizures, the routine use of antiepileptics is non indicated because of adverse furnishings of these medications. The use of antipyretics does non decrease the take chances of febrile seizures, although rectal acetaminophen reduced the take chances of short-term recurrence following a delirious seizure. Parents should be educated on the excellent prognosis of children with febrile seizures and provided with applied guidance on home management of seizures.

A febrile seizure is a seizure occurring in a child six months to v years of age that is accompanied by a fever (100.4°F [38°C] or greater) without primal nervous system infection.1  Febrile seizures are classified equally simple or complex (Tabular array 1).1 Complex seizures final 15 minutes or more than, are associated with focal neurologic findings, or recur inside 24 hours. Febrile seizures are the most common convulsive event in childhood, occurring in 2% to 5% of children.1

WHAT IS NEW ON THIS TOPIC

A 2018 randomized trial of 423 children with febrile seizures found that rectal acetaminophen given every vi hours for 24 hours significantly reduced the likelihood of curt-term recurrence compared with no use of antipyretics.

The measles-mumps-rubella vaccine is associated with an excess risk of x febrile seizures per ten,000 children 16 to 23 months of age, but only four seizures per x,000 children 12 to xv months. This highlights the importance of providing timely measles-mumps-rubella immunizations.

SORT: Central RECOMMENDATIONS FOR Do

Clinical recommendation Evidence rating References

Children with a unproblematic febrile seizure who are well-appearing practice not require routine diagnostic testing, such equally laboratory tests, neuroimaging, or electroencephalography.

C

1, 31, 32

Continuous or intermittent antiepileptic medications are not recommended after a first febrile seizure considering of potential agin effects.

B

42

Antipyretic agents do non reduce recurrence of unproblematic febrile seizures.

A

42

Risk factors for recurrence of delirious seizure are historic period younger than eighteen months, fever elapsing of less than one hour before seizure onset, get-go-caste relative with a history of febrile seizures, and a temperature of less than 104°F (40°C).

B

38

BEST PRACTICES IN NEUROLOGY

Recommendations from the Choosing Wisely Campaign

Recommendation Sponsoring arrangement

Do not routinely order an electroencephalography for neurologically salubrious children who have a simple delirious seizure.

American Academy of Nursing

Neuroimaging (computed tomography, magnetic resonance imaging) is not necessary in a child with a elementary febrile seizure.

American Academy of Pediatrics

Table 1

Characteristics of Uncomplicated vs. Complex Delirious Seizures

Simple (all of the following)

Duration of less than 15 minutes

Generalized

No previous neurologic problems

Occurs one time in 24 hours

Circuitous (any of the following)

Elapsing of 15 minutes or more

Focal neurologic signs

Recurs within 24 hours

Take a chance Factors

  • Abstract
  • Risk Factors
  • Evaluation
  • Acute Direction
  • Prognosis and Long-Term Management
  • Prevention
  • Anticipatory Guidance
  • References

The cause of febrile seizures is likely multifactorial. Viral illnesses, certain vaccinations, and genetic predisposition are common risk factors that may affect a vulnerable, developing nervous system under the stress of a fever. Other risk factors include exposures in utero, such as maternal smoking and maternal stress; being in the neonatal intensive care unit for more than 28 days (odds ratio [OR] = v.6); developmental delay (OR = 4.9); having a first-degree relative with a history of delirious seizures (OR = 4.5); having a 2d-degree relative with a history of delirious seizures (OR = iii.6); and day care attendance (OR = 3.1).ii–4

Certain genes that have been identified every bit run a risk factors for familial epilepsy syndromes may also increase the hazard of febrile seizures.5,half dozen Underlying genetic disorders may increase susceptibility to environmental risk factors. The take chances of febrile seizures is related to the superlative of the temperature elevation, not the charge per unit of temperature ascension, and seizure threshold varies by historic period and individual susceptibilities.three

Viral infections, particularly those associated with loftier fevers, increment the risk of febrile seizures considering loftier fevers have been shown to increment neuronal excitability and lower the seizure threshold.2 Viruses about commonly correlated with delirious seizures include human herpesvirus half-dozen, flu, adenovirus, and parainfluenza.vii,eight

Certain vaccine preparations and associated age at administration have been shown to increment the risk of febrile seizures.9 The measles-mumps-rubella vaccine is associated with an increased gamble of febrile seizures (10 additional cases per 10,000 children xvi to 23 months of age, but only four additional cases per 10,000 children 12 to 15 months of age).10,11 Because the increased adventure of seizures with measles-containing vaccines is lower when administered at 12 to xv months, the age recommended by the Centers for Disease Control and Prevention, it is important to provide timely immunizations to mitigate potential risks.11,12 There is also a slight increment in risk in the 24 hours following the administration of the measles-mumps-rubella-varicella vaccine compared with separate measles-mumps-rubella and varicella vaccines (3.v additional cases per ten,000 children).13

The risk of seizure is not significantly increased following the influenza vaccine or the modern acellular pertussis vaccine.12 Because the sequelae of preventable infections and the importance of maintaining herd amnesty are more important than the rare potential complications from vaccinations, the American Academy of Family Physicians and Advisory Commission on Immunization Practices recommend children receive all routine vaccinations.14,15 The Centers for Disease Control and Prevention does non recommend administering antipyretics following immunizations, considering this does not foreclose febrile seizures and has the potential to decrease antibody response.sixteen

Evaluation

  • Abstract
  • Risk Factors
  • Evaluation
  • Acute Management
  • Prognosis and Long-Term Management
  • Prevention
  • Anticipatory Guidance
  • References

The evaluation of children with febrile seizures should begin with a focused history and physical exam to decide the cause of the fever.ane,17–19 Key features of the history include description and duration of the convulsive episode, personal or family history of seizures or epilepsy, recent illness or antibody use, recent vaccinations, and immunization condition for Haemophilus influenzae blazon b and Streptococcus pneumoniae.ane Focal neurologic signs or Todd paralysis (i.e., postictal weakness or paralysis, usually on ane side of the body) should besides be noted because the presence of a focal exam finding would classify the seizure every bit complex.18

The causes of fever with or without seizure in children are similar. Children with a simple delirious seizure practice non accept a higher hazard of urinary tract infection, pneumonia, bacteremia, or bacterial meningitis.20–23 Therefore, children with a simple delirious seizure who are well-appearing do not require routine diagnostic testing, such as laboratory tests, neuroimaging, or electroencephalography, except every bit indicated to discern the cause of the fever.1

In patients with circuitous febrile seizures, the neurologic examination tin can help determine whether laboratory tests are indicated. Well-appearing children with complex febrile seizures have a low risk of hypoglycemia, and although they may accept slightly lower serum sodium levels, those levels practise non predict seizure recurrence.24,25 Persistently abnormal mental status between or after seizures should prompt evaluation for hypoglycemia and electrolyte abnormalities.

A febrile seizure in an infant or child raises the concern for meningitis. However, at that place is no prove that a well-appearing child with only a simple febrile seizure has an increased risk of bacterial meningitis. In a case series of 503 patients with meningitis occurring over twenty years, all children with a seizure had boosted findings suggestive of meningitis, such every bit obtunded or comatose mental status, nuchal rigidity, prolonged focal seizure, or petechial rash and multiple seizures.26 Retrospective studies of children with a first unproblematic febrile seizure did non identify any cases of bacterial meningitis.23,27 Therefore, the American Academy of Pediatrics does non recommend routine lumbar puncture for well-appearing children with a simple febrile seizure. Still, a lumbar puncture may be considered in these patients if they are at least 12 months of age and have incomplete or unknown immunization status for H. influenzae type b or Southward. pneumoniae (because signs of meningitis may exist less reliable in younger children) or if he or she was pretreated with antibiotics (this may affect the presentation of bacterial meningitis).1,24

Decisions almost diagnostic testing may not exist every bit straightforward in children with a complex delirious seizure, because complex febrile seizures are more heterogeneous. The neurologic test is crucial when deciding whether to perform a lumbar puncture. Children with signs and symptoms of bacterial meningitis should undergo lumbar puncture.28 Febrile status epilepticus should heighten suspicion for serious bacterial infection, intracranial aberration, or toxic ingestion.29 In a single series of 24 children with febrile status epilepticus, acute bacterial meningitis was diagnosed in 4 of the children; therefore, lumbar puncture should be performed in children with this condition.30

Similarly, the neurologic examination can aid in deciding whether to perform neuroimaging in children with a complex febrile seizure. The gamble of intracranial aberration is depression, fifty-fifty in these patients. In a case series of 526 patients with a first complex febrile seizure, only iv patients had clinically pregnant intracranial pathology, and three of those four had obvious findings on physical test.31 Neuroimaging is not necessary for complex febrile seizures unless the child has abnormal or focal findings on neurologic test.

Electroencephalography has no role in the acute management of febrile seizures and does non predict recurrence.32 However, outpatient electroencephalography should be performed in children with multiple risk factors for epilepsy (developmental delay, family unit history of epilepsy, and more than one defining feature of a complex febrile seizure) because of the adventure of subsequent nonfebrile seizures.17,29

Acute Management

  • Abstract
  • Adventure Factors
  • Evaluation
  • Acute Management
  • Prognosis and Long-Term Management
  • Prevention
  • Anticipatory Guidance
  • References

Prehospital and emergent management should focus on stabilizing the patient (ABCs [airway, breathing, and circulation]). Most febrile seizures are self-limited and finish before patients arrive at the hospital. However, seizures lasting longer than v minutes are unlikely to cease on their own, and a benzodiazepine should be administered to break the seizure.19 A 2018 Cochrane review ended that intravenous lorazepam (Ativan) and diazepam accept similar rates of seizure cessation and respiratory depression. When intravenous access is unavailable, buccal midazolam or rectal diazepam (Diastat) is acceptable. The Cochrane review concluded that there is insufficient bear witness to support the employ of intranasal benzodiazepines.33

Hospital access is unremarkably not required for children with febrile seizures, although factors to consider when making the decision include younger age, demand for farther observation because of abnormal test findings, or unreliable follow-up.34,35

Prognosis and Long-Term Management

  • Abstract
  • Risk Factors
  • Evaluation
  • Acute Management
  • Prognosis and Long-Term Management
  • Prevention
  • Anticipatory Guidance
  • References

A population-based accomplice study plant no increment in long-term mortality in children with elementary delirious seizures compared with the general population. Children with complex delirious seizures were more likely to die in the post-obit ii years when compared with children without febrile seizures (adjusted mortality rate ratio = 1.99), although this was at least in part secondary to neurologic abnormalities and subsequent epilepsy.36 A prospective cohort written report in the United kingdom found no difference in academic progress, intellect, and beliefs at 10 years of age in children who had a elementary or complex febrile seizure compared with control patients.37

Children with a beginning febrile seizure have a 33% risk of a recurrent febrile seizure. Table 2 lists four contained hazard factors for recurrent delirious seizure and quantifies the take a chance based on the combination of those factors.38 There is no difference in risk of recurrence based on whether the initial febrile seizure was simple or circuitous.38

Tabular array 2

Take a chance of Recurrence After an Initial Febrile Seizure

Take chances factors

Historic period younger than xviii months

Fever elapsing less than 1 hour before seizure onset

First-degree relative with febrile seizure

Temperature less than 104°F (xl°C)

Number of risk factors

Two-year risk of recurrence (%)

0

xiv

one

24

2

32

3

63

4

75

Based on a accomplice written report, children with febrile seizures are five times more likely to develop subsequent unprovoked seizures compared with children with no delirious seizures. The risk of epilepsy ranges from ii.iv% in children with simple febrile seizures to 6% to 8% in children with complex seizures. Children with whatsoever ii features of a circuitous seizure have a 17% to 22% risk of developing an unprovoked seizure, and those with all three features have a 49% take a chance.39 Table 3 lists the risk factors for a future unprovoked seizure after a febrile seizure.39–41

TABLE three

Chance Factors for Future Unprovoked Seizure After a Febrile Seizure

Age older than three years at the time of the outset febrile seizure

Complex febrile seizure

Family history of epilepsy

Fever duration of less than one hour before seizure onset

Neurodevelopmental abnormality

Prevention

  • Abstruse
  • Risk Factors
  • Evaluation
  • Acute Management
  • Prognosis and Long-Term Management
  • Prevention
  • Anticipatory Guidance
  • References

Multiple pharmacologic interventions take been studied to prevent recurrence of febrile seizures. Yet, potential benefits must exist weighed against potential risks. A Cochrane review showed that intermittent diazepam significantly reduced recurrent delirious seizures for up to 48 months compared with placebo or no handling. Continuous phenobarbital reduced recurrent febrile seizures compared with placebo at 6, 12, and 24 months but not at 18 or 72 months.42

Although an intermittent benzodiazepine or a continuous antiepileptic has clinically and statistically significant benefits, agin effects occur in upwards to 30% of patients.42 Given the beneficial nature of febrile seizures, routine apply of these medications is not recommended to reduce recurrence of febrile seizures.42

Ibuprofen and acetaminophen are postulated to decrease the take chances of febrile seizure by attenuating the effect of the fever as a trigger for the seizure. A Cochrane review constitute no benefit of antipyretics for decreasing the risk of febrile seizures.42 Even so, a contempo Japanese unblinded randomized trial of 423 children with febrile seizure found that rectal acetaminophen given every half-dozen hours for 24 hours significantly reduced the likelihood of short-term recurrence compared with no antipyretics (9.1% vs. 23.v%; P < .001; number needed to care for = seven).43

It has been suspected that zinc plays a role in febrile seizures because claret and cerebrospinal fluid levels of zinc are significantly lower in children who have had a febrile seizure compared with an afebrile seizure. However, the Cochrane review found no benefit of continuous zinc sulfate supplementation for preventing febrile seizures.42

Anticipatory Guidance

  • Abstract
  • Risk Factors
  • Evaluation
  • Acute Direction
  • Prognosis and Long-Term Management
  • Prevention
  • Anticipatory Guidance
  • References

Anticipatory guidance for parents should focus on reassurance, emphasizing the benign nature of febrile seizures and the overall excellent prognosis, even if the seizures recur.nineteen Physicians may also provide parents with guidance on the initial direction of delirious seizures. First, parents should protect the kid from injury during the seizure. The child should non be restrained, and nothing should exist put in the child's rima oris. The child should be placed in the recovery position when the seizure stops. Parents should be enlightened that the child may be sleepy following the seizure and should be instructed to call 911 if the seizure lasts longer than 5 minutes.44  Physicians may also provide parents with an estimated risk of febrile seizure recurrence using the tool in Table 2.38

This commodity updates previous articles on this topic by Graves, et al.,17 and Millar.45

Data Sources: A PubMed search was completed using the key terms febrile seizures and delirious convulsions. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. We as well searched the Cochrane database, Essential Show Plus, and the National Guideline Clearinghouse. References in these resources were also searched. Search dates: February xx, 2018; May 1, 2018; August 15, 2018; and Dec 8, 2018.

The views expressed in this article are those of the authors and practise not necessarily reverberate the official policy or position of the Department of the Navy, Section of Defense, or the U.Southward. government.

To encounter the full commodity, log in or purchase access.

The Authors

show all author info

DUSTIN One thousand. SMITH, DO, is senior medical officer at Naval Infirmary Yokosuka, Branch Health Clinic Diego Garcia, British Indian Sea Territory. At the time this article was written, he was the banana program director of the Jacksonville Family Medicine Residency Program at Naval Hospital Jacksonville and an assistant professor of family unit medicine for the Uniformed Services University of the Health Sciences, Jacksonville, Fla....

KERRY P. SADLER, Physician, is a principal resident in the Family Medicine Residency Program at Naval Infirmary Jacksonville.

MOLLY BENEDUM, MD, is an associate programme director of the Family Medicine Residency at Greenville (S.C.) Health Organisation, and a clinical assistant professor in the Department of Family unit Medicine at the University of South Carolina Greenville School of Medicine.

Address correspondence to Dustin K. Smith, DO, Naval Branch Wellness Clinic Diego Garcia, PSC 466 Box 302, FPO-AP 96595. Reprints are not bachelor from the authors.

Author disclosure: No relevant fiscal affiliations.

References

show all references

1. Subcommittee on Delirious Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a uncomplicated delirious seizure. Pediatrics. 2011;127(ii):389–394. ...

2. Thébault-Dagher F, Herba CM, Séguin JR, et al. Historic period at kickoff febrile seizure correlates with perinatal maternal emotional symptoms. Epilepsy Res. 2017;135:95–101.

iii. Berg AT, Shinnar S, Shapiro ED, Salomon ME, Crain EF, Hauser WA. Risk factors for a first delirious seizure: a matched instance-command study. Epilepsia. 1995;36(4):334–341.

iv. Bethune P, Gordon K, Dooley J, Camfield C, Camfield P. Which child will have a febrile seizure? Am J Dis Child. 1993;147(one):35–39.

5. Hardies Chiliad, Weckhuysen Southward, Peeters E, et al. Duplications of 17q12 tin cause familial fever-related epilepsy syndromes. Neurology. 2013;81(16):1434–1440.

6. Haerian BS, Baum L, Kwan P, et al. Contribution of GABRG2 polymorphisms to risk of epilepsy and febrile seizure: a multicenter cohort study and meta-analysis. Mol Neurobiol. 2016;53(eight):5457–5467.

7. Hall CB, Long CE, Schnabel KC, et al. Homo herpesvirus-vi infection in children. A prospective study of complications and reactivation. N Engl J Med. 1994;331(7):432–438.

8. Chung B, Wong V. Human relationship between 5 common viruses and delirious seizure in children. Arch Dis Child. 2007;92(7):589–593.

ix. Francis JR, Richmond P, Robins C, et al. An observational study of febrile seizures: the importance of viral infection and immunization. BMC Pediatr. 2016;16(one):202.

10. Maglione MA, Das L, Raaen L, et al. Prophylactic of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134(two):325–337.

11. Rowhani-Rahbar A, Fire fighter B, Lewis Eastward, et al. Event of age on the risk of fever and seizures following immunization with measles-containing vaccines in children. JAMA Pediatr. 2013;167(12):1111–1117.

12. Centers for Affliction Control and Prevention. Vaccine safety. Babyhood vaccines and febrile seizures. https://www.cdc.gov/vaccinesafety/concerns/delirious-seizures.html. Accessed September 30, 2018.

13. MacDonald SE, Dover DC, Simmonds KA, Svenson LW. Take chances of febrile seizures after outset dose of measles-mumps-rubella-varicella vaccine: a population-based cohort report. CMAJ. 2014;186(xi):824–829.

fourteen. Filer W. AAFP Maintains strong stance in back up of immunizations across the lifespan. June 2, 2016. https://world wide web.aafp.org/media-center/releases-statements/all/2016/aafp-maintains-strong-stance-in-support-of-immunizations-across-lifespan.html. Accessed August 31, 2018.

15. Kroger AT, Duchin J, Vázquez Yard. General best practice guidelines for immunization. Best practices guidance of the Informational Commission on Immunization Practices. http://world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf. Accessed Baronial 21, 2018.

16. Prymula R, Siegrist CA, Chlibek R, et al. Effect of safety paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open up-label, randomised controlled trials. Lancet. 2009;374(9698):1339–1350.

17. Graves RC, Oehler K, Tingle LE. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician. 2012;85(2):149–153.

18. Kimia AA, Bachur RG, Torres A, Harper MB. Febrile seizures: emergency medicine perspective. Curr Opin Pediatr. 2015;27(iii):292–297.

19. Agarwal M, Fox SM. Pediatric seizures. Emerg Med Clin North Am. 2013;31(three):733–754.

xx. Chamberlain JM, Gorman RL. Occult bacteremia in children with unproblematic febrile seizures. Am J Dis Child. 1988;142(10):1073–1076.

21. Shah SS, Alpern ER, Zwerling L, Reid JR, McGowan KL, Bell LM. Depression risk of bacteremia in children with febrile seizures. Arch Pediatr Adolesc Med. 2002;156(5):469–472.

22. Trainor JL, Hampers LC, Krug SE, Listernick R. Children with kickoff-fourth dimension unproblematic febrile seizures are at depression gamble of serious bacterial illness. Acad Emerg Med. 2001;8(eight):781–787.

23. Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure amidst children half-dozen to eighteen months of age. Pediatrics. 2009;123(one):six–12.

24. Rutter N, Smales OR. Role of routine investigations in children presenting with their starting time febrile convulsion. Curvation Dis Child. 1977;52(three):188–191.

25. Maksikharin A, Prommalikit O. Serum sodium levels practise non predict recurrence of febrile seizures within 24 hours. Paediatr Int Child Health. 2015;35(1):44–46.

26. Green SM, Rothrock SG, Clem KJ, Zurcher RF, Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993;92(4):527–534.

27. Guedj R, Chappuy H, Titomanlio L, et al. Risk of bacterial meningitis in children 6 to 11 months of age with a first simple febrile seizure: a retrospective, cross-sectional, observational report. Acad Emerg Med. 2015;22(11):1290–1297.

28. Joffe A, McCormick Grand, DeAngelis C. Which children with febrile seizures need lumbar puncture? A decision analysis approach. Am J Dis Child. 1983;137(12):1153–1156.

29. Hofert SM, Burke MG. Goose egg is uncomplicated nearly a circuitous febrile seizure: looking beyond fever as a cause for seizures in children. Hosp Pediatr. 2014;4(3):181–187.

30. Mentum RF, Neville BG, Scott RC. Meningitis is a common cause of convulsive status epilepticus with fever. Arch Dis Child. 2005;90(1):66–69.

31. Kimia AA, Ben-Joseph E, Prabhu S, et al. Yield of emergent neuroimaging amid children presenting with a beginning complex delirious seizure. Pediatr Emerg Care. 2012;28(iv):316–321.

32. Kuturec G, Emoto SE, Sofijanov N, et al. Febrile seizures: is the EEG a useful predictor of recurrences? Clin Pediatr (Phila). 1997;36(1):31–36.

33. McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2018;(one):CD001905.

34. Mastrangelo M, Midulla F, Moretti C. Actual insights into the clinical management of febrile seizures. Eur J Pediatr. 2014;173(8):977–982.

35. Okubo Y, Handa A. National trend survey of hospitalized patients with febrile seizure in the U.s.a.. Seizure. 2017;50:160–165.

36. Vestergaard 1000, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J. Decease in children with febrile seizures: a population-based cohort study. Lancet. 2008;372(9637):457–463.

37. Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. Due north Engl J Med. 1998;338(24):1723–1728.

38. Berg AT, Shinnar Due south, Darefsky AS, et al. Predictors of recurrent febrile seizures. A prospective accomplice study. Arch Pediatr Adolesc Med. 1997;151(4):371–378.

39. Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures subsequently febrile convulsions. N Engl J Med. 1987;316(9):493–498.

40. Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with delirious seizures. Epilepsia. 2013;54(12):2101–2107.

41. Shinnar S, Glauser TA. Febrile seizures. J Kid Neurol. 2002;17(suppl ane):S44–S52.

42. Offringa Thou, Newton R, Cozijnsen MA, Nevitt SJ. Safe drug management for febrile seizures in children. Cochrane Database Syst Rev. 2017;(2):CD003031.

43. Murata Southward, Okasora K, Tanabe T, et al. Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics. 2018;142(5):e20181009.

44. National Institute of Neurological Disorders and Stroke. Delirious seizures fact sheet. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Educational activity/Fact-Sheets/Febrile-Seizures-Fact-Sheet. Accessed September 13, 2018.

45. Millar JS. Evaluation and treatment of the child with febrile seizure. Am Fam Physician. 2006;73(10):1761–1764.

Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make 1 printout of the material and may use that printout merely for his or her personal, non-commercial reference. This cloth may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether at present known or subsequently invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

MOST Recent Event

Mar 2022

Access the latest issue of American Family Physician

Read the Issue


Electronic mail Alerts

Don't miss a unmarried effect. Sign up for the free AFP electronic mail tabular array of contents.

Sign Up At present