Editing Febrile seizure

{{Short description|Seizure associated with high body temperature}}
{{cs1 config|name-list-style=vanc}}
{{Use dmy dates|date=September 2017}}
{{Infobox medical condition (new) 
| name            = Febrile seizure
| synonyms        = Fever fit, febrile convulsion
| image           = Clinical thermometer 38.7.JPG
| caption         = An analog [[medical thermometer]] showing a temperature of {{convert|38.8|C|disp=or}}
| field           = [[Emergency medicine]], [[neurology]]
| symptoms        = [[Tonic-clonic seizure]]<ref name=AFP2012/>
| complications   = 
| onset           = Ages of 6 months to 5 years<ref name=AFP2012/>
| duration        = Typically less than 5 minutes<ref name=AFP2012/>
| types           = Simple, complex<ref name=AFP2012/>
| causes          = High [[body temperature]]<ref name=AFP2012/>
| risks           = [[Family history (medicine)|Family history]]<ref name=AFP2012/>
| diagnosis       = 
| differential    = [[Meningitis]], [[metabolic disorder]]s<ref name=AFP2012/>
| prevention      = 
| treatment       = [[Supportive care]]<ref name=AFP2012/>
| medication      = [[Benzodiazepine]]s (rarely needed)<ref name=AFP2012/>
| prognosis       = Good<ref name=AFP2012/>
| frequency       = ~5% of children<ref name=Gup2016/>
| deaths          = 
|alt=}}
<!-- Definition and symptoms -->
A '''febrile seizure''', also known as a '''fever fit''' or '''febrile convulsion''', is a [[seizure]] associated with a high [[body temperature]] but without any serious underlying health issue.<ref name=AFP2012/> They most commonly occur in children between the ages of 6 months and 5 years.<ref name=AFP2012/><ref name=Stat2019 /> Most seizures are less than five minutes in duration, and the child is completely back to normal within an hour of the event.<ref name=AFP2012>{{cite journal | vauthors = Graves RC, Oehler K, Tingle LE | title = Febrile seizures: risks, evaluation, and prognosis | journal = American Family Physician | volume = 85 | issue = 2 | pages = 149–53 | date = January 2012 | pmid = 22335215 }}</ref><ref name=NHS2012>{{cite web|title=Symptoms of febrile seizures|url=http://www.nhs.uk/Conditions/Febrile-convulsions/Pages/Symptoms.aspx|website=www.nhs.uk|access-date=13 October 2014|date=1 October 2012|url-status=live|archive-url=https://web.archive.org/web/20141006113015/http://www.nhs.uk/Conditions/Febrile-convulsions/Pages/Symptoms.aspx|archive-date=6 October 2014|df=dmy-all}}</ref> There are two types: simple febrile seizures and complex febrile seizures.<ref name="AFP2012" /> Simple febrile seizures involve an otherwise healthy child who has at most one [[tonic-clonic seizure]] lasting less than 15 minutes in a 24-hour period.<ref name=AFP2012 /> Complex febrile seizures have focal symptoms, last longer than 15 minutes, or occur more than once within 24 hours.<ref name=AAP2017 /> About 80% are classified as simple febrile seizures.<ref name=Leu2018/>

<!--Cause, mechanism, and diagnosis -->
Febrile seizures are triggered by fever, typically due to a [[viral infection]].<ref name=Leu2018/> They may run in families.<ref name=AFP2012/> The underlying mechanism is not fully known, but it is thought to involve [[genetics]], environmental factors, brain immaturity, and [[inflammatory mediators]].<ref name=BMJ2015 /><ref name=Kwon2018 /><ref name=Leu2018/> The diagnosis involves verifying that there is not an infection of the brain, there are no [[metabolic disorder|metabolic problems]], and there have not been prior seizures that have occurred without a [[fever]].<ref name=AFP2012/><ref name=Leu2018/> [[Blood test]]ing, imaging of the brain, or an [[electroencephalogram]] (EEG) is typically not needed.<ref name=AFP2012/> Examination to determine the source of the fever is recommended.<ref name=AFP2012/><ref name=Leu2018/> In otherwise healthy-looking children a [[lumbar puncture]] is not necessarily required.<ref name=AFP2012/>

<!--Prevention and management --> 
Neither [[anti-seizure medication]] nor [[anti-fever medication]] are recommended in an effort to prevent further simple febrile seizures.<ref name=AFP2012/><ref name=":0">{{cite journal|last1=Offringa|first1=Martin|last2=Newton|first2=Richard|last3=Nevitt|first3=Sarah J.|last4=Vraka|first4=Katerina|date=2021-06-16|title=Prophylactic drug management for febrile seizures in children|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=6 |pages=CD003031|doi=10.1002/14651858.CD003031.pub4|issn=1469-493X|pmc=8207248|pmid=34131913}}</ref> In the few cases that last greater than 5 minutes, a [[benzodiazepine]] such as [[lorazepam]] or [[midazolam]] may be used.<ref name=AFP2012/><ref>{{cite book| first1 = Paritosh | last1 = Prasad |title=Pocket Pediatrics: The Massachusetts General Hospital for Children Handbook of Pediatrics|date=2013|publisher=Lippincott Williams & Wilkins|isbn=9781469830094|page=419|url=https://books.google.com/books?id=DbptoZipfKkC&pg=PT419|url-status=live|archive-url=https://web.archive.org/web/20170906191045/https://books.google.com/books?id=DbptoZipfKkC&pg=PT419|archive-date=6 September 2017|df=dmy-all}}</ref> Efforts to rapidly cool during a seizure is not recommended.<ref name=FP2020>{{cite web |title=Febrile Seizures |url=https://familydoctor.org/condition/febrile-seizures/ |website=familydoctor.org |access-date=24 January 2020}}</ref>

<!-- Epidemiology and prognosis -->
Febrile seizures affect 2–10% of children.<ref name=Gup2016>{{cite journal |last1=Gupta |first1=A |title=Febrile Seizures. |journal=Continuum (Minneapolis, Minn.) |date=February 2016 |volume=22 |issue=1 Epilepsy |pages=51–9 |doi=10.1212/CON.0000000000000274 |pmid=26844730|s2cid=33033538 }}</ref> They are more common in boys than girls.<ref name=Ron2008>{{cite book|title=Pediatric hospital medicine : textbook of inpatient management|year=2008|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781770323|page=266|url=https://books.google.com/books?id=sV6-ifUGoMYC&pg=PA266|edition=2nd|editor=Ronald M. Perkin|url-status=live|archive-url=https://web.archive.org/web/20170906191045/https://books.google.com/books?id=sV6-ifUGoMYC&pg=PA266|archive-date=6 September 2017|df=dmy-all}}</ref> After a single febrile seizure there is an approximately 35% chance of having another one during childhood.<ref name=Leu2018/> Outcomes are generally excellent with similar academic achievements to other children and no change in the risk of death for those with simple seizures.<ref name=AFP2012/> There is tentative evidence that affected children have a slightly increased risk of [[epilepsy]] at 2% compared to the general population.<ref name=AFP2012/>

==Signs and symptoms==
Signs and symptoms depend on if the febrile seizure is simple versus complex. In general, the child's temperature is greater than {{convert|38|C|F|1}},<ref name="NHS2012" /> although most have a fever of 39&nbsp;°C (102.2&nbsp;°F) or higher.<ref name="Leu2018" /> Most febrile seizures will occur during the first 24 hours of developing a fever.<ref name="Leu2018" /> Signs of typical seizure activity include [[Unconsciousness|loss of consciousness]], opened eyes which may be deviated or appear to be looking towards one direction, irregular breathing, increased secretions or foaming at the mouth, and the child may look pale or blue ([[Cyanosis|cyanotic]]).<ref name="NHS2012" /><ref name="Leu2018" /> They may become incontinent (wet or soil themselves) and may also vomit.<ref name="NHS2012" />

=== Types ===
There are two types of febrile seizures: simple and complex.<ref name=AAP2017 /> Febrile [[status epilepticus]] is a subtype of complex febrile seizures that lasts for longer than 30 minutes.<ref name=BMJ2015 /> It can occur in up to 5% of febrile seizure cases.<ref>{{cite journal|vauthors=Ahmad S, Marsh ED|date=September 2010|title=Febrile status epilepticus: current state of clinical and basic research|journal=Seminars in Pediatric Neurology|volume=17|issue=3|pages=150–4|doi=10.1016/j.spen.2010.06.004|pmid=20727483}}</ref> 
{| class="wikitable"
|+Types<ref name="Leu2018" /><ref name=":9" /><ref name=BMJ2015>{{cite journal|vauthors=Patel N, Ram D, Swiderska N, Mewasingh LD, Newton RW, Offringa M|date=August 2015|title=Febrile seizures|journal=BMJ|volume=351|pages=h4240|doi=10.1136/bmj.h4240|pmid=26286537|s2cid=35218071}}</ref>
!
!Simple
!Complex
|-
|'''Characteristics'''
|[[Generalized tonic–clonic seizure|Generalized tonic clonic]] movements (stiffening and shaking of arms and legs)
|[[Focal seizure|Focal]] movements (usually affecting a single limb or side of the body)
|-
|'''Duration'''
|<15 minutes (with most lasting <5 minutes)
|>15 minutes
|-
|'''[[Postictal state]]'''
|None or short period of drowsiness
|Longer period of drowsiness; may experience [[Todd's paresis|Todd's paralysis]]
|-
|'''Recurrence'''
|No recurrence in the first 24 hours
|May recur in the first 24 hours
|}

==Causes==
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|+Genetic associations<ref name="pmid16887333"/>
! Type||[[OMIM]]|| Gene
|-
| FEB3A 
| {{OMIM|604403||none}}
| [[SCN1A]]
|-
| FEB3B 
| {{OMIM|604403||none}}
| [[SCN9A]]
|-
| FEB4 
| {{OMIM|604352||none}}
| [[GPR98]]
|-
| FEB8 
| {{OMIM|611277||none}}
| [[GABRG2]]
|}
Febrile seizures are due to fevers,<ref name=Ron2008/> usually those greater than {{convert|38|C|F|1}}.<ref name=Neuro2012>{{cite book| first1 = David A. | last1 = Greenberg | first2 = Michael J. | last2 = Aminoff | first3 = Roger P. | last3 = Simon |title=Clinical neurology|year=2012|publisher=McGraw-Hill Medical|location=New York|isbn=978-0071759052|edition=8th|chapter=12}}</ref> The cause of the fevers is often a viral illness.<ref name=AFP2012/> The likelihood of a febrile seizure is related to how high the temperature reaches.<ref name=AFP2012/><ref name="Leu2018" /> Some feel that the rate of increase is not important<ref name=AFP2012/> while others feel the rate of increase is a risk factor.<ref name=Engel2008/> This latter position has not been proven.<ref name=Engel2008>{{cite book |last=Engel |first=Jerome |title=Epilepsy: a comprehensive textbook |date=2008 |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |location=Philadelphia |isbn=9780781757775 |page=661 |url= https://books.google.com/books?id=TwlXrOBkAS8C&pg=PA661 |edition=2nd |url-status=live |archive-url=https://web.archive.org/web/20170906191045/https://books.google.com/books?id=TwlXrOBkAS8C&pg=PA661|archive-date=6 September 2017 |df=dmy-all }}</ref>

In children, illnesses that often cause a fever include [[Otitis media|middle ear infections]] and [[Upper respiratory tract infection|viral upper respiratory infections]].<ref name=AAP2017>{{cite book|title=American Academy of Pediatrics Textbook of Pediatric Care|last1=Roddy|first1=Sarah M|last2=McBride|first2=Margaret C|publisher=American Academy of Pediatrics|year=2017|isbn=978-1-61002-047-3|editor-last=McInerny|editor-first=Thomas K|edition=2nd|location=[Elk Grove Village, IL]|chapter=Chapter 327: Seizure Disorders|oclc=952123506}}</ref> Other infections associated with febrile seizures include [[Shigellosis]], [[Salmonellosis]], and [[Roseola]].<ref name=AAP2017 /> Although the exact mechanism is unknown, it is speculated that these infections may affect the brain directly or via a [[neurotoxin]] leading to seizures.<ref name=AAP2017 />

There is a small chance of a febrile seizure after certain [[vaccines]].<ref name=Mon2017/> The risk is only slightly increased for a few days after receiving one of the implicated vaccines during the time when the child is likely to develop a fever as a natural [[immune response]].<ref name="Leu2018" /> Implicated vaccines include:<ref name="Mon2017">{{cite journal | vauthors = Monfries N, Goldman RD | title = Prophylactic antipyretics for prevention of febrile seizures following vaccination | journal = Canadian Family Physician | volume = 63 | issue = 2 | pages = 128–130 | date = February 2017 | pmid = 28209678 | pmc = 5395384 }}</ref><ref name="Leu2018" />

* [[MMRV vaccine|measles/mumps/rubella/varicella]]
* [[DTaP-IPV/Hib vaccine|combined diphtheria/tetanus/acellular pertussis/polio/''Haemophilus influenzae'' type b]] 
* [[DPT vaccine|diphtheria-tetanus-whole-cell pertussis]], which is not used in North America anymore
* some versions of the [[pneumococcal vaccine]]
* some types of inactivated [[influenza vaccine]]

It was previously thought that febrile seizures were more likely to occur with the combined MMRV vaccine, but recent studies have found there to be no significant increase.<ref name=":3">{{cite journal|last1=Ma|first1=Shu-Juan|last2=Xiong|first2=Yi-Quan|last3=Jiang|first3=Li-Na|last4=Chen|first4=Qing|date=2015|title=Risk of febrile seizure after measles–mumps–rubella–varicella vaccine: A systematic review and meta-analysis|journal=Vaccine|language=en|volume=33|issue=31|pages=3636–3649|doi=10.1016/j.vaccine.2015.06.009|pmid=26073015}}</ref> Overall, febrile seizures triggered by vaccines are uncommon.<ref name=":3" /> Children who have a genetic predisposition towards febrile seizures are more likely to have one after vaccination.<ref name=":3" />

The seizures occur, by definition, without an [[central nervous system infection|intracranial infection]] or metabolic problems.<ref name=AFP2012/> They run in families with reported family history in approximately 33% of people.<ref name=AFP2012/><ref name="Leu2018" /> Several genetic associations have been identified,<ref name="pmid16887333">{{cite journal | vauthors = Nakayama J, Arinami T | title = Molecular genetics of febrile seizures | journal = Epilepsy Research | volume = 70 | pages = S190-8 | date = August 2006 | issue = Suppl 1 | pmid = 16887333 | doi = 10.1016/j.eplepsyres.2005.11.023 | s2cid = 34951349 }}</ref> including [[Generalized epilepsy with febrile seizures plus|GEFS+]] and [[Dravet syndrome|Dravet Syndrome]].<ref name=BMJ2015 /> Possible [[Inheritance (genetic algorithm)|modes of inheritance]] for genetic predisposition to febrile seizures include [[autosomal dominance]] with [[reduced penetrance]] and [[Polygene|polygenic]] [[multifactorial inheritance]].<ref name=":2" /><ref name="Leu2018" /> An association with [[iron deficiency]] has also been reported, particularly in the developing world.<ref>{{cite journal | vauthors = King D, King A | title = Question 2: Should children who have a febrile seizure be screened for iron deficiency? | journal = Archives of Disease in Childhood | volume = 99 | issue = 10 | pages = 960–4 | date = October 2014 | pmid = 25217390 | doi = 10.1136/archdischild-2014-306689 | s2cid = 43130862 }}</ref><ref>{{cite journal | vauthors = Kwak BO, Kim K, Kim SN, Lee R | title = Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis | journal = Seizure | volume = 52 | pages = 27–34 | date = November 2017 | pmid = 28957722 | doi = 10.1016/j.seizure.2017.09.009 | doi-access = free }}</ref>

== Mechanism ==
The exact underlying mechanism of febrile seizures is still unknown, but it is thought to be multi-factorial involving genetic and environmental factors.<ref name="Leu2018" /><ref name=BMJ2015 /> Speculation includes immaturity of the [[central nervous system]] at younger ages, making the brain more vulnerable to the effects of fever.<ref name="Leu2018" /><ref name=":2">{{cite journal|last1=Whelan|first1=Harry|last2=Harmelink|first2=Matthew|last3=Chou|first3=Erica|last4=Sallowm|first4=Delphin|last5=Khan|first5=Nadir|last6=Patil|first6=Rachit|last7=Sannagowdara|first7=Kumar|last8=Kim|first8=Jun Ho|last9=Chen|first9=Wei Liang|last10=Khalil|first10=Suad|last11=Bajic|first11=Ivana|date=2017|title=Complex febrile seizures—A systematic review|journal=Disease-a-Month|language=en|volume=63|issue=1|pages=5–23|doi=10.1016/j.disamonth.2016.12.001|pmid=28089358|doi-access=free}}</ref> The increased activity of [[neuron]]s during [[Development of the nervous system|rapid brain development]], may help explain why children, particularly younger than age 3, are prone to febrile seizures, with occurrences decreasing after age 5.<ref name=Leu2018/> Other proposed mechanisms include the interactions of [[Inflammation|inflammatory mediators]], particularly [[cytokine]]s, which are released during a fever, causing elevated temperatures in the brain, which may somehow lead to a seizure.<ref name=BMJ2015 /><ref name=Kwon2018>{{cite journal|last1=Kwon|first1=Aram|last2=Kwak|first2=Byung Ok|last3=Kim|first3=Kyungmin|last4=Ha|first4=Jongseok|last5=Kim|first5=Soo-Jin|last6=Bae|first6=Sun Hwan|last7=Son|first7=Jae Sung|last8=Kim|first8=Soo-Nyung|last9=Lee|first9=Ran|date=2018|title=Cytokine levels in febrile seizure patients: A systematic review and meta-analysis|journal=Seizure|language=en|volume=59|pages=5–10|doi=10.1016/j.seizure.2018.04.023|pmid=29727742|doi-access=free}}</ref> Specific cytokines implicated include elevated [[Cerebrospinal fluid|CSF]] [[Interleukin 1 beta|IL-1β]] and [[Serum (blood)|serum]] [[Interleukin 6|IL-6]].<ref name=Kwon2018 />

==Diagnosis==
The diagnosis is made by [[diagnosis of exclusion|eliminating]] more serious causes of [[seizure]] and fever: in particular, [[meningitis]] and [[encephalitis]].<ref name=":9">{{cite journal|last=Subcommittee on Febrile Seizures|date=2011-02-01|title=Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure|journal=Pediatrics|language=en|volume=127|issue=2|pages=389–394|doi=10.1542/peds.2010-3318|pmid=21285335|issn=0031-4005|doi-access=free}}</ref> However, in children who are immunized against [[Streptococcus pneumoniae|pneumococcal]] and ''[[Haemophilus influenzae]]'', the risk of bacterial meningitis is low.<ref name=BMJ2015 /> If a child has recovered and is acting normally, bacterial meningitis is very unlikely, making further procedures such as a [[lumbar puncture]] unnecessary.<ref name="Leu2018" />

Diagnosis involves gathering a detailed history including the value of highest temperature recorded, timing of seizure and fever, seizure characteristics, time to return to baseline, vaccination history, illness exposures, family history, etc.; and performing a physical exam that looks for signs of infection including meningitis and neurological status.<ref name="Leu2018" /> Blood tests, [[Neuroimaging|imaging of the brain]] and an [[electroencephalogram]] are generally not needed.<ref name=AFP2012/><ref name=":9" /> However, for complex febrile seizures, [[Electroencephalography|EEG]] and imaging with an [[Magnetic resonance imaging of the brain|MRI of the brain]] may be helpful.<ref name=":2" /><ref>{{cite journal|last1=Shah|first1=Pankaj B.|last2=James|first2=Saji|last3=Elayaraja|first3=Sivaprakasam|date=9 April 2020|title=EEG for children with complex febrile seizures|journal=The Cochrane Database of Systematic Reviews|volume=2020|issue=4 |pages=CD009196|doi=10.1002/14651858.CD009196.pub5|issn=1469-493X|pmc=7142325|pmid=32270497}}</ref>

Lumbar puncture is recommended if there are obvious signs and symptoms of meningitis or if there is high clinical suspicion.<ref name=":9" /> However, lumbar puncture is an option that may be considered in children younger than 12 months of age since signs and symptoms of meningitis may be atypical, if the child does not return to baseline, or if the child lacks immunization against ''Haemophilus influenzae'' and pneumococcal or vaccination status is unknown.<ref name=AAP2017 /><ref name="Leu2018" /><ref name=":9" />

Differential diagnosis includes other causes of seizures such as [[List of infections of the central nervous system|CNS infections]] (i.e. meningitis, encephalitis), [[Metabolic disorder|metabolic disturbances]] (i.e. [[electrolyte imbalance]]s), [[Head injury|CNS trauma]], drug use and/or withdrawal, genetic conditions (i.e. [[Generalized epilepsy with febrile seizures plus|GEFS+]]), [[Febrile infection-related epilepsy syndrome|FIRES]], [[shivering]], febrile [[delirium]], febrile [[myoclonus]], [[Breath-holding spell|breath holding spells]], and convulsive syncope.<ref name="Leu2018" /> However, febrile seizures are still the most likely cause of convulsions in children under the age of 5 years old.<ref name=":9" />

==Prevention==
There is no benefit from the use of [[phenytoin]], [[valproate]], [[ibuprofen]], [[diclofenac]], [[Paracetamol|acetaminophen]], [[pyridoxine]], or [[Zinc sulfate (medical use)|zinc sulfate]].<ref name=":0" /> There is no evidence to support administering fever reducing medications such as acetaminophen at the time of a febrile seizure or to prevent the rate of recurrence.<ref name=ILAE2015>{{cite journal|last1=Wilmshurst|first1=Jo M.|last2=Gaillard|first2=William D.|last3=Vinayan|first3=Kollencheri Puthenveettil|last4=Tsuchida|first4=Tammy N.|last5=Plouin|first5=Perrine|last6=Van Bogaert|first6=Patrick|last7=Carrizosa|first7=Jaime|last8=Elia|first8=Maurizio|last9=Craiu|first9=Dana|last10=Jovic|first10=Nebojsa J.|last11=Nordli|first11=Doug|date=August 2015|title=Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics|journal=Epilepsia|volume=56|issue=8|pages=1185–1197|doi=10.1111/epi.13057|issn=1528-1167|pmid=26122601|s2cid=13707556|doi-access=free}}</ref> Rapid cooling methods such as an ice bath or a cold bath should be avoided as a method to lower the child's temperature, especially during a febrile seizure.<ref name=FP2020 />

There is a decrease of recurrent febrile seizures with intermittent diazepam and [[phenobarbital]] but there is a high rate of adverse effects.<ref name=":0" />  They are thus not recommended as an effort to prevent further seizures.<ref name="AFP2012" />

==Treatment ==
[[File:Seizure Recovery Position.pdf|thumb|Side positioning for person having a seizure]]
If a child is having a febrile seizure, the following recommendations are made for caregivers:<ref name=NIH2017/>

*Note the start time of the seizure. If the seizure lasts longer than 5 minutes, call an ambulance. Medication to stop seizure, such as rectal diazepam or intranasal midazolam may be used.<ref name=Stat2019 /> The child should be taken immediately to the nearest medical facility for further diagnosis and treatment.<ref name=NIH2017/>  
*Gradually place the child on a protected surface such as the floor or ground to prevent accidental injury.  Do not restrain or hold a child during a convulsion.<ref name=NIH2017/>
*Position the child on his or her side or stomach to prevent choking.  When possible, gently remove any objects from the child's mouth. Nothing should ever be placed in the child's mouth during a convulsion.  These objects can obstruct the child's airway and make breathing difficult.<ref name=NIH2017/>
*Seek immediate medical attention if this is the child's first febrile seizure and take the child to the doctor once the seizure has ended to check for the cause of the fever.  This is especially urgent if the child shows symptoms of stiff neck, extreme lethargy, or abundant vomiting, which may be signs of meningitis, an infection over the brain surface.<ref name="NIH2017">{{cite web|url=https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Febrile-Seizures-Fact-Sheet|title=Febrile Seizures Fact Sheet. National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|url-status=live|archive-url=https://web.archive.org/web/20170728020309/https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Febrile-Seizures-Fact-Sheet|archive-date=July 28, 2017|access-date=August 9, 2017|df=dmy-all}} {{PD-notice}}</ref>

In those with a single seizure lasting greater than 5 minutes or two consecutive seizures lasting greater than 5 minutes in which the person has not returned to their baseline mental status, defined as [[status epilepticus]], intravenous lorazepam, rectal diazepam, or intranasal midazolam is recommended.<ref name="AFP2012" /><ref name=Stat2019 /> Anti-seizure medication are used in status epilepticus in an effort to prevent complications such as injury to the [[hippocampus]] or [[temporal lobe epilepsy]].<ref>{{cite journal | vauthors = Seinfeld S, Goodkin HP, Shinnar S | title = Status Epilepticus | journal = Cold Spring Harbor Perspectives in Medicine | volume = 6 | issue = 3 | pages = a022830 | date = March 2016 | pmid = 26931807 | pmc = 4772080 | doi = 10.1101/cshperspect.a022830 }}</ref>

Secondary causes of a seizure should be addressed if present. Questions that may be asked of the caregivers who witnessed the seizure include the length of the seizure, the timing of the day, loss of consciousness, loss of bowel or urinary continence, a period of altered level of consciousness or confusion once the seizure stopped, movement of the eyes to a specific side, recent infections, recent medication usage including antibiotics or fever reducer medications, family history of febrile and afebrile seizures, vaccination and travel history.{{citation needed|date=May 2020}}

Vital signs should be monitored in the emergency department along with observation for 6 hours. Evaluation for the cause of fever should be performed including signs of an infection such as a bulging tympanic membrane ([[otitis media]]), red pharynx, enlarged tonsils, enlarged cervical lymph nodes ([[streptococcal pharyngitis]] or [[infectious mononucleosis]]), and a widespread rash.<ref name=Leu2018 /> CNS infections such as meningitis, encephalitis and brain abscesses should be ruled out, along with electrolyte abnormalities.{{citation needed|date=May 2020}}

==Prognosis==
Long term outcomes are generally good with little risk of neurological problems or [[epilepsy]].<ref name=AFP2012/> Those who have one febrile seizure have an approximately 30- 40% chance of having another one in the next two years, with the risk being greater in those who are younger.<ref name=AFP2012/><ref name=Leu2018>{{cite journal | vauthors = Leung AK, Hon KL, Leung TN | title = Febrile seizures: an overview | journal = Drugs in Context | volume = 7 | pages = 212536 | date = 2018 | pmid = 30038660 | pmc = 6052913 | doi = 10.7573/dic.212536 }}</ref>

Simple febrile seizures do not tend to recur frequently (children tend to outgrow them) and do not make the development of adult [[epilepsy]] significantly more likely (about 3–5%){{Clarify|reason=Is it supposed to be "do not"? What does this percentage mean?|date=February 2025}} compared with the general public (1%).<ref>{{cite journal | vauthors = Shinnar S, Glauser TA | title = Febrile seizures | journal = Journal of Child Neurology | volume = 17 | pages = S44-52 | date = January 2002 | issue = Suppl 1 | pmid = 11918463 | doi = 10.1177/08830738020170010601 | s2cid = 11876657 }}</ref> Children with febrile convulsions are more likely to have a febrile seizure in the future if they were young at their first seizure (less than 18 months old), have a family history of a febrile convulsions in first-degree relatives (a parent or sibling), have a short time between the onset of fever and the seizure, had a low degree of fever before their seizure, or have a seizure history of abnormal [[neurological]] signs or [[Intellectual disability|developmental delay]]. Similarly, the [[prognosis]] after a complex febrile seizure is excellent, although an increased [[mortality rate|risk of death]] has been shown for complex febrile seizures, partly related to underlying conditions.<ref name="pmid18692714">{{cite journal | vauthors = Vestergaard M, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J | title = Death in children with febrile seizures: a population-based cohort study | journal = Lancet | volume = 372 | issue = 9637 | pages = 457–63 | date = August 2008 | pmid = 18692714 | doi = 10.1016/S0140-6736(08)61198-8 | s2cid = 17305241 }}</ref>

==Epidemiology==
Febrile seizures happen between the ages of 6 months and 5 years.<ref name=AFP2012/><ref name=Stat2019>{{Citation|last1=Xixis|first1=Kathryn L. |last2=Keenaghan|first2=Michael |title=Febrile Seizure|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK448123/|work=StatPearls|publisher=StatPearls Publishing|pmid=28846243|access-date=2020-01-13}}</ref><ref name=":1">{{cite journal | vauthors = Cerisola A, Chaibún E, Rosas M, Cibils L | title = [Febrile seizures: questions and answers] | journal = Medicina | volume = 78 | pages = 18–24 | date = 2018 | issue = Suppl 2 | pmid = 30199360 }}</ref> The peak age for a febrile seizure is 18 months, with the most common age range being 12–30 months of age.<ref>{{cite journal | vauthors = Waruiru C, Appleton R | title = Febrile seizures: an update | journal = Archives of Disease in Childhood | volume = 89 | issue = 8 | pages = 751–6 | date = August 2004 | pmid = 15269077 | pmc = 1720014 | doi = 10.1136/adc.2003.028449 }}</ref> They affect between 2-5% of children.<ref name=AFP2012/><ref name=Stat2019 /><ref name=":1" /> They are more common in boys than girls.<ref name=Ron2008/><ref name=Leu2018 /> Febrile seizures can occur in any ethnic group, although there have been higher rates in Guamanians (14%), Japanese (6-9%) and Indians (5-10%).<ref name=Patt2013>{{cite journal | vauthors = Patterson JL, Carapetian SA, Hageman JR, Kelley KR | title = Febrile seizures | journal = Pediatric Annals | volume = 42 | issue = 12 | pages = 249–54 | date = December 2013 | pmid = 24295158 | doi = 10.3928/00904481-20131122-09 }}</ref>

== References ==
{{reflist}}

== External links ==
{{Medical resources
|  ICD10          = {{ICD10|R|56|0|r|50}}
|  ICD9           = {{ICD9|780.31}}
|  MeshID         = D003294
|  OMIM           = 604352
|  DiseasesDB     = 4777
|  MedlinePlus    = 000980
|  eMedicineSubj  = neuro
|  eMedicineTopic = 134
}}
{{Seizures and epilepsy}}
{{Channelopathy}}
{{Authority control}}

{{DEFAULTSORT:Febrile Seizure}}
[[Category:Pediatrics]]
[[Category:Seizure types]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]