Febrile seizures: an overview

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Alexander KC Leung MBBS, FRCPC, FRCP (UK and Irel), FRCPCH, FAAP, Kam Lun Hon MD, FAAP, FCCM, Theresa NH Leung MBBS, FRCPCH, FHKAM (Paed)

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Background: Febrile seizures are the most common neurologic disorder in childhood. Physicians should be familiar with the proper evaluation and management of this common condition.

Objective: To provide an update on the current understanding, evaluation, and management of febrile seizures.

Methods: A PubMed search was completed in Clinical Queries using the key terms ‘febrile convulsions’ and ‘febrile seizures’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews.

Results: Febrile seizures, with a peak incidence between 12 and 18 months of age, likely result from a vulnerability of the developing central nervous system to the effects of fever, in combination with an underlying genetic predisposition and environmental factors. The majority of febrile seizures occur within 24 hours of the onset of the fever. Febrile seizures can be simple or complex. Clinical judgment based on variable presentations must direct the diagnostic studies which are usually not necessary in the majority of cases. A lumbar puncture should be considered in children younger than 12 months of age or with suspected meningitis. Children with complex febrile seizures are at risk of subsequent epilepsy. Approximately 30–40% of children with a febrile seizure will have a recurrence during early childhood. The prognosis is favorable as the condition is usually benign and self-limiting. Intervention to stop the seizure often is unnecessary.

Conclusion: Continuous preventative antiepileptic therapy for the prevention of recurrent febrile seizures is not recommended. The use of intermittent anticonvulsant therapy is not routinely indicated. Antipyretics have no role in the prevention of febrile seizures.

Keywords: anticonvulsants, antipyretics, epilepsy, febrile infection-related epilepsy syndrome, febrile status epilepticus, meningitis.

Citation: Leung AKC, Hon KL, Leung TNH. Febrile seizures: an overview. Drugs in Context 2018; 7: 212536. DOI: 10.7573/dic.212536

Contributions: Professor Alexander KC Leung is the principal author. Professor Kam Lun Hon and Dr Theresa NH Leung are the coauthors who contributed and helped with the drafting of this manuscript.

Disclosure and potential conflicts of interest: Professor Alexander KC Leung, Professor Kam Lun Hon, and Dr Theresa NH Leung confirm that this article has no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at https://www.drugsincontext.com/wp-content/uploads/2018/07/dic.212536-COI.pdf

Funding declaration: No funds were provided for this review nor for medical writing assistance.

Copyright: Copyright © 2018 Leung AKC, Hon KL, Leung TNH. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0, which allows anyone to copy, distribute, and transmit the article, provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Leung AKC, Hon KL, Leung TNH. https://doi.org/10.7573/dic.212536. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/febrile-seizures-an-overview

Correspondence: Alexander KC Leung, The University of Calgary, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5. aleung@ucalgary.ca

Provenance: invited; externally peer reviewed.

Submitted: 16 May 2018; Peer review comments to author: 15 June 2018; Revised manuscript received: 16 June 2018; Accepted: 19 June 2018; Publication date: 16 July 2018.

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