Pediatric Hospital Medicine

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Chapter 2 • Seizure

FEBRILE SEIZURE ■ INTRODUCTION

Febrile seizures are defined as a seizure accompanied by temperature ≥ 38.0 °C or 100.4 °F, without central nervous system infection. They occur most commonly in children 6 months to 5 years of age, with a predilection for children 12 to 18 months of age. Febrile seizures may be classified as simple or complex, based on their clinical features. Simple febrile seizures are a single generalized seizure lasting < 15 minutes. A febrile seizure that presents focally, occurs more than once during a con tiguous 24-hour period, or lasts > 15 minutes is considered complex. ■ EPIDEMIOLOGY AND RISK FACTORS Febrile seizures are the most common seizure type in childhood and occur in 2% to 5% of children. 1 A seasonal spike of febrile seizures is seen during winter due to greater febrile illnesses at this time. Febrile seizures do not have a gender predilection. See Table 2.5 for risk factors for febrile seizures. Unfortunately, febrile seizures recur in 30% to 50% of children who had a first febrile seizure. Table 2.6 shares the risk factors for recur rence of febrile seizures. TABLE 2.5 RISK FACTORS ASSOCIATED WITH FIRST FEBRILE SEIZURE Viral infections including influenza A and B, enterovirus, human herpes virus 6 (roseola), and respiratory syncytial virus Vaccinations that may induce fever, including measles, mumps, rubella Family history of febrile seizures or epilepsy Underlying neurodevelopmental deficits including cerebral palsy Low serum zinc or iron levels Children with two or more of the above-listed risk factors

Data from Sawires R, Buttery J, Fahey M. A review of febrile seizures: recent advances in understanding of febrile seizure pathophysiology and commonly implicated viral triggers. Front Pediatr. 2022;9:801321.

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■ CLINICAL MANIFESTATIONS The mechanism of febrile seizures is unknown. They may occur as a result of underlying irregular brain reaction to higher temperatures, and both environmental and genetic factors are presumed to play a