Learn more about Pediatric Neurology… Febrile seizures!

What is a Pediatric Neurologist? A Pediatric Neurologist is a doctor who trained in general Pediatrics and then specialized in Pediatric Neurology. Typically, this training takes 5-6 years after medical school and sometimes people do another one or two years of training after! I did an extra year in a fellowship called Neurophysiology, which helped me specialize in Epilepsy and seizures.

I wanted to start a month long series of posts about common disorders that Pediatric Neurologists evaluate in the office. We take care of children that have medical problems related to the nervous system, including brain, spine, nerves, and muscles.

Febrile seizures are the most common type of convulsion (seizure) in young children. They happen in 2-5% in children between 6 months to 6 years. On the other hand, epilepsy, which is a disorder in which recurring, unprovoked seizures can occur, affects 1% of the population.

What is a febrile seizure? It is a seizure that is triggered by fever, so it is considered to be provoked. The fever can already be present or sometimes it can come after the seizure happened. Typically, the seizure is characterized by stiffness followed by 4 extremity shaking lasting seconds to less than 5 minutes. This is called a generalized seizure. Sometimes, seizures can look different and only have one-sided shaking, staring or unresponsiveness, or eyes getting stuck to one side. This is considered a focal seizure.

A brief, generalized febrile seizure does not require evaluation by a Pediatric Neurologist, as most children will not have another one and it does not require any further evaluation with EEGs or brain imaging. This is called a simple febrile seizure. A complex febrile seizure lasts longer (15 minutes or more), can have focal features, or it may happen more than once within 24 hours. Febrile seizures most commonly occur between 12-24 months but can happen any time between 6 months and 6 years of age.

About 40% of children will have a second febrile seizure. Risk factors for another febrile seizure include young age less than 18 months, family history of febrile seizures, complex febrile seizure, or seizure occurring as first sign of illness.

Most febrile seizures are not harmful, only slightly increase the risk of developing epilepsy later on (2% risk instead of 1%), and a daily medication is not needed.

If your child has a febrile seizure, make sure they are safe. If able to lie them flat and turn them on their side, do so. This is to avoid injury to the child and to avoid them swallowing any extra saliva or vomit. Time the event and notice what the seizure looks like. It is reasonable to call 911 if it is the first time your child is having a febrile seizure but you don’t have to if the seizure stopped in less than 5 minutes.

It is important to see a physician any time a febrile seizure happens to look for any treatable source of fever, such as an ear infection. This can be your pediatrician, an urgent care if your pediatrician can’t see you that day, or the emergency department if the first two options are not available. Reasons to definitely call 911 include seizure lasting more than 5 minutes, trouble breathing even when the seizure stopped, or if your child is not returning to a comfortable baseline. It is normal for a child to be sleepy or tired after a seizure happens.

If the seizure lasted more than five minutes or if two or more happened within 24 hours, a rectal medication called Diastat can be prescribed to use as rescue if a seizure lasts more than 5 minutes . As I mentioned above, daily medications to prevent seizures from happening are not used very frequently.

When should you see a Pediatric Neurologist? If the febrile seizure was complex, if there are other risk factors, such as abnormal neurologic medical history (autism, developmental delays, brain damage), febrile seizure lasting 30 minutes or more, or recurring febrile seizures. A Pediatric Neurologist will decide whether a picture of the brain (MRI), an EEG (electroencephalogram), or any other tests are needed. We can prescribe the rescue medication and discuss whether or not a daily medication may be needed in cases of prolonged febrile seizure or frequent febrile seizures. Any seizure occurring without fever should prompt quick neurologic evaluation.

Myths and Facts About Febrile Seizures

• Alternating Tylenol and Motrin to keep the fever down can help prevent febrile seizures – MYTH
• Febrile seizures lasting more than 30 minutes can increase the risk of epilepsy significantly and cause brain injury – FACT
• Short febrile seizures cause brain damage – MYTH
• A seizure that happens when your child is sick without fever is also considered a provoked seizure – MYTH
• Long-term outcomes are excellent – FACT
• I should not vaccinate my child due to very low risk of febrile seizure – MYTH

Sources:

Febrile Seizures Fact Sheet. https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet. August 2019.

Febrile Seizures. https://www.epilepsy.com/learn/types-seizures/febrile-seizures. May 2019.