A febrile seizure is a generalized tonic-clonic (grand mal) seizure that occurs in some children as a response to a fever. Febrile seizures are usually associated with rapidly rising fevers, and usually occur early in the fever rather than later.

The seizure may last a few seconds up to a few minutes (although short seizures are more typical). It most commonly occurs in children between the ages of 6 months and 6 years of age. Approximately 2-5% of children will have a seizure associated with fevers. However, the exact cause of febrile seizures is unknown.

There is a tendency for febrile seizures to run in families. This suggest thats there are genetic factors involved. Occasionally, seizures associated with fever may be a symptom of other diseases such as poisoning, meningitis, or encephalitis.

Roseola, or infection with human herpesvirus-6, is also a frequent cause of febrile convulsions in children. Dysentary caused by shigella is frequently associated with a high fever and febrile seizures in children. A child who has a febrile seizure once may not have further seizures in response to a fever.

• Fever (especially a high temperature or rapid rise in body temperature)
• Tonic clonic or grand mal seizure
• Loss of consciousness that lasts 30 seconds to 5 minutes (experienced by almost all children with this condition)
• Tonic posturing (general muscle contraction and rigidity that usually lasts 15 to 20 seconds)
• Clonic movement (a violent, rhythmic muscle contraction and relaxation that commonly lasts for 1-2 minutes)
• Biting of cheek or tongue
• Clenched teeth or jaw
• Incontinence (loss of control of urine or stool)
• Breathing difficulty
  • Absence of breathing or difficulty breathing during a seizure
  • Blue skin color
  • Usually resuming deep, spontaneous breathing after the seizure

• Usually arousable within minutes, but may feel like sleeping for one hour or longer
• Loss of memory (amnesia), partial amnesia regarding events surrounding seizure episode
• Headache
• Drowsiness
• Confusion, temporary and mild

A febrile seizure may be diagnosed by the health care provider when a grand mal seizure occurs in a child with a fever and no prior history of seizure disorders (epilepsy). In infants and young children it is important to rule out other causes for a first-time seizure, especially meningitis.

In a typical febrile seizure the examination usually shows no abnormalities other than the illness causing the fever. Typically, a full seizure work up including an EEG, head CT, and lumbar puncture (spinal tap) is not warranted.

However, the child's condition must meet strict medical criteria if these tests are to be avoided:

• The child must be developmentally normal
• The seizure must be generalized (not focal), meaning more than one part of the body is involved.
• The seizure may not last longer than 15 minutes.
• The child cannot have had more than one febrile seizure in 24 hours.
• The child's neurologic exam performed by a physician must be normal to be called a simple febrile seizure.

If all of these criteria are met, no further studies are likely to be required.

A child with febrile seizures, especially a first-time febrile seizure, should be brought to his or her primary care doctor for an examination. While the actual seizure may not be worrisome, it is important to determine the source of the fever.

First-aid interventions for a seizure may include prevention of injury (by removing surrounding objects on which the child may become injured), turning the child to the side to prevent aspiration of vomit or mucus into the lungs, and watching to make sure the tongue does not obstruct breathing.

DO NOT stick anything into the individual's mouth.

Treat the fever with acetaminophen - oral or ibuprofen. Aspirin should not be used to treat fever in children with possible viral infections because this increases the risk of Reye's syndrome. The cause of the fever should be treated.

If the seizure(s) has not stopped by the time the child reaches the hospital, then it is probably not a "simple" febrile seizure

• Seizures (unrelated to fever)
• An injury that results from falling or bumping into objects
• Biting one's self
• Aspiration of fluid into the lungs, pneumonia
• Permanent brain damage
• Side effects of medications used to treat and prevent seizures (if prescribed)

Seizures may occur when the child's temperature is rising or falling rapidly. In many cases, the seizure may not be predicted or prevented. In the past prophylactic anticonvulsants were given to children who had multiple febrile seizures.

However, that practice is seldom used now. Occasionally, a physician will prescribe rectal diazepam for the treatment of prolonged febrile seizures.