pediatrics
Febrile Seizures
Introduction
Febrile seizures are diagnosed in children 6 months to 5 years of age who have fever>38°C that is not caused by a central nervous system infection and who have had no previous afebrile seizures. Diagnosis is clinical after exclusion of other causes. Treatment of seizures lasting<5 minutes is supportive. Seizures lasting≥5 minutes are treated with IVlorazepam, rectaldiazepam, or intranasalmidazolamand, if persistent, IVfosphenytoin,phenobarbital, valproate, orlevetiracetam. Maintenance medications are usually not indicated. (See also Neonatal Seizure Disorders .) Febrile seizures occur in about 2 to 5% of children 6 months to 5 years of age, and most occur between 12 months and 18 months of age. Febrile seizures may be simple or complex: Simple febrile seizureslast<15 minutes, have no focal features, and do not recur within a 24-hour period. Complex febrile seizureslast ≥ 15 minutes continuously or with pauses; or have focal features; or have focal onset; or recur within 24 hours. Most (>90%) febrile seizures are simple. Febrile seizures occur during non–central nervous system bacterial or viral infections. They sometimes occur after certain vaccinations such as measles, mumps, and rubella. Genetic and familial factors appear to increase susceptibility to febrile seizures. Monozygotic twins have a much higher concordance rate than dizygotic twins. Several genes associated with febrile seizures have been identified. Developmental delay increases risk of epilepsy after febrile seizure ( Reference ). 