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Journal of Pediatric Epilepsy 2019; 08(03): 062-066
DOI: 10.1055/s-0039-1692986
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Simple Febrile Seizures: A Benign Phenomena?

Edgard Andrade 
1   Division of Pediatric Neurology, Institute of Pediatric Neurosciences, Ocala, Florida, United States
› Author Affiliations
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Publication History

21 May 2019

22 May 2019

Publication Date:
09 July 2019 (online)

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Abstract

Febrile seizures are one of the most common neurological causes of visits to the emergency room. This article is a review of the current literature concerning the evaluation and treatment of children with febrile seizures. Longitudinal prospective studies such as the FEBSTAT study (consequences of prolonged febrile seizures in childhood) have contributed to elucidate the long-term outcome of patients with prolonged febrile seizures. Neurogenetic research also demonstrated the role of genetic mutations (mainly voltage-gated ion channels) in the etiology of febrile seizures. Most febrile seizures are self-limited events with low risk of injury or evolution into status epilepticus or sudden death. However, the use of rectal diazepam as acute abortive treatment for febrile seizures lasting 5 minutes or longer has gained acceptance as a first-line home intervention. Most patients with febrile seizures do not require extensive investigations, but the treatment involves a customized plan. Efforts should be directed to educate caregivers about prognosis and management of potential recurrences. In selected cases, appropriate use of preventive antiseizure medication may be a consideration.

Keywords

febrile seizure - interictal epileptiform discharges - ictogenesis
 

  • References

  • 1 Leung AK, Hon KL, Leung TN. Febrile seizures: an overview. Drugs Context 2018; 7: 212536
    CrossrefPubMedGoogle Scholar
  • 2 Consensus statement. Febrile seizures: long-term management of children with fever-associated seizures. Pediatrics 1980; 66 (06) 1009-1012
    PubMedGoogle Scholar
  • 3 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30 (04) 389-399
    CrossrefPubMedGoogle Scholar
  • 4 Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011; 127 (02) 389-394
    CrossrefPubMedGoogle Scholar
  • 5 Choi YJ, Jung JY, Kim JH. , et al. Febrile seizures: are they truly benign? Longitudinal analysis of risk factors and future risk of afebrile epileptic seizure based on the national sample cohort in South Korea, 2002-2013. Seizure 2019; 64: 77-83
    CrossrefPubMedGoogle Scholar
  • 6 Hesdorffer DC, Shinnar S, Lax DN. , et al; FEBSTAT study team. Risk factors for subsequent febrile seizures in the FEBSTAT study. Epilepsia 2016; 57 (07) 1042-1047
    CrossrefPubMedGoogle Scholar
  • 7 Epstein LG, Shinnar S, Hesdorffer DC. , et al; FEBSTAT study team. Human herpesvirus 6 and 7 in febrile status epilepticus: the FEBSTAT study. Epilepsia 2012; 53 (09) 1481-1488
    CrossrefPubMedGoogle Scholar
  • 8 Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976; 295 (19) 1029-1033
    CrossrefPubMedGoogle Scholar
  • 9 Sartori S, Nosadini M, Tessarin G. , et al. First-ever convulsive seizures in children presenting to the emergency department: risk factors for seizure recurrence and diagnosis of epilepsy. Dev Med Child Neurol 2019; 61 (01) 82-90
    CrossrefPubMedGoogle Scholar
  • 10 Camfield P, Camfield C. Febrile seizures and genetic epilepsy with febrile seizures plus (GEFS+). Epileptic Disord 2015; 17 (02) 124-133
    PubMedGoogle Scholar
  • 11 Zhang YH, Burgess R, Malone JP. , et al. Genetic epilepsy with febrile seizures plus: refining the spectrum. Neurology 2017; 89 (12) 1210-1219
    CrossrefPubMedGoogle Scholar
  • 12 Brunklaus A, Zuberi SM. Dravet syndrome--from epileptic encephalopathy to channelopathy. Epilepsia 2014; 55 (07) 979-984
    CrossrefPubMedGoogle Scholar
  • 13 Carvill GL, Heavin SB, Yendle SC. , et al. Targeted resequencing in epileptic encephalopathies identifies de novo mutations in CHD2 and SYNGAP1. Nat Genet 2013; 45 (07) 825-830
    CrossrefPubMedGoogle Scholar
  • 14 Wolking S, May P, Mei D. , et al. Clinical spectrum of STX1B-related epileptic disorders. Neurology 2019; 92 (11) e1238-e1249
    PubMedGoogle Scholar
  • 15 Carvill GL, Weckhuysen S, McMahon JM. , et al. GABRA1 and STXBP1: novel genetic causes of Dravet syndrome. Neurology 2014; 82 (14) 1245-1253
    CrossrefPubMedGoogle Scholar
  • 16 Wang J, Wen Y, Zhang Q. , et al. Gene mutational analysis in a cohort of Chinese children with unexplained epilepsy: identification of a new KCND3 phenotype and novel genes causing Dravet syndrome. Seizure 2019; 66: 26-30
    CrossrefPubMedGoogle Scholar
  • 17 Polizzi A, Incorpora G, Pavone P. , et al. Generalised epilepsy with febrile seizures plus (GEFS(+)): molecular analysis in a restricted area. Childs Nerv Syst 2012; 28 (01) 141-145
    CrossrefPubMedGoogle Scholar
  • 18 Umeoka EHL, Robinson EJ, Turimella SL. , et al. Hyperthermia-induced seizures followed by repetitive stress are associated with age-dependent changes in specific aspects of the mouse stress system. J Neuroendocrinol 2019; 31 (04) e12697
    CrossrefPubMedGoogle Scholar
  • 19 Şahin S, Uysal S, Yentür SP, Kaçar A. Reduced cerebrospinal fluid levels of interleukin-10 in children with febrile seizures. Seizure 2019; 65: 94-97
    CrossrefPubMedGoogle Scholar
  • 20 Farias-Moeller R, LaFrance-Corey R, Bartolini L. , et al. Fueling the FIRES: hemophagocytic lymphohistiocytosis in febrile infection-related epilepsy syndrome. Epilepsia 2018; 59 (09) 1753-1763
    CrossrefPubMedGoogle Scholar
  • 21 van Baalen A, Vezzani A, Häusler M, Kluger G. Febrile infection-related epilepsy syndrome: clinical review and hypotheses of epileptogenesis. Neuropediatrics 2017; 48 (01) 5-18
    PubMedGoogle Scholar
  • 22 Fukui KO, Kubota M, Terashima H, Ishiguro A, Kashii H. Early administration of vitamins B1 and B6 and l-carnitine prevents a second attack of acute encephalopathy with biphasic seizures and late reduced diffusion: a case control study. Brain Dev 2019; pii: S0387-7604(18)30517-5
    PubMedGoogle Scholar
  • 23 Chan S, Bello JA, Shinnar S. , et al; FEBSTAT Study Team. Hippocampal malrotation is associated with prolonged febrile seizures: results of the FEBSTAT study. Am J Roentgenol 2015; 205 (05) 1068-1074
    CrossrefPubMedGoogle Scholar
  • 24 Yamaguchi H, Nagase H, Nishiyama M. , et al. Nonconvulsive seizure detection by reduced-lead electroencephalography in children with altered mental status in the emergency department. J Pediatr 2019; 207: 213-219.e3
    CrossrefPubMedGoogle Scholar
  • 25 Harden C. Findings from the FEBSTAT study: can observations after a provoked seizure occurrence have broad implications for epileptogenesis?. Epilepsy Curr 2013; 13 (03) 143-145
    CrossrefPubMedGoogle Scholar
  • 26 Visser AM, Jaddoe VW, Ghassabian A. , et al. Febrile seizures and behavioural and cognitive outcomes in preschool children: the Generation R study. Dev Med Child Neurol 2012; 54 (11) 1006-1011
    CrossrefPubMedGoogle Scholar
  • 27 Knudsen FU, Paerregaard A, Andersen R, Andresen J. Long-term prognosis in febrile convulsions with and without prophylaxis [article in Danish]. Ugeskr Laeger 1997; 159 (23) 3598-3602
    PubMedGoogle Scholar
  • 28 Knudsen FU, Paerregaard A, Andersen R, Andresen J. Long term outcome of prophylaxis for febrile convulsions. Arch Dis Child 1996; 74 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 29 Nilsson G, Westerlund J, Fernell E. , et al. Neurodevelopmental problems should be considered in children with febrile seizures. Acta Paediatr 2019; ; (Jan): 7
    PubMedGoogle Scholar
  • 30 Shinnar RC, Shinnar S, Hesdorffer DC. , et al; FEBSTAT Study Team. Parental stress, pediatric quality of life, and behavior at baseline and one-year follow-up: results from the FEBSTAT study. Epilepsy Behav 2017; 69: 95-99
    CrossrefPubMedGoogle Scholar
  • 31 Nilsson G, Fernell E, Arvidsson T, Neville B, Olsson I, Gillberg C. Prevalence of febrile seizures, epilepsy, and other paroxysmal attacks in a Swedish cohort of 4-year-old children. Neuropediatrics 2016; 47 (06) 368-373
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Elshana H, Özmen M, Uzunhan TA. , et al. A tertiary care center's experience with febrile seizures: evaluation of 632 cases. Minerva Pediatr 2017; 69 (03) 194-199
    PubMedGoogle Scholar
  • 33 Okubo Y, Handa A, Nariai H. National survey of factors associated with repeated admissions due to febrile seizure. Seizure 2018; 61: 149-152
    CrossrefPubMedGoogle Scholar
  • 34 Tsai JD, Mou CH, Chang HY, Li TC, Tsai HJ, Wei CC. Trend of subsequent epilepsy in children with recurrent febrile seizures: a retrospective matched cohort study. Seizure 2018; 61: 164-169
    CrossrefPubMedGoogle Scholar
  • 35 Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of risk factors associated with first episode febrile seizure. J Clin Diagn Res 2016; 10 (05) SC10-SC13
    PubMedGoogle Scholar
  • 36 Shinnar S, Hesdorffer DC, Nordli Jr DR. , et al; FEBSTAT Study Team. Phenomenology of prolonged febrile seizures: results of the FEBSTAT study. Neurology 2008; 71 (03) 170-176
    CrossrefPubMedGoogle Scholar
  • 37 Ateşoğlu M, İnce T, Lüleci D, Ergör A, Aydın A. Sociodemographic risk factors for febrile seizures: a school-based study from Izmir, Turkey. Seizure 2018; 61: 45-49
    CrossrefPubMedGoogle Scholar
  • 38 Weiss EF, Masur D, Shinnar S. , et al; FEBSTAT study team. Cognitive functioning one month and one year following febrile status epilepticus. Epilepsy Behav 2016; 64 (Pt A): 283-288
    CrossrefPubMedGoogle Scholar
  • 39 Wilmshurst JM, Gaillard WD, Vinayan KP. , et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia 2015; 56 (08) 1185-1197
    CrossrefPubMedGoogle Scholar
  • 40 Takasu M, Kubota T, Tsuji T, Kurahashi H, Numoto S, Okumura A. The effects of antihistamines on the semiology of febrile seizures. Brain Dev 2019; 41 (01) 72-76
    CrossrefPubMedGoogle Scholar