Management of Febrile Seizures in Children

Definition and Classification

• Febrile seizures are seizures occurring in children between 6 and 60 months of age with fever, without intracranial infection, metabolic disturbance, or history of afebrile seizures 3, 4
• They are classified into two types: simple febrile seizures, which last <15 minutes, are generalized, and occur once in 24 hours, and complex febrile seizures, which last >15 minutes, are focal, or occur more than once in 24 hours 1, 4

Epidemiology and Risk Factors

• Febrile seizures affect 2-5% of children, with peak incidence around 18 months of age 3
• Risk factors for recurrence include age <12 months at first seizure, with a 50% recurrence risk, and family history of epilepsy 5
• Children >12 months have approximately 30% recurrence risk 5

Long-term Management

• Continuous anticonvulsant therapy with phenobarbital, primidone, or valproic acid is effective in reducing recurrence but is NOT recommended due to potential adverse effects, including fatal hepatotoxicity and thrombocytopenia 6
• The American Academy of Pediatrics strongly recommends against continuous or intermittent anticonvulsant therapy for children with one or more simple febrile seizures 1, 6

Prognosis

• Simple febrile seizures have excellent long-term outcomes, with no decline in IQ, academic performance, or behavior, and no evidence of structural brain damage 5
• The risk of developing epilepsy by age 7 is approximately 1%, similar to the general population 2
• Children with multiple simple febrile seizures, first seizure <12 months, and family history of epilepsy have slightly higher risk (2.4%) of developing epilepsy by age 25 5