Febrile seizures

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By Renée Shellhaas MD MS, Carol S Camfield MD, and Peter Camfield MD

Because fever is an essential element for the genesis of febrile seizures, it would seem intuitively correct that antipyretic medications would prevent the first or recurrent febrile convulsions. However, several studies have shown that appropriate, rigorous use of antipyretic medication does not prevent febrile seizures, as summarized by Offringa and Newton’s 2012 Cochrane Review and as confirmed in a recent meta-analysis (Rosenbloom et al 2013). The American Academy of Pediatrics Practice Guideline advises against the use of antipyretics for this purpose (American Academy of Pediatrics 2008; Offringa and Newton 2012).

A Finnish study randomized children to receive placebo or acetaminophen (10 mg/kg) at the time of illness for 2 years following a first febrile seizure (Uhari et al 1995). Those receiving placebo had recurrent febrile seizures during 8.2% of febrile illnesses, compared with 5.2% for those receiving acetaminophen. A similar randomized study showed that administration of ibuprofen syrup during a febrile illness does not prevent febrile seizure recurrences (van Stuijvenberg et al 1998). Finally, a randomized study comparing rectal placebo versus rectal diclofenac followed by oral placebo versus acetaminophen versus ibuprofen for fever control demonstrated no efficacy in prevention of febrile seizures (Strengell 2009). Therefore, the compulsive use of antipyretics for prevention of febrile seizures cannot be recommended. Sponging with tepid water or alcohol is also ineffective (Newman 1985). Although these interventions may lower the body temperature, they do not change the hypothalamic “set point,” which is elevated in response to pyrogens.

Dutch investigators followed a group of children who experienced a first febrile seizure (van Stuijvenberg et al 1999). Those with more frequent fever episodes during the following 6 months had more recurrent febrile seizures than those with fewer fevers (odds ratio 1.8). Another Dutch study demonstrated a linear relationship between the number of febrile illnesses and the risk of febrile seizures for children in their second and third year of life, but this was not true for those less than 12 months old (Visser et al 2012). The association between the number of fevers and the risk of febrile seizures was higher for those with recurrent febrile seizures. Gordon and colleagues demonstrated that children presenting with febrile seizures have higher temperatures than those presenting with febrile illness alone (Gordon et al 2009). However, we are unaware of any study that proves that efforts to reduce bouts of febrile illness result in fewer febrile seizures.

Despite evidence to the contrary, health care professionals continue to harbor inaccurate attitudes and knowledge about fever and continue to suggest antipyretics to reduce temperature and thereby reduce the risk of febrile seizures (Walsh et al 2005; Yilmaz et al 2008). Clearly, continued educational interventions are needed for health care workers.

In This Article

Historical note and nomenclature
Clinical manifestations
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited