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Febrile seizures

A seizure accompanied by fever 
( temp > = 100.4 ° F or 38° C by any methods ) without CNS infection 
that occurs in infants and children 6 through 60 months of age Occurs in 2-5 % of all children ( neurologically healthy ) Most common convulsive event in children < 60 months No previous neonatal or unprovoked seizure Simple febrile seizures represent 65-90 % of febrile seizures

SIMPLE Less than 15 mins Generalised tonic-clonic No previous neurological problems Do not not recur within 24 hrs OR
within the same febrile illness No post-ictal pathology  COMPLEX-Duration of > 15 mins Focal onset or focal features Recurrence within 24 hrs OR
within same febrile illness Febrile status epilepticus + 30 mins

Risk factors first seizure- High fever Viral infection Developmental delay Day care attendance Family history
○ 1ST degree relative who has had FS
○ a relative with epilepsy Certain vaccinations – 
unclear if a risk factor or not ( Barlow et al- immunization is rarely followed by a febrile seizure )

Pathophysiology-Mechanism causing FS is poorly understood Heterogeneous condition with a complicated
( yet unclear ) genetic and pathophysiological basis Rate of body temperature rise as a cause – frequently quoted theory but unsupported by evidence ie it is uncertain if

Degree of fever OR
Rate of rise of temp

history-Fever associated with seizure
 Typical features of FS’s as
○ child 6 months to 5 yrs of age 
○ duration 3-6 minutes
○ generalised tonic-clonic type presenting with
 body stiffening
 twitching – face , arms , legs
 eye rolling
 jerking of arms and legs
 loss of consciousness
 Full recovery within 1 hour May occur in a child with a previous h/o FS’s Ask about – 
○ family history
○ previous seizures 
○ recent antibiotics use
○ immunization history

When to admit-First seizure Subsequent seizure and child not seen by paeds Diagnostic uncertainty Complex seizure Child < 18 months of age Focal neurological deficit No serious findings but currently taking antibiotics or has recently been taking them Parental anxiety/failure to cope Suspected serious cause No obvious apparent focus of infection

Rectal diazepam dose as per CKS



NHS inform has a page which answers all questions that parents may ask

NHS on febrile seizures

An incredibly useful video has been produced by British Red Cross on how to manage a child who is having a febrile seizure

A colour coded Febrile Seizure Fact Sheet

Nationwide children’s org – info on febrile seizures

Aboutkidshealth Canada information for parents

National Institute of Neurological Disorders and Stroke – info on febrile seizures


Epilepsy society on febrile convulsions

American Family Physician Febrile Seizures: Risks, Evaluation and Prognosis

American Academy of Paediatrics Febrile Seizures: Clinical Practice Guideline for the Long-Term Management of the Child With Simple Febrile Seizures

Management of Pediatric Febrile Seizures in Int J Enviorn Res Public Health  2018 by Daniela Laino et al



  1. Mohammadi, Mahmoud. “Febrile seizures: four steps algorithmic clinical approach.” Iranian journal of pediatrics vol. 20,1 (2010): 5-15.
  2. Management of Febrile Seizures in Children
    Khawaja Tahir Mahmood, Tooba Fareed, Rabia Tabbasum 1
    Department of Pharmacy, Lahore College for Women, University, Lahore, Pakistan 2
    Drug Testing Laboratory, Lahore, Pakistan Khawaja Tahir Mahmood et al / J Biomed Sci and Res., Vol 3 (1), 2011,353-357
  3. Febrile Convulsions Patient UK Authored by Dr Colin Tidy, Reviewed by Dr Adrian Bonsall | Last edited 
  4. Febrile Seizures : Risks , Evaluation and Prognosis
  5. Febrile seizures. Patterson JL, Carapetian SA, Hageman JR, Kelley KR. ( Abstract )
  6. Armon K Stephenson T , MacFaul R , et al An evidence and consensus based guideline for the management of a child after a seizure . Emergency Medicine Journal 2003 ; 20: 13-20
  7. Febrile seizure Clinical Knowledge Summaries October 2013
  8. Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure Subcommittee on Febrile Seizures 
  9. BMJ Best Practice Febrile Seizure November 2017
  10. ABC of One to Seven Febrile Convulsions
  11. BMJ Volume 306 June 1993 Febrile seizures BMJ 2015 ; 351
  12. Pediatric Febrile Seizures Robert J Baumann et al emedicine.medscape Nov 2017
  13. Febrile Seizures Mohamad A Mikati et al Nesons Textbook of Paediatrics
  14. Leung, Alexander Kc et al. “Febrile seizures: an overview.”Drugs in contextvol. 7 212536. 16 Jul. 2018, doi:10.7573/dic.212536
  15. Vestergaard, Mogens1; Basso, Olga2; Brink Henriksen, Tine1,3; Østergaard, John R.3; Olsen, Jørn2Risk Factors for Febrile Convulsions, Epidemiology: May 2002 – Volume 13 – Issue 3 – p 282-287









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