Febrile seizures: Review article

Demographic, Genetic and clinical profiles Febrile seizures are broadly defined as seizures' occurring in the presence of fever, but in the absence of central nervous system infection. They occur in children aging from 6 months to 5 years with a mean age of onset of 18-24 months and they occur slightly more commonly in boys than in girls. 1 It is the most common reason for convulsions in children less than 6 years of age, and they occur in 2 to 5% of all children, although it has been reported to be more frequent in Asian countries. In Japan, the rate has been reported to be 7% and in Jordan 6.5%.2 It is thought that the rates in these areas are higher because some of the common infections of childhood may occur earlier in life when children are most susceptible to febrile seizures. 3 Febrile seizures can be divided into two types: simple and complex. Simple febrile seizures are characterized by the following: duration less than 15 minutes generally, and it occurs in normal children neurologically and developmentally. Complex febrile seizures have the following features: duration greater than 15 minutes, multiple within 24 hours, and/or focal. [2] The risk of recurrence after the first febrile seizure is about 33%. The risk factors for recurrence are: occurrence of the first febrile seizure at a young age; family history of febrile seizures; short duration of fever before the seizure; relatively low fever at the time of the initial seizure; and possibly a family history of an afebrile seizure. It has been observed that the time of recurrence is usually within the first year of onset. Although complex febrile seizures are not usually associated with an increased risk of recurrent febrile seizures, they may be a risk factor for epilepsy later in life. Febrile seizures seem to run in families, but their mode of inheritance is unknown. The risk for other siblings developing febrile seizures is about 10-20%, but may be higher if the parents also have a history of febrile seizures themselves. 4 In large families, the FS susceptibility trait is inherited by autosomal dominant pattern with a reduced penetrance. It has long been recognized that there is a significant genetic component for susceptibility to this type of seizure and this may be caused by a mutation in several genes.[2] In the presence of cases of FS and epilepsy in the same family one study the concept of a genetic epilepsy syndrome termed Generalized Epilepsy with FC plus [GEFS+]. GEFS has a spectrum of phenotypes including FC, and FC plus.[2]. Febrile seizures usually occur in the first 24 hours of the onset of fever. It has been suggested that it is the rapid rise in the child's temperature, which causes a febrile seizure rather than the actual height of the fever itself; however, there is no substantial proof to support this suggestion. The seizures are usually generalized and tonic-clonic, but other types may be present as well. There may be variations to this such as staring without stiffness, jerking movements without prior stiffening, and localized stiffness or jerking

lumbar puncture always necessary in the febrile child with convulsion?

Febrile convulsion is the most common benign convulsive disorder in children. Meningitis is one of the most important causes of fever and convulsions, diagnosed by lumbar puncture [LP], a painful and invasive procedure much debated regarding its necessity. This study evaluates the frequency of abnormal LP findings in a group of patients, to determine whether or not unnecessary LP can be prevented without missing patients with serious problems such as meningitis. The study was a descriptive, cross sectional study, conducted on 200 children suffering from fever and convulsions. Medical files of patients were taken from the hospital records and relevant data were collected to complete the appropriate forms. Of 200 patients included in the study, 116 [58%] children were male, and 84 [42%] were female. 47 cases [23.5%] underwent LP, of whom just one [0.5%] had abnormal LP and meningitis. Regarding Considering the low prevalence of meningitis in children with convulsion and fever, we conclude that by means of precise clinical examination and monitoring, it is possible to prevent unnecessary LP in these patients

Non increased neuron-specific enolase concentration in cerebrospinal fluid during first febrile seizures and year follow-up in pediatric patients

Febrile seizures are the commonest acute neurological disorder of early childhood. Studies suggested that febrile seizures are previous acute events from a more serious neurological problem. Due to neuron-specific enolase is generally accepted as a marker for neuropathological processes in the brain, 16 pediatric patients were studied during their first seizures and a year after it. Neuron-specific enolase in cerebrospinal fluid and blood were analysed by an immune enzyme assay. Non pathological neuron-specific enolase values were obtained in both periods in the group of patients. There no significative differences when paired series statistics test was performed with 95 per cent of confidence. Neuron-specific enolase appears not to be a marker for febrile seizures because its concentration not be increased in cerebrospinal fluid in this group of patients.

Valores normales del líquido cefalorraquideo en pediatria

El estudio de la celularidad y el nivel de proteínas en el líquido cefalorraquídeo demostró, entre niños menores de 5 años de edad y hospitalizados por fiebre y convulsión, que el máximo normal era de seis células entre lactantes menores de 6 meses (excluyendo los neonatales); de cinco células, entre menores de 2 años y mayores de 6 meses; y de cuatro células, entre mayores de 2 y menores de 5 años. La cifra normal de proteína era de 35 mg/d1, entre niños de 1 a 5 meses de edad; de 40 mg/d1, entre 6 meses y 2 años de edad; y de 32 mg/d1, entre niños de 2 a 5 años