Management of febrile convulsions

Febrile seizure episode in a child can be extremely frightening for parents. Healthcare professionals should

• reassure parents that the condition is not life threatening (1)
• inform that in the absence of underlying development problems, the child will not have lasting neurologic effects
  • a UK population based study which included 381 children with febrile seizures reported that academic, intellectual and behavioural performance at the age of 10 years is similar to other children of same age (2)

Risk of recurrence is similar between simple and complex febrile seizures. Prevention of recurrence should address controlling of fever and treatment of the underlying cause

• paracetamol and ibuprofen can be used to reduce high fevers
  • although antipyretics are used to reduce fever, no evidence exist that this prevents recurrent seizures
  • they may be helpful in relieving the discomfort of a febrile child
• tepid sponging is no longer recommended for children with fever since it may increase core body temperature
• children should not be underdressed (or overdressed)
• use of oral diazepam at the onset of a child’s fever may be considered if parental anxiety is high (1,2,3)

Main aim of management should be to educate and reassure parents

• advice on the common nature of febrile seizures, the rare association with epilepsy
• explain that the tendency diminishes with age as the brain matures
• provide written instructions/information leaflets on what should be done if further febrile seizures occur at home (1,2)

Reference:

• (1) Patel N et al. Febrile seizures. BMJ. 2015 ;351:h4240
• (2) Graves RC, Oehler K, Tingle LE. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician. 2012;85(2):149-53
• (3) Deakin K. Clinical Review – Febrile seizures. GPonline 2011