Professional Documents
Culture Documents
Definations:
Febrile fits (F.C.) are defined as fits occurring in association with fever in children between
3 months and 6 years of age, in whom there is no evidence of intracranial pathology or
metabolic derangement that could be the cause of the fit. Febrile fits, febrile convulsions
and febrile convulsions are synonymous terms. Children with previous afebrile fits are
excluded from this definition.
Magnitude of Problem
There is no comprehensive local epidemiological data. Studies in Western Europe quote a
figure of 3-4 % of children 5 years experiencing febrile fits with higher figures of up to
8% in Japan. This makes febrile fits the single most common problem in paediatric
neurology.
Types of Febrile Fits
Febrile fits are classified as either simple or complex. Simple febrile fits are short, 15
minutes, generalised fits that do not occur more than once in a febrile episode. Febrile fits
that are either prolonged ( 15 mins ) unilateral or recur within a single febrile episode
are classified as complex. (Nelson &Ellenberg,1978)
Issues in management of Febrile Fits.
The major issues are:a)
b)
c)
d)
e)
f)
g)
h)
The overall risk of recurrence is 30-40% and half of these go on to get a second
recurrence ( Aicardi ). However there is a range of risk. Those with O or 1 risk factor
have a low risk of 10 %, whereas those with all risk factors have an almost 100% risk.
The single most important risk factors is age at onset with children 1 year having a 50
% risk of recurrence compared to 28% for those above 1 year. Only 9-17% of cases have
3 or more recurrences.
Half of all recurrences occur within 6 months and 3 quarters have occurred by 1 year of
the first febrile fit.
Most long lasting fits are the first episode (Aicardi ). Only 1.4 % of children with an initial
brief F.C. developed a prolonged recurrence lasting 30 minutes or more, and none of these
had had an afebrile fit at 7 years of age (Nelson & Ellenberg 1978).
However children with prior abnormal neurological development may have a much higher
risk of a prolonged recurrence (Berg 1997)
In summary recurrent febrile fits are common especially among those with an early onset.
Most of these are brief and the number of recurrences has no bearing on long term
neurological, motor, intellectual or behavioural outcomes (Knudsen 1996).
B.Risk of Subsequent Afebrile Unprovoked Fits or Epilepsy
Non febrile fit follow F.C. in 2 to 7 % of cases, a rate that is 5-10 times higher than the
population incidence of 0.4 - 0.8 %.
Conversely 10-15% of patients with epilepsy have a positive history for febrile fits
compared to a population incidence for F.C. of 3-4 %.
The current feeling is that these children have inherited a lower threshold for fits that is
manifested as F.C. during the age of susceptibility for this condition.
Initial concerns arising from neurosurgical series about the relationship between Mesial
Temporal Sclerosis (MTS) and a preceding history of prolonged febrile fits have been
challenged by the findings of more recent cohort studies of adolescents with epilepsy, with
or without a prior history of febrile fits ( Berg 1999, Camfield 1994 ). A recent study has
also shown MRI evidence of MTS in relations of patients with intractable partial fits
secondary to this condition even through some of them have never experienced a fit,
febrile or otherwise. ( Fernandez 1998 ). This and other reports of MRI evidence of MTS
in children shortly after a febrile fit suggest that some individuals may have developmental
hippocampal abnormalities that predispose to F.C. and later epilepsy.
In an individual child with febrile fits, features that predict a high risk of later non febrile
fits are:1) Abnormal neurological development before first febrile fit.
2) Family history of idiopathic epilepsy
3) Complex febrile fits
References
1. Aicardi : Epilepsy in children, 2nd Edition International Review of Child Neurology
series 1994
Pages 253-275
2. American Academy of Paediatrics Practice Parameter : Long Term Treatment of the
child with simple Febrile Fits, Paediatrics Vol.103 No.6 1999 page 1307-1309
3. Berg AT, Shinnar S, Darefcky AS et al : Predictors of Recurrent Febrile Fit Arch.
Pediatric, Adoles. Med. 1997, 151:371-378
4. Berg A.T., Shinnar S, Levy SR, Testa F. M.
Childhood onset epilepsy with and without preceding febrile fits Neurology 1999; 53 :
1742-1748
5. Camfield P, Camfield C, Gorden K, Dooley J
What types of epilepsy are preceded by febrile fits? A population based study of
Children
Dev. Med. Child Neurol 1994; 36: 887-892
6. Fernandez G, Effenberger O, Viraz B, etal
Hippocampal Malformation as a cause of familial febrile fit and subsequent
hippocampal sclerosis
Neurology 1998 ; 50:909-917
7. Fukuyama Y., Seki T., Ohtsaka C., Miara H, Hara M
Practical Guidelines for Physicians in the Management of febrile fits
Brain & Development 1996; 18: 479-484
8. Knudsen F.U., Febrile Fits - treatment and outcome
Brain & Development 1996, 18: 438-449.
9. Nelson K.B. Ellenberg JH
Predictors of epilepsy in children who have experienced febrile fits
N Engl J Med 1976, 295:1029-1033
10.
Nelson K.B. , Ellenberg J.H.
Prognosis in children with febrile fits
Pediatrics 1978, 61:720-727
11. Macdonald BK, Johnson AC, Sander JWAS Sharon SD
Febrile fits in 220 children - neurological sequalae at 12 years follow-up
Eur Neurol 1999; 41: 179-186
12.
Verity CM, Greenwood R, Dolding J
Long term intellectual and behavioural outcomes of children with febrile fits
N. Engl. J. Med 1998; 338: 1723-8
Members of Panel
Dr Hussain Imam Hj Muhammad Ismail (Chairperson)
Prof Motilal
Prof Ong Lai Choo
Dr Sofiah Ali
Dr Malinee Thambyayah
Prof Zabidi Azhar Hussein
Dr Koh Chong Tuan
Dr Khoo Teck Beng
Comfort child
Seek medical advice on cause of fever
Fit stops
Comfort child
Seek medical advice
on cause of fever
Fit stops
Observe child
Fit does not recur
Determine cause of fever
Minor illness
Fit recurs