Quality in Practice Committee

Febrile Convulsions
Quick Reference
Guide for GPs
AUTHOR
Dr Declan O’Rourke, Consultant Paediatric
Neurologist, Children’s University Hospital,
Temple Street, Dublin 1

Based on original document: Guidelines on the

Management of Epilepsy in General Practice,
Dr Ray O’Connor, 2002

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DISCLAIMER AND WAIVER OF LIABILITY
Whilst every effort has been made by the Quality in
Practice Committee to ensure the accuracy of the
information and material contained in this document,
errors or omissions may occur in the content. This
guidance represents the view of the ICGP which was
arrived at after careful consideration of the evidence
available at time of publication.
This quality of care may be dependent on the
appropriate allocation of resources to practices
involved in its delivery. Resource allocation by the state
is variable depending on geographical location and
individual practice circumstances. There are constraints
in following the guidelines where the resources are not
available to action certain aspects of the guidelines.
Therefore, individual healthcare professionals will have
to decide what is achievable within their resources
particularly for vulnerable patient groups.
The guide does not however override the individual
responsibility of healthcare professionals to make
decisions appropriate to the circumstances of
individual patients in consultation with the patient
and/or guardian or carer.
Guidelines are not policy documents. Feedback from
local faculty and individual members on ease of
implementation of these guidelines is welcomed.
EVIDENCE-BASED MEDICINE
Evidence-based medicine is the conscientious, explicit
and judicious use of current best evidence in making
decisions about the care of individual patients.
In this document you will see that evidence and
recommendations are graded according to levels of
evidence (Level 1–5) and grades of recommendations
(Grades A-C) respectively. This grading system is an
adaptation of the revised Oxford Centre 2011 Levels of
Evidence.
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LEVELS OF EVIDENCE
Level 1: Evidence obtained from systematic review of
randomised trials
Level 2: Evidence obtained from at least one
randomised trial
Level 3: Evidence obtained from at least one non-
randomised controlled cohort/follow-up study
Level 4: Evidence obtained from at least one case-
series, case-control or historically controlled
study
Level 5: Evidence obtained from mechanism-based
reasoning
GRADES OF RECOMMENDATIONS
A Requires at least one randomised controlled
trial as part of a body of literature of overall
good quality and consistency addressing the
specific recommendation. (Evidence Levels 1, 2)
B Requires the availability of well-conducted
clinical studies but no randomised clinical trials
on the topic of recommendation. (Evidence
Levels 3, 4).
C Requires evidence obtained from expert
committee reports or opinions and/or clinical
experience of respected authorities. Indicates
an absence of directly applicable clinical
studies of good quality. (Evidence Level 5).
ICGP QUALITY IN PRACTICE COMMITTEE 2016
Dr Paul Armstrong, Dr Patricia Carmody, Dr Regina
Codd, Dr Harry Comber, Dr Mary Kearney, Dr Niamh
Moran, Dr Brian Osborne, Dr Maria O’Mahony, Dr Ben
Parmeter, Dr Philip Sheeran Purcell, Dr Patrick Redmond
ACKNOWLEDGMENTS
QIP Committee would like to thank Dr Elizabeth
O’Mahony, Paediatric Neurology Consultant at the Mid
Western Regional Hospital Limerick who carried out an
external review of this document.
CORRESPONDENCE TO
QRGfeedback@icgp.ie
Original Publication: 2002
Next Review Date: 2019
QUALITY IN PRACTICE COMMITTEE – Febrile Convulsions Quick Reference Guide for GPs

TABLE OF CONTENTS

Section 1 1
1.1 Background 1
1.2 Aims of this document 1

Section 2 2
2.0 Definitions 2
2.1 Incidence 3
2.2 Aetiology 3
2.3 Management 4
2.4 Medical Therapy 5
2.5 Advice to parents 7
2.6 Outcomes following febrile convulsions 9
2.7 Summary 9

Section 3: Key points/ Recommendations 11

Section 4: References 12

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Section 1

1.1 Background
A febrile convulsion is a seizure associated with a fever caused by infection or
inflammation outside the central nervous system (CNS) in a young child who is
otherwise neurologically normal. They occur in children 6 months to 60 months
of age. Febrile convulsions are common, occurring in 2 to 4% of all children and
account for the commonest convulsive event in children under 5 years of age.
Febrile convulsions can be defined as either simple or complex; simple febrile
convulsions last less than 15 minutes and do not reoccur within 24 hours,
complex febrile convulsions last longer than 15 minutes, have focal features
and can reoccur within 24 hours. Children with simple febrile convulsions do
not experience any increased risk of morbidity or mortality. The long-term risk
for epilepsy is only slightly higher than the general population. The main risk
associated with febrile convulsions is the risk of reoccurrence, which can occur in
up to one in three children. Several consensus statements and practice guidelines
have been developed regarding febrile convulsions all of which conclude that
febrile convulsions are benign events with an excellent prognosis.

1.2 Aims of this document

• To update practice guidelines on febrile convulsions to include recent
evidence based guidelines, policies, systematic reviews and key randomised
control trials since the last revision of this topic was made.
• To accurately diagnose febrile convulsions.
• To identify children who require hospital admission for further assessment.
• To help GPs educate caregivers about the benign nature of febrile convulsions.
• To inform parents of the home management of recurrent febrile convulsions.
• To optimise GPs understanding of the causes of febrile convulsions.
• To optimise GPs understanding of the various proposed treatments for
children with febrile convulsions.

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Section 2

2.0 Definitions
A febrile convulsion is defined as an epileptic seizure occurring in childhood
between the ages of six months to five years, associated with a fever not caused
by an infection of the CNS, without previous neonatal seizures or a previous
unprovoked seizure, and not meeting the criteria for other acute symptomatic
seizures. 1–2

Convulsions with fever include any convulsion in a child of any age with fever
of any cause, including meningitis or encephalitis. It is generally accepted that
seizures arising from these symptomatic causes should not be referred to as
febrile convulsions.

It is also recognized that in a small number of children, febrile convulsions are the
first sign that the child has an inherited seizure disorder that includes afebrile as
well as febrile seizures.

Febrile convulsions can be sub classified into simple or complex febrile

convulsions or febrile status epilepticus:

Characteristics of simple febrile convulsions

• Usually last less than 5 minutes but may last for 15 minutes
• No focal features
• Occur in children aged six months to five years
• Occur in children with no developmental or neurological abnormalities
• Complete recovery within one hour.
Characteristics of complex febrile convulsions
• Duration greater than 15 minutes
• A second seizure within 24 hours
• Focal features
Febrile status epilepticus
Febrile convulsion lasting more than 30 minutes or recurrent febrile convulsions
without a return to consciousness during that period. The 30-minute definition
is based on the duration of convulsive status epilepticus that by itself can lead to
permanent neuronal injury. 3

The consensus of the American Epilepsy Society February 2016 was that:

“Status epilepticus presents in several forms:

1. convulsive status epilepticus consisting of repeated generalized tonic–clonic
(GTC) seizures with persistent postictal depression of neurologic function
between seizures;

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2. nonconvulsive status epilepticus where seizures produce a continuous or

fluctuating “epileptic twilight” state; and
3. repeated partial seizures manifested as focal motor signs, focal sensory
symptoms, or focal impairment of function (e.g., aphasia) not associated
with altered awareness (epilepsia partialis continua).” 4

2.1 Incidence
• Febrile convulsions occur in between 2 and 4% of all children by the age of 5
years. They most commonly start in the second year of life and children are at
greatest risk between 6 months and three years of age. 5
• Recurrent febrile convulsions, meaning more than one episode of febrile
convulsions occurs in 34% of children. 6 A family history and age less than one
year predict increased risk.
• 90% are due to viral upper respiratory infections. 7

2.2 Aetiology
Genetic factors
A family history of febrile convulsions and epilepsy each provide independent
risk for febrile convulsions. 8, 9 Occurrence rates range from 10 to 46% in children
with positive family history. 10 Multifactorial inheritance is most likely with no
single mode of inheritance or causative gene identified for most. In the well
characterised epilepsy syndromes of “generalized epilepsy and febrile seizures
plus” (GEFS+), where patients can have febrile and afebrile seizures, mutations
in sodium channel subunit genes (SCN1A, SCN2A and SCN1B) and GABA receptor
subunit gene (GABRG2) have been identified. 11, 12

Prenatal and perinatal factors

There is limited evidence based on population studies for social, maternal and
perinatal influences on the occurrence of febrile convulsions. 13–15

Fever and precipitating factors

Viral infections commonly cause the fever that is associated with febrile convulsions.
There are strong associations between human herpes virus-6 (HHV-6), HHV-6B and
to a lesser extent HHV-7 and febrile convulsions and even febrile status epilepticus.

Additional common viruses associated with febrile convulsions are influenza,

adenovirus, parainfluenza, RSV and rotavirus. The risk of developing FS has been
found to be similar with influenza, adenovirus or parainfluenza and is higher
than with RSV or rotavirus. Type of viral infection was not found to be useful in
predicting complex features or future recurrences. 16

An abrupt rise in temperature rather than a high level is important. 17–19

Bacterial infections including urinary tract infection, pneumococcal bacteraemia,

shigella and even bacterial meningitis may be associated with febrile convulsions.

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Increased risk of febrile convulsions has been shown to occur on the day of
DPT (Diphtheria/Pertussis/tetanus) vaccine and 8 to 14 days following MMR
vaccination. 20, 21 Vaccination with DTaP-IPV-Hib (diphtheria, tetanus, pertussis,
polio, and Haemophilus influenza type b) has not been found to be associated
with an increased risk of epilepsy. 22

The long-term rate of epilepsy does not appear to be increased in children who
had febrile convulsions following the MMR vaccine compared to children who had
febrile convulsions following other causes. 23

2.3 Management
Brief telephone first aid advice can be given regarding taking off the clothes of
a feverish child and laying them in the recovery position, covered with a single
sheet only. 1 Do not restrain them or put anything in their mouth. The temperature
should be measured to confirm the child is febrile or enquiry should be made
if the child had fever preceding the convulsion. There may be evidence of an
exanthematous rash or upper respiratory tract infection. Other measures to
reduce temperature (tepid sponging, fluids and paracetamol) may also be advised.
See www.icgp.ie/QIPAntipyretics for printed advice for parents on fever reduction.

Most febrile convulsions are self-limiting and will stop within 5 minutes. However,
rescue medication should be administered if the seizure lasts 5 minutes or
longer. Even if the convulsion is brief the child should be assessed by a general
practitioner to determine the cause of the fever. Arrangements should be made to
see the child as quickly as possible. Measure blood glucose if the child cannot be
roused or is convulsing. Family support and full explanation are important.

Assessment by a paediatrician and admission to hospital

Febrile convulsions lasting more than a few minutes should be stopped and if
the convulsion cannot be stopped, the child should be admitted to hospital. If the
convulsion has stopped, it must be decided whether or not to admit the child.
Many children will not require admission.

THE FOLLOWING FACTORS FAVOUR ADMISSION AFTER THE FIRST FEBRILE CONVULSION: 24

✓✓Complex convulsion
✓✓Child less that 18 months
✓✓Early review by a doctor in the community not possible
✓✓The child is clinically well but is currently taking antibiotics or has recently
been taking them
✓✓Suspected serious cause of fever (e.g. Pneumonia, Meningitis)
✓✓Home circumstances inadequate, or unusual parental anxiety, or parents’
inability to cope

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Lumbar puncture
Lumbar puncture is recommended in children with febrile convulsions if 24 (Level 5,
Grade C)
• There are clinical signs of meningism
• After a complex convulsion
• If the child is unduly drowsy or irritable or systemically ill
• If the child is less that 18 months old (probably) and almost certainly if the
child is aged less that 12 months.
• Infant between 6 and 12 months who is deficient in immunizations or
pretreated with antibiotics
Ideally the decision whether or not to perform a lumbar puncture should be made
by an expert doctor. The child should be reassessed within a few hours if the
initial decision is not to undertake a lumbar puncture. The risk of coning should
be borne in mind as should the fact that clinical signs of meningism are much
less likely to be found in the younger child.

EEG and brain imaging

Neuroimaging and electroencephalography are not indicated routinely after a
single episode of simple febrile seizure. (Level 5, Grade c) 25

EEG is not helpful in assessing the prognosis of a child with febrile convulsions
and is therefore not recommended as part of the assessment. 15, 26–28 However, in
a minority, a child with an underlying neurological condition may first come to
medical attention with a febrile convulsion. A relevant history and examination
will guide the appropriateness to perform neuroimaging.

2.4 Medical Therapy

Management of fever
Fever should be treated for the child’s comfort. Paracetamol was found to be more
effective than sponging or unwrapping in controlling temperature in children at
home and was more acceptable to parents. 29 Working groups do not recommend
physical methods such as fanning, cold bathing and tepid sponging. 24

There is no evidence that antipyretics influence the recurrence of febrile

seizures. 24, 30, 31 (31 Level 1, Grade A)

Rescue medication
The use of home rectal diazepam 32–34 and buccal midazolam 35 have been shown
to be safe and effective in controlling and aborting febrile seizures. Unless there
has been a prior history of prolonged febrile convulsions (greater than 15 minutes)
or febrile status, best practice is to give wait for 5 minutes before administering
rescue medication, by which time most convulsions will have stopped.

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Buccal midazolam
• Can be administered as first–line treatment in children with prolonged or
repeated febrile convulsions in the community
• Treatment should be administered by trained clinical personnel or, if specified
by an individually agreed protocol drawn up with the specialist, by family
members or carers with appropriate training 36
• Is absorbed through the oro-mucosal area (between the gums and the buccal
mucosa) to stop prolonged seizures
• Most parents can be taught how to use this

The rationale for waiting 5 minutes before administering rescue medication

is that the majority of seizures are brief but once a seizure lasts more than 5
minutes it is likely to be prolonged. 37

Status treatment protocols have therefore employed a 5-minute definition to

minimize the risk of seizures reaching 30 minutes and the adverse outcomes
associated with needlessly intervening on brief, self-limited seizures. 4

The dose of Buccal midazolam depends on age:

AGE RANGE DOSE LABEL COLOUR

3 to 6 months hospital setting 2.5 mg Yellow
> 6 months to < 1 year 2.5 mg Yellow
1 year to < 5 years 5 mg Blue
5 years to < 10 years 7.5 mg Purple
10 years to < 18 years 10 mg Orange

Monitor for respiratory distress and contra-indicated in respiratory deficiency,

sleep apnoea and myasthenia gravis.

Rectal diazepam
• Administer rectal diazepam 33 if preferred or if buccal midazolam is not
available
• A dose of (0.5mg/kg) produces an effective blood concentration of
anticonvulsant within 10 minutes 33
• It is most conveniently given as an enema (Stesolid)
• A 5mg rectal tube is used for a child aged one to three years
• A 10mg tube for a child over three years
• Recommended doses of rectal diazepam (repeated after 5 minutes if
necessary) are:
-- Less than 1 month of age: 1.25–2.5mg
-- 1 month–1 year of age: 5mg
-- 2–11 years of age: 5–10mg

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IV Lorazepam
• If intravenous access is already established and resuscitation facilities are
available, administer intravenous lorazepam (0.1mg/kg).
Prophylactic treatment / Intermittent prophylactic treatment
For certain at risk children, one approach to preventing further febrile convulsions
is to intervene at the onset of the febrile illness. There is no evidence that
antipyretics influence the recurrence of febrile seizures. 24, 30, 31 (31 Level 1, Grade A)

Use of intermittent prophylactic oral or rectal diazepam at the time of illness or

fever, may help reduce the risk of recurrent febrile seizures. 38 This should only be
prescribed in conjunction with a paediatric specialist. (Level 2, Grade A)

Continuous prophylactic treatment

Continuous prophylactic medication is now not generally advised for children with
febrile convulsions, or at very least is rarely indicated and should be prescribed only
by a paediatric specialist. 39, 40 It does not reduce the risk of epilepsy after a febrile
seizure and is potentially toxic. 41 (Level 5, Grade c)

There is variable data showing the effectiveness of phenobarbitone and

sodium valproate to reduce the risk of recurrent febrile convulsions, and both
are associated with behavioural and cognitive effects. 28, 42–44 Ninety percent
of children who develop epilepsy following febrile convulsions never had a
convulsion lasting greater than 30 minutes. In the minority who became epileptic
following febrile status epilepticus, this was the first seizure of their lives. 45

Additionally, the occurrence of mesial temporal lobe sclerosis following

prolonged febrile convulsions is relatively rare, with the risk of this not warranting
prophylactic treatment of febrile convulsions. 45

Providing drug treatment to prevent or manage future seizures may be

considered appropriate in some circumstances, such as when the child has a
history of prolonged or frequent seizures. However, these circumstances are an
indication for urgent admission for specialist assessment and management,
including the decision to prescribe drugs to manage or prevent future seizures.

2.5 Advice to parents

Parents should be supported with practical advice and reassured about the
benign nature of febrile convulsions as many parents think their child is dying
when they witness the first seizure: 46

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ADVICE TO PARENTS

✓✓Febrile convulsions are common

✓✓Most children will have only one febrile convulsion in their life-time
General Advice
✓✓Febrile convulsions do not adversely effect intellect, neurological
function or behaviour

✓✓1 in 3 children will have another febrile convulsion, (50% risk of

recurrence if first seizure age <1, 30% if 1st seizure age >1)
✓✓75% of recurrences occur within 1 year
Advice regarding
✓✓Lower recurrence risk with higher fevers (35% recurrence with
risk of recurrence 47
temperature 38.5 and 13% recurrence with temperature 40)
✓✓There is a 50% recurrence risk after a second seizure
✓✓Recurrence risk is increased with family history of febrile convulsions 47

✓✓Protect the child from injury during the seizure

✓✓Do not restrain them or put anything in their mouths
Advise on ✓✓Place them in the recovery position until the seizure stops. Explain that
managing the child may be sleepy for up to an hour post the seizure
subsequent seizure
✓✓Seek medical advice if the seizure lasts greater than 5 min (if no
occurrence emergency seizure stopping medication given) or seek medical advice
if seizure has not stopped 5 minutes after emergency seizure stopping
medication is given

✓✓Explain that reducing the fever does not prevent seizure recurrence
✓✓Advise how to use ibuprofen and paracetamol appropriately to reduce
Coping with
fever for comfort
subsequent febrile
✓✓Practical measures on how to reduce fever and dehydration
illness
✓✓When to seek medical help because of prolonged symptoms, or
dehydration or if signs of serious illness such as meningitis

✓✓Advise parents to continue immunizations even if the febrile seizure

followed an immunization. Children who had a febrile seizure following
most immunizations were no more likely to have a subsequent
seizure than children who had a febrile seizure not associated with
immunization. 20 Children who had febrile convulsions after MMR
Advice on immunization may have a slightly increased risk of recurrent febrile
immunisations convulsions 23
✓✓Febrile convulsions following immunizations are not associated with
neurodevelopmental disorders 20
✓✓Children who develop febrile convulsions following immunizations do
not appear to be at risk of developing subsequent epilepsy 23

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2.6 Outcomes following febrile convulsions

Mortality
Large population based studies found no deaths that were directly attributable
to febrile convulsions. 40, 48, 49 Parents should be reassured that death after febrile
seizures is very rare, even in high-risk (pre-existing neurological condition)
children. 50

Epilepsy
Rate of epilepsy following febrile convulsions was found to be 2% by seven years 39
and 2.5% by 10 years. 45 Up to 85% of afebrile seizures may occur within four years
of febrile convulsions. 5

PREDISPOSING RISK FACTORS FOR SUBSEQUENT AFEBRILE SEIZURES INCLUDE:

✓✓Family history of epilepsy (three-fold risk in one study) 39

✓✓Febrile convulsion in child under one year of age 39

✓✓Abnormal neurological development before first afebrile seizure (three

times more likely to develop epilepsy by seven years of age) 39

✓✓Complex febrile convulsions 39, 45

✓✓There are conflicting reports on the risk of recurrent episodes of febrile

convulsions and subsequent epilepsy 5, 39, 51

Neurological and intellectual impairment

Neither febrile convulsions nor febrile status epilepticus are associated with
subsequent neurological deficits 39, 40, 52 or intellectual impairment. 14, 48, 53–54 One
study reported persistence of recognition memory impairment in a minority of
children. 55

Behaviour
Up to 35% of children can experience short-term behavioural effects following
febrile convulsions. There is little difference in behaviour from peers after long-
term follow up. 54

2.7 Summary
While the overall rate of recurrence of febrile convulsions is high, no significant
long-term effects of simple febrile convulsions have been reported.

Epilepsy risk is approximately double the general population risk but still remains
extremely low.

There is no data to suggest that intermittent or continuous use of prophylactic

anticonvulsant medication alters this risk.

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Antipyretics may improve the febrile child’s comfort but are ineffective in
preventing recurrent febrile convulsions.

While continuous anticonvulsant therapy may reduce the risk of recurrent

febrile convulsions, they are associated with potential toxic effects and therefore
their risk outweighs the relatively minor risks associated with simple febrile
convulsions.

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Section 3: Key points/ Recommendations

• Advise parents about what to do if further seizures occur, including how to
protect them from injury during the seizure and when to call for medical help.
• For a child who is fitting for more than 5 minutes, either rectal diazepam or
buccal midazolam should be given.
• If, 10 minutes after the first dose, the seizure has not stopped, the child has
ongoing twitching, or another seizure has begun before the child regains
consciousness, the child should be urgently admitted to hospital.
• Measure blood glucose if the child cannot be roused or is convulsing.
• Drugs should not be prescribed to manage or prevent future seizures unless
advised to do so by a specialist.
• In general, a simple febrile seizure does not usually require further
investigations, specifically EEGs, blood studies, or neuroimaging.
• Clinicians evaluating infants or young children after a simple febrile seizure
should direct their attention toward identifying the cause of the child’s fever.
• A lumbar puncture is an option in children who have been pre-treated with
antibiotics.

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Section 4: References
1. Valman HB. (1993) Febrile convulsions. Br. Med. J. 306: 1743–5.
2. Commission on Epidemiology and Prognosis, International League Against
Epilepsy (1993) Guidelines for epidemiologic studies on epilepsy. Epilepsia 34,
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3. Anon. Treatment of convulsive status epilepticus. Recommendations of the
Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA
1993 Aug 18; 270 (7): 854–859.
4. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, et al. Evidence-Based
Guideline: Treatment of Convulsive Status Epilepticus in Children and
Adults: Report of the Guideline Committee of the American Epilepsy Society.
Epilepsy Curr. 2016 Jan–Feb; 16(1):48–61. doi: 10.5698/1535-7597-16.1.48.
5. Verity, C.M. (1995) Febrile Convulsions. In: Epilepsy, 2nd Edition (Eds A. Hopkins
and S. Shorvon), pp. 352–369. Chapman and Hall, London.
6. Berg, A.T., Shinnar, S., Hauser, W.A. et al (1990) Predictors of recurrent febrile
seizures: a metaanalytic review. J. Pediatr. 116, 329–337.
7. O’Donohoe NV, Roger J, Dravet C, Bureau M, (1985) Ed. Epileptic syndromes in
infancy, childhood and adolescence. John Libbey Eurotext Ltd, 34–41.
8. Nelson, K.B. and Ellenberg, J.H. (1990) Prenatal and perinatal antecedents of
febrile seizures. Ann. Neurol. 27, 127–131.
9. Hauser, W.A., Annegers, J.F., Anderson, V.E. et al (1985) The risk of seizure
disorders among relatives of children with febrile convulsions. Neurology 35,
1268–1273.
10. Saghazadeh, A., Mastrangelo, M. and Rezaei, N. (2014) Genetic background of
febrile seizures. Rev. Neurosci.. 25(1), 129-61.
11. Nakayama, J. and Arinami, T. (2006) Molecular genetics of febrile seizures.
Epilepsy Res. 70, Suppl 1, 5190–5198.
12. Baulac, S., Gourfinkel-An, I., Nabbout, R. et al (2004) Fever, genes and epilepsy.
Lancet Neurol. 3(7), 421–430.
13. Forsgren, L., Sidenvall, R., Blomquist, H.K. et al (1991) Pre- and perinatal factors
in febrile convulsions. Acta Paed. Scand. 80, 218–225.
14. Verity, C.M., Butler, N.R. and Golding, J. (1985) Febrile convulsions in a national
cohort followed up from birth. II. Medical history and intellectual ability at 5
years of age. Br. Med. J. 290, 1311–1315.
15. Verity, C.M. (1995) Febrile Convulsions. In: Epilepsy, 2nd Edition (Eds A. Hopkins
and S. Shorvon), pp. 352–369. Chapman and Hall, London.
16. Chung B, Wong V. Relationship between five common viruses and febrile
seizure in children. Arch Dis Child. 2007 Jul; 92(7):589–93. Epub 2007 Feb 6.
17. Kondo K., Nagafuji, H., Hata A. et al (1993) Association of human herpesvirus
6 infection of the central nervous system with recurrence of febrile
convulsions. J. Infect. Dis. 167, 1197.

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18. Barone S.R., Kaplan M.H. and Krilov L.R. (1995) Human herpes-virus 6 infection
in children with first febrile seizures. J. Pediatr. 127, 95.
19. Epstein L.G., Shinnar S., Hesdorffer D.C. et al (2012) Human herpesvirus 6 and
7 in febrile status epilepticus: the FEBSTAT study. Epilepsia 53,1481–8.
20. Barlow, W.E., Davis, R.L., Glasser, J.W. et al (2001) The risk of seizures after
receipt of whole-cell pertussis or measles, mumps and rubella vaccine. New
Engl. J. Med. 345, 656–661.
21. Ward K.N., Bryant N.J., Andrews N.J. et al (2007) Risk of serious neurologic
disease after immunization of young children in Britain and Ireland.
Pediatrics 120,314–321.
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