What is a febrile convulsion?

Rapid temperature increases can cause febrile convulsions. Febrile convulsions occur in young children when there is a rapid increase in their body temperature. It affects up to 1 in 20 children between the ages of one and four but can affect children between six months and about five years old. Children who are at risk may naturally have a lower resistance to febrile convulsion than others.

What is the risk of suffering a febrile convulsion?
Children may inherit the tendency to suffer febrile convulsion from their parents.
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If either parent suffered a febrile convulsion as a child, the risk of the child getting it rises 10 to 20 per cent. If both parents and their child have at some point suffered a febrile convulsion, the risk of another child getting it rises 20 to 30 per cent.

Nevertheless, the child's susceptibility also depends on whether the child frequently gets infections. About 4 out of 10 children who have had febrile convulsions will get them again at some stage, although the risk differs greatly from child to child. The child's risk of febrile convulsion rises if:
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they are genetically predisposed to it they suffer frequent illnesses, which include high temperatures the first attack of febrile convulsion was accompanied by a relatively low body temperature - below 39ºC.

One in a thousand children may suffer a febrile convulsion after receiving the MMR (measles, mumps, rubella) vaccine. In these cases it occurs 8 to 10 days after the vaccination and is caused by the the measles component of the vaccine. However, this causes only about one tenth of cases of febrile convulsion compared with measles itself. Children who are prone to febrile convulsions should follow the same programme of vaccination as all other children.

Carefully turn the child's head to one side to prevent choking. The child goes limp.5ºC. This should never be attempted. it was common to place a stick in the child's mouth to prevent bites to the tongue or lips. In the past.What are the symptoms? y y y y y The attack often begins with the child losing consciousness. If fits are prolonged or follow each other rapidly. The attack ends after a few minutes and the shaking stops. It can be given into the rectum from a specific rectal tube and takes effect in a few minutes. . parents are sometimes advised to have the medicine diazepam ready in case an attack takes place. and shortly afterwards the body. It is important to give the recommended dose only. Some children regain consciousness faster than others. However. Has the child previously suffered febrile convulsions? y y If the child has a history of febrile convulsions. for example. When the fit subsides. For this reason. Give the child plenty of cold drinks. legs and arms go stiff. Some doctors advise parents to give the child mild painkillers such as paracetamol (eg Calpol) or ibuprofen (eg Nurofen for children). Does the child have a temperature? y y Make sure the child is not too hot by removing extra clothing or bedclothes. ie lying on its side. If the attack goes on for more than five minutes treatment can be repeated. The first time a child suffers febrile convulsions they should be admitted to hospital. to determine whether the convulsions are only due to a harmless viral infection. This lowers the temperature by between 1 and 1. hospitalisation is not always necessary. as it may result in lasting damage to the teeth. a doctor should always be consulted following an attack. The head is thrown backwards and the legs and arms begins to jerk. but bear in mind that the child should not get too cold either. If the room temperature seems high. call an ambulance. it is always important. but medical advice should always be sought in any prolonged fit. keep the child in the recovery position. and then normal colour and consciousness slowly return. Dosage instructions must be carefully adhered to. The skin goes pale and may even turn blue briefly. If the child has suffered attacks on earlier occasions. What to do if your child suffers an attack of febrile convulsion Do not intervene while the attack is taking place except in the circumstance outlined below. open a window.

It is a sudden alterations in normal brain activity that cause distinct changes in behavior and body function. They are thought to result from abnormal. uncontrolled electric discharges of neurons in the brain. the temperature will rise rapidly again. it rarely results in any permanent injuries. Seizures are classified as partial or generalized by the origin of the seizure activity and associated clinical manifestations. If not. Half of all sufferers will have another attack the next time they have a temperature. recurrent. y y If your child has had a febrile convulsion. central nervous system infection. they rarely have anything in common with this illness. your doctor may advise you to have special enemas containing diazepam on standby. If. the convulsions last a long time or the child suffers several attacks in quick succession. epileptic seizures. Predisposing factors include head or brain trauma. barbiturates). hypoglycemia or hyperglycemia. and absence seizures. and congenital neurodegenerative disorders. atonic. cranial surgery. such as paracetamol. Ninety-nine per cent of children who have had a febrile convulsion have no more fits after they reach school age.Although febrile convulsions look like epileptic fits. consult your GP on the best way to deal with them. tumors. myoclonic. epilepsy. and psychomotor symptoms without impairment of consciousness. however. Future prospects Although febrile convulsion often seems frightening. metabolic disorders (hypocalcemia. somatosensory. can help lower body temperature but need to be repeated. y y y y y Also known as convulsions. anoxia). Complex partial seizures ± manifest impairment of consciousness with or without simple partial symptoms. b. . Is it possible to prevent febrile convulsion? Temperature-lowering medicines. and if recurrent. slight disturbances in the brain function may occur. drug withdrawal states (alcohol. Pathophysiology of seizures is poorly understood but seems to be related to metabolic and electrochemical factors at the cellular level. drug toxicity. a. But the risk lessens with time and attacks should not occur after the age of about five. Generalized seizures ± manifest a loss of consciousness with convulsive or nonconvulsive behaviors and include tonic-clonic. hyponatremia. circulating disorders. Simple partial seizures ± manifest motor. If your child has suffered febrile convulsion in the past. c.

3. May be preceded by an aura such as a peculiar sensation or dizziness. neck. b. Assessment: 1. jerky contraction and relaxation of all muscles in clonic phase with incontinence and frothing at the lips. c. lasts 30 to 60 seconds. sudden. and complex partial seizures can secondarily become generalized. lasts several minutes. May cause children to drop or throw something. Infant may cry out. spreads arms out. grunt. laugh. Mixed flexor and extensor types may occur in clusters or alternate. and several seizure types are particular to children. e. may bite tongue or cheek. Seen in children or infants. Sleeping or dazed postictal state for up to several hours. but child may develop other types of seizures. forceful contractions of the muscles of the trunk.y y Simple partial seizures can progress to complex partial seizures. c. Rhythmic. Loss of contact with environment for 5 to 30 seconds. b. b. bend body backward in ³spread eagle´ position. Extensor type ± infant extends head. Resumes activity and is not aware of seizure. grimace. c. Seizures affect all ages. Rigid muscle contraction in tonic phase which clenched jaw and hands. nod head. g. Brief. f. or smack lips. move hands. d. Most cases of epilepsy are identified in childhood. 4. 2. or appear fearful during an attack. Appears to be day dreaming or may roll eyes. often with mental retardation. Partial (focal) motor seizure . Absence ( petit mal) seizure a. then sudden onset of seizure with loss of consciousness. caused by cerebral pathology. and extremities. d. Myoclonic seizure (infantile spasm) a. eyes open with pupils dilated. Infantile spasms usually disappear by age 4. Generalized tonic-clonic (grand mal) seizure a.

4. Generalized tonic-clonic seizure with fever over 101. or olfactory sensation. Partial (focal) somatosensory seizure a. Complex partial seizures ± begin as partial seizures and progress to impairment of consciousness or impaired consciousness at onset. taste. déjà vu feeling. spread. b. Single photon emission CT scanning (SPECT) or positron emission tomography (PET) identifies seizure foci. Occurs in children younger than age 5. b. 2. and toxicity screen determine the cause of first seizure. d. treat source of fever. Lasts seconds to minutes. c. locates epileptic focus. and control seizure. Auditory or visual hallucinations. auditory. known as jacksonian seizure. Long-term treatment to prevent recurrent seizures with fever is controversial. 5. intensity. d. such as picking at clothes.8 degrees Fahrenheit. . Serum electrolytes. chewing. Diagnostic Evaluation: 1. and grimacing. May spread to involve entire limb. with or without video monitoring. Partial psychomotor (temporal lobe) seizure a. Rhythmic twitching of muscle group. b. glucose. May also be visual. May be aura of abdominal discomfort or bad odor or taste. 7.a. Febrile seizure a. 3. 5. helps classify seizure type. 8. Repetitive purposeless movements (automatisms) may occur. 6. Numbness and tingling in a part of the body. c. or sense of fear or anxiety. smacking lips. b. Lumbar puncture and blood cultures may be necessary if fever is present. other extremities and face on that side. Neuropsychological studies evaluate for behavioral disturbances. Treatment is to decrease temperature. and duration. CT scanning or MRI identifies lesion that may cause of seizure. usually hand or face. 6. EEG.

7. leukopenia. = A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly. 12. such as skipped meals. lack of sleep. thrombocytopenia. urinalysis. Do not put anything in the patient¶s mouth during seizure. not all epileptic seizures lead to convulsions. and postictal state. and not all convulsions are caused by epileptic seizures. medical check ups. Nursing Interventions: 1. 3. Place the patient on side during a seizure to prevent aspiration. A wide variety of adverse reactions may occur. skin rash. Do not restrain the patient during seizure. including prodromal signs. mental activity. Temporal lobectomy. 2. Place the bed in low position. corpus callosotomy. 4. and nutritious diet. 9. Encourage the patient to determine existence of triggering factors for seizures. ataxia. 10. see non-epileptic seizures. Surgical treatment of brain tumor or hematoma may relieve seizures caused by these. 14. 13. Provide oxygen during the seizure if the patient become cyanotic. Maintain a patent airway until the patient is fully awake after a seizure. and reduce adverse effects. 6. including hepatic and renal dysfunction. drowsiness. resulting in an uncontrolled shaking of the body. psychotic symptoms. Monitor complete blood count. Antiepileptic drugs (AEDs) may be used singly or in combination to increase effectiveness. 5. Provide safe environment by padding side rails and removing clutter. For non-epileptic convulsions. treat mixed seizure types.[1] Because a convulsion is often a symptom of an epileptic seizure. stomach upset. Remind the family the importance of following medication regimen and maintaining regular laboratory testing. vision disturbances. Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to sedation. and emotional stress. including exercise. However. and visual examinations. Teach stress reduction techniques that will fit into the patient¶s lifestyle. or hemispherectomy may be necessary in medically intractable seizure disorders. 2. the term convulsion is sometimes used as a synonym for seizure. 2.Pharmacologic Interventions: 1. 11. anemia. and liver function studies for toxicity caused by medications. . Monitor the entire seizure event. 15. Surgical Interventions: 1. 8. and idiosyncratic reactions. Convulsions are also consistent with an electric shock. Encourage patient to follow a moderate lifestyle routine. seizure behavior. Protect the patient¶s head during the seizure. extratemporal resection.

Sometimes it is not accompanied by convulsions but a full body "slump". Difficult-to-manage epilepsy may require consultation with an epileptologist. unprovoked seizures is termed epilepsy. but seizures can occur in people who do not have epilepsy. tonic or clonic movements.[2][3] Treatment may reduce the chance of a second one by as much as half. occasionally referred to as a fit.- An epileptic seizure. convulsions. About 4% of people will have an unprovoked seizure by the age of 80 and the chance of experiencing a second seizure is between 30% and 50%. It can manifest as an alteration in mental state. Contents [hide] y y y y y y y y y y y 1 Classification 2 Signs and symptoms 3 Causes 4 Diagnosis o 4.1 Medication o 5. is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain".1 Physical examination o 4. and various other psychic symptoms (such as déjà vu or jamais vu).4 Determining the underlying cause o 4. a neurologist with an interest in epilepsy.2 Serum prolactin level o 4.3 EEG o 4. The medical syndrome of recurrent.5 Differential 5 Management o 5. see non-epileptic seizure. whereas investigation and management of ongoing epilepsy is usually done by neurologists.[1] The outward effect can be as dramatic as a wild thrashing movement (tonic-clonic seizure) or as mild as a brief loss of awareness. where the person simply will lose control of their body and slump to the ground.2 Other 6 Prognosis 7 Epidemiology 8 History 9 See also 10 References 11 External links [edit] Classification .[3] Most single episode seizures are managed by primary care physicians (emergency or general practitioners). For more information.

then it is a simple partial seizure. outdated terms such as "petit mal". there is typically a period referred to as postictal before a normal level of consciousness returns. [edit] Signs and symptoms The signs and symptoms of seizures vary depending on the type. awareness. Therefore seizures are typically classified as motor. psychogenic nonepileptic seizures are rare between midnight and 6 a m. lose consciousness and fall to the ground. and "temporal-lobe seizure" have fallen into disuse. Seizures are often associated with a sudden and involuntary contraction of a group of muscles and loss of consciousness. the full onset of a seizure event is preceded by some of the sensations described above. and never occur during sleep. These warning sensations are cumulatively called an aura and are due to a focal seizure. "grand mal". Partial and frontal seizures and focal epileptic discharges tend to happen more during sleep than during wakefulness. A partial seizure may spread within the brain²a process known as secondary generalization. A seizure can last from a few seconds to status epilepticus. but all involve loss of consciousness. "Jacksonian". a strange epigastric sensation. If consciousness is unaffected.or focal-onset seizures) or distributed (generalized seizures). Generalized seizures are divided according to the effect on the body. and convulse. and atonic seizures. myoclonic. visual changes. Some symptoms experienced by the person before a seizure may include dizziness.[4] Following standardization proposals published[by whom?] in 1970. autonomic. tonic±clonic. A mixed seizure is defined as the existence of both generalized and partial seizures in the same patient. otherwise it is a complex partial seizure. a seizure can also be as subtle as a fleeting numbness of a part of the body. emotional or cognitive.[5] Some patients are able to tell when a seizure is about to happen. a continuous group of seizures that is often lifethreatening without immediate intervention. sensory.Main article: Seizure types Clinicians organize different types of seizure according to whether the source of the seizure within the brain is localized (partial. often violently. These include absence. and some experience things in slow-motion just prior to the seizure. Some people have seizures that are not noticeable to . In contrast. sensation. tightening of the chest. or a sensation of fear and total state of confusion. tonic. After the active portion of a seizure. Partial seizures are further divided on the extent to which consciousness is affected (simple partial seizures and complex partial seizures). sensing/discharging of an unpleasant odor.[5] Seizures may cause involuntary changes in body movement or function. a brief or long term loss of memory. called vertiginous epilepsy. or behavior. lightheadedness. However. "psychomotor". clonic. Symptoms experienced by a person during a seizure depend on where in the brain the disturbance in electrical activity occurs. A person having a complex partial seizure may appear confused or dazed and will not be able to respond to questions or direction.[5] In some cases. These sensations can serve as a warning to that a generalized tonic±clonic seizure is about to occur.[7] A person having a tonic±clonic seizure may cry out.[6] Generalized epilepsy but not focal epilepsy is higher in the morning probably reflecting a diurnal variation in cortical excitability.

Many seizures have unknown causes.others. hyponatremia or hypoxia withdrawal from drugs (anticonvulsants. extreme confusion for a few seconds or sometimes into hours. and benzodiazepines. and brain hemorrhages. and on EEG testing. An MRI can quickly confirm or reject this as a cause. such as encephalitis or meningitis fever leading to febrile convulsions (but see above) metabolic disturbances. is more likely to be accompanied by seizures than other types of stroke multiple sclerosis sufferers may rarely experience seizures Some medications produce an increased risk of seizures and electroconvulsive therapy (ECT) deliberately sets out to induce a seizure for the treatment of major depression. binaural beat brainwave entrainment may trigger seizures in both epileptics and nonepileptics[dubious discuss] haemorrhagic stroke can occasionally present with seizures. in which the seizures chronically recur. a rare type of stroke. Seizures which are provoked are not associated with epilepsy. and brain hemorrhages. head injury may cause non-epileptic post-traumatic seizures or post-traumatic epilepsy. Seizures can occur after a subject witnesses a traumatic event. intoxication with drugs. arteriovenous malformation (AVM) is a treatable medical condition that can cause seizures. the seizures described above resemble those of epilepsy both outwardly.[citation needed] [edit] Causes Main article: Seizure trigger Unprovoked seizures are often associated with epilepsy and related seizure disorders. Causes of provoked seizures include: y y y y y y y y y y y y y y y y sleep deprivation cavernoma or cavernous malformation is a treatable medical condition that can cause seizures. embolic strokes generally do not (though epilepsy is a common later complication). antidepressants. This type of seizure is known as a psychogenic non-epileptic seizure and is related to posttraumatic stress disorder. However. Sometimes. barbiturates. such as hypoglycaemia. tumors) seizures during (or shortly after) pregnancy can be a sign of eclampsia. seizures in a person with hydrocephalus may indicate severe shunt failure.) space-occupying lesions in the brain (abscesses. . An MRI can quickly confirm or reject this as a cause. and people who experience such seizures are normally not diagnosed with epilepsy. cerebral venous sinus thrombosis. the only clue that a person is having an absence seizure is rapid blinking. and sedatives such as alcohol. headaches. headaches. for example aminophylline or local anaesthetics normal doses of certain drugs that lower the seizure threshold. such as tricyclic antidepressants infection.

[9] A 2007 review recommends an electroencephalogram and brain imaging with CT scan or MRI scan in the work-up. 3.[8] It is important to distinguish primary epileptic seizures from secondary causes. SN = 0.87)). SP = 0.[11] [edit] Serum prolactin level Two meta-analyses have quantified the role of an elevated serum prolactin. The first metaanalysis found that[12]: "If a serum prolactin concentration is greater than three times the baseline when taken within one hour of syncope.60 (95% CI (1." 2. the patient is nine times more likely to have suffered a GTCS as compared with a pseudoseizure positive LR = 8. five times more likely to have suffered a GTCS as compared with non-convulsive syncope positive LR 4. meningitis or drug overdose. then in the absence of test "modifiers": 1.92 (95% CI (1. but there is insufficient evidence to support their routine use in the work-up of an adult with an apparently unprovoked first seizure. A small study found that finding a bite to the side of the tongue was very helpful when present: while only a quarter of those with seizures had such a bite (sensitivity of 24%). when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event. is a useful adjunct for the differentiation of generalized tonicclonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B).40 to 0. repetitive seizures. SN = 0.71 (95% CI (0." The serum prolactin level is less sensitive for detecting partial seizures. SP = 0.[10] MRI is more sensitive in a first apparently unprovoked seizure.49 to 0.98)) 2.89 (95% CI (0. In this state they are drowsy and often confused. with only 1% due to other causes (specificity of 99%).60 to 0.85 (95% CI (0. lumbar puncture or toxicology screening can be helpful in specific circumstances suggestive of an underlying cause like alcohol or benzodiazepine withdrawal.31 to 60. "Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B).98)). " The second meta-analysis found:[13] 1.[edit] Diagnosis Only about 25 percent of people who have a seizure or develop status epilepticus have epilepsy. [edit] Physical examination Most patients are in a postictal state following a seizure. "Elevated serum prolactin assay.[14] . "The use of serum PRL assay has not been established in the evaluation of status" epilepticus.90)).62 (95% CI (0.55 to 0. Blood tests. the finding was very specific for seizures.25 to 16. and neonatal seizures (Level U).83)).91)). There may be signs of other injuries.

These may show structural lesions within the brain and heart. they should be placed in the recovery position.[10] Ongoing medication is not typically needed after a first seizure and is generally only recommended after a second has occurred or those with structural lesions in the brain. and failure to administer glucose would be harmful to the patient. [edit] Differential Differentiating an epileptic seizure from other conditions such as syncope can be difficult. as well as help identify causes of seizures. In addition.[5] [edit] Management Potentially sharp or dangerous objects should also be moved from the vicinity. [edit] Determining the underlying cause Additional diagnostic methods include CT Scanning and MRI imaging or angiography. for example. psychogenic seizures. Checking glucose levels. dystonia. barbiturates or propofol may be used. and strychnine poisoning. Other causes typically considered are syncope and cardiac arrhythmias. Caregivers may carry medicine. They can identify background epileptogenic activity. migraine headaches. but the majority of those with epilepsy show nothing unusual. [edit] Medication The treatment of choice for someone who is actively seizing is lorazepam.[10] This may be repeated if there is no effect after 10 minutes. is a mandatory action in the management of seizures as hypoglycemia may cause seizures.[10] . After the seizure if the person is not fully conscious and alert. see non-epileptic seizures. As seizures have a broad differential diagnosis. so that the individual is not hurt.[edit] EEG An isolated abnormal electrical activity recorded by an electroencephalography examination without a clinical presentation is called subclinical seizure. A seizure longer than five minutes is a medical emergency. it is common for patients to be simultaneously investigated for cardiac and endocrine causes. 5% of patients with a positive tilt table test may have seizure-like activity that seems to be due to cerebral hypoxia.[15] For more information.[10] If there is no effect after two doses. and occasionally panic attacks and cataplexy.[5] Other possible conditions that can mimic a seizure include: decerebrate posturing.

[edit] Other A seizure response dog can be trained to summon help or ensure personal safety when a seizure occurs. Rarely. . a dog may develop the ability to sense a seizure before it occurs.[16] Helmets may be used to provide protection of the head during a seizure. These are not suitable for everybody.

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