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Published in: Child's Nervous System 11/2013

01-11-2013 | Review Paper

Febrile seizures: recent developments and unanswered questions

Authors: Efterpi Pavlidou, Christian Hagel, Christos Panteliadis

Published in: Child's Nervous System | Issue 11/2013

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Abstract

Background

Febrile seizures (FS) are typically observed in infants and children affecting 2–5 % of the pediatric population and are the commonest seizures in childhood.

Objectives

The present review summarizes epidemiology, etiology, clinical picture, and diagnostic procedures as well as the therapeutic options and the different courses this disorder may take.

Method

An extensive review of literature is performed, while views and aspects towards the pathogenesis of FS are stated. Risk factors for multiple recurrences of FS and for subsequent epilepsy are analyzed. Questions regarding the treatment and follow-up of children with FS are answered.

Results

Whereas the frequency of epilepsy following simple FS is estimated to be 1.0–2.2 % of patients, and thus does not differ from the risk of normal population, complicated FS are associated with an increased risk of subsequent epilepsy in 4.1–6.0 %. Febrile status epilepticus with focal symptoms may result in approximately 5 % of cases in complex partial epilepsy. Furthermore, multiple recurrences increase the risk for generalized epilepsy (>4 %). The immediate management of FS, intermittent prophylaxis, and the effectiveness of the treatment in combination with antipyretics are presented in detail.

Conclusion

FS can cause a great anxiety and even panic to parents and to the whole family. Parents should be educated about the benign condition and the good prognosis. Although much information has been gained, much remains to be learned.
Literature
1.
go back to reference Willis T (1684) Doctor Willis's practice of physic. Harper & Leigh, London Willis T (1684) Doctor Willis's practice of physic. Harper & Leigh, London
2.
go back to reference Lennox MA (1949) Febrile convulsions in childhood; a clinical and electroencephalographic study. Am J Dis Child 78:868–882PubMedCrossRef Lennox MA (1949) Febrile convulsions in childhood; a clinical and electroencephalographic study. Am J Dis Child 78:868–882PubMedCrossRef
3.
go back to reference Bridge EM (1949) Epilepsy and convulsive disorders in children. McGraw-Hill, New York Bridge EM (1949) Epilepsy and convulsive disorders in children. McGraw-Hill, New York
4.
go back to reference Livingston S (1958) Convulsive disorders in infants and children. Adv Pediatr 10:113–195 Livingston S (1958) Convulsive disorders in infants and children. Adv Pediatr 10:113–195
5.
go back to reference Commission on Epidemiology and Prognosis, International League Against Epilepsy (1993) Guidelines for epidemiologic studies on epilepsy. Epilepsia 34:592–596CrossRef Commission on Epidemiology and Prognosis, International League Against Epilepsy (1993) Guidelines for epidemiologic studies on epilepsy. Epilepsia 34:592–596CrossRef
7.
go back to reference Pavlidou E (2007) Prospective study of febrile seizures: prognostic factors for subsequent epilepsy. Dissertation, Medical School of Aristotle University of Thessaloniki, Greece Pavlidou E (2007) Prospective study of febrile seizures: prognostic factors for subsequent epilepsy. Dissertation, Medical School of Aristotle University of Thessaloniki, Greece
8.
go back to reference Berg AT, Shinnar S, Darefsky HT, Shapiro E, Salomon M, Crain E, Hauser E (1997) Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med 151:371–378PubMedCrossRef Berg AT, Shinnar S, Darefsky HT, Shapiro E, Salomon M, Crain E, Hauser E (1997) Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med 151:371–378PubMedCrossRef
9.
go back to reference Tsuboi T, Endo S, Ιida N (1991) Long-term follow-up of a febrile convulsion cohort. Acta Neurol Scand 84:369–373PubMedCrossRef Tsuboi T, Endo S, Ιida N (1991) Long-term follow-up of a febrile convulsion cohort. Acta Neurol Scand 84:369–373PubMedCrossRef
10.
go back to reference Berg AT, Shinnar S (1996) Unprovoked seizures in children with febrile seizures: short-term outcome. Neurology 47:562–568PubMedCrossRef Berg AT, Shinnar S (1996) Unprovoked seizures in children with febrile seizures: short-term outcome. Neurology 47:562–568PubMedCrossRef
11.
go back to reference Adinolfi M (1985) The development of the human blood–CSF–brain barrier. Dev Med Child Neurol 27:532–537PubMedCrossRef Adinolfi M (1985) The development of the human blood–CSF–brain barrier. Dev Med Child Neurol 27:532–537PubMedCrossRef
12.
go back to reference Chang YC, Huang CC, Huang SC (2008) Long-term neuroplasticity effects of febrile seizures in the developing brain. Chang Gung Med J 31:125–135PubMed Chang YC, Huang CC, Huang SC (2008) Long-term neuroplasticity effects of febrile seizures in the developing brain. Chang Gung Med J 31:125–135PubMed
13.
go back to reference Ben-Ari Y (2006) Basic developmental rules and their implications for epilepsy in the immature brain. Epileptic Disord 8:91–102PubMed Ben-Ari Y (2006) Basic developmental rules and their implications for epilepsy in the immature brain. Epileptic Disord 8:91–102PubMed
14.
go back to reference Hauser WA, Annegers JF, Anderson VE, Kurland LT (1985) The risk of seizure disorders among relatives of children with febrile convulsions. Neurology 35:1268–1273PubMedCrossRef Hauser WA, Annegers JF, Anderson VE, Kurland LT (1985) The risk of seizure disorders among relatives of children with febrile convulsions. Neurology 35:1268–1273PubMedCrossRef
15.
go back to reference Waruiru C, Appleton R (2004) Febrile seizures: an update. Arch Dis Child 284:751–756CrossRef Waruiru C, Appleton R (2004) Febrile seizures: an update. Arch Dis Child 284:751–756CrossRef
16.
go back to reference Audenaert D, Van Broeckhoven C, De Jonghe P (2006) Genes and loci involved in febrile seizures and related epilepsy syndromes. Hum Mutat 27:391–401PubMedCrossRef Audenaert D, Van Broeckhoven C, De Jonghe P (2006) Genes and loci involved in febrile seizures and related epilepsy syndromes. Hum Mutat 27:391–401PubMedCrossRef
17.
go back to reference Kang JQ, Shen W, MacDonald RL (2006) Why does fever trigger febrile seizures? GABA receptor gamma2 subunit mutations associated with idiopathic generalized epilepsies have temperature-dependent trafficking deficiencies. J Neurosci 26:2590–2597PubMedCrossRef Kang JQ, Shen W, MacDonald RL (2006) Why does fever trigger febrile seizures? GABA receptor gamma2 subunit mutations associated with idiopathic generalized epilepsies have temperature-dependent trafficking deficiencies. J Neurosci 26:2590–2597PubMedCrossRef
18.
go back to reference Kira R, Ishizaki Y, Torisu H (2010) Genetic susceptibility to febrile seizures: case–control association studies. Brain Dev 32:57–63PubMedCrossRef Kira R, Ishizaki Y, Torisu H (2010) Genetic susceptibility to febrile seizures: case–control association studies. Brain Dev 32:57–63PubMedCrossRef
19.
go back to reference Dube C, Vezzani A, Behrens M, Bartfai T, Baram TZ (2005) Interleukin-1beta contributes to the generation of experimental febrile seizures. Ann Neurol 57:152–155PubMedCrossRef Dube C, Vezzani A, Behrens M, Bartfai T, Baram TZ (2005) Interleukin-1beta contributes to the generation of experimental febrile seizures. Ann Neurol 57:152–155PubMedCrossRef
20.
go back to reference Fukuda M, Suzuki Y, Ishizaki Y, Kira R, Kikuchi C, Watanabe S, Hino H, Morimoto T, Hara T, Ishii E (2009) Interleukin-1beta enhances susceptibility to hyperthermia-induced seizures in developing rats. Seizure 18:211–214PubMedCrossRef Fukuda M, Suzuki Y, Ishizaki Y, Kira R, Kikuchi C, Watanabe S, Hino H, Morimoto T, Hara T, Ishii E (2009) Interleukin-1beta enhances susceptibility to hyperthermia-induced seizures in developing rats. Seizure 18:211–214PubMedCrossRef
21.
go back to reference Reid AY, Galic MA, Teskey GC, Pittman QJ (2009) Febrile seizures: current views and investigations. Can J Neurol Sci 36:679–686PubMed Reid AY, Galic MA, Teskey GC, Pittman QJ (2009) Febrile seizures: current views and investigations. Can J Neurol Sci 36:679–686PubMed
22.
23.
go back to reference Visser AM, Jaddoe VW, Hofman A, Moll HA, Steegers EA, Tiemeier H, Raat H, Breteler MM, Arts WF (2010) Fetal growth retardation and risk of febrile seizures. Pediatrics 126:e919–e925PubMedCrossRef Visser AM, Jaddoe VW, Hofman A, Moll HA, Steegers EA, Tiemeier H, Raat H, Breteler MM, Arts WF (2010) Fetal growth retardation and risk of febrile seizures. Pediatrics 126:e919–e925PubMedCrossRef
24.
go back to reference Verity CM, Golding J (1991) Risk of epilepsy after febrile convulsions: a national conhort study. Br Med J 303:1373–1376CrossRef Verity CM, Golding J (1991) Risk of epilepsy after febrile convulsions: a national conhort study. Br Med J 303:1373–1376CrossRef
25.
go back to reference Vestergaard M, Pedersen C, Sidenius P, Olsen J, Christensen J (2007) The long-term risk of epilepsy after febrile seizures in susceptible groups. Am J Epidemiol 165:911–918PubMedCrossRef Vestergaard M, Pedersen C, Sidenius P, Olsen J, Christensen J (2007) The long-term risk of epilepsy after febrile seizures in susceptible groups. Am J Epidemiol 165:911–918PubMedCrossRef
27.
go back to reference Rantala H, Tarkka R, Uhari M (1997) A meta-analytic review of the preventive treatment of recurrences of febrile seizures. J Pediatr 131:922–925PubMedCrossRef Rantala H, Tarkka R, Uhari M (1997) A meta-analytic review of the preventive treatment of recurrences of febrile seizures. J Pediatr 131:922–925PubMedCrossRef
29.
go back to reference Pavlidou E, Tzitiridou M, Kontopoulos E, Panteliadis C (2008) Which factors determine febrile seizure recurrence? A prospective study. Brain Dev 30:7–13PubMedCrossRef Pavlidou E, Tzitiridou M, Kontopoulos E, Panteliadis C (2008) Which factors determine febrile seizure recurrence? A prospective study. Brain Dev 30:7–13PubMedCrossRef
30.
go back to reference Offringa M, Bossuyt PM, Lubsen J, Lubsen J, Ellenberg JH, Nelson KB, Knudsen FU, Annegers JF, el-Radhi AS, Habbema JD, Derksen-Lubsen G et al (1994) Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr 124:574–584PubMedCrossRef Offringa M, Bossuyt PM, Lubsen J, Lubsen J, Ellenberg JH, Nelson KB, Knudsen FU, Annegers JF, el-Radhi AS, Habbema JD, Derksen-Lubsen G et al (1994) Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr 124:574–584PubMedCrossRef
31.
go back to reference Abou-Khalil B, Krei L, Lazenby B, Harris PA, Haines JL, Hedera P (2007) Familial genetic predisposition, epilepsy localization and antecedent febrile seizures. Epilepsy Res 73:104–110PubMedCrossRef Abou-Khalil B, Krei L, Lazenby B, Harris PA, Haines JL, Hedera P (2007) Familial genetic predisposition, epilepsy localization and antecedent febrile seizures. Epilepsy Res 73:104–110PubMedCrossRef
32.
go back to reference Ahmad S, Marsh ED (2010) Febrile status epilepticus: current state of clinical and basic research. Semin Pediatr Neurol 17:150–154PubMedCrossRef Ahmad S, Marsh ED (2010) Febrile status epilepticus: current state of clinical and basic research. Semin Pediatr Neurol 17:150–154PubMedCrossRef
33.
go back to reference Tzitiridou M (2003) The effect of long-term anti-epileptic treatment on cognitive function of children. Dissertation, Medical School Aristotle University of Thessaloniki, Greece Tzitiridou M (2003) The effect of long-term anti-epileptic treatment on cognitive function of children. Dissertation, Medical School Aristotle University of Thessaloniki, Greece
34.
go back to reference Dravet C, Bureau M, Oguni H, Fukuyama Y, Cokar O (2005) Severe myoclonic epilepsy in infancy: Dravet syndrome. Adv Neurol 95:71–102PubMed Dravet C, Bureau M, Oguni H, Fukuyama Y, Cokar O (2005) Severe myoclonic epilepsy in infancy: Dravet syndrome. Adv Neurol 95:71–102PubMed
35.
go back to reference Scheffer IE, Bercovic SF (1997) Generalized epilepsy with febrile seizures plus. A genetic disorder with heterogeneous clinical phenotypes. Brain 120:479–490PubMedCrossRef Scheffer IE, Bercovic SF (1997) Generalized epilepsy with febrile seizures plus. A genetic disorder with heterogeneous clinical phenotypes. Brain 120:479–490PubMedCrossRef
36.
go back to reference Shinnar S, Hersdorffer DC, Nordli DR Jr, Pellock JM, O'Dell C, Lewis DV, Frank LM, Moshé SL, Epstein LG, Marmarou A, Bagiella E, FEBSTAT Study Team et al (2008) Phenomenology of prolonged febrile seizures: results of the FEBSTAT study. Neurology 71:170–176PubMedCrossRef Shinnar S, Hersdorffer DC, Nordli DR Jr, Pellock JM, O'Dell C, Lewis DV, Frank LM, Moshé SL, Epstein LG, Marmarou A, Bagiella E, FEBSTAT Study Team et al (2008) Phenomenology of prolonged febrile seizures: results of the FEBSTAT study. Neurology 71:170–176PubMedCrossRef
37.
go back to reference Nordli DR, Moshé SL, Shinnar S (2010) The role of EEG in febrile status epilepticus (FSE). Brain Dev 32:37–41PubMedCrossRef Nordli DR, Moshé SL, Shinnar S (2010) The role of EEG in febrile status epilepticus (FSE). Brain Dev 32:37–41PubMedCrossRef
38.
go back to reference Subcommittee on Febrile Seizures (2011) Clinical practice guideline-febrile seizures: guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 127:389–394CrossRef Subcommittee on Febrile Seizures (2011) Clinical practice guideline-febrile seizures: guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 127:389–394CrossRef
39.
go back to reference Capovilla G, Mastrangelo M, Romeo A, Vigevano F (2009) Recommendations for the management of “febrile seizures”. Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia 50:2–6PubMedCrossRef Capovilla G, Mastrangelo M, Romeo A, Vigevano F (2009) Recommendations for the management of “febrile seizures”. Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia 50:2–6PubMedCrossRef
40.
go back to reference Batra P, Gupta S, Gomber S, Saha A (2011) Predictors of meningitis in children presenting with first febrile seizures. Pediatr Neurol 44:35–39PubMedCrossRef Batra P, Gupta S, Gomber S, Saha A (2011) Predictors of meningitis in children presenting with first febrile seizures. Pediatr Neurol 44:35–39PubMedCrossRef
41.
go back to reference Uhari M, Rantala H, Vainionpaa L, Kurtilla R, (1995) Effect of acetaminophen and of low intermittent doses of diazepam on prevention of febrile seizures. J Pediatr 126:991–995PubMedCrossRef Uhari M, Rantala H, Vainionpaa L, Kurtilla R, (1995) Effect of acetaminophen and of low intermittent doses of diazepam on prevention of febrile seizures. J Pediatr 126:991–995PubMedCrossRef
42.
go back to reference Pavlidou E, Tzitiridou M, Panteliadis C (2006) Effectiveness of intermittent diazepam prophylaxis in febrile seizures: long-term prospective controlled study. J Child Neurol 21:1036–1040PubMedCrossRef Pavlidou E, Tzitiridou M, Panteliadis C (2006) Effectiveness of intermittent diazepam prophylaxis in febrile seizures: long-term prospective controlled study. J Child Neurol 21:1036–1040PubMedCrossRef
43.
go back to reference American Academy of Pediatrics (2008) Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics 121:1281–1286CrossRef American Academy of Pediatrics (2008) Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics 121:1281–1286CrossRef
44.
go back to reference Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, Rantala H (2009) Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 163:799–804PubMedCrossRef Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, Rantala H (2009) Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 163:799–804PubMedCrossRef
Metadata
Title
Febrile seizures: recent developments and unanswered questions
Authors
Efterpi Pavlidou
Christian Hagel
Christos Panteliadis
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 11/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-013-2224-3

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