Journal of Clinical Outcomes Management. 2017 July;24(7)
References
It is unclear whether benefit is present to using intermittent benzodiazepine doses prior or during a febrile illness for those prone for recurrent febrile seizures [33]. Physicians may consider this option in patients with frequent recurrent seizures, when caregivers can identify the fever before the seizure occurs.
Overall, parental education of efficacy and side effect profiles should be discussed in detail when considering any treatment options for complex febrile seizures [34]. It is important to remember that the long-term prognosis in terms of developing epilepsy or neurological and cognitive problems is not influenced by the use of antiepileptic medications for recurrent febrile seizures [17]. Even in the case of prolonged febrile seizures in otherwise neurodevelopmentally normal children, antiepileptics have not been shown to cause damage to the brain [19].
Febrile Status Epilepticus
Febrile status epilepticus is a subtype of complex febrile seizures and is defined as a febrile seizure lasting greater than 30 minutes. Overall, febrile status epilepticus accounts for approximately 5% of all presentations of febrile seizures [35]. It represents about 25% of all episodes of childhood status epilepticus and more than two-thirds of cases during the first 2 years of life. Literature suggests that an increased risk for focal epilepsy exists [36]. Children presenting with febrile status epilepticus are more likely to have a family history of epilepsy and a history of a previous neurological abnormality [22]. It is likely to reoccur if the first presentation was febrile status epilepticus. However, increased risk for death or developmental disability as a result of the seizure is not seen [37].
The prospective multicenter study of the consequences of prolonged febrile seizures in childhood (FEBSTAT) has been conducted. The study reported that febrile status epilepticus is usually focal (67% of episodes), occurs in very young children (median age 1.3 years), and is frequently the first febrile seizure [22]. In this study, the median duration of the seizure was about 68 minutes and 24% of children had an episode lasting more than 2 hours. In 87% of the events, seizures did not stop spontaneously and benzodiazepines were needed. Focal features observed were eye and head deviation, staring, and impaired consciousness prior to the seizure and an asymmetric convulsion or Todd’s paresis.
Case 3: Epilepsy Syndromes Associated With Febrile Seizures
A 1-year-old female presents for evaluation of seizures that began at age 8 months. Seizures are described as occurring in the setting of fever with bilateral symmetric tonic clonic activity lasting durations of less than 10 minutes on average, but at least 2 instances of seizure lasting 20 minutes or more. The family notes that seizures have occurred almost every time the child has had a febrile illness and often cluster over several days. They report at least 1 seizure that occurred in the absence of fever. Development has been normal to date and an EEG done by their primary provider was also normal.
What epilepsy syndromes are associated with febrile seizures?
While febrile seizures represent a benign and infrequent type of seizure in the majority of patients, rare circumstances exists for which febrile seizures represent the first symptom of an epilepsy syndrome. The severity of these syndromes can vary from milder phenotypes of Genetic Epilepsy with Febrile Seizures Plus syndrome (GEFS+) to the more devastating epileptic encephalopathy of Dravet syndrome. Recognizing the early signs and symptoms of these disorders, particularly the more severe phenotypes, is essential to avoid misdiagnosis and misleading reassurance. Likewise, early recognition of many of these syndromes may alter the treatment paradigm which in turn may impact outcome. The sections below provide an overview of the most common epilepsy syndromes for which febrile seizures are a central and often initial symptom of the disorder ( Table
