Title:Febrile Seizures: An Updated Narrative Review for Pediatric Ambulatory
Care Providers
Volume: 20
Issue: 1
Author(s): James Sze-Chuck Leung*
Affiliation:
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario,
Canada
Keywords:
Febrile seizures, febrile convulsions, status epilepticus, prognosis, counseling, recurrence, epilepsy.
Abstract:
Background: While generally self-limited, febrile seizures result in significant familial
distress. Ambulatory pediatric care providers must be prepared to counsel families on the causes,
risk factors, management principles, and prognosis of children with febrile seizures.
Objective: To provide an updated, evidence-based review of febrile seizures focused on the needs of
an ambulatory pediatric care provider.
Methods: A narrative review of the literature prioritizing landmark articles, metanalyses, longitudinal
population longitudinal cohort studies and national level guidelines.
Results: Febrile seizures are aberrant physiological responses to fever in children caused by complex
interactions of cytokine mediated neuroinflammation, environmental triggers, and genetic predisposition.
Other than investigations to determine fever etiology, routine bloodwork, lumbar punctures,
neuroimaging and electroencephalograms are low yield. The general prognosis is excellent,
however, clinicians should be aware of long-term outcomes including: cognitive impairment with
non-simple febrile seizures; neuropsychiatric associations; recurrent febrile seizure and epilepsy
risk factors; and the association between complex febrile seizures and sudden unexpected death.
Children with a high risk of recurrence, complex febrile seizures, limited access to care, or extreme
parental anxiety may benefit from intermittent oral diazepam prophylaxis.
Conclusion: Clinicians should consider four management priorities: 1) terminating the seizure; 2)
excluding critical differential diagnoses; 3) investigating fever etiology; and 4) providing adequate
counselling to families. The clinical approach and prognosis of febrile seizure can be based on subtype.
Children with non-simple (i.e. complex or febrile status epilepticus) febrile seizures require
closer care than the vast majority of children with simple febrile seizures, who have excellent outcomes.
