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Seizures occurring in children aged 6 months to 6 years, triggered by fever, without underlying epilepsy or CNS infection.
Seizures occurring in children aged 6 months to 6 years, triggered by fever, without underlying epilepsy or CNS infection.
Risk Factors
Age (6 months to 6 years)
Family history of febrile seizures
Rapid rise in temperature
Viral infections (e.g. influenza, HHV-6, adenovirus)
Post-vaccination fevers (e.g. MMR)
Aetiology
Immature CNS more susceptible to fever-induced neuronal hyperexcitability
Fever acts as a trigger, not a direct cause of seizure
Often associated with benign viral illness
Pathophysiology
Fever → neuronal instability → generalised tonic-clonic seizure
No structural brain abnormality
No long-term effect on neurodevelopment
Diagnosis
Types
Simple: generalised, <15 min, no recurrence in 24 hrs, normal neuro exam
Complex: focal features, >15 min, or >1 seizure in 24 hrs
Clinical diagnosis
Witnessed seizure with fever in correct age range
Exclude CNS infection (meningitis, encephalitis) – especially if <12 months, focal features, or prolonged postictal period
Normal exam post-ictally
Differential Diagnosis
Meningitis/encephalitis
Epilepsy
Hypoglycaemia
Trauma
Breath-holding spells
Investigations
Usually none for simple febrile seizures
If signs of CNS infection – LP
FBC/CRP if infection suspected
Blood glucose to exclude hypoglycaemia
EEG and MRI not routinely indicated
Management
Supportive – ensure airway safety during seizure
Antipyretics for comfort (do not prevent seizures)
If seizure >5 min – give benzodiazepine (e.g. midazolam)
Education and reassurance to family
Rectal diazepam or buccal midazolam for prolonged/future seizures
Complications & Prognosis
Excellent prognosis – most children outgrow by age 6
Slightly increased risk of epilepsy (~2-4%)
Recurrence risk: 30% after 1st seizure, 50% after 2nd
No cognitive impairment from simple febrile seizures
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