Seizures accompanied by fever in children between one month and six years of age who do not have a central nervous system infection and an identified cause are called febrile seizures or febrile seizures(Febrile Convulsion).
The frequency varies between societies. may differ. For example, it is between 2-4% in the USA and Europe, 3.3% in Turkey, and 9-10% in Japan. It is most common between 6 months and 3 years of age. The frequency of occurrence is 14-18. It peaks in months.
Febrile seizures are more common in some children than in the general population:
- Those with a family history of febrile seizures,
- Febrile seizures are seen in the hospital during the neonatal period. Those who stay for more than a month,
- Those with developmental delays
- The risk is higher in those who go to nursery.
Children with two of these risk factors have fever compared to other children in the society. The seizure rate is 30% higher. Similarly, if a parent has a febrile seizure, the risk is 10-50%, and if a sibling has a febrile seizure, the risk is 10-25%.
Studies show that the first cause of fever is upper respiratory tract infection or pharyngitis (38%), respectively. showed middle ear infection (23%), pneumonia (15%), gastroenteritis (7%) and sixth disease (Roseola infantum) (5%).
High Fever Causes Seizures
How fever causes seizures; It is explained that it is due to the increase in brain temperature under the influence of infection, as well as the role of genetic predisposition, by releasing some molecules (glutamate, etc.) and increasing the excitability of nerve structures through receptors (IL-1β). As a result of these mechanisms, we clinically encounter a seizure/seizure lasting between 10 seconds and 10 minutes, accompanied by a fever of 38.4 °C and above, with contractions and/or relaxations involving the whole body. It should not be forgotten that seizures may occur while the fever is rising, high or falling. If these seizures last less than 15 minutes, concern the whole body rather than a part of the body, occur once a day, and there is a similar history in the family, we call these seizures simple febrile seizures. If you have had more than one seizure on the same day, if the seizure lasted longer than 15 minutes, if the seizure occurred with contractions in a part of the body (e.g. If there is epilepsy (epilepsy) in the family (only in the arm or leg) and there is a family history of epilepsy, we call this situation "complicated febrile seizure".
Febrile seizure. A thorough examination and some tests should be performed to investigate the factors that may cause seizures in children who apply. Meningitis (inflammation of the brain membranes) can be detected as the cause of febrile seizures in 3 to 5% of these children. It is known that meningitis disease can cause seizures at a rate of 13 to 16%, and no examination findings may be detected in 30-35% of patients. In other words, a disease such as meningitis, which can be fatal if undiagnosed, can remain hidden in young children without causing any symptoms. For this reason, all children aged 12 months and under who have febrile seizures must have a lumbar puncture (taking spinal fluid from the waist) to distinguish whether they have meningitis. EEG recording is not recommended for the first simple febrile seizure. It may be recommended for those with a family history of epileptic seizures, those with unilateral or complicated seizures, those with impaired neurological development, or those with additional neurological problems. MRI scan is also not recommended for simple febrile seizures. It can be taken with the doctor's decision in those who have focal seizures, if there is a neurological disorder and in very long-lasting febrile seizures (Febrile Status Epilepticus).
Temperature Measurement in Children
Fever (body temperature) measurement in children can be done through the mouth, It can be measured from the butt, armpit, forehead and inside the ear with suitable thermometers. Classic thermometers are made of a system based on the principle that the mercury in a small glass tube expands with heat and rises in the tube. It is not practical for home use due to the risk of glass breakage and the evaluation requires experience.
Permanent and progressive brain damage is not expected in simple febrile seizures, and since it is generally a benign condition, treatment is usually not required. It is important for parents to be informed about febrile seizures. Parents are advised to recognize and control fever at home. Runny nose, sneezing, cough, weakness, loss of appetite, diarrhea, vomiting, etc. Symptoms may indicate an infection and therefore fever. mulberry The increase in temperature can be better noticed by touching the child's forehead and neck with your hands or the back of your hand. As another clue, cold hands and feet, chills and shivering in young children may indicate an increased body temperature. As a recommendation, a thermometer (degree, thermometer) should be kept in every home where there are children. Children who have previously had febrile convulsions should be taken to the nearest health institution as soon as fever is noticed, without waiting.
How to Intervene in Children with High Fever
As general precautions in children with fever; First of all, their clothes should be removed and they should be removed from the environment with high temperatures. Before going to the health institution, antipyretic medication can be given at home in a dose appropriate to the child's age. Placing a cloth or cotton soaked in warm water (not cold water) on the child's neck, neck and armpits (warm compression) is useful in controlling the fever. If the fever persists despite these, the child can be showered in warm water (not cold water). To reduce fever, use cold water (e.g. tap water is cold), cologne, alcohol, vinegar, etc. Using it may harm children and increase the fever even more after a short time.
It is very important for parents to act without panicking during a seizure at home. Since the child may lose consciousness and have convulsions at this time, the most important help that parents can give is to prevent the patient from being harmed during falls, collisions and struggles, and not to keep him in a position where his breathing may become blocked. Trying to open the child's mouth during a seizure, trying to put a finger or something into his mouth, holding him to water, blowing into his mouth, or shaking him are behaviors that harm the child and should be avoided. If there is no anti-convulsant medication (rectal diazepam suppository administered rectally) recommended by the doctor, trying to stop the seizure at home is not the right thing to do, and the best thing to do is to reach the nearest health institution. If the body temperature exceeds 38 C despite all measures to prevent fever, apply the anti-convulsion medication "rectal diazepam" (butt suppository). This will prevent it from having a seizure. The same drug may occur during seizures. It can also be used to stop an incoming transfer. Do not use this anti-convulsant medication at home except once in total (but it can be repeated after 12 hours if necessary). Consult your doctor as soon as possible. If you have used the medicine at home, be sure to inform the doctor you go to.
In case of complicated febrile seizures, apart from the general precautions we have mentioned before, treatments including intermittent treatment or long-term anti-seizure drugs are applied by the relevant specialist physicians according to the results of the child's examination and examination. .
I wish our patients a speedy recovery.
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