Febrile convulsion (FK)s is the most common convulsive disorder in childhood. They are convulsions that usually occur between the ages of three months and five years, associated with fever, without any signs of intracranial infection. It is seen in 2-5% of children under five years of age. Those who have previously had afebrile seizures are not included in this group. FKs are rare under nine months and after five years of age. Fever is a facilitating factor. Most often 14-18. It is seen between months. It is more common in boys. Pathophysiology: It is thought that the convulsive threshold against fever is low in children with FK. Zinc deficiency, immaturity in fluid-electrolyte balance in the brain, disruption of the circadian rhythm in melatonin release, and the role of the enkephalinergic system are among the factors that lower the threshold. Clinical Features: Otitis media and tonsillitis are the most common infections.
High fever and a history of FK in first-degree relatives are important risk factors for the first FK. It is known that human herpes virus-type 6 is a common agent in the etiology of first FCs in young children and that recurrent PKss may occur with the reactivation of the infection
Vaccination also poses a risk for FCs. The risk of convulsion increases 0-3 days after DTP vaccination. Completing DTP vaccination up to four months of age reduces the risk of DTP-related PK by four times; It is known that in 67% of the cases hospitalized due to convulsions 6-11 days after MMR vaccination, the convulsions were due to the measles component of the vaccine. While the rate of increase in fever may be effective in convulsion, fluid-electrolyte imbalance, bacterial toxins, antihistamines and the use of high levels of penicillin, especially in patients with renal failure, may predispose. Generally, convulsions are related to the rate at which the fever rises and occur when the central body temperature is 390C or higher. FCss are evaluated in two groups:
1- Simple FCs: Seizures are generalized o The loop takes less than 15 minutes. It does not recur within the same day. There is a family history of FK. Fever is higher than 380C.
2- Complicated FCs: Convulsion occurs when the fever is slightly high. Seizure duration is longer than 15 minutes. Focal seizures and postictal neurological deficits may be observed. It may recur within the same day.
It can be seen in children younger than six months and older than six years. There is a strong correlation between the focality of the seizure and the prolongation of the convulsion duration in both first and recurrent FC's. There is a higher tendency for recurrence in complicated febrile seizures that have lasted a long time. FKs seen before the age of one year are twice as likely to last longer than 15 minutes, and the risk of recurrence during the same febrile illness is higher. Those who have FK under the age of one have a higher risk of having convulsions in the future. Prognosis: The risk of recurrence of FK is on average 33%. The first recurrence occurs 50% of the time in the first six months, 75% in the first year, and 90% in the first two years. If the first seizure occurred under the age of one, the risk of recurrence increases to over 50%, and if the first seizure occurred after the age of three, the risk of recurrence decreases to 20%. In 60% of patientsPKoccurs only once. If a child in the family has had FK, the risk for his or her sibling is 1/5. If the father and one child have a history of FK, the risk for the other child is 1/3. A family history of epilepsy, a complicated type of convulsion, and a neurodevelopmental disorder do not increase the risk of recurrence. Low degree and short duration of fever before the first PCI increase the risk of recurrence. The risk of FK turning into epilepsy is the aspect of the issue that worries the family the most. While the rate of epilepsy is 0.5% in the normal population, this rate is on average 4% in those with FC. In children with FK, a family history of epilepsy, a complicated type of seizure and neurological deficit, whether the seizure is focal or long-lasting, and retardation in psychomotor development are factors that increase the risk of epilepsy. The relationship between FKs and temporal lobe epilepsy is controversial; FK, temporal lobe epilepsy and mezie The most important determining factor in the relationship between l temporal sclerosis is the duration of FK. Hippocampal sclerosis is not the result of temporal lobe epilepsy; There are also studies suggesting that it is the cause. It is known that FCs do not affect academic performance and intellectual capacity in the future; However, the situation is not the same for those who have febrile status epilepticus. The most important risk factors for sequelae such as speech disorder, severe neurological sequelae and epilepsy are the need to use many medications to stop the convulsion and the duration of the convulsion. It is recommended that patients with febrile status epilepticus be monitored for at least one year in terms of sequelae.
Read: 0
