Seizures that occur as a result of fever due to infections outside the central nervous system, usually between 6 months and 6 years of age, are called 'febrile convulsions'. In our society, 2 to 5% of healthy children up to the age of 5 have one or more febrile seizures. It is more common in boys than in girls. The age of onset of seizures occurs in the first three years of life in 90% of cases, before 6 months in 4%, and after the age of 3 in 6%. It is most commonly observed between 18-24 months. Febrile convulsions seen before 6 months and after 6 years of age require careful investigation.
Fever, which usually occurs during upper respiratory tract viral infections and rarely during gastroenteritis, cannot be limited and causes abnormal electrical discharge in the immature child's brain, clinically causing contraction throughout the whole body. or a short-term loss of consciousness in the form of jelly. Rarely, in the first seizure, a seizure lasting longer than an hour, which we call febrile status, may occur. Or the seizure may be observed focally (on one side of the body). This suggests that the underlying cause is a more serious brain problem.
Seizures are divided into two groups: simple and complicated. 80-90% of them are of the simple type.
Simple febrile convulsion: fever of 39 degrees and above, seizure lasting less than 15 minutes, normal neurological development of the child, family history of a parent experiencing febrile seizures. It is understood that the seizure type is seen all over the body (generalized type).
Complicated type In febrile convulsion, the seizure is provoked by a low fever of 38 degrees or less, the neurological development of the child is abnormal, the seizure occurs. It is possible that the seizures last longer than 15 minutes, more than one seizure occurs within 24 hours, there is a family history of epilepsy, and the seizure type is on one side of the body (focal type).
The risk of recurrence of seizures is generally 33% (25-%). 50), the risk of recurrence is highest if the seizure first started at age 1. The risk of recurrence increases by 50% in those with a positive family history. 50% of the seizures recur within the first 6 months, 75% within one year, and 90% within two years.
In diagnosis;The possibility of meningitis is detected in the first febrile seizure under 12 months. To rule it out, lumbar puncture and cerebrospinal fluid examination are recommended. Between 12-18 months If there is no other focus of fever in children, a decision should be made during follow-up. Routine lumbar puncture is not recommended in children over 18 months. Temporary irregularities may be observed in EEG in the acute post-seizure period. The likelihood of findings on EEG is higher in complicated febrile convulsions. Imaging is not recommended for simple febrile seizures.
In the complicated type, its location is controversial. Generally, febrile seizures are 90-95% age-related and disappear after the age of 6. Rarely, there is a 5-10% chance of turning into fever-free seizures (epilepsy). During the treatment, general precautions and recommendations regarding fever are explained to the family. In addition, depending on whether it is a simple or complicated type, intermittent preventive treatment (rectal diazepam) or continuous preventive treatment with antiepileptic drugs for at least one year is recommended.
The family's concern on this issue must be resolved. It should be explained that there is no situation that will affect the child's intelligence in the future and that this is a condition with a good prognosis due to age, and the use of rectally administered medication to stop seizures for first intervention in the event of a seizure should be described in detail.
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