Fever Seizures

Fever in children can cause epileptic seizures. Febrile seizures can be described as a hereditary predisposition to benign seizures triggered by fever without central nervous system infection (brain infection). This age-dependent condition is seen between the ages of 6 months and years. It most commonly occurs in children aged 18-22 months. Seizures, which are often due to viral infections, are usually seen on the first day of fever. The development of febrile seizures in children is expected.

Presence of first or second degree relative with a history of febrile seizures
Leaving the hospital after 28 days of delivery story
Family realizes that the child's development is slow
Going to nursery

WHAT IS COMPLEX OR SIMPLE FEVER SEIZURE?

This classification is useful for predicting the prognosis (course) of the disease. In simple febrile seizures,

Children aged 6 months to 5 years who have no neurological disease before the seizure
Generalized seizure lasting less than 15 minutes ( contraction of the whole body)
Recurs once in 24 hours in febrile illness.
Complex febrile seizures,

Prolonged (>more than 15 minutes)

Repeated 2 or more times in 24 hours
They show one or more of the onset features that are focal (for example, from the arm).
If the single febrile seizure lasts longer than 30 minutes or the patient does not regain consciousness between recurrent seizures, febrile seizure status epilepticus is in question.

WHAT ARE THE FACTORS THAT INCREASES THE RISK OF REPEAT OF FATHIBIAN SEIZURES?

Recurrence of seizures in approximately half of the patients after the first febrile seizure , half of those with repeat seizures had at least one more seizure. expected to pass. Recurrent seizures,

Fever in first-degree relatives who had their first febrile seizure when younger than 1 year old, who had low fever seizures and complex seizures
It is expected in patients with a history of seizures
It is expected in patients whose neurological development is affected.
In which patients should CSF (Taking water from the waist) examination be performed?
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Exclusion of central nervous system infection is important in the emergency approach to febrile seizures. Especially in patients under 2 years of age, in the presence of accompanying symptoms along with fever, CSF examination is required in patients presenting with status epilepticus or complex febrile seizure. CSF examination is recommended for every patient under the age of one who presents with a febrile seizure. It is not useful in determining the recurrence of the disease or the development of epilepsy. EEG examination is recommended after recurrent seizures or after the first seizure with complex features.

What are the determining risk factors for the development of epilepsy (episode) in patients with febrile seizures?

First Presence of neurological disease or developmental delay before the febrile seizure
Family history of epilepsy
Complex febrile seizures

Is the mental and behavioral development of patients with febrile seizures affected?

It has been shown that school success of patients with febrile seizures is not different from their peers. ) HOW TO DECIDE AND APPLY TO THE TREATMENT DECISION?

The first step in the treatment of febrile seizures is to inform the family and regain confidence. Prophylactic treatment is not recommended after the first simple febrile seizure. Prophylaxis can be applied in patients with frequent recurrent seizures, concomitant neurological disease and complex febrile seizures. Daily phenobarbital or valproic acid is preferred for continuous prophylaxis, while benzodiazepines used on feverish days for intermittent prophylaxis are suitable. >Seen in our country Let's look at a most interesting epileptic disorder with patient examples.

A four-year-old five-month-old male patient presented with complaints of stagnation during the bath, looking at a fixed point, and then falling asleep, which his mother noticed. The patient, whose psychomotor development was appropriate for his age, had no previous history of febrile seizures or family history of epilepsy. Neurological examination was normal. Magnetic resonance imaging (MRI) and inter-seizure electroencephalogram (EEG) of the patient were found to be normal. Since the complaints of the patient, whose head was not wetted in the bath with hot water and whose whole body was washed with 35°C water, did not recur, the patient was advised to take a bath with lukewarm water and followed without complaints She presented with complaints of looking at a fixed point, clenching her teeth, and bruising. The patient, whose psychomotor development was appropriate for his age, had no previous history of febrile seizures or family history of epilepsy. Neurological examination was normal. Between seizures, sharp waves mixed with the ground were detected in the wake EEG, and rare sharp waves originating from the right frontal region were detected in the sleep EEG. Magnetic resonance imaging was within normal limits. The seizures of the patient who was started on valproic acid treatment decreased. Clonazepam was given to the 3-year-old patient, who developed continuous jumping movements while taking a shower, one hour before the shower for preventive purposes. With treatment, their jumping completely disappeared.

Hot water epilepsy has been reported mostly in boys, preschool and school age. More complex partial seizures were observed in the patients, and pathological changes were detected in only 15-20% of the inter-seizure EEGs. Yalcin et al. In their series of 25 cases, the most obvious triggering factors were found to be the temperature of the water and spillage from a bowl. The gender and age group of the first case were compatible with the other reported cases. His seizures were of a complex partial type, beginning with a pensive aura and ending with a clouding of consciousness. No pathology was detected in the inter-seizure EEG. The way of washing was sitting down, pouring hot water over the head from a bowl. Stensman and Ursing blamed complex tactile and thermal stimulation in the pathogenesis of SSE. Seizures triggered by pouring hot water on the patients' heads in the laboratory environment They have shown that it is not formed by knitted towels, sauna and hot air blowing. Santishchandra suggested that increased intracranial temperature due to impaired thermoregulation causes seizures in patients. In the treatment of hot water epilepsy, precautions including washing the head with warm water and for a shorter period of time are primarily recommended. The seizures of the first case were controlled by washing with water under body temperature.

Carbamazepine, phenytoin and valproic acid are the antiepileptics used in the treatment of hot water epilepsy cases. Valproic acid was preferred in the treatment because pathological findings were detected in the wakefulness and sleep EEG of the second case. In the follow-up of the patient, when myoclonies appeared in the legs during the shower, a complete response was obtained to the clonazepam added to the treatment. In our country, epileptic conditions related to water can be encountered in the follow-up of healthy children. After excluding other conditions that cause seizures, lowering the water temperature to 35-37 C or administering clonazepam preservatives can be applied by pediatricians as simple preventive treatments, and I think that long-term antiepileptic use should be reserved for patients who do not have a typical course and have pathological findings.

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