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Febrile seizure is a seizure occurring in children between 6 months and 5 years of age associated with fever, without evidence of intracranial infection or another primary central nervous system cause. The average age of onset is around 18–22 months. It is the most common pediatric convulsive disorder, affecting approximately 2–4% of children, and typically occurs in otherwise healthy children during a systemic illness, most often viral. Febrile seizures are classified into simple and complex types. Simple febrile seizures are generalized, brief (less than 10–15 minutes), self-limited, and occur only once within a 24-hour period. Complex febrile seizures are longer than 15 minutes, may have focal features, or recur within 24 hours. Risk factors include a family history of febrile seizures, delayed neurologic development, and male sex.
The condition is usually triggered by common childhood infections, particularly viral illnesses. Frequent causes include upper respiratory infections, otitis media, gastroenteritis, and Roseola. The seizure often occurs early in the illness, sometimes coinciding with the initial rapid rise in temperature rather than the peak fever.
Clinically, children present with fever and a seizure, most commonly a generalized tonic–clonic event. The seizure may involve an initial phase of muscle rigidity followed by rhythmic jerking movements and may be associated with apnea or urinary incontinence. Most episodes are brief and resolve spontaneously within a few minutes. Other possible manifestations include staring spells, limpness, or isolated jerking movements. After the seizure, a short postictal phase with drowsiness or confusion is common. A thorough history should include the duration and characteristics of the seizure, symptoms of infection, recent immunizations, medication exposure, trauma, developmental history, and family history of seizures. Physical examination should focus on identifying the source of fever and excluding serious conditions such as meningitis, looking for signs like nuchal rigidity, bulging fontanelle, or persistent altered mental status.
Evaluation is generally minimal for simple febrile seizures. Routine laboratory testing is not required unless there is concern for a serious bacterial infection, in which case tests such as complete blood count, urinalysis, and cultures may be performed. Lumbar puncture is not routinely indicated but should be considered in certain situations, such as in children aged 12–18 months with concerning symptoms (e.g., irritability, lethargy, poor feeding), incomplete immunization status, or signs suggestive of central nervous system infection. It is also indicated in older children if there are clear signs of meningitis or persistent altered mental status. Neuroimaging and EEG are not routinely required and are reserved for atypical presentations, such as focal seizures or underlying neurologic abnormalities.
Management is primarily supportive because most febrile seizures are self-limited. Initial priorities include maintaining airway, breathing, and circulation, and protecting the child from injury during the seizure. Oxygen and supportive care should be provided as needed. Pharmacologic treatment is rarely required, but benzodiazepines such as lorazepam, diazepam, or midazolam may be used for prolonged seizures or if the child is compromised. Rectal diazepam or intranasal midazolam can be effective in emergency settings. If seizures persist despite benzodiazepines, second-line agents such as phenytoin, fosphenytoin, or phenobarbital may be used. Antipyretics such as acetaminophen or ibuprofen are recommended to improve comfort, although they do not prevent recurrence of seizures. If a bacterial infection is identified, appropriate antibiotic therapy should be initiated.
The prognosis is generally excellent. About one-third of children will experience recurrence, especially those with early onset, a family history of seizures, or lower fever at the time of the initial episode. The risk of developing epilepsy later in life is only slightly increased compared to the general population, particularly in children with simple febrile seizures and normal neurologic development. Most children can be safely discharged if they return to baseline, have a normal neurologic examination, and the source of fever is identified and manageable. Parental reassurance and education are essential, as febrile seizures are typically benign. Aggressive fever control does not prevent recurrence, and long-term anticonvulsant prophylaxis is generally not recommended.
The condition is usually triggered by common childhood infections, particularly viral illnesses. Frequent causes include upper respiratory infections, otitis media, gastroenteritis, and Roseola. The seizure often occurs early in the illness, sometimes coinciding with the initial rapid rise in temperature rather than the peak fever.
Clinically, children present with fever and a seizure, most commonly a generalized tonic–clonic event. The seizure may involve an initial phase of muscle rigidity followed by rhythmic jerking movements and may be associated with apnea or urinary incontinence. Most episodes are brief and resolve spontaneously within a few minutes. Other possible manifestations include staring spells, limpness, or isolated jerking movements. After the seizure, a short postictal phase with drowsiness or confusion is common. A thorough history should include the duration and characteristics of the seizure, symptoms of infection, recent immunizations, medication exposure, trauma, developmental history, and family history of seizures. Physical examination should focus on identifying the source of fever and excluding serious conditions such as meningitis, looking for signs like nuchal rigidity, bulging fontanelle, or persistent altered mental status.
Evaluation is generally minimal for simple febrile seizures. Routine laboratory testing is not required unless there is concern for a serious bacterial infection, in which case tests such as complete blood count, urinalysis, and cultures may be performed. Lumbar puncture is not routinely indicated but should be considered in certain situations, such as in children aged 12–18 months with concerning symptoms (e.g., irritability, lethargy, poor feeding), incomplete immunization status, or signs suggestive of central nervous system infection. It is also indicated in older children if there are clear signs of meningitis or persistent altered mental status. Neuroimaging and EEG are not routinely required and are reserved for atypical presentations, such as focal seizures or underlying neurologic abnormalities.
Management is primarily supportive because most febrile seizures are self-limited. Initial priorities include maintaining airway, breathing, and circulation, and protecting the child from injury during the seizure. Oxygen and supportive care should be provided as needed. Pharmacologic treatment is rarely required, but benzodiazepines such as lorazepam, diazepam, or midazolam may be used for prolonged seizures or if the child is compromised. Rectal diazepam or intranasal midazolam can be effective in emergency settings. If seizures persist despite benzodiazepines, second-line agents such as phenytoin, fosphenytoin, or phenobarbital may be used. Antipyretics such as acetaminophen or ibuprofen are recommended to improve comfort, although they do not prevent recurrence of seizures. If a bacterial infection is identified, appropriate antibiotic therapy should be initiated.
The prognosis is generally excellent. About one-third of children will experience recurrence, especially those with early onset, a family history of seizures, or lower fever at the time of the initial episode. The risk of developing epilepsy later in life is only slightly increased compared to the general population, particularly in children with simple febrile seizures and normal neurologic development. Most children can be safely discharged if they return to baseline, have a normal neurologic examination, and the source of fever is identified and manageable. Parental reassurance and education are essential, as febrile seizures are typically benign. Aggressive fever control does not prevent recurrence, and long-term anticonvulsant prophylaxis is generally not recommended.
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