Febrile seizures in a child. Consequences and forecasts. Signs and symptoms of febrile seizures

At present, it is preferable to speak not of "febrile convulsions", but of "febrile seizures", since in clinical picture given state not only convulsive, but also non-convulsive paroxysms can be observed.

Febrile convulsions/attacks(hereinafter referred to as AF) is a benign, age-dependent, genetically determined syndrome (in which the brain is susceptible to epileptic seizures that occur in response to high temperature), occurring after 1 month (usually from 3 months to 5 years ) life in children with a febrile illness not associated with a neuroinfection, as well as without previous unprovoked seizures and not meeting the criteria for other acute symptomatic convulsive episodes. If a child has AF, there is a possibility of their transformation (2 - 5%) into afebrile convulsions and epilepsy (see below - "complex AF").

note! Seizures that occur against the background of neuroinfection cannot be attributed to AF; cases where afebrile seizures precede AF; seizures with the presence in the clinical picture of clear symptoms of symptomatic epilepsy (including seizures against the background of an acute metabolic disorder that can cause convulsions). According to the 2001 draft classification, AF is classified as a condition with epileptic seizures that does not require a diagnosis of epilepsy.

The frequency of FS in the pediatric population is 2 - 5%; more often observed in boys - 60% of cases. The peak onset of AF occurs between 1 and 2 years of age. Recurrent attacks after the first AF occur in 1/3 of patients, and most relapses occur within 1 year after the first AF. When assessing the risk of developing AF recurrence, the age of the child, gender, hereditary history, neurological status, degree of fever, frequency of diseases occurring with hyperthermia.

The issues of the etiopathogenesis of AF have not been fully studied. In the occurrence of AF in children importance have the following factors: genetic predisposition (defect in the genes that control sodium channels and GABA receptors), morpho-functional immaturity of the brain, perinatal pathology CNS, hyperthermia. Morphofunctional immaturity of the brain, manifested in increased excitability subcortical structures, lability and rapid generalization of excitation, weakness of inhibitory processes in the cortex, insufficient myelination of conductors, instability metabolic processes, increased vascular permeability and hematoliquor barrier, hydrophilicity of brain tissues contribute to the development of AF.

AF are paroxysms of various duration, which, as a rule, occur in the form of tonic or tonic-clonic seizures in the limbs in children at a body temperature of at least 37.8 - 38.5 ºС (with the exception of convulsions initiated by infections of the central nervous system). [! ] In time febrile illness chills and involuntary movements of the child can be mistaken for convulsions. With chills, trembling is visible throughout the body, but usually does not capture the facial and respiratory muscles and is not accompanied by loss of consciousness, which makes it possible to distinguish it from convulsions. AF are observed during the first day of hyperthermia. Any infection may cause AF. Most often, AF occurs against the background of acute respiratory viral infections and acute intestinal infections, mainly viral etiology. Up to a third of cases of AF in children of the first year of life are manifested against the background of infections caused by the herpes virus type 6. There are typical (simple) and atypical (complex) AF (75% of all AF are simple):

■ simple AF are characterized by the following features: age of debut from 6 months. up to 5 years; high percent familial cases of AF and idiopathic epilepsy among relatives of the proband; seizures, as a rule, generalized tonic-clonic convulsions; the duration of the attacks is less than 15 minutes, in most cases 1-3 minutes, and do not recur within 24 hours; seizures stop on their own; high probability FP repeatability; occur in neurologically healthy children; epileptiform activity in the EEG in the interictal period is not recorded; there are no changes in the brain during neuroimaging; AF resolves on its own after reaching 5 years;

■ complex AF are characterized by the following features: onset age from several months to 6 years; absence of family cases of AF and epilepsy among relatives of the proband; generalized tonic-clonic or secondary generalized seizures (often with a predominance of the focal clonic component), less often focal motor (including hemiclonic) or automotor; the duration of the attacks is more than 30 minutes; possible development of status epilepticus; often the occurrence of post-attack symptoms of prolapse (Todd's paresis, speech disorders, etc.); the presence in the neurological status of focal neurological symptoms; mental, motor or speech development; the presence in the EEG study of continued regional slowdown, more often in one of the temporal leads; detection of structural changes in the brain during neuroimaging (typically hippocampal sclerosis), which may not occur immediately after AF, but develop with age; high risk transformation into symptomatic focal epilepsy (the most likely risk of developing epilepsy after febrile seizures in case of detection of local signs on the EEG, as well as their occurrence in the first year of life, especially the first half of the year or with a later debut - after 3-4 years).

In the presence of hyperthermia in children with a history of AF, it is necessary to take measures to reduce body temperature, including rubbing with water room temperature. According to the WHO recommendation, for children with a history of AF, the threshold for prescribing antipyretic drugs can be reduced to a level of 37.5 - 38 ºС. The antipyretic of the first choice is paracetamol in a single dose of 10-15 mg/kg (up to 60 mg/kg/day). Ibuprofen is also recommended in a single dose of 5-10 mg/kg (20-40 mg/kg/day).

A child with a generalized seizure should be laid on his side, head gently pulled back to ease breathing; forcibly open the jaws should not be because of the danger of damage to the teeth; if necessary, free the airways. With typical AF long term appointment antiepileptic drugs (AEP) is unacceptable. There are 2 possible therapies: intermittent oral antiepileptic drugs during fever and parenteral administration drugs at the onset of an attack. Intermittent AED prophylaxis is carried out during the whole fever and 2-3 days after it. The drug of first choice is phenobarbital at a dose of 3-5 mg / kg / day in 2 doses with a 12-hour interval. The second choice drug is clobazam at a dose of 0.5 mg/kg/day in 2 divided doses. We will use convulex (valproic acid) in the form of prolonged-release tablets at a dose of 30 mg/kg/day for 7 days. At the time of the onset of attacks, parenteral administration of drugs is recommended to stop the attack and prevent the development of a prolonged attack and epistatus. Diazepam is shown intravenously or intramuscularly at a single dose of 0.25 mg/kg (possible administration 2 times a day), as well as convulex intravenously in a stream of 10-15 mg/kg/day.

In atypical AF and the presence of risk factors for recurrence of seizures, it is recommended to prescribe continuous anticonvulsant therapy in accordance with the nature of seizures for a period of at least 2 years. The drug of choice is valproic acid at a dose of 20-40 mg/kg/day twice a day. Prophylactic anticonvulsant therapy in AF is not indicated.

Children with complex AF are sent to a neurological hospital to exclude the onset of epilepsy. Children with AF (simple and complex) should be included in the dispensary observation group. Dispensary observation carried out up to 5 years of age. The frequency of visits is 2 times a year with an active call of patients to the clinic. With an increase in AF, a change in the nature of the attack, the appearance of seizures during normal temperature, the appearance of focal symptoms in the neurological status, it is necessary to send the child to the neurological department.

more in the article Febrile seizures in children. Modern Aspects definitions, classification, pathogenesis and treatment of A.I. Khamzin, Kyrgyz-Russian Slavic University. B.N. Yeltsin, Kyrgyzstan (journal "Neurosurgery and Neurology of Kazakhstan" No. 4, 2016) [read]

Read also:

recommendations “Febrile seizures in children. Recommendations for diagnosis and treatment” information letter for pediatricians, November 2014 (BUZ VO “Vologda Regional Children’s Hospital”) [read]

© Laesus De Liro

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Febrile seizures are generalized seizures that occur during elevated temperature body. This condition may develop in case of acute respiratory viral infection, otitis. In most cases, such convulsions are observed in children over the age of three months and can last up to five years. As a rule, convulsions appear if the body temperature rises above 38 degrees. The attack begins with the fact that the child's body freezes in a tense state, after which convulsive twitches of the arms and legs develop.

The causes of febrile seizures in children are not fully understood. However, it has been established that one of the main causes of this condition is an insufficiently mature nervous system and weakness of inhibitory processes - this is what creates all the conditions for the appearance of febrile convulsions.

It should be noted that such attacks can occur only against the background of an increase in temperature. provoking factors in this case it can be anything - teething, vaccination, SARS, a cold.

One of the important points in this case is hereditary predisposition - for example, the presence of epilepsy in the child's parents or his relatives.

Signs and symptoms of febrile seizures

It should be noted that doctors do not regard febrile convulsions as a form of epilepsy, although they have a number of symptoms similar to this disease. There are several forms of febrile seizures, in particular:

1. Tonic convulsions - they are accompanied by a significant tension in all the muscles of the child's body. It can be bending the arms to the chest, rolling the eyes, straightening the legs, throwing back the head. Then this state is replaced by rhythmic twitches or shudders, which become less and less frequent and gradually disappear.
2. Atonic convulsions - they are characterized by instant relaxation of the muscles of the body, as well as involuntary defecation and urination.
3. Local convulsions - accompanied by rolling the eyes, twitching of the limbs.

In most cases, the child does not react in any way to the words or actions of the parents, he stops crying, loses contact with reality, may turn blue or hold his breath. It should be borne in mind that every third child who has previously experienced such attacks will suffer from them and subsequently with an increase in body temperature.

What do febrile seizures look like?

The seizure usually begins with the child losing consciousness, and after a while his whole body and limbs become rigid. At the same time, the head unbends back, after which rhythmic twitching of the limbs is observed.

The skin may become pale or pale blue. As a rule, febrile convulsions stop after a couple of minutes, after which the child regains consciousness, but weakness persists. Gradually return to normal skin color and normal level consciousness.

Some children recover fairly quickly, while others recover for a long time. During the attack, parents completely lose their sense of time, and therefore a short attack can be regarded as a very long one.

Risk group

Of course, not every child suffers from such a problem. Febrile seizures are associated with individual features nervous system of the baby - in this case, he has an increased sensitivity threshold. In addition, some children may experience seizures at a temperature of 39 degrees, while for others, 38 is enough. At the same time, most children do not suffer from such convulsions at all.

In babies with a high threshold of sensitivity, febrile convulsions can be observed once, several times, and can be with each case of an increase in body temperature.

To date, doctors do not have reliable data on which children are more likely to experience such seizures. However, in most cases, febrile convulsions affect premature babies, babies with pathologies of the central nervous system, children who have spinal hernias, as well as babies who have had a difficult or rapid birth.

First aid for febrile seizures

At home, care for febrile seizures should take into account two points:

1. Prevention of entry of vomit, food, saliva into the respiratory tract.
2. Prevention of traumatic injuries during a seizure.

To solve these problems, it is necessary to put the child on a stable, flat surface away from dangerous objects. At the same time, his body should be in the so-called rescue position, that is, the child should be placed on his side, and his face should be turned down. This will eliminate the possibility of liquid entering the respiratory tract. It is not recommended to take other actions on your own.

Before the doctor arrives, it is necessary to remember the duration of the attack and its manifestations - it is this information that will help specialists understand what kind of help the child needs. It is very important to pay attention to the presence of consciousness, posture, position of the head, limbs, eyes. It should be borne in mind that the doctor may ask eyewitnesses to show the movements and posture of the child.

What can not be done during an attack?

During such an attack, in no case should you put any objects into your mouth or take out your tongue. Contrary to popular myth, it is impossible to swallow the tongue, while any manipulation of the oral cavity can lead to traumatic injuries teeth, jaws, tongue. In addition, there is a risk that the wreckage introduced into oral cavity object or broken teeth will enter the respiratory tract, and this represents real threat for life.

You should not try to hold the child by force, since this in no way affects the course of the attack and does not bring any benefit to the patient. In addition, artificial respiration is not recommended in this case. Before full recovery consciousness, in no case should you give water to drink or medications because there is a risk that they will be inhaled.

Diagnosis of febrile seizures

A child who has at least once had a febrile seizure should definitely be shown pediatric neurologist. The physician must rule out neurological causes such seizures, including various forms epilepsy.

In this case, it is necessary to conduct the following types of research:

• biochemical and general analysis blood and urine;
• analysis cerebrospinal fluid- this is done to rule out meningitis or encephalitis;
• electroencephalogram;
• nuclear magnetic resonance or computed tomography.

Treatment of febrile seizures

If a child has a febrile seizure, it is imperative to call an ambulance. Before the doctors arrive, you should give the baby first aid:

1. If you are alone, you need to call for help.
2. Immediately put the baby on a hard surface and turn his head to the side.
3. Monitor the rhythm of the child's breathing. If he is tense and not breathing, then immediately after the end of the convulsions, artificial respiration should be started.
4. Ventilate the room and undress the child. The air temperature in the room should not be higher than 20 degrees.
5. Can apply physical methods reducing high temperature.
6. Give the child an antipyretic - suppositories with paracetamol are ideal.
7. Until the convulsions stop, in no case should you leave the child alone or try to force him to swallow the medicine.

In the event that febrile convulsions last no more than fifteen minutes and recur quite rarely, no other treatment is required. If such seizures are repeated quite often or are of a prolonged nature, an intravenous injection may be required. anticonvulsants- such an injection will be made by doctors from the ambulance brigade.

It must be remembered that febrile convulsions and high body temperature can be observed with quite dangerous diseases- neuroinfections. Fortunately, such diseases are rare, and their diagnosis does not cause any particular difficulties. If in doubt, the doctor may lumbar puncture to take some cerebrospinal fluid. This method allows you to put correct diagnosis in doubtful cases.

Preventive measures and consequences of febrile seizures

Prophylaxis is required only if febrile seizures recur very often or last too long. In any case, the decision regarding preventive treatment accepted exclusively by a neurologist.

Although febrile seizures are very dramatic in themselves, they rarely cause any serious damage to the central nervous system. Such a threat arises only if such attacks are repeated often and are of a long-term nature, but in any case, damage to the nervous system is rarely serious enough.

It should be noted that in children who have suffered such convulsions, there is a risk of developing epilepsy, but it is minimal and amounts to only about 2%.

Thus, despite the fact that febrile convulsions have enough terrible symptoms, they do not pose a serious danger to the life and health of the child. The main thing in this situation is to master the methods of first aid. This is what will allow you to wait for the doctors without compromising the health of the baby. To exclude the presence serious problems, you need to contact a neurologist - the doctor will prescribe necessary examinations and be able to make a correct diagnosis.

The first thing to know is that febrile seizures in children have nothing to do with epileptic seizures. This phenomenon is usually seen in children. preschool age during severe form flu, colds and other diseases accompanied by high fever. Convulsions in children at a temperature have single character and after the recession, the heat does not recur.

Should I be worried?

Any mother is worried about such conditions in a child. Doctors say that if convulsive states take place only during high temperature (from 38 degrees), but do not appear after recovery, there is no reason for concern.

In addition, if the attack lasts less than a quarter of an hour, then it does not require additional treatment. Seizures lasting longer than 15 minutes require special anticonvulsant drugs.

The disease usually affects children from six months to three years and endure it without consequences.

Another thing is if febrile convulsions occur in children older than 6 years. This condition can already speak of epilepsy. And yet, this can only be confirmed after a full examination.

What causes febrile seizures

Doctors still do not know for sure why convulsions occur in children with high temperature. The most common theory is that they, like many convulsions of a different kind, are provoked by inhibitory processes in the development of the brain.

Also, the cause of this ailment can be a head injury, drug poisoning, immaturity of the nervous system, congenital malformation and genetic diseases.

Only one thing is certain - febrile seizures occur due to high fever. The impetus for this can be not only pneumonia or SARS, but also the usual routine vaccination. In addition, the fever may rise against the background allergic reaction. In this case, there is a risk of confusing febrile convulsions in a child at a temperature with anaphylactic shock.

In order to find out for certain the cause of convulsive conditions, and in the future to stop them, it is necessary to find out if any of the close relatives have a predisposition to such a syndrome.

How do muscle spasms manifest?

Some mothers often confuse seizures in a child with high fever with epilepsy. Indeed, there are some similarities between these attacks. Signs of a convulsive state are as follows:

• at tonic convulsions the body of the child seems to be under current - the legs and arms are pulled along the string, the head is thrown back, the baby cannot cry, move, bend the limbs. The body is constantly shaking. As the seizure subsides, a large trembling begins to pass through the body, which gradually stops;
• local convulsions are expressed in single twitches of the limbs or individual parts of the body and are more like nervous tick. Sometimes this condition is accompanied by rolling the eyes;
• against the background of atonic convulsions, symptoms of muscle atrophy appear. Occasionally, isolated manifestations of enuresis or involuntary defecation may occur.

Complete or partial disorientation makes a child's febrile seizures look even more like epileptic seizure. During an attack, the baby may stop breathing for a while.

Sometimes convulsive states last 15 minutes without a break, sometimes - in short series. There is a fairly high chance of a recurrence similar condition at the next temperature rise.

What to do to parents during an attack

Many mothers do not know what to do during seizures in a child with a high temperature, and may panic. Fuss and shouting will not lead to anything good. You need to calm down and act.

1. First of all, you need to call a doctor.
2. Then, undress the child as much as possible, lay it on a hard surface, for example, a tabletop, and ensure the flow fresh air into the room. In summer you can open the window, in winter you can turn on the fan.
3. You need to be inseparably close to the child, observing his condition. If the baby is holding his breath, do not touch him. It is better to wait until he exhales and start doing artificial respiration. During the attack, it is impossible to carry out artificial respiration, since the upper respiratory tract is blocked by convulsions.
4. No need to take the initiative and try to pour any medicine or water into the child's mouth. Also, do not open his jaw to insert a finger or a spoon into his mouth. Similar actions can only aggravate the condition of the baby.
5. To reduce the temperature during a seizure, drugs should not be given orally, but it is quite acceptable to use rectal suppositories with paracetamol.

Short-term seizures (up to 15 minutes), which appear singly or very rarely, do not require medical treatment.

To stop more frequent and prolonged seizures, the doctor may prescribe anticonvulsant drugs like Phenobarbital, Phenytoin, Valproic acid, etc.

Prevention

Febrile seizures can only be prevented with medication. Such treatment is prescribed by a neuropathologist in the case of regularly occurring long-term attacks.

One of the indicators for the prophylactic treatment of febrile seizures in children is the risk of degeneration into epilepsy. Since such a probability is negligible, then prevention is prescribed extremely rarely.

Most often, convulsive conditions are stopped by timely intermittent prophylaxis. Similar treatment involves taking Paracetamol, Ibuprofen and Diazepam for the first three days illness.

If intermittent prophylaxis is delayed, long-term therapy will be required. She means intravenous injections Sodium valproate and Phenobarbital for several years.

Since these drugs have pronounced side effects, doctors recommend mothers to abandon prophylaxis, because febrile convulsions are not dangerous.

We repeat that the risk of degeneration of febrile convulsions into epilepsy is negligible (about 2%), so you need to be patient and just go through this period with your child.

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Febrile convulsions can be discussed in the event of convulsive (convulsive) seizures at high body temperature (above 38 C) in children under six years of age who have not previously suffered from convulsive seizures.

Treatment depends primarily on the duration of seizures: if they last less than fifteen minutes, it is enough to bring down the temperature with antipyretics and then monitor the child's condition. If convulsions last more than 15 minutes, anticonvulsant medication should be provided.

A disease such as epilepsy should be distinguished from febrile convulsions. If seizures occur in children over the age of 6 years, then most likely the child suffers from epilepsy.

Febrile seizures affect 5% of all children who have not reached the age of six. Most often, febrile convulsions are observed in babies from six months to three years.

Causes of febrile seizures

The causes of febrile seizures in a child have not yet been finally established. But it is known for certain that one of the main factors is the weakness of inhibitory processes and the insufficient maturity of the nervous system, which creates conditions for the occurrence of seizures.

Febrile seizures occur only against a background of elevated temperature. The common cold, SARS, teething, as well as various vaccinations can provoke the appearance of febrile seizures.

One of critical factors development of febrile seizures is considered a hereditary predisposition, for example, if his parents or other relatives are sick with epilepsy.

Signs and symptoms of febrile seizures

As mentioned earlier, febrile convulsions are not regarded in medical practice as a form of epilepsy, although they have a number of external signs in common with this disease.

Febrile seizures are divided into:

• tonic convulsions- significant tension in the child of all the muscles of the body (rolling the eyes and tilting the head back, bending the arms to the chest, straightening the legs), giving way to rhythmic shudders or twitches, gradually becoming rarer and gradually disappearing;
• atonic convulsions- instant relaxation of all muscles of the body, involuntary loss of feces and urine;
• local convulsions- twitching of limbs, rolling eyes.

Most often, during convulsions, the child does not respond to the actions and words of the parents, loses contact with the outside world, stops crying, may turn blue and hold his breath.

Rarely, seizures last more than 15 minutes. In some cases, they can come in series.

One in three children who have previously experienced febrile seizures experience them during subsequent episodes of fever.

Diagnostics

A child suffering from seizures should be shown to a pediatric neurologist. The doctor will rule out neurological causes seizures in particular, various forms of epilepsy.

The complex of examinations of children with febrile convulsions includes:

• analysis of cerebrospinal fluid and lumbar puncture to rule out encephalitis or meningitis;
• biochemical and general analysis of urine and blood;
• computed tomography or nuclear magnetic resonance;
• electroencephalogram (EEG).

Treatment of febrile seizures

In the event of a febrile seizure in a baby, an ambulance team should be called immediately. Before the arrival of the ambulance, it is necessary to provide the child with first aid:

Call for help if you and your child are alone;

Place the child with convulsions immediately on a hard, flat surface and turn his head to the side;

It is important to monitor the rhythm of the baby's breathing. If he does not breathe and is tense, it is necessary to wait for the convulsions to end and start artificial respiration. During the attack itself, artificial respiration useless;

No need to try to open the child's mouth and stick a finger, spoon or other objects in it - this can only aggravate the situation;

Ventilate the room and undress the child. Indoor air temperature should not exceed +20 degrees C ̊.

Apply physical methods to reduce heat (for example, rubbing with vinegar and water);

Give the child an antipyretic (best of all, if these are suppositories with paracetamol);

You can not leave the baby alone until the febrile seizures stop or try to give the baby a drink of water, force him to swallow the medicine.

This article contains materials for many years of observation by epileptologists, doctors with experience in managing febrile convulsions in children. The data of the leading experts of the country and the world on epilepsy were used, statistical studies were carried out, and own observations of hundreds of patients with febrile convulsions were analyzed.

You will learn what febrile convulsions are, what they are, the causes of their occurrence, characteristic symptoms diseases. We will analyze the tactics of management, the principles of therapy for patients with convulsions against the background of fever. So, you are waiting for information from practicing epileptologists who observe hundreds of patients with epilepsy and febrile convulsions.

Febrile seizures are

Febrile convulsions- these are seizures that are clinically similar to epileptic ones, but provoked by a rise in temperature and intoxication, are observed in children under 6 years of age (usually from 6 months to 5 years). Febrile seizures are not epilepsy.

The exceptions are neuroinfections and febrile seizures in epilepsy.

This frequency of the disease is anatomical and physiological features of the brain of children: immaturity, high sensitivity to external and internal damaging factors, hydrophilicity (or a tendency to edema) of the brain tissue, a tendency to hyperergic (in other words, excessive) responses. Special meaning has a hereditary predisposition - the tendency of the brain to febrile seizures and epilepsy.

Fever leads to impaired metabolism and blood supply to the brain, hanging convulsive readiness brain.

How common are febrile seizures in children?

1. With a frequency of 2-5% in the child population.
2. Depending on age: more than 50% at the age of 1.5 -2 years, 6% - after 3 years.
3. They have seasonality: more often in winter, in spring.

Febrile convulsions symptoms.

Characteristic features of typical febrile seizures:

1. More often they have a generalized type -

70% generalized tonic-clonic seizures,

30% tonic and atonic seizures.

1.1.tonic convulsions : tension of the muscles of the body, arching of the body, tilting the head back, bringing the eyes up, stretching or bringing the arms together, stretching the legs.

1.2. Atonic convulsions : "softening", relaxation of the muscles of the body, stopping the gaze, stopping the activity, does not react, pallor or cyanosis.

2. More often short-term - last 2-5 minutes, do not exceed 15 minutes.

3. Do not repeat during the day.

4. After attacks, neurological symptoms do not appear.

6. More often there is no epileptiform activity on the EEG.

7. More often there is no delay in speech and motor development in a child.

Characteristic features of atypical febrile seizures:

1. The nature of the seizures is different:

1.1. generalized (generalized tonic-clonic, atonic).

1.2. focal (abduction eyeballs aside, clonic seizures in one or both hands, nystagmoid eyeball movements, hemiclonic - convulsions of half of the body).

2. More often longer - more than 15 minutes.

3. Repeated during the day - more often no more than 2 attacks per day, with a break more often than 2-4 hours.

4. After attacks, there may be Todd's paresis - weakness in the limbs (in 8% of cases).

5. More often do not recur more than 2-3 times in a lifetime.

6. Sometimes there may be epileptiform activity on the EEG.

7. There may be a combination with a delay in speech and motor development in a child.

Why are febrile seizures dangerous?

May develop febrile seizure status is a seizure or series of seizures lasting more than 30 minutes.

The patient does not regain consciousness between attacks.

Status frequency 4% of all febrile seizures.

Not life-threatening.

Febrile seizures in children causes:

1. Febrile fever is body temperature , measured rectally, above 38.
2. Viral infection.
3. Genetic predisposition:

Inheritance is autosomal recessive or polygenic, meaning a breakdown in several different genes can cause seizures.

4. perinatal lesion central nervous system:

Maternal miscarriage, nephropathy during pregnancy, resuscitation the child immediately after birth.

Upper infections respiratory tract – 38%.

Otitis - 23%.

Pneumonia - 15%.

Gastroenteritis - 7%.

Herpetic infections - 5%.

What should parents know about febrile seizures?

1. Risk of recurrence of febrile seizures:

In 30-40%, a febrile seizure will recur.

The third attack will happen with a 50% chance after the second.

10% of children have more than 2 attacks on the background of fever.

Seizures recur more often within 1 year or more often.

2. What provokes the recurrence of febrile seizures?

How younger child, more often up to 1.6 years, the higher the likelihood of recurrence.

If there were febrile convulsions in close relatives, then such convulsions are more likely to recur and also have a course similar to them.

If the seizures were atypical, then a relapse is more likely.

If the attack recurs within a day, then we are waiting for repeated (double) and further.

If the patient has focal neurological syndromes.

3. The risk of epilepsy after febrile seizures is 0.5 - 5% (average 2%).

More often, epilepsy occurs in the aftermath in the presence of the following factors:

1. Epilepsy develops with atypical febrile seizures.
2. If the first febrile seizure developed before 1 year or after 3 years.
3. In premature babies up to 32 weeks - 17%.
4. In children with neonatal (in the period up to 1 month of life) convulsions.
5. In children with cerebral palsy. In children with delayed psycho-motor development. In children with neurological deficit - 30%.
6. With multiple febrile seizures - 4%, and with a simple single febrile seizure - only 1.5%.
7. With burdened heredity - 4%.
8. If the attack is more than 15 minutes - 6%.
9. If the attack is focal - 29%.
10. The probability increases when these factors are added together.

So, with multiple febrile seizures + if the seizures are focal + if the seizures last more than 15 minutes - the probability is 50%.

Why are febrile seizures dangerous? Consequences of febrile seizures:

1. In children with a history of epilepsy, 15% of cases had febrile seizures earlier.

There is evidence that febrile convulsions can lead to "epilepticization" of the brain. This phenomenon is associated with acute oxygen deficiency of neurons during seizures. Hypoxia leads to the launch of apoptosis, that is, a genetically programmed process of cell death. Hypoxia accelerates apoptosis, which leads to necrosis, that is, the death of part nerve cells. "Targets" are certain areas of the brain: structural disturbances arise in the cells of the temporal regions. AT temporal region an epileptic focus is formed, which in months or years can cause focal epilepsy.

2. After prolonged, recurring febrile seizures, hippocampal sclerosis is formed with the development of temporal lobe epilepsy as a consequence.

3. The consequences in the form of a violation in the neurological status or the formation of a developmental delay are variable:

3.1. Absent in typical febrile seizures.

3.2. Unlikely in atypical febrile seizures.

3.3. Possible, but rare after febrile status epilepticus.

4. Consequences after febrile status epilepticus:

4.1. Mortality was not registered.

4.2. Newly appeared motor or intellectual disabilities not registered.

Methods of examination in febrile seizures.

1. It is believed that with typical febrile seizures, it is possible not to conduct examinations: EEG, MRI of the brain, lumbar puncture. But the need for these methods is determined by the doctor.
2. On the EEG in children with febrile seizures:

2.1. No deviations - 35%.

2.2. Slowing down the main diffuse or regional activity of the brain.

2.3. The presence of elements of epiactivity - spike - wave, spikes, sharp waves.

2.4. When falling asleep, a flash of high-amplitude delta activity, often in combination with spikes.

2.5. These changes do not play a role in the prognosis and treatment of febrile seizures.

3. On MRI in children with febrile seizures

3.1. Asymmetry of the hippocampus.

3.2. Other changes in the brain.

Own observations.

At the appointment of an epileptologist, patients with febrile seizures occur almost daily, and in the spring-winter season, during epidemics, the frequency can be 3-5 patients per working day. As a rule, parents already assume that we are talking about the diagnosis of febrile convulsions. But they are tormented by the fear that it could be epilepsy. The diagnosis is not difficult to make. And asking in detail how exactly the seizures proceeded, we specify their nature and duration; we analyze the actions of parents. Features of febrile seizures determine our tactics and prognosis. As a rule, parents need more help to calm down and understand the nature of the disease. Get detailed instructions how to act in case of recurrence of seizures, how to prevent their recurrence. For febrile seizures and any other seizures, be sure to contact an epilepsy specialist. Parents should take care and obtain the necessary qualified medical care for their children. And in each case, an individual approach is important.

Our own research on febrile seizures in children:

1. 100 patients with febrile seizures were studied, according to the analysis outpatient cards appointment of an epileptologist who applied for 4 months in the period from December 2013 to March 2014.
2. 65 boys, 35 girls.
3. For 100 of all patients who applied for an appointment with an epileptologist - 10-20% of patients with febrile convulsions in the spring-winter-autumn period, no more than 1-3% of patients in summer.
4. Typical febrile seizures were observed in 67%, atypical - in 34% of those who applied.
5. Single febrile seizures - in 48%, repeated - in 24%, the third attack had - 9%, from 4 to 12 seizures - in 19% of children. None of the children had more than 12 seizures.
6. Heredity is burdened, that is, at least one of the close relatives had some kind of seizures in history, but more often it is the presence of febrile convulsions in the father or mother - in 38% of children. The rates increase if the child has more than one bout of fever.
7. Diseases against the background of which there was a rise in temperature followed by a febrile seizure:

7.1. SARS, not specified etiology - 40%.

7.2. Angina - 25%.

7.3. Pneumonia - 15%.

7.4. Acute intestinal infections – 10%.

7.5. Other diseases - 7%.

7.6. Otitis - 3%.

1. called out ambulance – 72%.
2. Ambulance actions (according to parents):

9.1. When we arrived, the attack was already stopped in 2-3 minutes on its own, the child was sleeping. The doctors examined the child and made recommendations. emergency care did not provide – 46%.

9.2 Entered lytic mixture- the attack stopped (on its own?) - 30%.

9.3. Introduced a lytic mixture and an anticonvulsant drug, the attack stopped immediately after administration - 15%.

9.4. Introduced a lytic mixture and an anticonvulsant drug, the attack did not stop after the injection, the child was taken to the intensive care unit infectious hospital, where the attack stopped - 5%.

9.5. Hospitalized in the infectious disease department of the hospital - 40%.

9.6. Provided assistance to parents who showed excessive aggression or expressed anxiety and concern about the child's condition - 40%.

1. Further therapy of febrile convulsions in children consisted of the following stages: A. Relief of seizures; B. Prevention of relapses; C. In the period of fever - antiepileptic drugs. only in 20% of children.
2. Refused hospitalization offered by Ambulance – 45%
3. Turned to a pediatrician or a neurologist after the first attack - 36%, after the second - 25%, after the third - 12%, did not seek advice, and the information is known from the anamnesis in patients with epilepsy - 27%.
4. An additional examination was carried out:

12.1. EEG - 40% of those who applied.

12.2. MRI of the brain - 5%.

1. Patients sought repeated help from an epileptologist:

13.1. For the purpose of dynamic monitoring - 20%

13.2. In order to evaluate the survey - 30%

13.3. After repeated febrile convulsions - 20%.

13.4. Ask them questions that are not related to febrile seizures - 50%

13.5. After epileptic seizure, not associated with fever, the possible debut of epilepsy - 20%.

13.6. Were observed with epilepsy for a long time - 5%.

1. Epilepsy debuted after 3-5 years - in 10% of all those who applied for help after febrile seizures. More often (in 50%) in patients with atypical seizures, hereditary burden for epilepsy.
2. Consequences after febrile seizures:

15.1. No consequences - 30%.

15.2. Neurotic reaction of children and parents to "white coats" - 50%.

15.3. The syndrome of excitability, irritability, sleep disturbances, loss of appetite, weight loss, fatigue, fear of letting go of the mother - in 50%.

15.4. Regression of speech skills, regression of motor skills (stopped walking, again mastered walking 1-2 months after a febrile attack) - 30%.

15.5. The appearance of focal neurological pathology no one observed.

Thus, febrile convulsions do not lead to neurological deficit, the risk of subsequent epilepsy is low, prophylaxis of epilepsy with antiepileptic drugs is not effective, and side effects with prolonged use of anticonvulsants are highly likely. Hence follows the rational therapy for febrile seizures.

Watch a video from YuoTube on the topic:

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