Febrile convulsions and their consequences. Febrile seizures are divided into. Causes of temperature convulsions

From 6 months to 5 years of age. If they appeared once, then the probability of repetition is 30%. In most cases, this phenomenon is temporary and harmless. Let's look at this issue in more detail.

Symptoms of this condition

Febrile convulsions are generalized convulsions, in this state everything twitches in children: both arms, both legs, head.

Febrile seizures usually appear on the background of acute respiratory infections. viral infections, or inflammation of the gastrointestinal tract, occurring with fever. Seizures are divided into three types, each of which is characterized by its own symptoms. But there are some common ones:

• loss of consciousness;
• the child does not react to anything;
• stops crying;
• the body twitches, the head throws back;
• sometimes it is even possible to stop breathing (then the skin turns blue).

Did you know? Although the maximum allowable temperature body for a person is considered 42 degrees, there is a case when the American Willie Jonesthis figure wasequals 46.5 degrees. The man received heatstroke, which led to such a figure on the thermometer. Fortunately, everything ended well, and after a few weeks the patient was discharged from the hospital.

The reasons

So far, doctors have not been able to determine exact reasons occurrence of febrile seizures in children. It is only known that in the background intense heat you may have a febrile seizure. This happens due to the fact that in infants and kindergarten children the formation nervous system not completed yet. She is not able to fully control complex passes. nerve impulses into the brain.

Capable of calling febrile convulsions:

• viral and bacterial infections;
• infectious diseases of the upper respiratory tract;
• ear inflammation;
• inflammatory processes in the gastrointestinal tract;
• varieties.

Kinds

There are several types of febrile seizures in a child: tonic, atonic, local.

tonic

For them, the appearance of tension throughout the body is typical. Accompanied by straightening lower extremities, flexion and pressing to the chest of the upper. The head at this moment throws back, and the eyes roll back. Then there is a strong twitching of the body, gradually declining.

Atonic

Accompanied by complete relaxation of the muscular skeleton, which leads to involuntary emptying Bladder and intestines.

Local

During such convulsions, excessive stress limbs, twitching them and rolling the eyes. Very similar to tonic, only convulsions are not throughout the body, but in its individual parts (limbs).

First aid

The appearance of seizures in children causes panic in parents, especially if the child infancy. From confusion, mom and dad can even fall into a stupor so that this does not happen, we will indicate some recommendations on what to do when this problem occurs.

For babies

Having found the first signs of convulsions without fever in a child, one should:

• remove from the baby all objects with which he can harm himself. It is best to take him to the crib;
• the surface on which the child lies must be flat;
• lay on its side so that it is easier for the baby to breathe, and he does not choke on vomit or saliva;
• remove tight clothes;
• ventilate the room;
• control breathing;
• do not move away from the baby a single step and detect the duration of the attack.

After the attack is over, you need to call an ambulance or a doctor at home.

Convulsions accompanied by high fever

The algorithm of action is the same as with spasms in the baby. In addition, you should try to cool the child by wiping it with a damp towel in the inguinal, axillary, elbow and knee areas. When the attack ends, call an ambulance and give antipyretics. As a rule, such seizures last from 10 seconds to a minute.

Important! Try to prevent an attack from occurring. At the first sign of an increase in temperature, start knocking it down. If it rises above 38 degrees, then the likelihood of a febrile seizure is high.

What not to do during an attack

• try to hold twitching limbs;
• try to open your mouth and insert something into it;
• try to put a pill in your mouth, drink water;
• try to do artificial respiration if the child has stopped breathing, massage the heart.

Diagnostics

Usually, if convulsions occur against a background of intense heat, their duration is no more than 10 minutes, and they appear extremely rarely, then special treatment not required. In most cases, the baby outgrows them. But in order to prevent the possibility of developing some serious illness, it is best to go through full examination. This is especially important if the nature of the convulsions was slightly different from that described above.

To diagnose the type of seizure, your doctor will prescribe:

• computed tomography;
• total blood and urine;
• lumbar puncture in order to prevent the development and encephalitis;
• an electronic encephalogram to rule out epileptic seizures.

Treatment and prevention

A febrile seizure does not need to be interrupted. He must go on his own. We can only ease its course and prevent serious damage from occurring.

If convulsions occur, then the following treatment is applied:

• 25% glucose solution intravenously at the rate of four milliliters per kilogram of weight;
• vitamin B6 intravenously;
• an injection of a ten percent solution of calcium gluconate, at the rate of two milliliters per kilogram of weight, but not more than 10 milliliters;
• an injection of a 50% magnesium solution, at the rate of 0.2 milliliters per kilogram of weight;
• intravenous administration of phenobarbital, at the rate of ten to thirty milligrams per kilogram of weight. Enter slowly;
• intravenous administration of phenytoin, at the rate of twenty milligrams per kilogram of body weight.

• cool down skin covering a child with alcohol or vinegar rubbing;
• you can put cold on the forehead;
• after an attack, give any antipyretic. If the temperature is over 38 degrees, then it is best to give the medicine in liquid form;
• if the attack is prolonged (more than 15 minutes), you may need to give an injection of an anticonvulsant.

Possible consequences

Most often children's body outgrows febrile convulsions. If up to six years at a high temperature they did not occur, then they definitely will not appear. Their course is not accompanied by any consequences, except for short-term weakness after an attack, but it goes away by itself. There may be injuries caused by incorrect or untimely first aid.

Often, parents whose children have had febrile seizures worry about whether this will cause the development of epilepsy. The occurrence of this disease, against the background of the above, is very a rare event. In fact, epilepsy can be provoked by:

• predisposition of the child to epilepsy, i.e. if one of the parents had this disease;
• Availability neurological problems who were diagnosed before the onset of the first attack;
• deviation in psychological development;
• spasms are local in nature and last more than 15 minutes;
• repetition of spasms within a day or two and without temperature;
• nocturnal convulsions, sleepwalking.

Did you know? At the beginning of the 20th century, it was believed in Britain that if the temperature of the sang were lowered, this would increase life expectancy. It is not clear where this opinion came from, since even in our time its veracity has not been proven.

We hope we made it clear to you that febrile seizures in children are not such a terrible phenomenon, although they can scare an inexperienced parent. But the main thing is to pull yourself together, do everything without panic and consistently. And if something does not correspond to the above symptoms, immediately see a doctor.

Febrile called convulsions of varying duration, occurring in the form of tonic or tonic-clonic seizures and occurring in a child with elevated temperature body more than 38 ° C, which can be observed against the background of SARS, teething, post-vaccination reaction. They usually occur in children aged 6 months to 5 years (especially often in infants from 6 to 18 months).

According to statistics, a high temperature can provoke a seizure in every 20 babies in the first years of life. In addition, in about 30% of children with subsequent increases in body temperature, seizures recur.

Febrile seizures in children can be of 2 types- typical (simple) and atypical (complex). In the first case, they involve the whole body, cause loss of consciousness, last no more than 5 minutes and do not recur within 24 hours. In the second - they usually prevail in some part of the body, last more than 15 minutes and can be repeated several times during the day. These seizures require closer observation as they may be a sign of another serious illness.

Reasons for development

Until now, doctors have not finally established why convulsions occur at elevated body temperature. Some believe that the immaturity of the nervous system and the weakness of the processes of inhibition of the central nervous system are to blame for this. Others are sure that heredity is to blame. If parents or close relatives in childhood had convulsive seizures against the background of high temperature, then their appearance in the child is not excluded.

signs

Febrile seizures in children are similar to epileptic seizures. There are the following types of seizures:

• local (tilting the eyes, twitching of the limbs);
• tonic (strong muscle tension, tilting the head back, rolling the eyes, straightening the legs, pressing the arms to the chest, shuddering or rhythmic twitching of certain parts of the body);
• atonic (sharp relaxation of the muscles of the body, involuntary urination or defecation).

Convulsions at elevated body temperature in a child often last 2-5 minutes, often they appear in series (several consecutive seizures). During convulsive attack children stop responding to the actions and speech of their parents, they may experience a delay in breathing with blue skin.

First aid

In the event of a febrile seizure in a child, an ambulance should be called immediately. Before the arrival of doctors, he should be given first aid. First aid is to prevent getting various injuries and getting into Airways vomit, saliva, food. The child must be placed on hard surface away from heavy sharp objects and take him a position lying on his side. You should also ventilate the room, the air temperature in which should not be more than +20 ˚С.

During an attack, you can not leave the child alone, try to hold him by force, do artificial respiration, give him water, medicine to drink, open his mouth to put a spoon in.

Examination after an attack

A child who has had a febrile seizure must be shown to a neurologist to establish a diagnosis and rule out a more serious disease - epilepsy.

The examination package includes:

• general and biochemical analysis blood, urine;
• electroencephalogram;
• CT scan;
• cerebrospinal fluid analysis.

Effects

After an attack, the child may feel drowsiness, lethargy in the body, stop orienting in space for a while.

Febrile seizures in a child, although they look scary, are not dangerous and do not cause brain damage. However, in some children (2% of cases) who have had them, there is a risk of developing epilepsy as a consequence.

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 respiratory tract infections - 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:

What to do with a high temperature in a child

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. For the relief of seizures lasting longer than 15 minutes, special anticonvulsants.

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 a 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 quite high probability repetition 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 preventive treatment febrile seizures in children is the risk of degeneration into epilepsy. Since such a probability is negligible, then prevention is prescribed extremely rarely.