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The Science Behind Febrile Seizures

by Sue Hubbard, M.D.

With the “sick season” upon us, I have been seeing many children with fevers so I thought it would be a good time to talk about febrile seizures.

A febrile seizure is defined as a seizure associated with fever in the absence of other known causes of seizures. About 5 percent of children between the ages of six months and six years will have a febrile seizure. That doesn’t sound like a lot of children but seeing that I have a son that had febrile seizures it is that statistic that really doesn’t mean much when you have a child that is part of that statistical equation. Did that make sense? Reassuring a parent that a febrile seizure is benign and will not cause any long-term problems is a “hard sell” while they are watching their child seize. I even felt scared and helpless and I knew what was happening!

When my son had his first febrile seizure at about 18 months of age, I will never forget a nurse saying to me, “Didn’t you give him Tylenol or something, as he has a high fever?” She did not realize that I was a pediatrician, and I tell this story to other parents whose children have febrile seizures, as parents always feel guilty. (What is that with parental guilt?). I hope she did not have realized how guilty that might make a parent feel, for as I already thankfully knew, giving anti-pyretics (like Tylenol or ibuprofen) does not necessarily prevent a child from having a febrile seizure.

We know that febrile seizures may occur in some children with a fever of only 101 degrees, while another child may be running a much higher temperature and not have a seizure. About 30 percent of children that have a first febrile seizure will go on to have another. That is the concern of many parents who have children who experienced a febrile seizure. Parents will try to do anything they can to “ward off” another seizure when their child gets yet another fever.

I was reminded of this again while I was reading an article from the September issue of The Archives of Pediatric and Adolescent Medicine. The study, done in Japan, looked at giving children with a history of febrile seizures, extra doses of fever reducing medications. Despite this, fever-reducing medications did not appear to reduce the incidence of recurrences, even when children received an extra dose of medication.

It seems that children who have febrile seizures may respond differently to fever reducing medications during a febrile event. There seems to be an innate difference in mechanism of fever in those children who have seizures and those that do not. We have known that there is often a history of other family members having febrile seizures, so this may be further evidence or metabolic differences in some individuals with fever?

So, despite a parent’s best effort to lower a fever, especially in a child who has already had a febrile seizure, a seizure may still occur. Take home message: Febrile seizures are scary, but benign and children outgrow these seizures. Never feel guilty, even if you are asked if you gave Tylenol, or something to lower the fever. Looking at this study it probably wouldn’t have changed a thing.

That’s your daily dose, we’ll chat again tomorrow.

Send your question to Dr. Sue!

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