Hello,
Thank you for your query at DoctorSpring.com
Febrile seizures are a benign manifestation of the tendency of the brain (of children) to throw a seizure when exposed to higher temperatures. This tendency is usually gone by the age of 5-6 years as the child grows up. Simple febrile seizures are associated with no significant increase in risk for epilepsy or any significant neurological sequelae in later life. But, the question is - Is it true simple febrile seizure ??
For the diagnosis of true simple, febrile seizures, the following points are essential:
1. Characteristic age group: Children aged 6 months - 6years; In your child's case, she is 18 month old and that would fit in.
2. No underlying neurological illness/ developmental delay. Child should have achieved all her developmental milestones on time. So is your daughter at 18 months age talk, walk and behave like other 18 month olds?
2. No history of any seizures in the past (afebrile seizures).. Please ask your relatives and parents for any such history in the family.
3. No family history of epilepsy or neurological disorders... Please ask your relatives and parents for any such history in the family.
4. Seizure - single episode of generalized tonic clonic seizures occurring within twenty four hours of onset of fever and lasting less than 10 minutes - Does this description of seizure fit ?
Does your child satisfy all these criteria??? Please provide answer to the above questions so that we can discuss it further. If it is indeed a simple, febrile seizure, then we would be able to confidently discuss the prognosis and future course of events.
Regards
Dr. Saptharishi L G
Dr. Saptharishi L G
Patient replied :
Hi,
Below are the answers to your questions.
1. Characteristic age group: Children aged 6 months - 6years; In your child's case, she is 18 month old and that would fit in.
Current age is 18 months, she fits in as you stated.
2. No underlying neurological illness/ developmental delay. Child should have achieved all her developmental milestones on time. So is your daughter at 18 months age talk, walk and behave like other 18 month olds?
Yes, She behaves and plays like the 18 Month old. Shouts on me to.. gets angry
2. No history of any seizures in the past (afebrile seizures).. Please ask your relatives and parents for any such history in the family.
As such there is no history
3. No family history of epilepsy or neurological disorders... Please ask your relatives and parents for any such history in the family.
As such there is no history
4. Seizure - single episode of generalized tonic clonic seizures occurring within twenty four hours of onset of fever and lasting less than 10 minutes - Does this description of seizure fit ?
yes, the seizure occures in the first 24 hrs of fever and nearly lasted to 10 mins, as stated to me. as i was not there.
Please help me, i am really worried.
Dear Parent,
Thank you for responding to my queries. It does appear to be a case of SIMPLE FEBRILE SEIZURE. The diagnosis of a simple febrile seizure is entirely a clinical one. There is absolutely no indication for performing a MRI or EEG in these children, as more often than not incidental findings can confuse the clinician as well as the parents, as has happened in your case. Most of the international recommendations advise against performing MRI/EEG.
It is also recommended that in case EEG is performed, it should be done only after 2 WEEKS of seizures, as within the first two weeks there can be non-specific findings. So, in your daughter, I advise that we repeat it after 2 WEEKS. The EEG should be at least 30 min in wakefulness and in sleep as per international guidelines to avoid misinterpretation.
Secondly, there is no need to prescribe PHENOBARBITONE (Gardena) to children with febrile seizures as a treatment modality. In children where the seizures are recurrent or prolonged, these therapies may be used. For prevention, it is safe to use diazepam (calmpose) or SOS intranasal or buccal midazolam to abort seizures in case they occur. There is absolutely no need to worry. Just be aware that your child could develop seizures if there is fever. But, there is no reason to get unduly worried as most children do not have a recurrence and even if they do, it is a short-lasting one with no serious problems and aborts spontaneously.
You should understand that 2-5% of perfectly normal children develop febrile seizures and that is quite a large number and I must tell you that there is enough evidence to show that there are no long term adverse events of simple febrile seizures (even if they recur). The risk for occurrence of subsequent epilepsy is around 1% or lesser.
Feel free to discuss further.
Patient replied :
Thanks for the response.
Our doctor suggted to giver 1/2 tablet of calmpose and calpol when there is the fever next time.
Is this the correct advice to follow and after this incident my daughher has become somewhat irritating, is it because of the medicine that she has gone through ?
Dear Parent,
You could give her PARACETAMOL (Calpol) alone whenever she has fever. I personally do not advise CALMPOSE (diazepam) as it can make the child very drowsy. However, if used, it can be used as a 1/4th tablet for a 18 month old once daily (at night). But, my personal choice would be to avoid CALMPOSE.
There is NO evidence to show that using cold/tepid sponging brings down the risk of febrile seizures. So, the best strategy is:
1. Use paracetamol every 6 hourly
2. Be aware of the risk and be around the child especially during the first 24 hours
3. Have a MIDAZOLAM nasal spray (commercial product name: INSED spray) at hand. In case, the child throws a seizure, use nasal sprays - 2 on each side to abort seizures and then seek medical help.
Regards.
Patient replied :
Thanks very much for the response. just one last question, which is the best thermometer to measure her tempretaure (digital or infra one currently i am using the Dr. Morphen thermometer but it shows different reading each time) I should give her the medicine , when the temp is > 99 or >100
Dear Parent,
Yeah. You could use any digital thermometer. Remember to use it as per the instructions provided by the manufacturer. You need to wait for the appropriate time or the beep (depending on the model) before you read the temperature.
By definition, fever is defined as body temperature more than 38 C or 100.4 F. As axillary (underarm) temperature is usually 0.5 C lesser than rectal/core body temperature, you could use a cut-off of 37.5 C or 99.7 F when you measure temperature after placing the thermometer in the underarm