Patient's question:
My son was born in October 2002 and has had 4 episodes of high fever seizures since then. He had another seizure recently. This time, the seizure occurred only 1 month after the last one. Moreover, after the seizure this time, his temperature was measured, and unlike the previous 4 episodes where it was above 39°C, it only rose from 36.5°C to 37.7°C and did not increase further.Could high fever seizures in children develop into epilepsy? How can it be prevented and treated?
Details of this episode and duration: Approximately 1 month
Current general condition: Seizure occurred yesterday
Medical history: 4 episodes of high fever seizures
Previous diagnosis and treatment history and outcomes: High fever seizures. Medications like Monk Fruit Powder and Baby Treasure were taken during the illness, which showed good effects. Medication was stopped after recovery.
Doctor's answer:
Febrile seizures are a common pediatric condition that occurs in children under 6 years old and are secondary to infections outside the central nervous system. The symptoms are extremely similar to "epilepsy," specifically grand mal seizures. However, in most cases, the condition progresses favorably, though there is a tendency for recurrence or progression to epilepsy. Clinical surveys indicate that children with febrile seizures have a 3 to 6 times higher incidence of epilepsy compared to general children, and any type of seizure can evolve from febrile seizures.During high fever, the central nervous system is in an overexcited state, and the underdeveloped thalamus experiences intense electrochemical bursts. These bursts are transmitted through synapses, clinically manifesting as convulsive symptoms such as limb twitching, upward gaze, and foaming at the mouth. High fever is a trigger for seizures, and the relationship between febrile seizures and epilepsy is closely linked. Approximately 20% of children with febrile seizures eventually develop epilepsy, with some cases determined by genetic factors and others caused by brain damage resulting from hypoxic neuronal discharges during seizures.
Febrile seizures can also lead to sequelae such as intellectual disability, behavioral disorders, and delayed motor development, which result from irreversible brain damage caused by prolonged convulsions. Retrospective statistics on children who have progressed to epilepsy show that 40% to 70% of cases experience their first afebrile seizure (i.e., epilepsy) within 1 year of a febrile seizure, 37% to 77% within 3 years, and 85% within 4 years. In some cases, afebrile seizures and febrile seizures may alternate, ultimately leading to epilepsy.
The main risk factors for the progression of febrile seizures to epilepsy include:
1. A family history of epilepsy.
2. Suspected or confirmed neurodevelopmental abnormalities prior to the first febrile seizure.
3. Complex febrile seizures, such as those lasting more than 15 minutes, repeated episodes within 24 hours of fever, or focal seizures with abnormal neurological signs post-attack.
Additionally, electroencephalogram (EEG) testing can help predict whether febrile seizures may progress to epilepsy. However, it is important to note that the most accurate EEG should be conducted 1 to 2 weeks after the seizure, as approximately 1/5 to 3/5 of children may show non-specific slow-wave activity in the EEG within the first week of a febrile seizure.
For children under 6 who frequently have fevers, parents and doctors should actively prevent the progression of febrile seizures to epilepsy. In addition to improving the overall health of infants and young children to reduce the occurrence of febrile seizures, two main measures should be taken:
1. Immediately administer intravenous slow infusion of diazepam at a dose of 0.2 to 0.5 mg/kg during a febrile seizure, while ensuring airway patency and taking measures such as oxygenation and fever reduction.
2. For children with risk factors for febrile seizures, use short-term intermittent antiepileptic drugs or, based on the recurrence risk factors, long-term administration of antiepileptic drugs such as phenobarbital and sodium valproate. Phenobarbital can be given at a dose of 3 to 5 mg/kg per day, divided into two oral doses or given once at bedtime, with the course of treatment lasting from the day of the last seizure for 1 to 3 years.
Traditional Chinese medicine employs methods such as anti-epilepsy, clearing heat, resolving phlegm, opening the orifices, and replenishing marrow to prevent febrile seizures in children and treat their sequelae. Practical evidence shows that these methods are not only effective but also help avoid the many side effects associated with Western medications.