Patient's question:
Hello Doctor. My daughter is 2 years and 1 month old. Today, she had a fever of 39 degrees Celsius and experienced a high-temperature seizure. Her eyes were fixed, and there was a little white foam in her mouth. It lasted for about 2 minutes before stopping. After that, she was slightly unconscious. She has now gone to the hospital and received injections for fever reduction and anti-seizure. The doctor said she should have an electroencephalogram (EEG) in 20 days. Both my husband and I have never had this condition. Could you please tell me if seizures can occur again after the first one? What should we pay attention to? Thank you very much!Doctor's answer:
Febrile seizures are a common condition in pediatrics. According to statistics, 3% to 4% of children experience at least one febrile seizure. The occurrence of febrile seizures in children is due to underdeveloped brain maturation and poor ability to analyze and differentiate stimuli. Even weak stimuli can cause abnormal discharges in motor neurons, leading to seizures. Clinical manifestations can be divided into two types: simple and complex.Characteristics of simple febrile seizures:
1. Age: Between 6 months and 4 years old; rarely seen after 5 years.
2. Fever: Usually acute fever from a cold; seizures most often occur when the temperature rapidly rises to 38.5°C to 39.5°C.
3. Attack pattern: Loss of consciousness, generalized symmetrical tonic-clonic spasms, or may manifest as staring, strabismus, or upward deviation.
4. Duration: Lasts for several seconds or minutes, generally not exceeding 15 minutes; no recurrence within 24 hours; consciousness returns quickly after the attack.
5. Electroencephalogram (EEG): Normal after the body temperature returns to normal, typically within 2 weeks.
6. Family history: Significant family history.
Simple febrile seizures have a good long-term prognosis and do not affect intelligence, learning, or behavior. As the child grows and the brain matures, febrile seizures generally do not recur.
Characteristics of complex febrile seizures:
- Age > 6 years
- Seizure occurs when the temperature is < 38.5°C
- Attack pattern is focal
- Convulsions last more than 15 minutes
- Recurrence within 24 hours
- EEG remains abnormal even after the body temperature returns to normal for 2 weeks
The prognosis is poor, and about 1% to 2% may develop epilepsy.
When a child has a febrile seizure, parents should take the following actions:
1. Stay calm and keep the environment quiet; avoid unnecessary stimuli.
2. Ensure the airway is clear. Place the child flat with their head tilted to one side; promptly clear any secretions or vomit from the mouth to prevent aspiration or pneumonia.
3. Administer oxygen immediately if the seizure is severe and the child develops cyanosis to reduce hypoxic brain damage.
4. If anticonvulsant medication is unavailable, press the GV26 (Ren 26) and LI4 (He Gu) points; avoid excessive force to prevent skin injury and unnecessary pain.
5. Seek hospital treatment for complex febrile seizures.
After the first febrile seizure, about 40% of children may have a recurrence. Risk factors for recurrence include:
(1) Younger age at onset
(2) Family history of febrile seizures or epilepsy
(3) The first attack exhibits complex febrile seizure characteristics
Repeated convulsions can cause significant brain damage, so it is essential to prevent further seizures from leading to intellectual disabilities.
Preventive measures:
1. Avoid fever-inducing factors as much as possible. Encourage outdoor activities to help the child adapt to temperature changes in the environment. However, monitor temperature fluctuations and adjust clothing to prevent colds.
2. Maintain a balanced diet to strengthen the child’s overall health.
3. If fever occurs, lower the body temperature to below 38°C as quickly as possible. First, administer antipyretic medication. A commonly recommended option is phenobarbital and aspirin (phenobarbital for anticonvulsant effects and aspirin for fever reduction). Immediate physical cooling should also be applied, such as using 25% to 50% alcohol for sponge baths. Note: Avoid applying alcohol to areas with major blood vessels, such as the neck, chest, feet, sides of the neck, armpits, and groin. Medication-induced cooling is slower than physical cooling.
4. Children diagnosed with complex febrile seizures must take medication regularly and consistently for at least 3 years, starting from the day of the last seizure. The dosage is 3 to 5 mg/kg/day of phenobarbital.