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Febrile seizures
Lynette G Sadleir and Ingrid E Scheffer BMJ 2007;334;307-311 doi:10.1136/bmj.39087.691817.AE

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CliniCal Review

Febrile seizures
Lynette G Sadleir,1 Ingrid E Scheffer2
Department of Paediatrics, Wellington School of Medicine, University of Otago, Wellington, New Zealand 2 Departments of Medicine and Paediatrics, University of Melbourne, Austin Health and Royal Children’s Hospital,Melbourne, Australia Correspondence to: I Scheffer scheffer@unimelb.edu.au
1

BMJ 2007:334:307-11 doi: 10.1136/bmj.39087.691817.AE

Seizures associated with fever are a common pae­ diatric problem. Differentiation of febrile seizures from acute symptomatic seizures secondary to cen­ tral nervous system infection or seizures triggered by fever in children with epilepsy is essential. The syndrome offebrile seizures is defined as seizures associated with fever in the absence of central ner­ vous system infection or acute electrolyte imbal­ ance in a young child.w1 The prevalence of febrile seizures is between 3% and 8% in children up to 7 years of age.1 w2 Variation in prevalence relates to dif­ ferences in case definitions, ascertainment methods, geographical variation, and culturalfactors. Here we discuss the investigation, management, and outcome of febrile seizures.
Sources and selection criteria We searched Medline, Embase, and the Cochrane Collaboration from 2000 onwards by using the medical subject heading “seizures, febrile” or key words “febrile convulsions” or “febrile seizures”. We searched the same databases before that date, focusing on the medical subject headingsonly. We selected relevant articles from the abstracts and hand searched these for other pertinent publications. why and at what age do children have febrile seizures? Febrile seizures result from a combination of genetic and environmental factors.2 Of children with febrile seizures, 24% have a family history of febrile seizures and 4% have a family history of epilepsy.3 Although polygenicinheritance is usual, a small number of families exist in whom the inheritance of febrile sei­ zures is autosomal dominant, and several chromo­ somal loci and a few genes have been identified. 4 Mutations in sodium channel and γ­aminobutyric acid A receptor genes have been identified in chil­ dren with febrile seizures,w3 w4 suggesting that genes coding for ion channels are likely to underlie the syndrome.Febrile seizures are defined as occurring between 6 months and 6 years of age.5 The median age of onset is 18 months, and half of children present between 12 and 30 months.3 what is the relation of the fever to the seizure? The fever associated with a febrile seizure is usu­ ally defined by a temperature of at least 38°C.3 No

SuMMaRy pointS
Febrile seizures are the most common seizure...