Seizure occurring in infancy or early childhood, associated with fever ≥38°C, without evidence of central nervous system infection, metabolic disturbance, or prior afebrile seizures.
Aetiology
Epidemiology
- Occurs in 2–5% of children
- Age range: 6 months to 5 years
- Peak incidence: 12–18 months
- Slight male predominance
- Higher incidence in children with:
- Family history of febrile seizures
- Rapid rise in temperature
Common Causes of Fever:
- Viral infections (most common)
- Upper respiratory tract infections
- Gastroenteritis
- Otitis media
- Post-immunization fever (e.g., DPT)
⚠️ The height of fever is less important than the rapidity of temperature rise.
Clinical presentation
Simple Febrile Seizure (Most Common)
- Generalized
- Duration <15 minutes
- Occurs once in 24 hours
- No postictal neurological deficit
Complex Febrile Seizure
Any of the following:
- Duration ≥15 minutes
- Focal features
- Recurs within 24 hours
- Postictal neurologic deficit
Febrile Status Epilepticus
- Seizure ≥30 minutes
- Rare but high risk for later epilepsy
Investigations
Not routinely required in simple febrile seizure.
Consider investigations if:
- Signs of meningitis
- Age <12 months (selectively)
- Complex febrile seizure
- Persistent altered consciousness
Test | Indication |
Lumbar puncture | Suspected meningitis |
Blood tests | Severe illness |
EEG | Not routine |
CT/MRI | Only if focal deficits |
Management
- Antiviral medications - aciclovir treats HSV and VZV
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