Decision Making and the Child with Febrile Seizures
John M. Freeman MD1
Eileen P. G. Vining MD2
1 Lederer Professor of Pediatric Epilepsy and Professor of Pediatrics and Neurology, The Johns Hopkins Medical Institutions, Baltimore, MD.
2 Co-Director, The Pediatric Epilepsy Center; Associate Professor of Pediatrics and Neurology, The Johns Hopkins Medical Institutions, Baltimore, MD.
Seizures, both febrile and nonfebrile, are the most common neurologic problem seen in children. Most seizure problems can, and should, be managed by the pediatrician. This article, along with the following one, represents a dialogue—one we often have with pediatricians about the evaluation and management of seizures in children.
A seizure is defined as a paroxysmal electrical discharge of neurons in the brain resulting in alteration of function or behavior. A febrile seizure is defined as a seizure caused by fever. The diagnosis of a febrile seizure is one of exclusion. Before the diagnosis is made definite, it must be established that there was not another cause for the seizure.
Factors Important in the Diagnosis of Febrile Seizures
AGE
Febrile seizures are most common between the ages of 6 mo and 5 y. Beyond this range, seizures are more likely to have another etiology. However, this does not mean that every child outside of this age range needs a brain scan and an extensive initial evaluation.
TEMPERATURE
The height of the fever at the time of the seizure is helpful to know. Anyone can have a seizure if his or her temperature is sufficiently high. Therefore, in the absence of other demonstrable causes, the higher the fever, the more likely that an initial seizure, occurring in the typical age range, was precipitated by the fever.
