Febrile Seizures - a beginners guide

From Dr. Rotenberg (www.txmss.com)...

Many parents need information on febrile seizures. Please note that there is no data that "temperature" management prevents febrile seizures.

Simple febrile seizures are well-managed by general pediatricians. Please develop a seizure action plan for school. JR

Febrile Seizures

Link here

A febrile seizure is a convulsion in a child triggered by a fever. These convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause.

Causes

About 3 - 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families.

Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness

Febrile seizures are usually triggered by fevers from:

• Ear infections
• Roseola infantum (a condition with fever and rash caused by several different viruses)
• Upper respiratory infections caused by a virus

Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down.

A child is likely to have more than one febrile seizure if:

• There is a family history of febrile seizures
• The first seizure happened before age 12 months
• The seizure occurred with a fever below 102 degrees Fahrenheit

Symptoms

A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body.

Febrile seizures may begin with the sudden contraction of muscles on both sides of a child's body -- usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine.

The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue.

Finally, the contraction is broken by brief moments of relaxation. The child's body begins to jerk rhythmically. The child does not respond to the parent's voice.

A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is usually followed by a brief period of drowsiness or confusion. A complex febrile seizure lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness.

Febrile seizures are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure.

Exams and Tests

The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis.

In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap).

To avoid having to undergo a seizure workup:

• The child must be developmentally normal.
• The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child's body, and not confined to one part of the body.
• The seizure must not have lasted longer than 15 minutes.
• The child must not have had more than one febrile seizure in 24 hours.
• The child must have a normal neurologic exam performed by a health care provider.

Treatment

During the seizure, leave your child on the floor.

• You may want to slide a blanket under the child if the floor is hard.
• Move him only if he is in a dangerous location.
• Remove objects that may injure him.
• Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up.
• If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.

Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down:

• Insert an acetaminophen suppository (if you have some) into the child's rectum.
• Do NOT try to give anything by mouth.
• Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse.
• After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever.

Outlook (Prognosis)

The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties.

A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures.

Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy.

About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime.

Most children outgrow febrile seizures by age 5.

Possible Complications

• Biting oneself
• Breathing fluid into the lungs
• Complications if a serious infection, such as meningitis, caused the fever
• Injury from falling down or bumping into objects
• Injury from long or complicated seizures
• Seizures not caused by fever
• Side effects of medications used to treat and prevent seizures (if prescribed)

When to Contact a Medical Professional

Children should see a doctor as soon as possible after their first febrile seizure.

If the seizure is lasting several minutes, call 911 to have an ambulance bring your child to the hospital.

If the seizure ends quickly, drive the child to an emergency room when it is over.

Take your child to the doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child.

Call or see the health care provider if other symptoms occur before or after the seizure, such as:

• Abnormal movements
• Agitation
• Confusion
• Drowsiness
• Nausea
• Problems with coordination
• Rash
• Sedation
• Tremors

It is normal for children to sleep or be briefly drowsy or confused right after a seizure.

Prevention

Because febrile seizures can be the first sign of illness, it is often not possible to prevent them. A febrile seizure does not mean that your child is not getting the proper care.

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile seizures that occur more than once. However, no medication is completely effective in preventing febrile seizures.

Alternative Names

Seizure - fever induced

References

Johnston MV. Seizures in childhood. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 593.

Update Date: 2/11/2010

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation programis an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

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At Last, Football Faces Concussion Problems Head-On

Post by Dr. Rotenberg...

August 14, 2011

The NFL got back to the playing field this past week for its first preseason games since the players and owners agreed to a new collective bargaining agreement. But the scene at NFL training camps is a bit different this year.

New rules now limit the amount of full-contact practice that players can participate in. Gone are the grueling summer two-a-days.

These rules were put in place to address growing concerns about player injuries, concussions in particular. Medical research suggests that the bone-crunching hits that energize fans have serious health consequences for players long after they hang up their pads.....

listen here...

http://www.npr.org/2011/08/14/139621182/at-last-football-faces-concussion-problems-head-on

Sleep and Epilepsy

As part of a comprehensive approach to treating epilepsy and preventing seizures, sleep disorders should be addressed.

Watch this short video by Dr Rotenberg on the topic

http://www.youtube.com/watch?v=Fll_WIxqy9s&feature=related

Retracted autism study an 'elaborate fraud,' British journal finds

(CNN) -- A now-retracted British study that linked autism to childhood vaccines was an "elaborate fraud" that has done long-lasting damage to public health, a leading medical publication reported Wednesday.

An investigation published by the British medical journal BMJ concludes the study's author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study -- and that there was "no doubt" Wakefield was responsible.....

http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html?hpt=T1

November is Epilepsy Awareness Month - Get the Seizure Facts

Get the facts about seizures and epilepsy!!

Here is a great one page resource on the facts about seizures. JR

Seizure First Aid Do you know what to do?

From Dr. Rotenberg, Child & Adolescent Neurologist
Board Certified Epileptologist
Member American Epilepsy Society 
www.txmss.com - 714-464-4107

Do you know what to do?
Find out How Seizure Smart You Are and Take the Quiz!

This November, for National Epilepsy Awareness Month, the Epilepsy Foundation is asking everyone to Get Seizure Smart about seizure first aid, recognition and types. Epilepsy affects people of all ages and races, and represents one percent of the population in this country—nearly 3 million people.

Review Seizure First Aid (convulsive, generalized tonic-clonic)

http://www.epilepsyfoundation.org/neam/

Great Site for the Autism Industry Skeptic

I am reposting this one since it contains a link for labs performing tests with "NON- STANDARD" techniques

What does this mean? Diagnostic tests are performed using validated and standardized techniques. As a result, you get similar results in different labs.

Would you build a bridge with non-standard techniques? Would you fly in plane fixed with non-standard techinique?

Why would you treat a child based on such methods?

Great Site for the Autism Skeptic - This is a great one stop shop for rational inquiry.

http://www.autism-watch.org/

CHILDHOOD SLEEP APNEA LINKED TO BRAIN DAMAGE, LOWER IQ

---“A Wake-Up Call” for Parents and Pediatricians--

In what is believed to be the first study showing neural changes in the brains of children with serious, untreated sleep apnea, Johns Hopkins researchers conclude that children with the disorder appear to suffer damage in two brain structures tied to learning ability.

Writing in the Aug. 22 issue of the global online journal Public Library of Science Medicine, the Hopkins investigators say they compared 19 children with severe obstructive sleep apnea (OSA) to 12 children without the disorder. Using a special type of MRI, researchers identified changes to the hippocampus and the right frontal cortex. Next, using IQ tests and other standardized performance tests that measure verbal performance, memory and executive function, researchers were able to link the changes in the two brain structures to deficits in neuropsychological performance.

The hippocampus, a structure in the temporal lobe, is vital to learning and memory storage, while the right frontal cortex governs higher-level thinking, such as accessing old memories and using them in new situations.

“This should be a wake-up call to both parents and doctors that undiagnosed or untreated sleep apnea might hurt children’s brains,” says lead author Ann Halbower, M.D., a lung specialist at the Johns Hopkins Children’s Center. “This is truly concerning because we saw changes that suggest brain injury in areas of the brain that house critical cognitive functions, such as attention, learning and working memory.”

Link to article http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030301

Site - http://www.hopkinsmedicine.org/press_releases/2006/08_21_06.html

Neuropsychological and behavioural aspects in children and adolescents with idiopathic epilepsy

Neurology note - A comprehensive approach to epilepsy includes attention to neuropsychological function. Dr Rotenberg

Seizure. 2010 Aug 21. [Epub ahead of print]

Neuropsychological and behavioural aspects in children and adolescents with idiopathic epilepsy at diagnosis and after 12 months of treatment.

Piccinelli P, Beghi E, Borgatti R, Ferri M, Giordano L, Romeo A, Termine C, Viri M, Zucca C, Balottin U.

Child Neuropsychiatry Unit, University of Insubria, Macchi Foundation Hospital, Varese, Italy; Department of Child Neurorehabilitation, "Eugenio Medea" Scientific Institute, Bosisio Parini, Italy.

Abstract

PURPOSE: To study neuropsychological functions in children with idiopathic epilepsy at onset of treatment and after 1 year of therapy and to identify factors associated with cognitive impairment.

METHODS: 43 Subjects aged 5.2-16.9 years with newly diagnosed idiopathic epilepsy were enrolled and started treatment with valproate or carbamazepine. At admission and after 12 months, all patients underwent clinical examinations, the Child Behavioural Checklist, EEG and a neuropsychological test battery. The results of each test were correlated to demographic, clinical, electrophysiological and therapeutic variables.

RESULTS: Except for attention, all neuropsychological functions were normal at admission and after 12 months. An improvement with time was noted for memory (p<0.05)>

DISCUSSION: Idiopathic epilepsy can affect attention, even before starting treatment. Emotional and behavioural difficulties and a low socio-economical status are associated with cognitive impairment.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WWW-50V8C2T-1&_user=10&_coverDate=08%2F22%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4851dfcbab966c0685a372d1cb3cdf6a&searchtype=a

PMID: 20732824 [PubMed - as supplied by publisher]

Sudden Unexplained Death in Epilepsy - Unmasking Silent Killer in Epilepsy

Unmasking Silent Killer in Epilepsy

By ALIYAH BARUCHIN
On July 9, 2009, Steve Wulchin went to wake his 19-year-old son, Eric, in their home in Boulder, Colo. Eric had been given a diagnosis of epilepsy three years earlier, but other than that, his father said, “there was nothing out of the ordinary.” His seizures had been well controlled; he had not had one in six months.


Yet that morning, Mr. Wulchin found Eric lying on the floor. CPR and paramedics were too late; Eric had died at about 2:30 a.m.


The cause of Eric’s death was ultimately listed as Sudep, for sudden unexplained death in epilepsy. The syndrome accounts for up to 18 percent of all deaths in people with epilepsy, by most estimates; those with poorly controlled seizures have an almost 1 in 10 chance of dying over the course of a decade.


Yet many patients and their families never hear about Sudep until someone dies. Mr. Wulchin said none of Eric’s four neurologists ever mentioned it to the family.


“The message we got back was, ‘There’s no reason why he can’t live a long and normal life,’ ” he said. “It never occurred to me that this was a possibility.”


Now, physicians, researchers, advocates and relatives like Mr. Wulchin, a technology executive, are trying to raise awareness about Sudep. One of their goals is to establish registries of deaths and autopsy results, building databases to support future research.


Sudep most often affects young adults, typically ages 20 to 40, with a history of the convulsive seizures once known as “grand mal.” Others at risk include those with difficult-to-control seizures, or seizures at night; people who take a large number of anti-epileptic medications or take them irregularly; African-Americans with epilepsy; and people with epilepsy whose I.Q. is under 70......more....


http://www.nytimes.com/2010/07/27/health/27epil.html?_r=1&ref=global-home

Baby Emergencies iphone App - When your mind goes blank

From Dr. Robertson

RN Tara Summers was inspired to make an iPhone app after a frightening episode where she saw her infant child choking. Because she was a nurse, she sprang into action and gave the Heimlich maneuver, but worried about parents (or babysitters) without the same training.

So, along with her emergency medicine physician husband, she created MedBasics -- a readily accessible information packet for the home about things to do in an emergency. Now, they're announcing an iPhone app called BabyMedBasics, for emergencies when you're not at home.

http://www.medgadget.com/archives/2010/08/baby_medbasics_app_when_your_mind_goes_blank.html

Symptoms of a seizure can be subtle...

Symptoms of a seizure can be subtle...

Symptoms of a Seizure

A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below.

Seizures have a beginning, middle, and end

When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning.
Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor.

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion.

The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “post-ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti-seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post-ictal period, much like a person waking up from anesthesia after an operation. There are other symptoms that occur during the post-ictal period and are detailed below.

Please note: Below is only a partial list, some people may experience other symptoms not listed below. These lists are meant to help patients communicate with their physicians.

Early seizure symptoms (warnings)

Sensory/Thought:
Deja vu
Jamais vu
Smell
Sound
Taste
Visual loss or blurring
Racing thoughts
Stomach feelings
Strange feelings
Tingling feeling

Emotional:
Fear/Panic
Pleasant feeling

Physical:
Dizziness
Headache
Lightheadedness
Nausea
Numbness

No warning: Sometimes seizures come with no warning

Seizure symptoms

Sensory/Thought:
Black out
Confusion
Deafness/Sounds
Electric Shock Feeling
Loss of consciousness
Smell
Spacing out
Out of body experience
Visual loss or blurring

Emotional:
Fear/Panic

Physical:
Chewing movements
Convulsion
Difficulty talking
Drooling
Eyelid fluttering
Eyes rolling up
Falling down
Foot stomping
Hand waving
Inability to move
Incontinence
Lip smacking
Making sounds
Shaking
Staring
Stiffening
Swallowing
Sweating
Teeth clenching/grinding
Tongue biting
Tremors
Twitching movements
Breathing difficulty
Heart racing

After-seizure symptoms (post-ictal)

Thought:
Memory loss
Writing difficulty

Emotional:
Confusion
Depression and sadness
Fear
Frustration
Shame/Embarrassment

Physical:
Bruising
Difficulty talking
Injuries
Sleeping
Exhaustion
Headache
Nausea
Pain
Thirst
Weakness
Urge to urinate/defecate

If you or someone you know has the symptoms listed above -- you are not alone.


Adapated from: Schachter SC, editor. Brainstorms: epilepsy in our words. New York: Raven Press; 1993; and Schachter SC, editor.The brainstorms companion: epilepsy in our view. New York: Raven Press; 1995..