Febrile seizures in children: what is it, causes, treatment

Types of seizures

Cramps are involuntary muscle contractions that can involve individual muscle fibers or muscles or spread across multiple muscle groups. There are several types of seizures in children.

Tonic cramps are prolonged muscle tension or spasms. In this case, the child takes an extension position, throws back his head, stretches and tenses his legs, spreads his arms and turns his palms outward. Sometimes respiratory failure is characterized by a type of respiratory arrest, which is accompanied by cyanosis of the nasolabial triangle, limbs, and redness of the facial skin.
Clonic convulsions are a rapid change in muscle tension and relaxation (about 1-3 twitches per second).

According to their prevalence, clonic seizures are classified into the following types: focal, multifocal and generalized.

Focal - twitching of individual parts of the face, arms, legs (for example, convulsions during sleep with loss of magnesium).
Myoclonic - contractions and twitching in a muscle or group of muscles.
Tonic-clonic are characterized by alternating clonic muscle contractions and increased tone.
Fragmentary are eye symptoms, motor equivalents (flexion of limbs, nodding of the head), blackouts or cessation of breathing (apnea).

First aid

The appearance of seizures in children causes panic in parents, especially if the child is an infant. Out of confusion, mom and dad may even fall into a stupor; to prevent this from happening, we will provide some recommendations on what to do when this problem arises.

For babies

Having discovered the first signs of seizures without fever in a child, you should:

Remove all objects from your baby that could cause harm to themselves. It is best to take him to his crib;
the surface on which the child lies must be flat;
lay him on his side so that it is easier for the baby to breathe and he does not choke on vomit or saliva;
remove tight clothing;
ventilate the room;
control breathing;
Do not leave your baby even one step and note the duration of the attack.

After the attack ends, you must call an ambulance or a doctor at home.

Unfortunately, at a young age, children are more susceptible to illness. Therefore, a caring mother needs to know how to detect stomatitis, conjunctivitis of the eyes, laryngotracheitis, streptoderma, bronchitis, dysarthria, constipation, rubella, prickly heat, colic, pyloric stenosis, umbilical hernia, jaundice.

For convulsions accompanied by high fever

The algorithm of action is the same as for spasms in infants. In addition, you should try to cool the child by wiping him with a damp towel in the groin, axillary, elbow and knee areas. When the attack ends, call an ambulance and give antipyretics. Typically, these seizures last from 10 seconds to a minute.

Important! Try to prevent an attack from occurring. At the first sign of a rise in temperature, begin to bring it down. If it rises above 38 degrees, then there is a high probability of a febrile attack.

What are febrile seizures?

Febrile seizures develop in children with convulsive readiness against the background of increased body temperature. This type of seizure is diagnosed in children under six years of age due to fever, if they have not previously had seizures. Typically, such attacks develop if the high temperature exceeds 38 degrees.

Since approximately every third child has febrile seizures that may recur during subsequent episodes of fever, in children who have had such an attack once, it is advisable to lower the temperature, starting from 37.5 degrees.

Febrile seizures are not epilepsy and do not require special treatment; they should be distinguished from epileptic seizures. Epilepsy can occur at any age, while febrile seizures can occur up to 6 years of age due to high fever.

Why do they occur at temperature?

The reasons for their occurrence are not fully understood, but most scientists agree that this is caused by a predominance of excitation processes over inhibition in the brain of children, which leads to the appearance of pathological impulses in nerve cells. An acute respiratory viral infection, any infectious disease or vaccination can provoke such a reaction in the body. It is assumed that there is a hereditary predisposition to febrile seizures.

Since the nervous system becomes more mature after 6 years, febrile seizures should not occur if seizures occur in a child over 6 years of age - this is due to epilepsy, infection or tumor.

Signs of seizures in a child with fever

Usually, during convulsions, the baby does not react to the actions and words of the parents, loses contact with others, stops crying, and the skin may turn blue and he may hold his breath. Febrile seizures are similar to epileptic seizures and can be of the following types:

tonic with throwing back the head, tension of the body, which change to clonic rhythmic twitching, which gradually fades;
focal with twitching of arms or legs, rolling of eyes;
atonic with sudden muscle relaxation, involuntary urination and defecation.

Such convulsions rarely last more than 15 minutes, sometimes they can occur in series of 1-2 minutes, but go away on their own. Read below about helping your child with such seizures.

Risk factors

Febrile seizures are caused by fever, usually above 38.8°C. There are several risk factors for developing febrile seizures. When more than one risk factor is present, the likelihood of occurrence is even higher.

While the specific causes of febrile seizures are poorly understood, we do know about who is at risk for febrile seizures.

The main risk factors for febrile seizures are:

age (most often occur from 3 months to 5 years);
developmental delay (eg, cerebral palsy, mental retardation);
family predisposition;
frequent fevers (such as those caused by a viral or bacterial infection);
high body temperature;
maternal smoking and alcohol consumption during pregnancy;
meningitis;
presence of a febrile attack in the anamnesis (in the past);
hospitalization during the neonatal period;
visiting preschool institutions.

Relevant: What antibiotics can be taken for colds and flu?
Some pathogens (viruses, bacteria) provide a high risk of developing febrile seizures. These pathogens include influenza A virus, herpes virus type 6, which causes roseola, and the bacteria Shigella and Campylobacter, which cause gastroenteritis.

Why are seizures common in children today?

Unfortunately, the number of children who are ready to respond with a convulsive seizure to a variety of situations is growing year by year.

this is due not only to the inherited characteristics of the metabolism of nerve cells and their convulsive readiness
immaturity of the nervous system of young children, but also
with the number of successfully cared for newborn children who, in the “wild” environment of past centuries, simply did not live to see convulsive debuts
This includes the majority of very premature babies weighing up to one and a half kilograms
children with hemorrhages in different parts of the brain
children from emergency caesarean sections due to placental abruption
severe placental insufficiency with oxygen starvation
with other factors leading to a pathological pregnancy (intrauterine infection), birth trauma, in which children are born with severe damage to the central nervous system.

Thus, today every fiftieth child suffers from convulsive syndrome, 60% of all cases of primary development of seizures occur in the first three years of life. But convulsions cannot be considered in their pure form. This is not a separate disease, but a complex of symptoms that can develop in a variety of diseases.

Causes of seizures in infants and newborns

In the first month of his life, a child in some cases has a very unstable system that can respond with convulsions to various disadvantages.

Convulsions due to birth trauma

They arise as a result of hypoxic damage to brain tissue, hemorrhage or shock waves of cerebrospinal fluid. Develops in the first eight hours of a baby's life. Hemorrhages in the cerebral ventricles are characterized by tonic convulsions, while hemorrhages in the subarachnoid space are characterized by clonic convulsions. For cerebral hematomas or hemorrhages under the dura mater, generalized tonic or clonic convulsions develop.

Hypoglycemic seizures

Such convulsions appear in the first two days against the background of very low blood sugar levels (less than 1.1 mmol per liter). Initial manifestations are characterized by hyperactivity, sweating, anxiety, and breathing problems. The stronger the hypoglycemia, the more severe the generalized tonic seizures. Such conditions are caused by metabolic disorders of the infant, galactosemia, hormonal disorders, birth asphyxia, prematurity, and low birth weight.

Anoxic seizure syndrome

This syndrome is a consequence of deep oxygen starvation of the brain in children with asphyxia, which leads to cerebral edema. Tonic-clonic seizures usually develop. The first phase is tonic, followed by stopping of the eyeballs and holding the breath. The attack lasts several minutes and is replaced by lethargy and tearfulness of the child. Cramps appear immediately on the day of birth. If a similar condition develops in children older than a month, you should suspect an infectious process and be wary of the development of epilepsy.

Fifth day cramps

They occur between the third and seventh day of a baby’s life and manifest themselves as short-term (up to three minutes) clonic twitches, the frequency of which reaches forty times per day. These disorders are associated with low levels of zinc in the blood of newborns.

Convulsions due to hemolytic disease of the newborn

Such convulsions are caused by the toxic effect of bilirubin on the central nervous system. These generalized tonic seizures develop during the first week of the child and are accompanied by jaundice, depressed reflexes, drowsiness, and impaired sucking. With the development of kernicterus, the subcortical structures of the brain are affected. Obsessive involuntary movements and delayed motor and mental development of the baby appear.

Spasmophilia (tetanic convulsions)

This is the result of a calcium metabolism disorder. The early version appears on the third day from birth, the late version - after the fifth day. Characterized by a spasm of upward gaze, tonic spasms of the arms and legs (curling and cramping of the fingers). Following this, a tonic phase may develop with loss of consciousness.

Pyridoxine dependent

This is a consequence of a violation of vitamin B6 metabolism. They are typical for the first three days of a baby’s life. Manifest in the form of widespread muscle twitching, head nodding, and shuddering.

Seizures due to brain malformations

They are quite rare (about 10% of all cases of neonatal seizures), and occur in the first days after birth. Also considered a rare option is the familial nature of the syndrome with convulsions up to 20 times a day, which begin to appear in the second week of life.

Withdrawal syndromes

These are seizures in children born to mothers suffering from alcoholism or drug addiction who used drugs during pregnancy. Similar conditions can occur in infants whose mothers used barbiturates.

Symptoms

Most febrile seizures are extensive. In other words, the whole body is involved.

During an extensive attack, the following manifestations can be seen:

the muscles of the body are toned and “stiff”;
large twitching of arms and legs;
complete lack of response to any stimuli;
the child's eyes roll back or are wide open;
clenched jaws and lips;
urinary incontinence;
noisy breathing, heavier and slower than usual (rarely the child stops breathing completely).

When you observe childhood convulsions, a seizure can seem like an eternity. But in reality, most of these episodes are only 1 - 5 minutes long. After this, the child is usually sleepy and begins to react to others after 15 - 30 minutes.

After a seizure, the child may remain somewhat “jerky,” with intermittent small jerking movements of the arms or legs. It is difficult to distinguish these movements from an attack, but parents can reassure themselves. If the baby's muscles are relaxed, breathing is regular, and the baby begins to show some signs of responding to stimulation (will respond if you talk to him), everything is fine.

Cases of focal spasms are less common and, as the term suggests, only affect one part of the body. Abnormal movements may only be seen on the face (eye blinking, lip closing, other mouth movements) or one side of the body. Variable changes in consciousness are sometimes observed with focal seizures. Some attacks begin as focal and then become widespread.

Primary seizure syndrome is epilepsy

At the same time, there is a hereditary predisposition to seizures, since a certain type of metabolism in the nerve cells of the brain is inherited, which reduces their threshold of excitability. This is the so-called convulsive readiness of the brain, which, in the event of unfavorable events, can result in a convulsive attack.

Epilepsy affects 1 to 5% of children, and the disease first appears in childhood in 70% of all affected adults. In addition to seizures, epilepsy can manifest itself as autonomic, mental or sensory disorders. Seizures at night are not typical for epilepsy.

Epilepsy is distinguished with focal or generalized seizures.

Simple focal seizures are convulsions of individual muscle groups without loss of consciousness, complex seizures are convulsions with loss of consciousness.
Generalized seizures may be accompanied by clonic, tonic-clonic, atonic or myoclonic seizures or petit mal seizures (absences).
Status epilepticus is a prolonged epileptic seizure (about half an hour) or a series of convulsions with loss of consciousness. It can be triggered by electrolyte disturbances, infections, and medications. Often epistatus is the onset of a brain tumor.

How does a typical epileptic seizure occur?

The onset of an epileptic seizure is an aura:

visual
auditory
olfactory or sensory impressions that become exaggerated and intrusive

In addition to the aura, headaches, irritability, and a feeling of fear may appear.

During a generalized attack

The child suddenly loses consciousness and falls down with a scream or groan. The tonic phase with muscle tension lasts for several seconds:

throwing back the head
stretching your legs
arms outstretched

At this time, there may be cessation of breathing or biting of the tongue due to clenching of the jaws. The child's pupils dilate and his gaze may freeze.

During the phase of clonic convulsions, the following are noted:

short-term twitching of various muscle groups (up to two minutes)
noisy breathing
there may be involuntary urination or bowel movements
foaming from the mouth

After the convulsions, relaxation occurs and the child falls asleep. Upon awakening, as a rule, the child does not remember the events of the attack.

Focal seizures

They cause twitching of individual muscles, taste, tactile, visual, and auditory disorders. They may be accompanied by headache or abdominal pain, palpitations or sweating, and mental disorders.

Minor seizure

This includes turning off consciousness (lasting up to 20 seconds), stopping movements and speech, and freezing the gaze. After the attack ends, the child does not remember its circumstances. Sometimes absence seizures are accompanied by simple or even complex motor activity (muscle twitching, monosyllabic movements, or even imitation of meaningful activity).

Secondary seizures develop against the background of various damage to neurocytes

Withdrawal syndrome is usually characteristic when barbiturates are used in children.
Spasmophilia due to an overdose of vitamin D or hypoparathyroidism has a clinical picture similar to tetany in newborns.
Traumatic brain injuries leading to massive hemorrhages in different parts of the brain can lead to seizures.
Cramps in diabetes mellitus are the result of a drop in blood sugar.
Brain tumors often first manifest themselves as a convulsive syndrome in the program of secondary vascular epilepsy.

Neuroinfections

Meningitis, arachnoiditis against the background of meningococcal, staphylococcal infections, influenza, botulism can cause convulsions. The most typical example of tetanic convulsions with a fatal outcome is tetanus, which, although not common, can take the life of a child, which does not defeat the purpose of DTP vaccination.

West syndrome (infantile seizures)

These are myoclonic seizures, which can occur against the background of epilepsy or, more often, against the background of impaired growth and development of the cerebral cortex in children from three to eight months of age. This type of convulsions is facilitated by asphyxia or severe hypoxia suffered during childbirth, cerebral palsy, metabolic abnormalities, and increased intracranial pressure. In this case, seizures appear at lightning speed and are often combined with delays in mental development. Flexion of the limbs (leg cramps in a child) and spine are typical, followed by muscle relaxation (described by West) or extension cramps. It is noted that convulsions occur in series and occur more often in the morning.

Poisoning from medicines, mushrooms, plants

Poisoning with drugs - antidepressants (amitriptyline, azaphene), strychnine, isoniazid, ethylene glycol, anticholinergics (cyclodol, diphenhydramine, atropine), antipsychotics (haloperidol, triftazine);
Mushrooms: fly agaric, toadstool;
Plants: henbane, raven's eye, datura.

Dehydration or blood loss

Hypovolemia or a decrease in circulating blood volume due to dehydration (frequent diarrhea and vomiting, improper drinking regimen) or blood loss leads to oxygen starvation of the nerve cells of the brain and can cause seizures.

With blood loss or dehydration, night cramps are very typical due to an imbalance of magnesium and calcium ions.

Diagnostics

Usually, if cramps occur against a background of intense heat, their duration is no more than 10 minutes, and they occur extremely rarely, then no special treatment is required. In most cases, the baby outgrows them. But in order to prevent the possibility of developing some serious illness, it is best to undergo a full examination. This is especially important if the nature of the convulsions was slightly different from that described above.

To diagnose the type of seizure, your doctor will prescribe:

First aid for seizures in a child

Call an ambulance
Lay the baby on a hard, flat surface on his side so that the head and chest are in line, and raise the head end with a rolled up blanket. In this case, the cervical spine should not be displaced and it is important to lay the child down so that he does not fall out of nowhere.
Remove all objects around the child that could injure him.
Free your neck and chest from tight clothing to allow breathing freely.
Ventilate the room; the air temperature should not be higher than 20 C.
Do not forcefully restrain the child from involuntary movements, do not unclench his jaws, do not pour liquids into his mouth, do not insert a spoon, finger, etc.!

Treatment of seizures

Emergency care for neonatal seizures

Intravenous administration of 25% glucose solution (4 ml per kg of weight).
Vitamin B6 (pyridoxine) 50 mg intravenously.
10% calcium gluconate solution up to 10 ml (2 ml per kg of weight).
50% magnesium solution 0.2 ml per kg.
Phenobarbital (10-30 mg per kg body weight) administered slowly intravenously.
Phenytoin 20 mg per kg intravenously.

How to treat seizures during fever in a child

If the seizures are rare and last no more than 15 minutes, no treatment is necessary.

You should cool the child using any safe physical methods: rubbing with a weak solution of table vinegar or an alcohol solution (since the baby’s skin actively absorbs substances, you should be careful), or applying cold to the forehead, a cold, damp towel to the armpits, popliteal and elbow folds, and groin folds.
After stopping the attack, you should give an antipyretic drug - paracetamol, suppositories - tsifecon, efferalgan, panadol).
For longer and more frequent seizures, you may need intravenous anticonvulsant medications; the need for this will be determined by your doctor.
The doctor may also prescribe Diazepam (0.5 mg per kg of weight) or Phenobarbital (10 mg per kg) or Lorazepam (0.05 mg per kg).

From the moment febrile convulsions begin, the baby should not be left alone unattended, and medications or water should not be given during an attack, in order to avoid aspiration.

Stopping an epileptic seizure

0.5% solution of diazepam (0.3 mg per kg in children over 3 years of age and 0.5 mg per kg in children under 3 years of age), or midazolam (0.2 mg per kg). If there is no effect, sodium thiopental (5-10 mg per kg) intravenously.

Emergency care for status epilepticus

Early stage (5-10 minutes from the onset of the status): diazepam or midazolam or valproic acid.
Established epistatus (10-30 minutes): intravenous valproic acid 15-30 mg per kg, then at a dose of 5 mg per kg per hour.
Stage of refractory status (up to an hour): propofol 2 mg per kg, sodium thiopental 5 mg per kg, midazolam 100-200 mg per kg intravenously.
Super-resistant epistatus (longer than a day): third-stage drugs plus pyridoxine 30 mg per kg intravenously, dexamethasone, naloxone if drug addiction is suspected. If necessary, artificial ventilation.

Prevention

It is almost impossible to prevent the development of febrile seizures. If there is a genetic predisposition to them, then neither doses of an antipyretic nor constant monitoring of temperature will help. In children who were given Paracetamol every 3-4 hours at a temperature above 38.0 degrees, febrile convulsive syndrome occurred with the same statistical frequency.

However, according to established practice, and this is more important for parents rather than for the child, doctors advise monitoring the thermometer readings and giving medications for fever. This is much more useful for adults, as it helps them calm down and create a flurry of activity around the patient.

The use of tranquilizers to prevent seizures, as was previously practiced for children exposed to such a scourge, is considered inappropriate and harmful to the health of children.

The best prevention is parental vigilance. If a child is sick and has a high temperature, be sure to follow the doctor’s recommendations, do not self-medicate, do not pour mustard in his socks and do not put jars on him. The doctor will prescribe a dose of antipyretic. Drinking plenty of fluids and bed rest until the temperature drops are important.

A baby who has already suffered febrile convulsions needs tighter control. It is advisable to monitor him even in his sleep, so that the attack does not take anyone by surprise, and the baby can immediately receive first aid in full. Now you know how to provide it.

Consequences of seizures

In most cases of febrile seizures, the child will not have any traces of them in the future. Babies under one year of age, having a high potential for recovery of the brain, the development of which is not yet complete, emerge from frequent seizures with less brain deficit than older children. The more often the seizures, the longer they last, the deeper the oxygen starvation of neurocytes, the more serious the consequences.

When it comes to primary or secondary epilepsy, a serious approach to the problem, comprehensive treatment and observation by an epileptologist are very important. Without control of epilepsy and as it progresses, each new seizure will take away the child's intellectual capabilities, which can lead to severe losses in his abilities and mental abilities.

Author:

Postnova Maria Borisovna general practitioner

Prohibited actions for febrile spasms

It is important not only to provide timely first aid, but also not to cause harm. When convulsions occur during a child’s fever, what should not be done:

forcefully open your mouth, stick your finger or spoon into it;
try to give medicine or water;
leave unattended.

Febrile seizures in young children are spasms triggered by high fever. They are associated with incomplete development of the nervous system and disappear without a trace over time. To avoid seizures, it is enough to control the fever and try to bring it down above 37.5 ºC. If possible, the baby's body temperature should be reduced by rubbing and compresses. If this approach turns out to be ineffective, it is permissible to use medications approved by the doctor and adapted to the baby’s age.