Febrile Seizures

[david]

My son is 10 months old and has had at least three seizures that were classified as febrile seizures.  During the first he went limp got cold turned blue and was unresponsive.  He came out of it on the way to the hospital and was givin tylenol and advil for the fever.  The second we caught early and got tylenol in him to control the fever adn the seizure abated.  The third happened at night.  At 1:30am he was happy and without a fever.  At 2:30am he was burning up and convulsing.  He again came out of it on the way to the hospital and was givin tylenol.

The questions: If all three of these are febrile seizures, why are they so different?  We could handle them better if we knew what to expect.  Should the baby undergo a neurological exam?  No such exam has been performed.  No real work up has been done.  According to the doctors, the fact that they (the seizures)are always accompanied by a fever indicates febrile.  Could it be something else?  How worked up do we need to get?  Could they damage the baby?

Any information and guidance is appreciated.

[CCF Neuro[P] MD, RPS]

Dear David:

Sorry to hear about your son's febrile seizures.  First, and most important is that febrile seizures are common and the vast amount of studies that have been done on children with febrile seizures are that the seizures do not cause long term damage of the brain.  Although there is some thought about problems with seizures later in life, the percentage is low 2-7%.  The general population the figure is 1-3%.

Is there is family history of febrile convulsions, as there is a type that is genetically linked.  Is he developmentally normal?  The usual time frame for febrile convulsions is 6 months to 5 years.  Most children only have 1 event, but 33% of these will have a second and of those 50% will have multiple episodes.  Unfortunately, the convulsion is usually the herald of an illness and fever so parents cannot often tell if a seizure event will happen.  Tylenol for fever reduction is important.  Most epileptologist (including everyone here at the Clinic) wound not give seizure medications to prevent these unless there are complicating factors.  What most of would do, would be to prescribe a rectal form of valium named diastat.  If the convulsion lasts longer than 4 minutes we tell the parent to give diastat.  This is to prevent long duration of seizure activity.  

Your son is in the correct age group and has all the symptoms that would indicate a febrile convulsive condition.  Almost all will outgrow this by the age of 6.  It is frightening but not damaging.  As far as seeing a pediatric neurologist, if you are concerned it would be good.  But, truthfully, if your son has been developmentally normal I would just follow with your pediatrician.  This would be especially true if there is a family history of febrile convulsions.  If your son has abnormal development then I would see a pediatric neurologist.

Sincerely,

CCF Neuro MD

[Laura Entwistle]

I am a 28 year old female.  In May of 1999 I contracted a mild case of chicken pox which I quickly recovered from.  In June I had flu-like symptons and a bulls eye on my jawline.  I had horrible headaches and fatigue.  I was diagnosed and treated for Lyme disease.  In August I had an impacted wisdom tooth removed - the oral surgeon said that the extraction was very difficult.  Following the wisdom tooth removal I started having twitching under my left eye and over my right eye.  I attributed the twitching to the Lyme disease - which I was still being treated for.  I now have no other Lyme symptons aside from the twitching.  The small muscles that twitch have now palsied, or drooped or are paralyzed - whatever the correct term is.  I read in a neurology book that my symptons could be related to either Lyme or chicken pox exposure or nerve damage.  What do you think that it is and what do I do about it?  I have made an appointment with a neurologist for a full check-up.
Thank you for answering me.

[CCF Neuro[P] MD, RPS]

Dear Laura:

Not exactly febrile seizures.  I don't really think that you have lyme disease causing your problems.  Since your being treated directly after the rash, it would be alittle early to see neurological symptoms.  The varicella would more be related to sensory symptoms and not the type of symptoms you describe.  The varicella would also be seen with pustules in the ear canal and you do not describe this.  I would bet that your facial symptoms are a Bell's palsy.  This is usually viral in nature and commonly herpes simplex.  Most of the time, this condition heals itself in a few weeks-months.  If your having trouble with closing your eye lid, some eye lube may be necessary at night.  But, I would see your neurologist and have things checked out because over the internet we cannot do a good physical exam.

Sincerely,

CCF Neuro MD