seziure due to fever

I am interested in more information on seziures associated with high fevers.  A relative's child, less than 2 years old, had a fever of 101 degrees.  The parent was giving the child tylenol to try to bring the fever down, the parent also called the child's doctor and was told to call back during office hours.  It went up to 105 degrees, at which time the child suffered a seziure.  The mother called the ambulance, where the child was treated with high doses of motrin to bring the fever down, then he was released.  Please tell me what the long-term damage of this episode could be.  Is there a medical journal which discusses this subject in depth?  Thanks so much for your input.

[CCF Neuro[P] MD, RPS]

Dear Regina:

When a child has a seizure due to high fever (high is actually a misnomer as children have seizures with temperatures at 100 degrees, which is a very modest temperature elevation), we call them febrile convulsions.  In many cases there is a family history of febrile convulsions, and there are at least 4 genes that are strongly correlated to these events.  The majority of children are completely normal and will not have epilepsy when they get older.  The usual event is when a child gets febrile (some get the convulsion before a fever is noticed)and has a generalized tonic clonic (all limbs jerking) that lasts for 1-2 minutes and then ceases on it's own.  There is not more than 1 in a 24 hour period.  These are called simple febrile convulsions.  If they last longer than 15 minutes, seizures focal in presentation (seizure begins with only one body part), the child is abnormal neurologically, there is an abnormal neurological exam.  These children have complex febrile seizures and have a higher probability of having epilepsy when they get older.  The population percentage of someone having epilepsy is about 1-2 percent.  If they have had simple febrile convulsions and not having the one gene that is dominantly inherited (this is very rare) then the chances of epilepsy is about 3-4%.  If the child has complex febrile seizures then the percentage goes up to about 7%.  The intellectual outcome is almost completely normal, unless the child has a neurological problem prior to the febrile convusions.

Usually, if the febrile seizure event lasts for greater than 10 minutes we give the parents rectal valium to use if the seizure last longer than 5 minutes.  Otherwise, we tell parents to try and not worry, turn the head when the event begins, remove near by furniture, and call 911 if the seizure lasts longer than 5 minutes.  

The outcome is basically excellent with the vast majority of children being completely normal with no epilepsy.  

Sincerely,

CCF Neuro MD

[regina]

THANKS SO MUCH FOR YOUR RESPONSE!

[CCF Neuro[P] MD,RPS]

you are very welcome.

CCF Neuro MD

[Carol]

Dear Regina,
My daughter had a seizure from a low grade fever when she was about 6 months old and another when she was about 10 months old.  The doctor gave me a sedative to give her when I felt that she was in danger of having any fever at all.  She is 33 now and has had a healthy pregnancy and is currently chasing a two year old all over, and seems to have never had any problems because of the seizures.  She had outgrown this problem by the time she was three.  So, I hope this encourages you.  I, too, was terrified by the seizure she was having, but other than sleeping them off, she seemed none the worse for wear.
God bless you!
Carol

[CCF Neuro[P] MD, RPS]

thanks for the comments.

CCF Neuro MD

[hibees]

A related discussion, febrile seizure temperature monitor was started.

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