Clinical Review

Febrile seizures

BMJ 2007; 334 doi: 10.1136/bmj.39087.691817.AE (Published 8 February 2007)
Cite this as: BMJ 2007;334:307

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  1. Lynette G Sadleir, senior lecturer1,
  2. Ingrid E Scheffer, chair of paediatric neurology research2
  1. 1Department of Paediatrics, Wellington School of Medicine, University of Otago, Wellington, New Zealand
  2. 2Departments of Medicine and Paediatrics, University of Melbourne, Austin Health and Royal Children's Hospital, Melbourne, Australia
  1. Correspondence to: I Scheffer, Repatriation Hospital Campus, Level 1, Neurosciences Building, Banksia Street, Heidelberg, Victoria 3081, Australia scheffer{at}unimelb.edu.au

    Seizures associated with fever are a common paediatric problem. Differentiation of febrile seizures from acute symptomatic seizures secondary to central nervous system infection or seizures triggered by fever in children with epilepsy is essential. The syndrome of febrile seizures is defined as seizures associated with fever in the absence of central nervous system infection or acute electrolyte imbalance in a young child.w1 The prevalence of febrile seizures is between 3% and 8% in children up to 7 years of age.1 w2 Variation in prevalence relates to differences in case definitions, ascertainment methods, geographical variation, and cultural factors. Here we discuss the investigation, management, and outcome of febrile seizures.

    Summary points

    • Febrile seizures are the most common seizure disorder

    • They are benign and have a normal cognitive outcome

    • Febrile seizures recur in a third of children and are associated with a low risk of epilepsy

    • Risk factors for epilepsy include complex febrile seizure, neurological abnormality, and family history of epilepsy

    • Febrile seizures are prolonged in 9% of cases; these should be treated with buccal or intranasal midazolam

    Sources and selection criteria

    We searched Medline, Embase, and the Cochrane Collaboration from 2000 onwards by using the medical subject heading “seizures, febrile” or key words “febrile convulsions” or “febrile seizures”. We searched the same databases before that date, focusing on the medical subject headings only. We selected relevant articles from the abstracts and hand searched these for other pertinent publications.

    Why and at what age do children have febrile seizures?

    Febrile seizures result from a combination of genetic and environmental factors.2 Of children with febrile seizures, 24% have a family history of febrile seizures and 4% have a family history of epilepsy.3 Although polygenic inheritance is usual, a small number of families exist in whom the inheritance of febrile seizures is autosomal dominant, and several chromosomal loci and a few genes have been identified.4 …

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