Clinical Review

Febrile seizures

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4240 (Published 18 August 2015) Cite this as: BMJ 2015;351:h4240
Managing febrile seizures infographic
View a printable infographic, showing diagnosis and management of febrile seizures, including advice for parents.

  1. Nikhil Patel, medical student1,
  2. Dipak Ram, grid trainee in paediatric neurology2,
  3. Nina Swiderska, grid trainee in paediatric neurology2,
  4. Leena D Mewasingh, consultant paediatric neurologist3,
  5. Richard W Newton, consultant paediatric neurologist1,
  6. Martin Offringa, professor, senior scientist and programme head4
  1. 1Imperial College School of Medicine, Imperial College, London SW7 2AZ, UK
  2. 2Department of Neurology, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
  3. 3Department of Paediatric Neurology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
  4. 4Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada
  1. Correspondence to: R W Newton richard.newton{at}cmft.nhs.uk

The bottom line

  • Febrile seizures are the commonest childhood seizure

  • There is a low risk (1 in 40) of developing epilepsy in simple febrile seizures

  • Benzodiazepines can be used as rescue treatment for recurrent prolonged febrile seizures

  • There is no evidence of benefit for prophylactic antiepileptic drugs

  • Children with simple febrile seizures have good cognitive outcomes

  • Some children with recurrent or prolonged febrile seizures may have some memory impairment. It is not yet clear if this is permanent or if they “catch up” in time

The International League Against Epilepsy (ILAE) defines a febrile seizure as “a seizure occurring in childhood after one month of age associated with a febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure, and not meeting the criteria for other acute symptomatic seizures.”1 The cumulative incidence of febrile seizures is estimated between 2% and 5% in the US and Western Europe,2 3 between 6% to 9% in Japan, and 14% in India and Guam.1 Febrile seizures have a peak incidence at 18 months and are most common between the ages of 6 months and 6 years.4 5 6

This review aims to summarise how to recognise a febrile seizure and rule out other underlying causes, how to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Sources and selection criteria

To prepare this review, we consulted the Cochrane Collaboration and Medline and Embase search engines for articles from 2004 onwards. Key words of “febrile convulsion” and “febrile seizure” were used. We also searched these databases before 2004 using similar medical search headings. We focused on high quality randomised controlled trials, meta-analyses, and systematic reviews.

Was it a febrile seizure?

Take the child’s temperature after the seizure has ended. Beware an alternative diagnosis if the …

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