Review Article

Febrile Seizures
Address correspondence to
Dr Ajay Gupta, Cleveland
Clinic Lerner College of
Medicine, Cleveland Clinic
Ajay Gupta, MD Foundation, 9500 Euclid
Avenue, Cleveland OH 44195,
[email protected].
Relationship Disclosure:
ABSTRACT Dr Gupta has served on the
Purpose of Review: This article provides an update on the current understanding advisory board of Lundbeck
and has received research
and management of febrile seizures. Febrile seizures are one of the most common support from the Tuberous
age-related epileptic convulsions that lead to outpatient consultations, emergency Sclerosis Alliance for the Natural
department visits, and hospital or intensive care admissions. History Database Study.
Unlabeled Use of
Recent Findings: The Consequences of Prolonged Febrile Seizures in Childhood Products/Investigational
(FEBSTAT) study, an ongoing multicenter prospective longitudinal study, is providing Use Disclosure:
valuable insights into the subset of patients who develop febrile status epilepticus, the Dr Gupta discusses the
unlabeled/investigational use
most life-threatening type of febrile seizures with potential long-term consequences. of benzodiazepines for the
Mutations in voltage-gated ion channels and neurotransmitter receptor genes have treatment of febrile seizures.
been shown to result in familial occurrence of febrile seizures and epilepsy. Acute * 2016 American Academy
abortive treatment of febrile seizures using a commercially available rectal delivery kit of Neurology.
has gained widespread use by nonmedical caregivers as a first-line treatment at home.
Summary: Most febrile seizures are self-limiting episodes with low risk of injury,
death, and long-term neurologic consequences. Most fevers and infections that cause
febrile seizures are relatively benign and do not require extensive testing or procedures.
Long-term management requires thorough assessment and risk stratification to devise
a customized plan for each child, paying attention to the caregiver situation at home
and day care. Most important treatment efforts are directed at caregiver education
and, when appropriate, on effective use of abortive seizure treatment at home.

Continuum (Minneap Minn) 2016;22(1):51–59.

INTRODUCTION criteria for other acute symptomatic

Febrile seizures are one of the most seizures.2 While the two operational
commonly encountered acute neuro- definitions differ in the age range and
logic conditions in children. A consensus specifications of the exclusion criteria,
development conference of the National on a practical level both emphasize a thor-
Institutes of Health (NIH) first formalized ough history, physical examination, and
the definition of a febrile seizure as “an judiciously selected laboratory tests to
event in infancy or childhood, usually rule out intracranial infection, trauma, and
occurring between three months and metabolic causes (such as hypoglycemia,
five years of age, associated with fever hyponatremia, or dehydration) before
but without evidence of intracranial making a diagnosis of a febrile seizure.3
infection or defined cause.”1 In 1993,
the International League Against Epi- EPIDEMIOLOGY AND
lepsy (ILAE) proposed another definition TRIGGERING FACTORS
of a febrile seizure as a seizure occurr- The incidence of febrile seizures in the
ing in childhood after age 1 month, white population is reported to be 2%
associated with a febrile illness not to 5%.4 A few studies quote a higher
caused by an infection of the central incidence of 8% to 10% in the Asian
nervous system (CNS), without previ- population.5,6 The age range for febrile
ous neonatal seizures or a previous seizures in the literature is perplexingly
unprovoked seizure, and not meeting variable and ranges from 1 month up

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 Febrile Seizures

KEY POINTS
h The peak age for the to 8 years. A national cohort study (GEFS+). GEFS+ is reported to be caused
occurrence of febrile reported that 90% of children had their by mutations in the subunit genes
seizures is 18 to first febrile seizure before the age of (SCN1A, SCN2A, and SCN1B) that com-
24 months, and the 3 years, with the peak age being 18 to pose the neuronal voltage-gated sodium
majority of children with 24 months.4,7 Only 6% of febrile sei- channel. The GEFS+ phenotype has
febrile seizures continue zures occur before 6 months of age also been reported due to mutations
to have normal growth and 4% after 3 years of age, indicating in the GABA-A receptor subunit gene
and development. that the age of onset is a critical consid- (GABRG2).11 These conditions may re-
h Mutations in eration in further evaluation of children sult in a clinical presentation of febrile
voltage-gated sodium with febrile seizures. The majority of seizures, febrile seizures that persist
channel subunits and children with febrile seizures have nor- beyond early childhood, and even fe-
GABA receptor gene mal growth and development. Febrile brile seizures with coexisting epilepsy
subunits explain family seizures show no clear sex predilection. (afebrile spontaneous seizures) of vari-
history of febrile Most febrile seizures occur at or around able severity and seizure types. Dravet
seizures and epilepsy
the onset of fever. The fever of febrile syndrome is the most severe form of
in some patients.
seizures is commonly due to self-limiting voltage-gated sodium channelYrelated
viral infections affecting ear, nose, and epileptic encephalopathy, with febrile
throat or respiratory or gastrointestinal seizures, febrile status epilepticus, the
systems, and the risk of CNS infection is development of intractable generalized
low.3,8 However, recent studies further epilepsy, and severe cognitive impair-
specify viral strains in children who ment. Vast intrafamilial and interfamilial
have prolonged febrile seizures or fe- variation exists in the clinical course of
brile status epilepticus. In the Conse- genetic epilepsies, and genotype-
quences of Prolonged Febrile Seizures phenotype characterization is complex
in Childhood (FEBSTAT) study, febrile and poorly understood. It is important
status epilepticus was associated with to keep in mind that the majority of
the presence of human herpesvirus children with febrile seizures do not
(HHV) 6B DNA and RNA in serum (but have a family history of them, and ge-
not HHV-6A or HHV-7), suggesting acute netic testing is not routinely warranted.
HHV-6B viremia. Overall, HHV infec- Other pathophysiologic triggering
tions were found in 30% of all patients factors, such as rate of rise of fever, peak
with febrile status epilepticus in the body temperature during the illness, vac-
FEBSTAT study, suggesting an HHV-6B cinations (mainly diphtheria-pertussis-
infection as a specific trigger of febrile tetanus and measles-mumps-rubella),
status epilepticus.9 Despite this new find- low birth weight and in utero growth
ing, routine use of viral studies cannot retardation, respiratory alkalosis, and
be recommended in febrile seizures at systemic release of proinflammatory cy-
this time as they do not have direct tokines have been reported. These trig-
clinical or prognostic implications. gers remain a matter of much debate
Genetics seem to play a major role in and are not helpful in directing clinical
febrile seizures. As many as 25% to 40% management.12Y17
of children with febrile seizures have a Febrile infectionYrelated epilepsy syn-
family history of febrile seizures.10 Re- drome (FIRES) is controversial but touted
cently, a robust relationship has been as a distinct entity and reported in the
demonstrated between familial febrile literature. FIRES is a catastrophic epi-
seizures and genetically determined leptic encephalopathy that is clinically
epilepsies. The most established is the characterized by recurrent febrile sei-
clinically defined syndrome of genetic zures and febrile status epilepticus in
epilepsy with febrile seizures plus the acute phase during infancy, followed
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 KEY POINT
by intractable epilepsy and intellec- than one event within 24 hours or the h Between 20% and 30%
tual impairment. The etiopathogenesis same illness, a duration longer than of all febrile seizures
is unknown, and whether FIRES repre- 15 minutes, or focal symptomatology. may be complex febrile
sents a unique disease is still a matter It is estimated that about 20% to 30% seizures, defined as
of controversy.18 of all febrile seizures may be complex more than one seizure
febrile seizures.12,20,21 Febrile status within 24 hours or
TYPES OF FEBRILE SEIZURES epilepticus is a subset of complex febrile the same illness, a
Because most febrile seizures occur at seizures that is most severe and poten- duration longer than
home and provoke acute caregiver anx- tially life threatening. 15 minutes, or
iety, scant data exist on accurate symp- focal symptomatology.
tomatology, duration, and the clinical DIAGNOSTIC WORKUP AND
circumstances surrounding them. While, ACUTE TREATMENT OF
on interview, the majority of caregivers FEBRILE SEIZURES
report a convulsive seizure, a history of Prompt bedside history and examina-
tonic body stiffening, apnealike episodes, tion are key to establishing the diagno-
limpness with pallor or cyanotic hue, and sis, distinguishing complex from simple
trembling (like shivering) with altered febrile seizures, considering differential
awareness are not uncommon descrip- diagnoses, and initiating acute treat-
tions of febrile seizures, and sometimes ment (Case 3-1).
it remains undetermined whether the Although rare, a child may still be
event was indeed a seizure. seizing or in febrile status epilepticus
In an attempt to stratify the risk of when first seen. Prompt attention
developing epilepsy in the future, fe- should be given to airway, breathing,
brile seizures are classified into two types: and circulation, and IV anticonvulsant
simple febrile seizures and complex fe- agents should be administered. Acute
brile seizures.19 Simple febrile seizures abortive treatment of prolonged febrile
are defined as solitary events during an seizures or frank febrile status epilep-
illness, usually in the form of nonfocal ticus is no different from any other
convulsions of fewer than 15 minutes in status epilepticus. Caution is warranted
duration. Complex febrile seizures are in children with a known diagnosis of so-
defined as events that do not meet the dium channelopathies (voltage-gated so-
criteria of simple febrile seizures, ie, more dium channelYrelated epilepsies) where

Case 3-1
A 22-month-old boy was referred for an office consultation after a
recent emergency department visit. His mother witnessed whole-body
convulsions that lasted for 2 minutes during a fever of 38.9-C (102-F).
The child had a runny nose for 2 days before he had the fever, which
was later determined to be due to an ear infection. By the time the
child was transported to the emergency department, he had fully
recovered. With temperature control, he became cheerful again and
had good oral intake in the emergency department. His examination
raised no concerns. The child’s history had no red flags, and he had
normal growth and development. He was fully immunized.
Comment. This child had a simple febrile seizure. His history is typical
for a febrile seizure that is most likely predicted to have a benign course.
No further tests are warranted. The mother should be educated and
counseled about this condition.

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 Febrile Seizures

KEY POINT
h Brain imaging, EEG, sodium channel blockers such as infection rather than a consequence of
and blood testing are fosphenytoin may be relatively contrain- febrile seizures or febrile status epilepti-
indicated only dicated because of the potential for cus. A 2012 study showed that even in
infrequently in selected worsening of seizures. febrile status epilepticus, CSF pleocy-
children with febrile Gradually reducing high fever with tosis is rarely a result of febrile status
seizures, and their antipyretics and gentle measures is gen- epilepticus.22 The American Academy
widespread use should erally recommended. It is not known if of Pediatrics established guidelines for
be discouraged. such measures impact the duration of lumbar CSF testing in children presenting
febrile seizures or the chance of recur- with febrile seizures (Table 3-1).3
rence of another febrile seizure. Neuroimaging, brain CT or MRI, is
Finding and treating the cause of generally not indicated unless clinical
the fever presenting with febrile sei- suspicion of an acute neurologic condi-
zures is key. CNS infection and acute tion or a history of focal hemiconvulsions
metabolic/toxic derangement are the suggesting a structural substrate exists.3,23
two most important causes that must EEG is of limited use during febrile
be ruled out. A good history and physical seizures or in the postacute state. Up
examination as well as rapid and full to one-third of patients with febrile
postictal recovery in febrile seizures may seizures, whether simple or complex,
establish the often self-limiting nature may show transient EEG abnormalities
of febrile illness without the need for during the postacute state; however,
further tests. Monitoring of vital signs EEG alone seldom dictates manage-
and close observation of neurologic status ment of febrile seizures.24,25 EEG may
following the febrile seizure are essential be justifiable in a subset of patients, as
in all children, and other laboratory tests, shown by the FEBSTAT study, an ongo-
including lumbar puncture (for CSF anal- ing multicenter prospective longitudinal
ysis), should be selectively considered study on consequences of prolonged
depending on each clinical scenario. febrile seizures.26 In this study, EEGs
Until proven otherwise, any finding of were performed within 72 hours of fe-
CSF pleocytosis, even without remark- brile status epilepticus. Focal slowing or
able changes in glucose and protein, attenuation on the EEG was highly as-
should be considered as an evidence of sociated with acute hippocampal injury

TABLE 3-1 Key Action Statements on the Indications of Lumbar Puncture a(Cerebrospinal Fluid
Examination) in a Child Who Presents With Seizure and Fever

In Any Child Who Presents With a Seizure and Fever,

a Lumbar Puncture: Level of Evidence
1a: Should be performed if the child has meningeal signs and symptoms B (Overwhelming evidence
or history or examination raises a possibility of meningitis or from observational studies)
intracranial infection
1b: Is an option in an infant 6Y12 months of age when the child is considered D (Expert opinion, case reports)
deficient in Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae
immunizations or when immunization status cannot be determined
1c: Is an option when the child has been pretreated with antibiotics, D (Reasoning from clinical
because antibiotic treatment can mask the signs and symptoms experience, case series)
of meningitis
a
Data from Subcommittee on Febrile Seizures; American Academy of Pediatrics, Pediatrics.3

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 KEY POINTS
on the brain MRI. The study concluded seizure, the higher the risk of febrile h Caregivers often
that EEG may be a sensitive, reliable, seizure recurrence. One study showed confuse febrile seizures
and noninvasive marker of acute injury febrile seizure recurrence in 50% of with epilepsy. It is
associated with febrile status epilepti- patients who were younger than 1 year important that
cus and, hence, a potential marker for of age at the time of the first febrile physicians clearly
long-term consequences after febrile seizure. In comparison, only 20% had differentiate between the
status epilepticus.26 febrile seizure recurrence when the two while counseling.
age at the time of the first febrile seizure h Age at the time of the
POSTACUTE MANAGEMENT, was older than 3 years.30 Other risk fac- first febrile seizure is
RISK ASSESSMENT, AND tors identified in various studies include cited as the most
COUNSELING history of febrile seizure in first-degree important risk factor for
relatives, relatively low-grade fever dur- recurrence of a febrile
Caregivers of children with febrile sei-
ing the febrile seizure, and occurrence seizure. The younger
zures often express a sense of anxiety the age at the time of
after witnessing a seizure at home. State- of the febrile seizure at the inception
the first febrile
ments such as “I felt as if my child were (sometimes before recognition) of
seizure, the higher the
dying” and “I felt powerless to help my fever/illness.21,28Y30 Ironically, whether
risk of recurrence.
child” are commonly used to express the first febrile seizure was simple or
complex did not seem to affect the h Less than 5% of
parental concern. Experience tells us that children with
the caregivers often confuse terms such febrile seizure recurrence risk, nor did
febrile seizures will
as febrile seizures and epilepsy. It is im- the duration of the first febrile seizure.31
develop epilepsy.
portant that physicians clearly differenti- However, subsequent febrile seizures
can be prolonged if the initial seizure h Risk factors for
ate febrile seizures from epilepsy while epilepsy in a child with
discussing treatment goals during counsel- was prolonged.32
a febrile seizure are
ing. Parents of children with febrile sei- developmental delay or
RISK OF EPILEPSY
zures usually ask four questions, which abnormal neurologic
are answered consecutively in the sec- The risk of developing unprovoked sei- examination, complex
tions that follow: zures after a febrile seizure is estimated febrile seizures, and a
to be 2% to 5%.33 This risk is approx- first-degree relative
& Can this occur again? imately 2 to 3 times the risk of epilepsy with epilepsy.
& Is this epilepsy or will it become in the general population; however, it
epilepsy?
is still low enough to warrant judicious
& Does this cause brain damage? evaluation in only a few selected chil-
& What can I do to stop it next time? dren who are at high risk. The most
important predictive risk factors for the
RISK OF RECURRENCE OF development of epilepsy are develop-
FEBRILE SEIZURES mental delay or an abnormal neuro-
A second febrile seizure is likely to logic examination before the onset of
occur in about one-third of patients. A the febrile seizure, a history of complex
third febrile seizure is reported in about febrile seizures (including febrile status
half of the patients who had a second epilepticus), and a first-degree relative
febrile seizure, ie, only 15% of the en- with epilepsy (Case 3-2). Prolonged febrile
tire febrile seizure cohort will have three seizures and febrile status epilepticus
febrile seizures. More than three febrile are increasingly being recognized as
seizures are rare and seen in less than 5% potential risk factors for epilepsy.19,34Y36
of the febrile seizure cohort.21,27Y29 Mechanisms for the development of
Age at the time of the first febrile epilepsy after a febrile seizure are unclear;
seizure is cited as the most important however, these risk factors could possibly
risk factor for recurrence. The younger suggest a preexisting congenital, perina-
the age at the time of the first febrile tal, or metabolic-genetic vulnerability to
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 Febrile Seizures

Case 3-2
A 7-month-old infant was referred for consultation 2 weeks after she was
discharged from a hospital. She was admitted for a prolonged convulsive
seizure. Her parents were unaware of the fever or illness until after the
convulsion. The seizure apparently lasted 35 minutes and only stopped
after administration of IV lorazepam in the emergency department. Later,
a fever of 37.8-C (100-F) was noted, and a viral upper respiratory infection
was diagnosed. Blood biochemistry was normal. On further questioning,
the parents reported she had a history of previous febrile seizures at the
age of 3 months and 5 months that were 15 to 20 minutes in duration but
stopped before arriving at the emergency department. The infant was fully
immunized. Concerns regarding hypotonia and delayed motor milestones
were previously noted and confirmed at this office visit. On examination,
truncal ataxia and a few body jerks suggestive of myoclonia were noted.
Comment. This child had complex febrile seizures. In fact, the last episode
was febrile status epilepticus, the most severe form of febrile seizure. She
had many red flags, including early age of onset, the duration of seizures,
low fever or lack of documented fever at the onset of seizures, delayed
development, and abnormal neurologic examination. Her clinical scenario is
consistent with a possibility of an epileptic encephalopathy, such as Dravet
syndrome or other genetic epilepsy. Counseling may be difficult in such
situations when the family is expecting a benign diagnosis of febrile seizures.
Further diagnostic workup, such as EEG and genetic testing, is warranted
to confirm the diagnosis. This child is likely a candidate for initiation of
appropriate long-term anticonvulsant treatment. Also, she is at risk for future
prolonged convulsions, and it is prudent to devise a rescue plan, including
a prompt call to emergency medical services. Longitudinal follow-up is
critical in this child.

seizures that manifests with the second in these patients. There has been a long-
hit of fever/illness followed by enduring standing observation of the association
epilepsy. In a prospective FEBSTAT MRI of febrile status epilepticus, hippocam-
study of children presenting with acute pal sclerosis, and mesial temporal lobe
febrile status epilepticus, acute hip- epilepsy37; however, the cause-and-
pocampal injury due to febrile status effect relationship is yet to be confirmed
epilepticus was commonly seen. It was and may perhaps be more complex than
found that children with febrile status previously hypothesized.
epilepticus (defined as a seizure dura- While confirming the risk factors dis-
tion longer than 30 minutes) and acute cussed above, a 2013 study also identi-
hippocampal injury commonly had con- fied two other risk factors in multivariate
genital hippocampal malformations/ analyses: the occurrence of four or more
malrotations that could contribute to febrile seizures in a child and late age
the development of febrile status of febrile seizure onset (older than
epilepticus.34 Long-term follow-up of 3 years).38 This finding may need be
the febrile status epilepticus cohort is replicated in other larger studies. How-
ongoing to understand the possible ever, as discussed earlier, it makes sense
development of hippocampal sclero- as less than 5% of children with febrile
sis and mesial temporal lobe epilepsy seizures will have more than four seizures

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 KEY POINTS
or have their first febrile seizure after as soon as fever is recognized to help h The risk of developmental,
the age of 3 years. comfort the child. Prompt attention to behavioral, and
diagnose the cause of the fever is es- academic disability in
RISK OF FEBRILE STATUS sential. A few studies have reported ben- children with febrile
EPILEPTICUS efit from intermittent benzodiazepines seizures is no greater
Only a small number of patients with during fever for preventing febrile sei- than in the
febrile seizures present with febrile zures and reducing emergency depart- general population.
status epilepticus either as the first or ment visits and hospital admissions. A h Febrile status
subsequent seizure episode. In a case- 2- to 3-day course of oral diazepam or epilepticus is the most
control study that compared children clobazam was used successfully to pre- severe and potentially
with a first febrile seizure, febrile status vent recurrences.42,43 Such use of ben- life-threatening form of
epilepticus was associated with younger zodiazepines in children is not approved febrile seizures, with
age, lower body temperature, longer dura- by the US Food and Drug Administration long-term consequences;
tion of unrecognized fever before febrile (FDA). In addition, benzodiazepines can it must be emergently
treated just as any other
seizure, female sex, documented struc- cause sedation, can interfere with hydra-
status epilepticus.
tural temporal lobe abnormalities on a tion and feeding, and may delay the
previous brain MRI, and a first-degree recognition of a serious illness.
relative with febrile seizures. When such Rectal diazepam is available in the
risk factors exist alone or in combina- United States as an acute abortive treat-
tion, it may be prudent to develop an ment of an ongoing seizure and has been
acute seizure intervention at home, fol- successfully used in febrile seizures. Care-
lowed by initiating an emergency med- givers should be educated in the timing
ical services call for early and effective and technique of administering the med-
treatment of potential febrile status epi- ication as well as close monitoring after
lepticus. Delayed treatment and the de- its use. Using rectal diazepam at home is
velopment of febrile status epilepticus an attractive option in the hands of savvy
in a child is a risk factor for acute brain caregivers but may provide a false sense
injury, the development of epilepsy, and of security. Caregivers should be cau-
long-term neurocognitive disability.31 tioned that if the convulsion continues
after rectal diazepam (total duration
RISK OF INTELLECTUAL DISABILITY longer than 5 minutes) or sensorium
Longitudinal studies suggest that the does not recover, emergency medical
risk of developmental, behavioral, and services should be immediately con-
academic disability in children with fe- tacted for treatment of potential fe-
brile seizures is no greater than in the brile status epilepticus. A 2014 study
general population.21,39Y41 This infor- concluded that once established, febrile
mation should be emphasized when status epilepticus rarely stops sponta-
developing an individualized plan for neously, and it is fairly resistant to anti-
each child. However, one should keep epileptic medications. Earlier onset of
in mind that a subset of children with effective treatment results in shorter
prolonged febrile seizures or febrile total seizure duration. In this study, even
status epilepticus could develop long- the subjects who received medication
term neurologic consequences.31 prior to emergency department arrival
seized for a median of 81 minutes. Un-
TREATMENT OF FEBRILE SEIZURES fortunately, 19% of them had suboptimal
Antipyretic medications and measures dosing of benzodiazepines before arrival
remain controversial in preventing to the emergency department. Therefore,
febrile seizures, but they are generally it may be prudent to suggest administra-
recommended to caregivers at home tion of rectal diazepam at the onset of
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 Febrile Seizures

KEY POINT
h Long-term daily febrile seizures in children who are at 5. Tsuboi T. Epidemiology of febrile and
afebrile convulsions in children in Japan.
anticonvulsants are not risk of febrile status epilepticus.44
Neurology 1984;34(2):175Y181.
usually indicated No justification exists for the use of
6. Hackett R, Hackett L, Bhakta P. Febrile seizures
in children with daily anticonvulsant medications. Phe- in a south Indian district: incidence and associations.
febrile seizures. nobarbital and valproate are touted Dev Med Child Neurol 1997;39(6):380Y384.
to successfully reduce the recurrence 7. Steering Committee on Quality Improvement
of febrile seizures; however, they may and Management, Subcommittee on Febrile
not reduce the ultimate risk of devel- Seizures American Academy of Pediatrics. Febrile
seizures: clinical practice guideline for the
oping epilepsy. Long-term treatment with long-term management of the child with simple
daily anticonvulsants may be justifiable febrile seizures. Pediatrics 2008;121(6):1281Y1286.
only in a small subset of children with doi:10.1542/peds.2008-0939.
complex febrile seizures and febrile status 8. Kimia AA, Capraro AJ, Hummel D, et al.
epilepticus with multiple risk factors Utility of lumbar puncture for first simple
febrile seizure among children 6 to
that portend a high risk of epilepsy. 18 months of age. Pediatrics 2009;123(1):
No guidelines exist for initiation of daily 6Y12. doi:10.1542/peds.2007-3424.
anticonvulsants in febrile seizures, and 9. Epstein LG, Shinnar S, Hesdorffer DC, et al.
it remains a matter of clinical judgment.7 Human herpesvirus 6 and 7 in febrile
A customized febrile seizure action plan, status epilepticus: the FEBSTAT study.
Epilepsia 2012;53(9):1481Y1488.
surveillance on febrile seizure recurrences, doi:10.1111/j.1528-1167.2012.03542.x.
and monitoring physical and developmen-
10. Hauser WA, Annegers JF, Anderson VE,
tal behavioral milestones are critical in Kurland LT. The risk of seizure disorders
the management of febrile seizures. among relatives of children with febrile
convulsions. Neurology 1985;35(9):1268Y1273.
CONCLUSION
11. Scheffer IE, Berkovic SF. Generalized
Febrile seizures are a common neuro- epilepsy with febrile seizures plus. A genetic
logic emergency in children. It is im- disorder with heterogeneous clinical
phenotypes. Brain 1997;120(pt 3):479Y490.
portant to recognize this condition and
offer a customized evidence-based plan 12. Verity CM, Butler NR, Golding J. Febrile
convulsions in a national cohort followed up
of care to each family. The majority of from birth. IIVmedical history and intellectual
children can be managed by application ability at 5 years of age. Br Med J (Clin Res Ed)
of the essential clinical principles outlined 1985;290(6478):1311Y1315.
in this article. 13. Barlow WE, Davis RL, Glasser JW, et al.
The risk of seizures after receipt of
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