Febrile seizures (FS) are convulsions that occur in children with febrile illnesses and are the most common pediatric convulsive events, with peak incidence from 6 months to 3 years of age (90% of cases), are clearly age-dependent, are somewhat self-limiting, and most seizures stop after 6 years of age. In recent years, the concept of febrile convulsions has changed, and the treatment options are different, so the progress of the diagnosis and treatment of febrile convulsions is reviewed as follows. In 1980, the National Institute of Health (NIH) consensus symposium on febrile convulsions proposed the following definition: febrile convulsions are convulsions occurring between the ages of 3 months and 5 years, accompanied by fever but without specific causes such as intracranial infection. The International League Against Epilepsy (ILAE) in 1993 defined febrile convulsions as convulsions in children older than 1 month of age in the febrile state and excluded central nervous system infection and acute electrolyte imbalance as well as non-febrile convulsions. The two definitions of febrile convulsions are very close, differing only in age of onset, but both exclude patients with neurological injury and do not clarify the relationship between fever and convulsions. Age, fever, and convulsions should be the three basic elements of the definition of febrile convulsions. The more recognized and widespread concept is that it refers to convulsions occurring in pediatric febrile illnesses, generally with a temperature above 38°C and no prior seizures, mostly in infants and children aged 6 months to 5 years, but excluding acute central nervous system infections (e.g., encephalitis, meningitis, etc.) and febrile convulsions in combination with other organic diseases of the brain. The prevalence of FS in children is 2% to 5% in Europe and the United States, 5% to 6% in China, 6% to 9% in Japan, and 11.4% in the Western Pacific Malian Islands, showing obvious racial and geographical differences. There is a clear age-dependent distribution of FS onset, with 90% occurring between 6 months and 3 years, 4% < 6 months, 6% > 3 years, and an intermediate age of 17 to 23 months. This age distribution feature may be closely related to brain development, immune status or genetic factors. 3. The etiology and pathogenesis of febrile convulsions are determined by both genetic and environmental factors. 24% of children with febrile convulsions have a family history of febrile convulsions, and 4% of febrile convulsions have a family history of epilepsy. Polygenic inheritance is a common cause of febrile convulsions, and mutations in some sodium channel genes and GABA receptor genes have been shown to cause febrile convulsions. The clinical classification of febrile convulsions is traditionally divided into simple febrile convulsions and complex febrile convulsions according to the age of onset, severity of convulsions, and neurological signs. Simple febrile convulsions: convulsions occur as a full-blown, one episode does not exceed 15 min, no further episodes within 24 h, and acute CNSI is excluded, age 6 months to 5 years, no previous neurological pathology (i.e., no prenatal, perinatal or postnatal pathological factors producing brain injury, normal psychomotor development and no history of febrile convulsions). The temperature height of the previous episode is not important, but should be at least transient. Complex febrile convulsions (CFC): convulsive episodes either present as focal seizures or as single episodes lasting >15 min or recurrent within 24 h and/or with post-ictal neurological abnormalities, usually post-ictal paralysis (e.g. Todd’s palsy), or with previous neurological pathology. Children in this group require AED therapy (e.g., Valium) to prevent possible (potential) reoccurrences. cfc itself can be a malignant febrile convulsion continuum with a single episode greater than 15 min, or consecutive brief episodes with no recovery of consciousness between episodes. The diagnosis of complex febrile convulsions should include at least one of the following factors: partial seizures, seizures lasting more than 10-15 min, multiple recurrent seizures within 24 hours or the same febrile illness. 5. Concepts related to febrile convulsions As the research on the molecular genetics of epilepsy and febrile convulsions progresses, the traditional category of febrile convulsions is challenged, and some children with complex febrile convulsions will eventually develop epilepsy, and febrile convulsions become an early manifestation of epilepsy or epileptic syndrome. New concepts have been proposed for this part of febrile convulsions in recent years. Febrile seizures plus (FS+): are febrile seizures that remain after 6 years of age, with or without febrile generalized tonic clonic seizures, and are not other epileptic syndromes that have been defined so far. In contrast, generalized epilepsy with febrile convulsions plus (GEFS+) is a familially inherited epilepsy syndrome with genetic and phenotypic heterogeneity, the most common phenotype being FS, followed by FS+. It is currently believed that FS+ and GEFS+ are different manifestations of the same gene, with the locus located at autosomal 19q1311 or 2q212q33. It is an epilepsy syndrome controlled by genetic factors, with autosomal dominant inheritance with incomplete episodic rate. with a family history of other generalized seizures. From the above concepts, it can be seen that the concepts of FS+ and complex febrile convulsions are duplicated. The author believes that the diagnosis of FS+ should focus on reflecting its familial nature, while the diagnosis of complex febrile convulsions should reflect the characteristics of partial seizures, seizure duration of more than 10-15 minutes, repeated seizures within 24 hours or the same febrile illness several times. 6, Diagnosis The diagnosis of FS should have the following conditions: (1) the age of first occurrence is mostly 6 months to 6 years; (2) the convulsive episode is accompanied by fever and rectal temperature ≥ 38°C at the time of the episode; (3) there is no previous history of febrile convulsions; (4) except for intracranial infections and convulsions due to other exact etiologies (such as organic and metabolic abnormalities). Febrile convulsions and convulsions with fever are different concepts, and intracranial infection must be excluded at the time of diagnosis. lumbar puncture CSF is required for convulsive seizures with fever whenever there is clinical suspicion of a serious bacterial infection, especially septic meningitis (especially partially treated chemoencephalitis). 1996 American Academy of Pediatrics (AAP) recommended; (1) lumbar puncture should be highly considered at age <12 months for the first episode. (2) Lumbar puncture should be considered in children aged 12-18 months; (3) Lumbar puncture should only be considered in children aged >18 months with signs of meningeal irritation or signs of intracranial infection. In addition, attention should be paid to the presence of preexisting central nervous system abnormalities, triggered convulsions due to fever, and the presence of temporary metabolic disorders such as hypocalcemia and hypoglycemia. 7. Treatment 7.1, general treatment ① keep quiet, prohibit all unnecessary stimulation; ② keep the respiratory tract unobstructed, timely aspiration of throat secretions, head sideways to the side, so as not to inhale vomitus, secretions, etc., which can cause asphyxia or aspiration pneumonia; ③ give oxygen in severe cases to reduce hypoxic brain damage. 7. 2, control of convulsions Most FC seizures are brief and terminate on their own within a few minutes, so there is no need to apply anti-convulsants. However, for prolonged or on-going convulsions, the child should be placed in a lateral position immediately to prevent vomit inhalation, with proper oxygenation, and intravenous slow injection of Valium (diazepam) immediately, which can be repeated after 20 min if necessary. After the convulsions are controlled, anticonvulsant drugs should be continued until the fever subsides because there is still a possibility of a second or more convulsions during a febrile illness, and phenobarbital is the drug of choice for maintenance treatment. There are two effective prophylactic treatments for FC: (1) continuous administration of phenobarbital (PB) or valproate (VPA); and (2) short course administration of (DZP) suppositories, syrups, or tablets. Currently, there are different clinical opinions, but most of the literature believes that for children with FS who have multiple risk factors for recurrence of FS, especially those with multiple risk factors for secondary epilepsy, in the early stage of the febrile process, in addition to immediate and active measures for cooling and treatment of the original disease, short-term intermittent prophylactic treatment such as diazepam can be given until the body temperature returns to normal, but FS is mostly sudden, so it is impossible to predict whether and when convulsions will occur. However, FS is mostly sudden, so it is not possible to predict whether and when the convulsions will occur, so the preventive effect is more check, and it is generally not recommended. Children with frequent FS can be given antiepileptic drugs such as sodium valproate for long-term regular prevention and treatment, while children with simple FS without risk factors may not receive this treatment. Although this method can reduce the recurrence of FC, it cannot reduce the incidence of epilepsy and is often associated with side effects such as allergic dermatitis and liver function impairment, which is difficult for families to accept and therefore difficult to promote clinically. 8 Prognosis 8.1, Risk of epilepsy after FS Recent studies over the past 25 years have found that the prognosis of febrile convulsions is usually benign, and no detectable brain damage has been found. While the epileptic syndrome associated with febrile convulsions can manifest as febrile convulsions in early stages, and some of them will be transformed into epilepsy due to various factors. However, the proportion of this disease that later develops into epilepsy is not high and varies among reports due to different case sources, investigation methods and seizure types, generally <5%. The following risk factors for secondary epilepsy in FS have been suggested by different clinical studies (1) CFS; (2) pre-existing neurodevelopmental abnormalities; (3) history of epilepsy in first-degree family members. risk factors for secondary epilepsy in FS and epileptogenesis (1) without any RF, epilepsy incidence 1%; (2) with one RF, epilepsy incidence 2%; (3) with two to three of the above, epilepsy incidence 10%. 8.2. Recurrence of FS It is currently believed that after the first FS seizure, about 30%-40% have the risk of recurrence of convulsions in each infected fever, of which 50% have multiple recurrences; 70%-75% of the recurrence time is within 1 year of the first seizure, and 0% recurrence within 2 years; the faster the occurrence of convulsions after fever, the higher the rate of recurrence of convulsions; the relationship with the age of the first seizure: the younger the age of the first seizure, the higher the rate of recurrence. The relationship between FS recurrence and the degree of first-episode temperature increase was inversely proportional; Knudsen proposed risk factors (rislcfactors, RF) to predict FS recurrence including (1) first-episode age <15 months; (2) history of FS in first-degree family members; (3) history of epilepsy in first-degree family members; (4) already had multiple episodes; (5) first-episode with CFS. those with 1~2 of these, the The recurrence rate was 25% to 50%, and for 3 or more items, the recurrence rate was 50% to 100%.