Febrile convulsions are an emergency symptom of abnormal central nervous system function that is more common in pediatrics. Febrile convulsions are more common in infants and young children, with a prevalence of 6 months to 5 years of age, with a peak of 9 months to 20 months, and an incidence of about 2% to 4%, slightly more in boys than in girls. The vast majority of children with febrile convulsions no longer have seizures after the age of 5 years.
I. Etiology.
Most febrile convulsions are caused by a variety of infectious diseases, of which respiratory infections are the most common. Febrile convulsions are associated with a sudden rise in body temperature in febrile illnesses. The results of several family chain analyses suggest that genetic factors are involved in the occurrence of febrile convulsions.
II. Clinical manifestations.
There is a sudden loss of consciousness, mostly accompanied by upward turning of both eyes, staring or squinting, tonicity of facial or limb muscles, spasms or incessant jerking. The duration of seizures can range from a few seconds to a few minutes, sometimes repeatedly, even in a continuous state. Severe febrile convulsions may leave neurological sequelae.
III. Diagnosis.
It is generally not difficult to diagnose based on age, history, and clinical manifestations, but must be differentiated from the following diseases.
1, metabolic diseases, such as phenylketonuria, low calcium, low sodium, high sodium, low potassium, hypoglycemia, vitamin B6 dependence.
2, various toxic encephalopathies.
3, central nervous system lesions, including congenital malformations of the brain, traumatic brain injury, etc.
4, hysteria, epilepsy, etc.
The above-mentioned diseases are usually not febrile, but sometimes, due to the long duration of convulsions, they can also cause an increase in body temperature. At this time, fever is a consequence of convulsions rather than the cause.
Fourth, a few febrile convulsions are atypical, called complex febrile convulsions.
The main features of complex febrile convulsions include.
1, a convulsive episode lasting more than 15 minutes.
2, recurrent seizures ≥ 2 times within 24 hours.
3, focal seizures.
4. repeated and frequent seizures with a cumulative total of 5 or more seizures.
V. Several factors increase the risk of epilepsy in children with febrile convulsions, called epilepsy risk factors.
The main ones include.
1. complex febrile convulsions.
2. a history of epilepsy in the immediate family.
3. delayed or abnormal neurological development or signs before the first febrile convulsion. The incidence of epilepsy at age 7 years averages more than 9% in those with 2-3 of these risk factors, compared with less than 1% in febrile convulsions without risk factors. The value of EEG in the prediction of epilepsy risk is inconclusive, so for simple febrile convulsions there is no need to do EEG generally, but for children with complex febrile convulsions, if new epileptic waves are issued in the EEG, it may indicate the risk of epilepsy occurrence.
VI. General principles of management.
For simple febrile convulsions, treatment for the primary cause only, including antipyretic and other physical cooling measures, is sufficient. However, for those who have a tendency to relapse, diazepam (Valium) 0.02-0.05mg/(kg./time), 3 times/day, orally, for 2-3 days, or until the temperature of the original disease returns to normal. If Valproic acid or sodium phenobarbital can be given orally for a long time for 1-2 years, individual need to be extended appropriately. Other traditional antiepileptic drugs have poor preventive effect on FS seizures.
The drug must be taken under the guidance of a specialist, pay attention to the occurrence of adverse reactions, not allowed to use indiscriminately, otherwise the consequences are serious!