1. Is it true that the higher the fever, the more likely convulsions will occur?
Febrile convulsions are convulsions that occur in the postnatal period from 3 months to 5 years of age, at the onset of fever or during the rapid rise in body temperature, and require the exclusion of central nervous system infection and any other acute illness that triggers convulsions, and no previous history of fever-free episodes. The prevalence is about 2% to 5%, and it is the most common convulsive disorder in infancy and childhood, with a prevalence of 3% to 4%. The term febrile convulsions is inaccurate, and there is no international requirement for the degree of fever to diagnose febrile convulsions. However, febrile convulsions often occur when the body temperature rises fastest, and within 24 hours after the appearance of fever.
2. Are vaccinations more likely to trigger pediatric convulsions?
Genetic factors may play a key role in the development of the disease. Environmental factors, such as viral and bacterial infections, are important contributing factors to febrile convulsions, with viral infections being more common.
Vaccination fever is a common adverse effect of vaccination. Certain vaccines are more likely to cause febrile convulsions, particularly live attenuated vaccines (e.g., MMR) and whole-cell preparations (e.g., whole-cell pertussis). However, there is no evidence that febrile convulsions after such vaccination are associated with the development of distant epilepsy G. According to international guidelines from major developed countries, febrile convulsions are not a contraindication to vaccination.
3. What are the clinical manifestations and staging?
The first seizure in FS occurs between 6 months and 3 years of age, with an average of 18-22 months. It is slightly more common in boys than in girls. Most of them do not recur after 5 years of age.
According to the clinical characteristics, FS can be divided into two types: simple and complex. Simple type: The seizure is a generalized seizure without focal seizure characteristics; the duration of the seizure is less than 15 min; there is only one seizure within 24 h or in the same febrile course. This type accounts for 75% of febrile convulsions. Complex type: with one of the following characteristics: long seizure duration (>15min); focal seizures; ≥2 episodes of convulsions within 24h or in the same febrile course.
4.How to correctly diagnose febrile convulsions?
The diagnosis of febrile convulsions is mainly based on the specific age of occurrence as well as typical clinical manifestations, and most importantly, excluding various other diseases that may lead to febrile-phase convulsions, such as central nervous system infection, infectious toxic encephalopathy, acute metabolic disorders, etc. Therefore, after each febrile convulsion, you should seek medical attention promptly so that the doctor can examine and determine whether the febrile convulsion can be diagnosed and exclude the possibility of other serious diseases.
5.It is said that febrile convulsions can make children’s brains pumped out, is it true?
The overall prognosis for febrile convulsions is good, and no cases of death directly due to febrile convulsions have been reported. 95% or more of children with febrile convulsions do not develop epilepsy later. risk factors for the development of epilepsy after febrile convulsions include: ① complex febrile convulsions; ② the presence of central nervous system abnormalities (such as developmental delay); ③ a family history of epilepsy G.
6.Do pediatric febrile convulsions recur?
After the first febrile convulsion, overall only about 30% of children will have febrile convulsions again in the course of subsequent febrile illnesses.
Risk factors for recurrent febrile convulsions include: (1) onset before 18 months of age; (2) temperature <38°C at the time of the febrile convulsion; (3) family history of febrile convulsions; and (4) short duration of fever (<1h) before the onset of febrile convulsions. In children with all risk factors, 76% will have recurrent febrile convulsions, while only 4% of children without all the above risk factors will have recurrent febrile convulsions. Most children with febrile convulsions have good intellectual-motor development, and even in children with complex febrile convulsions, there are no significant differences in their long-term intellectual-motor and behavioral development compared to children of the same age.
7. Can febrile convulsions be prevented by taking antipyretic drugs as soon as the fever breaks out?
Parents can be clearly told that antipyretic treatment, even when used at the beginning, cannot prevent febrile convulsions! This is proven by the results of numerous studies.
Some parents will say that we sometimes have no seizures when we actively reduce fever. In fact, as already mentioned, even children with febrile convulsions do not have febrile convulsions every time they have a fever, so it is not a direct result of increased body temperature that convulsions occur. If an individual child, indeed, has seizures every time he has a fever, he should be highly alert to the fact that it is not febrile convulsions, but some serious early manifestations of epilepsy, such as severe myoclonic epilepsy in infants (Dravet syndrome).
And the country often overuse antipyretic drugs, in fact, serious adverse reactions to such drugs is not uncommon, and the fever itself is only a protective response of the body to infection and a signal of serious inflammatory disease. Unless the super high fever leads to heatstroke, most of the time, antipyretic treatment is only able to make people comfortable, and does not have any positive therapeutic effect.
8. Which children need the most prevention of convulsions?
The first thing to emphasize is that febrile convulsions are overwhelmingly a benign process, and overtreatment is common in China today. Secondly, it is most important to educate parents about the benign prognosis of most febrile convulsions, and that short-lived febrile convulsions, unless there is an accidental injury such as a fall, will not have a significant impact on the brain, and will not “smoke the child silly”. It is also important to teach parents how to deal with acute seizures, so as to avoid excessive parental stress and anxiety.
If prophylactic treatment is needed, antiepileptic drugs can be used for long-term prophylaxis or temporary prophylaxis during fever. Although these prophylactic measures can reduce the recurrence of febrile convulsions, there is no evidence that any prophylactic treatment can change the long-term prognosis, including cognitive function and the incidence of G. If the possible adverse effects of various prophylactic measures are taken into account, the current findings confirm that for the vast majority of children with febrile convulsions No prophylactic treatment is advocated for the vast majority of children with febrile convulsions.
For a small number of children with too frequent febrile convulsions (>5 convulsions/year) or with persistent febrile convulsions (>30 minutes), the following prophylactic measures can be taken under medical supervision, as appropriate. ①Long-term prophylaxis: Valproic acid or levetiracetam or phenobarbital can be used for oral administration. ②Intermittent temporary prophylaxis: timely oral or rectal application of diazepam at a dose of 0.3 mg/kg each time in the early stages of fever, which can be applied every 8 h interval for a maximum of 3 consecutive applications. However, it should be emphasized that the common adverse effects of this approach are central nervous system symptoms such as drowsiness and ataxia, which may mask serious diseases such as meningitis and encephalitis. Moreover, some febrile convulsions occur within a short period of time after the initial onset of fever, or even after the onset of convulsions, so the application of temporary oral prophylaxis is often not timely and leads to failure of prevention. Whether long-term or temporary prevention is used, the possible advantages and disadvantages should be carefully evaluated, and the decision should be made after full communication with parents.
9.How to deal with febrile seizures at home?
The most important thing for parents is to prevent accidental injury caused by seizures, put the child on a flat and non-injurious surface or bed, keep the head tilted to one side to facilitate the flow of oral contents, and do not insert any objects into the mouth; do not press the patient too hard to avoid fractures; avoid unnecessary stimulation, there is no evidence that pressing the person can shorten the duration of seizures, and more than 90% of seizures There is no evidence that compressions can shorten the duration of seizures, and more than 90% of seizures can be spontaneously relieved within 5 minutes, and if excessive compressions lead to skin breakdown at the human midsection, meningitis can easily develop. If you have had previous febrile convulsions or if the current seizure does not resolve after more than 3 minutes, you should call the emergency services as soon as possible.