Febrile convulsions are a common emergency symptom in childhood, most often occurring in children 6 months to 5 years of age, with a peak incidence in children 9 months to 3 years of age. They occur within the first 24 hours of fever and can cause generalized or localized muscle tonicity, spasms or jerking, unconsciousness, inability to respond to calls, with eyes rolled up, staring or squinting, teeth closed, foaming at the mouth, with or without incontinence. The duration of seizure may vary from a few seconds to a few minutes, and consciousness is quickly restored after natural relief. Generally, there is only one seizure in the course of a fever, but a few may have repeated seizures or even seizures lasting >10 min in a continuous state of convulsions. 1. Why are some children prone to febrile convulsions? Most children have immature central nervous system development. Children whose parents have a history of convulsions are more likely to have febrile convulsions. In addition, decreased immune function, micronutrient deficiency and anemia are also causes of convulsions. 2, in daily life, some children have convulsions when their body temperature reaches more than 40 ℃, and some children have convulsions when their body temperature is less than 38 ℃, what is the difference? Clinically, febrile convulsions are divided into simple febrile convulsions and complex febrile convulsions. Typical simple febrile convulsions are full-blown seizures that occur mostly within the first 24 h of fever, occur only once during a course of illness, last <10 min, and do not recur until about 6 years of age, with no neurological deficits in the child. Complex febrile convulsions are characterized by (1) first onset at <6 months of age or >6 years of age; (2) first episode with persistent convulsions; (3) ≥2 convulsions in a single fever; (4) ≥5 recurrent febrile convulsions; (5) convulsions at a temperature below 38 °C or even without fever; (6) partial seizures; and (7) associated neurological deficits. Complex febrile convulsions are easily transformed into epilepsy, affecting brain function and causing brain damage. 3. Why are febrile convulsions prone to recurrent seizures? Is febrile convulsion a seizure? The first age <15 months, first-degree relative with epilepsy or history of febrile convulsions, and the first seizure with complex febrile convulsions are high-risk factors for recurrent febrile convulsions in children, and the probability of recurrence can be as high as 50%~100% for those who have these three risk factors at the same time. The recurrence rate of first febrile convulsions >5 years old is low, and the risk of transformation into epilepsy is also low; while the recurrence rate of first febrile convulsions is higher in those who are younger, and the risk of developing epilepsy is higher. 4, febrile convulsions are a common emergency symptom in pediatric neurology, once febrile convulsions occur, parents and clinicians should take active measures to control the convulsions: 4.1 most febrile convulsions occur before seeking medical attention, parents can lay the child flat, head to the side to prevent accidental attraction of asphyxia, pay attention not to overly suppress the child’s spastic limbs to avoid fractures. Simple febrile convulsions generally resolve automatically in 2-3 min without special treatment, but to prevent further convulsions and to clarify the cause, medical attention should be sought as soon as possible. 4.2 Reduce body temperature If the child is conscious, parents can give oral antipyretic drugs, such as ibuprofen, acetaminophen and so on. At the same time, encourage the child to drink more water and urinate more often, ventilate the room to cool down, and combine with the application of antipyretic patches, warm water baths and other physical methods to achieve the purpose of reducing body temperature. Usually the body temperature is lower than the threshold of convulsions will not occur again. 4.3 Remove the cause of febrile convulsions are mostly induced by various non-central nervous system infectious diseases leading to high fever, more than 70% are related to upper respiratory tract infections, such as tonsillitis, herpes pharyngitis, etc.; they can also be seen in gastrointestinal infections, urinary tract infections, appendicitis and mumps and other types of infectious diseases. All infectious diseases that can cause fever may induce febrile convulsions, need to further clarify the foci of infection and the nature of infection, the symptomatic application of anti-infective drugs to remove the cause. 4.4 Further clarify the cause of convulsions The diagnosis of febrile convulsions requires attention to exclude a series of diseases such as encephalitis, meningitis, toxic encephalopathy, epilepsy, etc. It is necessary to continue to observe the clinical symptoms and to exclude them one by one through the corresponding examination. For example, CT examination of the head can exclude congenital developmental abnormalities of the brain, cerebral hemorrhage, brain tumor, hydrocephalus, etc.; lumbar puncture examination to test cerebrospinal fluid to exclude central nervous system infection; EEG examination can exclude the presence of epilepsy; blood and urine screening to exclude metabolic diseases, etc. 4.5 In the diagnosis of febrile convulsions in children and the assessment of treatment effect and its prognosis, electroencephalography (EEG) has been used as one of the routine tests, which is non-invasive and easily accepted by patients. EEG is often performed 10-14 days after a febrile convulsion, and if the EEG shows limited slow waves or spikes, spikes, or spikes-slow complex waves, there is a greater likelihood of future transformation to epilepsy or persistent EEG abnormalities. However, a normal EEG does not exclude the possibility of progression to epilepsy. In conclusion: prevention of recurrent febrile convulsions and improvement of prognosis are common concerns of clinicians and parents of affected children. Parents need to take good care of the child, keep antipyretic drugs on hand, and give timely cooling treatment once the fever is >37.5 ℃. The focus of relapse prevention should be on self-management, education and counseling of parents in dealing with fever and convulsions, popular health education; guiding children to participate in appropriate physical activities, strengthening physical exercise, correcting malnutrition and anemia, preventing recurrent respiratory infections, and reducing the chance of fever to reduce febrile convulsions. It can effectively reduce the economic and psychological burden of parents and improve the prognosis and quality of life of the children. Tel: Shanghai Deji Hospital Epilepsy Center 021-66300999-8311